Ductal carcinoma in situ

The ductal carcinoma in situ, shortly DCIS according to abbreviationfinder, is a very early discovered form of breast cancer. The breast cancer tumor is still restricted to the milk ducts and has not been able to form metastases. Therefore, ductal carcinoma is always curable in situ and has a good prognosis.

What is ductal carcinoma in situ?

The ductal carcinoma in situ is not a real breast cancer, but the preliminary stage of breast cancer. Since DCIS did not break through the tissue separating it, the affected area did not grow into the surrounding area and metastases were not formed.

The ductal carcinoma is mostly found in situ in the milk ducts. These can be completely or partially lined with the atypical cells; the tissue change can occur in one or more places on the breast.

In rare cases, however, the tumor has spread to the neighboring tissue; one then speaks of an invasive one growth. In particular, DCIS foci with a size of over 2 cm often have invasive areas, which, however, remain so small that they can only be found with meticulous histological preparation.

Causes

The exact causes of ductal carcinoma in situ have not yet been fully scientifically clarified. As with breast cancer, one could observe spontaneous cases of illness for which no medical cause could be identified. However, the risk factors that are known to be beneficial for breast cancer appear to be present.

These are:

• Childlessness and late pregnancies after the age of 30,

• the early onset of your period and the late onset of menopause,

• a permanently unhealthy, fat-heavy diet,

• Smoking and alcohol consumption

• and the long-term use of female sex hormones.

In particular, taking the pill and hormone replacement therapy for menopausal symptoms increase the risk of breast cancer, albeit slightly. It is true that today we speak of genetic predisposition more often, but a genetic component could only be determined in 5 to 10% of those affected. A genetic test for women in risk groups is still recommended.

Symptoms, ailments & signs

Since this disease is a tumor, it is always associated with the usual symptoms and risks of tumor disease. Often, early treatment cannot be given because the disease is not associated with certain symptoms and complaints. Only in a very few cases can this result in chest pain, so that treatment is only required at a later date.

A dark secretion can also emerge from the nipple itself, which indicates the disease. The other complaints, however, depend to a large extent on the severity of the tumor, so that a general prediction is not possible. If no treatment is given, the tumor spreads to different regions of the body, which can lead to metastasis.

This significantly reduces and restricts the life expectancy of the person affected. The affected person becomes very tired and exhausted, whereby the resilience also drops significantly. The internal organs are also attacked by the tumor, so that the patient can die of kidney disease or cirrhosis of the liver. Strong psychological complaints also arise, so that many people affected and their relatives suffer from depression or other psychological disorders.

Diagnosis & course

Because ductal carcinoma rarely occurs in situ with symptoms such as chest pain, palpable tumors, or bloody secretion from the nipple, early diagnosis is difficult. As a rule, the DCIS is only discovered during a mammography. For a more precise diagnosis, the radiologist takes small tissue samples that are analyzed by a pathologist.

A three-level WHO scheme is used to determine the aggressiveness of the tumor. The higher the core grade, the more aggressive the tumor and the more uncertain and risky the course. In principle, ductal carcinomas can develop into real carcinomas in situ, but they do not have to.

When should you go to the doctor?

If chest pain is noticed, a doctor should be consulted. Ductal carcinoma in situ rarely occurs with clear symptoms, but complaints in the area of ​​the breasts must be clarified in any case.

If the tumor is detected during a routine examination, treatment is recommended. Affected women should consult an expert on this. Based on the severity of the ductal carcinoma, the doctor can then determine an individual treatment in situ with the lowest possible radiation exposure and surgical risks.

After the tumor has been successfully removed, you should consult your doctor on a regular basis. If there is any bleeding or serious after-effects of the radiation therapy, a visit to a doctor is indicated. If there are signs of a breast tumor, the clinic should be visited as soon as possible so that the suspicion can be dispelled or, in the case of a carcinoma, the necessary steps can be taken immediately. Since a serious illness can also cause emotional stress on those affected, therapeutic advice is recommended in addition to medical treatment.

Complications

Ductal carcinoma in situ is a relatively common invasive early cancer of the female breast. The symptom mostly occurs in the milk ducts, but leaves the basement membrane intact because the scattering properties are extremely low. If measures are introduced in good time, ductal carcinoma in situ has excellent chances of recovery.

However, if the affected person does not identify the tissue nodes in time or ignore them, the carcinoma can grow and develop negative as a complication within a few years. If the growths have already assumed a variable shape, they grow and even expand to the lymph nodes. The skin and nipple change and a central necrosis sometimes forms. In the case of hardship, the breast must be amputated.

Therefore, in the event of any suspicion or infestation, regular mammography screening is extremely important. Furthermore, in order to keep the risk of complications of a malignant cancer stage low, surgical measures are quickly targeted. The ductal carcinoma is removed in situ with a sufficient safety margin.

