- Еуромедик, Булевар уметности 29, Београд
Treatment of ductal carcinoma in situ (DCIS)
Прим др Милош Почековац
What is ductal carcinoma?
Ductal carcinoma in situ is a non-invasive carcinoma located in the milk duct itself. This means that the tumor has not penetrated the duct wall and has not spread to the surrounding breast tissue.
The clinical picture of intraductal papilloma is bloody content on the nipple or a palpable mass behind the nipple in solitary papillomas. It is believed that the cause of the bleeding is the pressure of the papilloma on the fibrovascular tissue, which leads to necrosis, ischemia and finally bleeding.
If left untreated, it is estimated that 20-50 percent of cases, and according to some authors 30-60% of DCIS can progress to invasive breast cancer
About 80% of cases are detected by mammography.
The prognosis is good.
SURGICAL TREATMENT
Sparing surgery
The most common operation for DCIS is breast surgery, which involves removing the tumor along with the surrounding healthy tissue. It is enough that the pathologist declares that there is healthy tissue around the tumor – at least 2mm. The amount of breast tissue to be removed depends on the size of the DCIS as well as its location.
The indication for sparing surgery is a localized solitary DCIS.
In addition to sparing surgery, radiotherapy is usually applied in order to eliminate abnormal, i.e., tumor cells, if they may have remained after the operation, but also as a preventive measure against the appearance of the disease, i.e., recurrence.
Most cases of DCIS are positive for hormone receptors, so hormone therapy is used postoperatively.
Indications for mastectomy ie. complete removal of the mammary gland:
- When there are two or more tumors differently localized in one breast.
- When there are positive margins after excision
- Diffuse microcalcifications
- Positive resection margins after repeated operations
- Large primary tumors in which it is not possible to achieve a good cosmetic effect with post surgery
- Tumors in younger women in whom only a minimal negative resection margin can be achieved due to small breasts.
Axillary lymph nodes in DCIS
- Axillary lymph node dissection is not recommended.
- Sentinel node biopsy is recommended in:
- Patients in whom mastectomy is planned
- Patients with tumor associated with DCIS or diffuse DCIS
- Increased risk for invasive cancer