Doctor insights on:
Intraductal Carcinoma In Children
Cancer is a group of diseases that is characterized by uncontrolled cell growth leading to invasion of surrounding tissues that spread to other parts of the body. Cancer can begin anywhere in the body and is usually related to one or more genetic mutations that allow normal cells to become malignant by interfering with internal cellular control mechanisms, such as programmed cell death or by preventing ...Read more
Noninvasive: Intraductal carcinoma is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. ...Read more
Yes BUT: There is debate about stage 0 breast cancer and how diff it is now vs how we found it 10-20 yrs ago. Some say smaller, low grade lesions shouldn't be called "cancer". Hi grade dcis certainly has risk of invasion over time. There are complementary treatments offered. Fam history & risk reduction should be considered. Tough to find cohort of pts w/ grade 2-3 dcis for whom radiation not beneficial. ...Read more
What is the normal timescale in finding a breast cancer and being operated on? In relation to 5mm of intraductal carcinoma grade 3?
Varies: This can depend on your overall health, your surgical risks, timing of getting a surgeon consultation. Availability of the operating room, scheduling with radiology to localize such a small lesion of 5 mm. Etc. This may take 1-3 weeks to schedule depending on these and other potential factors. ...Read more
Intraductal Papillary Mucinous Neoplasm on pancreas. 3mm. Same for 2 1/2 yrs. Cancer? Dr only follow with MRI. Should it be removed?
Good question: This may or not be a cancer, but without changes in appearance in 2 1/2 yrs and not knowing your complete medical history I would suggest that you follow your physician's plan and to feel better emotionally ask him/her to refer you to an oncologist for a second opinion. It is not unusual for doctors to agree to this request. ...Read more
For a 5mm intraductal breast cancer with 1mm of invasion, taken at lumpectomy and then a mastectomy performed, how many lymphs should be removed?
It depends: The current standard is to perform a sentinel lymph node biopsy; if (+), additional nodes are removed (unless radiation therapy planned, which would not be the case with this minimal tumor). The median number of sentinel nodes people have are 2-3, however some have 1, others can have many more--this does not reflect the tumor but rather the way the breast drains towards the armpit. ...Read more
Viral insertion: DCIS is the earliest phase of transformation to malignancy developing in the ductal system before invasion into parenchyma has occurred. It is defined on mammo by clustered microcalcification. In general the long terminal repeat of the MMTV viral genome enters the ductal cell to initiate transformation. With time the cells become aggressive and invade basement membrane helped by the EBV virus ...Read more
Genetic mutations: This is mostly a random event. There's a natural instability in the human genome even if you are never exposed to anything that's obviously a mutagen. The other factors that place you at risk for breast cancer (nulliparity, brca1 / brca2 mutations, etc.) are risk factors here, but no woman (and actually no man either) is immune. ...Read more
Possible: There is no biologic reason to not have the lesions you described. ...Read more
Is it possible for breast high grade ductal carcinoma insitu (dcis) to spread to the major organs?
Yes, though rare.: We know that a very small % of pts with high-grade dcis will have lymph node involvement, of which a smaller % can develop distant (metastatic) disease. ...Read more
Dx w/ invasive ductal carcinoma er + & pr +. Grade 2. Waiting on DCIS. Meeting w/ two oncologists & surgeon. What do I ask??
Depends tumor size: If tumor small and was non palpable but only defined on mammogram, if lesion with intraductal components smaller than 1 cm, and sentinel node bx neg. I would wait to hear about margins. Margins that are adequate about 1cm around lesion suggests lesion in high 90% cure without RT. If larger lesion then possibly RT and tamoxifen. ...Read more
In one word unknown: Ductal carcinoma in situ dcis is simply the sleeping cancer cells inside the breast ducts, like a garden hose loaded with cancer cells safe if they are inside the duct, once they are out side then is invasive cancer, ready to spread, cause is unknown at this time, from genetic mutations, braca I & ii age, hormonal uses. Environment, late age pregnancy life style etc are all attributed. ...Read more
It can be:
Dcis, the earliest form of breast cancer, can be associated with brca mutations. 13% of women under 50 diagnosed with dcis had a brca mutation in retrospective (looking backwards) studies. Women with a family history of breast or ovarian cancer or dcis before age 50 should have genetic counseling. For more info:
http://clincancerres. Aacrjournals. Org/content/13/14/4306.Full. ...Read more
You are right: Ordinarily, mastectomy is not necessary for precisely the reasons you have mentioned. So the standard treatment is excision of the dcis followed by radiotherapy to the affected breast. The only exception may be, if there are multiple dcis lesions in one breast....So unless you have this type of dcis, you do not need a mastectomy. ...Read more
Approx. How long would it take for dcis to spread to the lymph nodes? I have heard it is a fairly slow growing cancer.