The operation is generally well tolerated. In some cases, anti-hormonal therapy or chemotherapy is recommended after the procedure. Depending on the condition and acceptance of the symptom, those affected react with psychological and physical problems, which are taken into account in the holistic diagnosis and are included in the therapy plan.

Treatment & Therapy

Doctors generally advise women affected by ductal carcinoma in situ to receive treatment in order to rule out the risk of developing into real carcinoma. Modern research doubts the correctness of this procedure, especially because of the radiation exposure and the operational risks, and suggests regular observation.

If the patient decides to have a treatment, she should definitely have it carried out by an expert. Only this can determine the individually correct treatment, which has to be based, among other things, on the severity of the ductal carcinoma in situ.

The standard therapy is the surgical removal of the affected tissue. This takes place with a safety distance of five to ten millimeters from healthy tissue. It is usually possible to preserve the breast, but depending on the extent and size of the tumor, it may be necessary to remove the entire mammary gland. In contrast to breast cancer operations, the axillary lymph nodes can usually be left in place.

Although science has not been able to demonstrate any healing benefits from chemotherapy, postoperative radiation has now become an integral part of therapy. After a detailed individual risk assessment, the doctor and patient can also opt for anti-hormonal therapy. This is usually done with tamoxifen, the main side effects of which are missed periods, hot flashes, nausea, and headache and bone pain.

If the ductal carcinoma was completely removed in situ, the prognosis can be described as very good.

Outlook & forecast

Ductal carcinoma in situ has a good prognosis. The form of breast cancer is discovered in the early stages and can be treated and treated well with the current medical possibilities. The tissue changes are completely removed in a surgical procedure. Since metastases do not form in this form of carcinoma, the patient is usually considered cured after the operation. There is no further health risk for cancer.

In most cases, however, cancer follow-up is carried out as a precaution. Radiation or chemotherapy is scheduled to prevent further carcinomas from developing. These forms of therapy are associated with numerous side effects and sequelae. The quality of life is greatly reduced during the time of cancer therapy. After completing the therapy, the patient needs several months or years until he has fully recovered and can go about his day-to-day life without worries.

The ductal carcinoma in situ can develop again at any time despite the cancer follow-up. The good prognosis is also good if it returns. The path to cure becomes problematic for patients who suffer from a mental disorder due to ductal carcinoma in situ. An anxiety disorder or depression can lead to a further reduced quality of life. The prognosis for ductal carcinoma in situ is still unaffected.

Prevention

Other than avoiding risk factors of DCIS, women are currently unable to take preventive measures due to insufficient research.

Aftercare

Good, high-quality follow-up care by a doctor is very important for ductal carcinoma in situ; recurrences or metastases must be recognized in good time and treated. For this purpose, the patient is called in every three months for the first three years after therapy and asked about her current situation.

The breast is examined clinically, blood analyzes and imaging procedures are also used here. Examination of the contralateral breast is also necessary; tumors of other organs must also be excluded. In addition, the patient has to check herself regularly and if there are any abnormalities, she has to present herself to her gynecologist.

This ensures an improvement in the quality of life and performance after the therapy. In addition, the possible side effects of the treatment must be closely monitored and treated. It is also helpful to join appropriate self-help groups to share and help in the community.

A very important goal is a healthy lifestyle, including weight loss, alcohol and nicotine abstinence, as well as cardiac exercise. It is also important to reduce stress; psychosocial counseling can be helpful for this. Overall, the prognosis for ductal carcinoma in situ is very good, as it can be completely treated by surgery, but patients should remain vigilant and adopt a healthy lifestyle.

You can do that yourself

Ductal carcinoma in situ is a tumor disease that can usually be cured without serious complications if diagnosed early. Numerous self-help options are available to the patient to positively support the healing process.

Due to its nature, ductal carcinoma in situ has little tendency to spread, but this depends a priori on the physical condition, the surgical measures used and the age of the person affected. Depending on the degree of the syndrome, the patient should change their lifestyle as a first self-help measure. This includes eating a low-fat diet rich in vitamins, avoiding sugar, alcohol, cigarettes and drugs as well as avoiding stress and extreme physical strain.

During radiation therapy and the subsequent administration of anti-hormone drugs, it is advisable to cope with everyday life in peace. In the case of a severely impaired condition, the patient is provided with assistance. Therapeutic measures and self-help groups can alleviate and even avoid the risk of depression caused by possible pain.

An artistic activity in the context of self-help or rehabilitation is also a great support. Light physical activities such as walking, yoga, and meditation to cope with the illness can release new life energy and strength.

Even after a positive course of treatment, a healthy lifestyle should be maintained and regular check-ups should be taken.