Ductal Carcinoma in Situ
Considered to be the earliest form of breast cancer, ductal carcinoma in situ (DCIS) is also referred to as stage 0. Because the cancer remains confined to its site of origin—a duct that carries milk from a milk-producing gland (lobule) to the nipple—it is highly treatable. DCIS is also known as intraductal carcinoma.
Tampa General Hospital’s Cancer Institute and Breast Cancer Center offer the latest diagnostic and treatment options for ductal carcinoma in situ and all other stages of breast cancer. Accredited by the Commission on Cancer (CoC), TGH is proud to have earned the “High Performing in Cancer” designation from U.S. News & World Report for 2022-23, which ranks us among the top 10% of hospitals in the nation.
What Causes DCIS Breast Cancer?
Ductal carcinoma in situ occurs when cells that line a milk duct undergo abnormal DNA changes that cause them to grow uncontrollably. However, the cancerous cells remain in place (in situ); they do not pass through the wall of the milk duct, invade nearby tissues or enter the lymphatic system or bloodstream.
DCIS vs. LCIS
Lobular carcinoma in situ (LCIS) is another type of stage 0 breast cancer, but it is much less common than DCIS. It occurs when cells in a milk-producing gland (lobule) undergo abnormal DNA changes that cause them to grow rapidly. LCIS is not cancer, nor is it an immediate health threat. However, it is a marker for a higher-than-average risk of breast cancer and therefore should be monitored by a physician.
DCIS Symptoms
Unlike many other types of breast cancer, ductal carcinoma in situ does not have distinctive symptoms, such as a breast lump or skin changes. In most cases, the cancer is detected during a routine mammogram before any symptoms become apparent. In an imaging scan, new calcium deposits and distorted breast tissue (architectural distortion) are possible signs of DCIS that warrant follow-up. As DCIS progresses and cancerous cells invade the milk duct, noticeable symptoms such as itchy skin and ulceration (sores) may develop.
How Is Ductal Carcinoma in Situ Diagnosed?
If a screening mammogram produces suspicious findings, a physician will typically order a breast biopsy, which involves taking a small sample of cells for microscopic evaluation by a pathologist. One option that is frequently used to diagnose DCIS is a stereotactic core needle biopsy. During this nonsurgical outpatient procedure, a physician numbs the breast area, then uses a fine needle guided by mammography to collect the cell sample.
Ductal Carcinoma in Situ Treatment
The current standard of care for DCIS is breast-preserving surgery, such as a lumpectomy followed by radiation therapy to help prevent a recurrence. Sometimes, a cell mass is larger than expected based on the images, in which case the patient may need a re-excision lumpectomy to remove all of the cancer. If DCIS is estrogen-receptor- or progesterone-receptor-positive, hormone therapy may be considered. Because ductal carcinoma in situ is noninvasive, systemic treatments such as chemotherapy are unnecessary.
Why Have a Mastectomy for DCIS?
Usually, the combination of breast-preserving surgery and radiation therapy is an appropriate alternative to a mastectomy for treating ductal carcinoma in situ. However, a mastectomy may be needed to remove widespread cancer cells, such as when:
- DCIS is present in more than one quadrant of the breast (multicentric breast disease)
- The tumor is large relative to the overall size of the breast
Radiation therapy is generally not needed after a mastectomy is performed to treat DCIS.
What Is Considered a Large Area of DCIS?
After a surgical procedure is performed to remove the area of DCIS, a pathologist will measure the removed tissue across (in greatest dimension) by:
- Viewing the DCIS under a microscope
- Examining the DCIS with their naked eye
- Noting the number of microscopic slides that contain the DCIS
The larger the area of DCIS, the more likely it is to recur after surgery. An area of DCIS is considered to be large if it measures between 2 and 2.5 centimeters across.
Benefit From World-Class Care at TGH
If you are diagnosed with ductal carcinoma in situ, you can confidently entrust your care to the multidisciplinary team at TGH. Your breast cancer journey will be guided by dedicated care navigators who will ensure that you are fully supported and informed throughout your treatment and beyond. If would like to talk with an expert on our team, contact us at (800) 844-4554 to request an appointment.