It varies: When it's found, 1 case in 100 has metastasized. There must have been a few cells that got through the basement membrane that the pathologist didn't find -- or the primary may have regressed. But don't mess around with a dcis diagnosis. Choose the option that is right for you -- and you'll be offered a choice. ...Read more
Should tamoxifen be stopped if it caused endometrium thickening? Taking it for dcis, will it lead to endometrium cancer if continued?
In a female in their 20's the discovery of dcis is unusual and raises possibility of the need for prevention of other breast disease with tamoxifen
furthermore endometrium cancer is very unusual in a women on tamoxifen of this age and particularly if she still has periods
most doctors if concerned by thickening will do a biopsy and resolve the concern. ...Read more
Should tamoxifen be stopped if it caused endometrium thickening? Taking it for dcis, will it lead to endome cancer if continued? Asking about mom 54yr
It depends...: Endometrial thickening does not equal cancer. Tamoxifen can be continued but the endometrium should be investigates with consultation with a gynecologist. Tamoxifen should be discontinued only if the endometrial biopsy shows any atpia. But the best guidance should come from a gynecologist. ...Read more
My mother was 57 when she got dcis. I was told it wasnegative and no chemotherpay was needed. Does this mean that she had trip negative cancer?
"Negative" Clarified: Breast cancers are defined by the presence of certain proteins on their cells (tumor markers), including estrogen-, progesterone-, and her2/neu receptors. "triple negative" means that all 3 of these receptors are absent. This is very pertinent for rx of invasive cancer. Dcis, by definition, cannot travel outside the breast; therefore, these markers are less critical since chemo unnecessary. ...Read more
Is DCIS already cancer or pre-cancerous, internet research shows diff. Of opinion, which is correct? Daughter already had surgery, lymph nodes clear,
If left alone: Current thought is that if left untreated, dcis will develop into invasive breast cancer. ...Read more
Unknown: It is very difficult if not impossible to attribute one factor alone as a cause of breast cancer. A recent study looked at stress levels in breast cancer patients and found the stress scores higher in those with more aggressive cancers, but it's hard to know whether the stress caused the aggressive form or if the aggressive cancer caused more stress. Regardless, stress, obviously, is never good. ...Read more
Long process: While not all dcis will become invasive cancer, many cases will and to date we can not differentiate between those that will and those that won't. Those cases that become invasive, can then spread to lymph nodes or other organs. The latter, breast cancer that spreads to other organs, is stage IV breast cancer. ...Read more
DCIS calcifications, biopsy itself removed all bad cells, lumpectomy pathology that followed 100% cancer free, radiation to aggressive? 44 yr old.
Depends: Two important other pieces of information are what the "grade" of the DCIS was which implies how aggressive it might be, and how much normal tissue was between the edge of what was removed and the DCIS. Both of these are taken into consideration when evaluating the role of radiation therapy for DCIS. Talk to your oncologist, your surgeon, and your radiation oncologist for more details. ...Read more
In light of the recent article in the ny times on breast cancer would you recommend surgery for a 90 year old woman recently diagnosed with dcis?
Depends: Depends on how good she is at 90 yrs and the size, type of DCIS. "Good-risk" DCIS has small size, low aggressive, and good-looking under microscope. You can leave it alone without surgery. "High-risk" DCIS has large size, aggressive, or ugly-looking. So, surgery (wide excision) may be considered if she functions well. However, radiation or tamoxifen is neither needed nor helpful in elderly. ...Read more
In light of the recent article in the ny times on breast cancer would you recommend surgery for a 90 year old woman recently diagnosed with DCIS?
No, but give choice: The most extensive study of 100, 000 pts with DCIS followed over 20 years, the risk of dying, about 3.3 percent was very low, between the group that had lumpectomies with or without radiation and the group that had mastectomies. That said, a young 90 year old, wishing 110 span (OK?), need to be given a choice, since aggressive DCIS upped risk to just 7.8% in 20 yrs, so some opt for no tx, but close ffup ...Read more
I was told my mom had dcis and it was negative. No chemo. Can you have triple negative breast cancer with dcis? Or is the negative something else?
Talk to the doctor: I suggest you to d/w her surgeon or oncologist. Yes, dcis can be found coincidentally along with a triple negative breast cancer. However in this case it most likely means - dcis with negative evidence of invasive carcinoma - and that is why no chemo is needed on this case. However, I advice you to discuss with the doctor for confirmation ...Read more
Felt bead-like 2-3mm mass just outside areola so stopped vivelle (estradiol). After 1 wk, shaped like a caplet <1mmx3mm, less tender. Could it be cancer or dcis?
See your doctor.: I have been a breast cancer surgeon for over 20 years and I am still fooled by some exams. With that said, there are some generalizations about which breast lumps are more concerning than others. Cancers tend to be rock-hard, fixed, and 3-dimensionally round or oval. Benign lumps tend to be rubbery, cigar-shaped or pancake-shaped. What you are describing sounds benign but you must be seen. ...Read more