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Ductal Carcinoma (Invasive and In Situ)

How is ductal carcinoma in situ treated? continued...

Most women with ductal carcinoma in situ don't have the breast removed with a mastectomy. Instead, they receive breast-conserving treatment.

The most common course of treatment consists of a lumpectomy followed by radiation. A lumpectomy is a surgical procedure in which a surgeon removes the cancer and a small area of normal tissue around it. The risk of lymph node involvement with ductal carcinoma in situ is only 1% to 2% so the lymph nodes under the arm do not need to be removed, as may be the case with other types of breast cancer. The area of normal tissue is taken to make sure all the cancer cells have been removed. 

After lumpectomy, radiation therapy significantly reduces the likelihood that the cancer will come back. Cancer coming back is called recurrence. Radiation can be delivered from an external source to the entire breast. Or it can be given internally to certain areas of the breast.

Some women with an extremely low likelihood of cancer recurrence may be treated for ductal carcinoma in situ with a lumpectomy only. This may be an option for older women with small tumors whose surgery showed large amounts of healthy tissue on all sides of the cancer. You should discuss the risks of forgoing radiation therapy with your doctor before deciding against it.

You and your doctors may decide that a mastectomy to remove the breast is the best course of treatment if you have any of the following:

  • A strong family history of breast cancer
  • Very large areas of ductal carcinoma in situ
  • DCIS lesions located in multiple areas throughout your breast

Whatever form of treatment you have, you and your treatment team may also consider the use of tamoxifen. Tamoxifen is a breast cancer drug that reduces the risk of invasive breast cancer not only in the involved breast, but in the opposite breast as well. This risk reduction continues even after the tamoxifen is discontinued.

What is invasive ductal carcinoma?

Invasive ductal carcinoma accounts for about 80% of all invasive breast cancers in women and 90% in males with breast cancer.

Like ductal carcinoma in situ, it begins in the milk ducts of the breast. But unlike DCIS, invasive ductal carcinoma is not contained. Instead, it grows through the duct walls and into the surrounding breast tissue. And it can metastasize. That means it can spread to other areas of your body.

How is invasive ductal carcinoma diagnosed?

Invasive ductal carcinoma may cause a hard, immovable lump with irregular edges to form in your breast. That lump can be felt during a breast examination. In some cases, the cancer causes the nipple to become inverted. A mammogram may show areas of calcification where calcium has collected in old cancer cells.

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