DCIS - Ductal Carcinoma In Situ

If you have just been diagnosed with DCIS (or you know somebody who has), you probably have many questions:

• Is DCIS really cancer?
• What type of treatment will you need?
• Will you have to lose your breast—and will your hair fall out?
• Can the cancer come back even after treatment?

Is DCIS really cancer?

We generally think of cancer as a type of disease that grows out of control. DCIS, on the other hand, is not an invasive cancer. It stays inside the milk duct of the breast in which it started. It can grow to cover a small or large area of the breast. But it does not spread OUTSIDE the duct into the normal surrounding breast tissue, to the lymph nodes, or to other organs.

In the staging system that doctors use to classify cancer, DCIS is known as Stage 0. And it is sometimes called "pre-cancer." You may also hear it referred to as Tis, which means that the cancer is non-invasive. Tis stands for "tumor in situ" or "in the same place."

So, is DCIS actually cancer? The answer is yes, because DCIS is an uncontrolled growth of breast cells. On the other hand, it is a cancer that doesn't behave like most cancers. DCIS hasn't started to break through normal tissue, which means it's not life-threatening like cancer. However, DCIS still requires careful medical treatment.

What type of treatment will you need?

If the area of DCIS is small enough, you will probably be treated with a lumpectomy, which is breast-conserving surgery that removes only the area of the breast containing the cancer. However, if the cancer is large or appears in several places throughout the breast, then breast-removing surgery (mastectomy) may be necessary.

Lumpectomy is usually followed by radiation. Radiation to the whole breast is the standard of care. But you might be able to participate in new studies looking at radiation to just part of the breast.

If the DCIS is serious enough to require a mastectomy, you will not receive radiation unless lab tests reveal some remaining cancer in or near the edge of the removed breast tissue.

Hormonal therapy may be recommended to women with DCIS if lab tests show that the cancer cells have hormone receptors. At this time, the only hormonal treatment recommended for women with this kind of DCIS is tamoxifen. This drug is prescribed to lower the risk of the cancer coming back and to reduce the risk of getting a new cancer. Ongoing studies are looking at whether aromatase inhibitors, another form of hormonal therapy, can help women with DCIS.

Chemotherapy is not needed for DCIS, because this type of cancer has not invaded other tissue.

Will you have to lose your breast—and will your hair fall out?

Most women with DCIS do not have to lose their breast. Breast-removing surgery (mastectomy) is only required for DCIS that is large or occurs in several places in the breast.

Chemotherapy is not necessary for women with DCIS. Therefore, you will not lose your hair.

Can the cancer come back even after treatment?

When you have had DCIS, you are at higher risk for the cancer coming back or for developing a new breast cancer than a person who has never had breast cancer before. About 25% to 50% of DCIS cases come back as invasive cancer. However, it may be reassuring to know that DCIS itself is NOT invasive.

On the following pages you can learn about:

The Basics of DCIS

Find out what DCIS means, who's at risk, how DCIS is diagnosed, and how serious it is.

Type and Grade of DCIS

Learn about the different grades and patterns of growth in DCIS.

How the Extent of DCIS Affects Treatment Options

The DCIS will be examined to find out areas of involvement, the cancer size, the margins of resection, findings of the post-biopsy radiology testing, and whether there is any bloody nipple discharge.

How the Tumor Characteristics of DCIS Affect Treatment Options

Each tumor has its own set of characteristics, and doctors refer to this as the "personality" of the cancer. The "personality" of DCIS is judged by the cancer grade of dead cells in the tumor, pattern of growth, microinvasion, hormone-receptor status, and how the stage of the disease might change in certain situations.

How Family History and Personal Factors Affect Treatment Options

A family history of breast cancer will also affect your treatment options, as will your access to a radiation oncologist, a reconstructive surgeon, and your own decision-making style.

How DCIS Is Treated

Your doctor will discuss breast-conserving and breast-removing surgery, and possibly radiation—depending on your situation.

Is Breast-conserving or Breast-removing Treatment Right for You?

The decision about whether you need a lumpectomy or mastectomy, with or without radiation, depends mostly on the extent of DCIS in the breast.

Additional Treatment and Follow-up for DCIS

Occasionally, a sentinel lymph node evaluation is useful, even though DCIS rarely spreads beyond the breast. There may be a role for hormonal therapy, to help reduce your risk of breast cancer in the future. You can also find out what you need to know about follow-up care.

The medical expert for DCIS is Marisa Weiss, M.D., breast radiation oncologist, Thomas Jefferson University Health System, Philadelphia, PA.

Dr. Weiss is a member of the Breastcancer.org Professional Advisory Board, including over 70 medical experts in breast cancer-related fields.