Diseases

Ductal Carcinoma In Situ [DCIS]

After childbirth, the female breast is responsible for production and release of milk during feeding. It is made up of fatty tissue as well as glandular tissue. Milk producing part is divided into 15 – 20 sections called as lobes. Within each lobe, there are small structures called as lobules where milk is produced. Milk travels through tiny tubes called as ducts which unite to form one large duct and opens at nipple. Cancer that forms in the breast cells, in the inner lining of milk ducts is called as ductal carcinoma. The cancer which is confined to the ducts and has not spread or invaded surrounding tissues [in situ = in place] is called as ductal carcinoma in situ [DCIS] or non invasive breast cancer. It is the most common type of breast cancer.

Published January 12, 2022

Causes and risk factors

The exact cause of DCIS is unknown. It is found to be caused due to genetic mutations in the DNA of ductal cells of the breast. It can be inherited. There are some risk factors which are associated with the disease like age above 50 years, women who have height more than average, overweight women, close relatives with breast cancer, past history of breast cancer, past history of non-cancerous lumps, dense breast tissue, women on hormones replacement therapies, women with early menarche or late menopause, women with first pregnancy after age 30, radiation exposure, alcohol consumption, jobs causing exposure to carcinogens or endocrine disturbance. It is common in females, but can also occur in males.

Clinical presentation

A patient with DCIS is mostly asymptomatic. She may experience a small lump in breast. There can be abnormal or bloody discharge from nipple. Slight pain or tenderness in breast may be experienced by some patients. Additional symptoms may include swelling in the armpit, flattening or indentation on the breast, change in the size, contour, texture, or temperature of the breast.

Investigation

Self breast examination may reveal lump in breast. Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Mammogram is an essential diagnostic tool for early detection of any type of breast cancer. Calcifications in the breast tissue seen in mammogram suspect the disease. Further investigations include fine needle aspiration cytology [FNAC] which confirms the diagnosis. Imaging studies such as USG of breast, MRI scan of breast is useful for further evaluation.

Treatment

Treatment depends upon the stage of cancer. Most patients with DCIS are treated with breast conservation treatment such as lumpectomy. It is followed by radiation treatment. Supportive care is given to prevent further spread of cancer such as medicines by chemotherapy, hormonal therapy and targeted cell therapy. In case of DCIS involving multiple ducts, mastectomy is recommended.

Other Modes of treatment

The other modes of treatment can also be effective in treating DCIS. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating DCIS.

Facts and figures

Out of total breast cancers 83% are diagnosed as DCIS. 20 to 53 % of women with DCIS develop invasive breast cancer if left untreated.