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NCCN Guidelines for Patients Ductal Carcinoma in Situ our Pleaseonline surveycomplete at NCCN.org/patients/survey NCCN GUIDELINES FOR PATIENTS® 2020 Breast Cancer Ductal Carcinoma In Situ Presented with support from: Available online at NCCN.org/patients Ü Ductal Carcinoma In Situ It's easy to get lost in the cancer world Let Ü NCCN Guidelines for Patients® be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients®: Ductal Carcinoma In Situ, 2020 1 About NCCN Guidelines for Patients® are developed by the National Comprehensive Cancer Network® (NCCN®) NCCN Clinical Practice ® Ü Ü NCCN Guidelines NCCN Guidelines in Oncology ® ® for Patients (NCCN Guidelines ) 9 An alliance of leading 9 Developed by doctors from 9 Present information from the cancer centers across the NCCN cancer centers using NCCN Guidelines in an easy- United States devoted to the latest research and years to-learn format patient care, research, and of experience 9 For people with cancer and education 9 For providers of cancer care those who support them all over the world 9 Explain the cancer care Cancer centers options likely to have the that are part of NCCN: 9 Expert recommendations for best results NCCN.org/cancercenters cancer screening, diagnosis, and treatment Free online at Free online at NCCN.org/patientguidelines NCCN.org/guidelines and supported by funding from NCCN Foundation® These NCCN Guidelines for Patients® are based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer (Version 3.2020, March 6, 2020). © 2020 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN Foundation® seeks to support the millions of patients and their families NCCN Guidelines for Patients® and illustrations herein may not be reproduced affected by a cancer diagnosis by funding and distributing NCCN Guidelines for in any form for any purpose without the express written permission of NCCN. No Patients®. NCCN Foundation is also committed to advancing cancer treatment one, including doctors or patients, may use the NCCN Guidelines for Patients for by funding the nation’s promising doctors at the center of innovation in cancer any commercial purpose and may not claim, represent, or imply that the NCCN research. For more details and the full library of patient and caregiver resources, Guidelines for Patients that have been modified in any manner are derived visit NCCN.org/patients. from, based on, related to, or arise out of the NCCN Guidelines for Patients. The NCCN Guidelines are a work in progress that may be redefined as often National Comprehensive Cancer Network® (NCCN®) / NCCN Foundation® as new significant data become available. NCCN makes no warranties of any 3025 Chemical Road, Suite 100 kind whatsoever regarding its content, use, or application and disclaims any Plymouth Meeting, PA 19462 responsibility for its application or use in any way. 215.690.0300 NCCN Guidelines for Patients®: Ductal Carcinoma In Situ, 2020 2 Supporters Endorsed by Breast Cancer Alliance FORCE: Facing Our Risk of Cancer Receiving a cancer diagnosis can be overwhelming, Empowered both for the patient and their family. We support the As the nation’s leading organization serving the NCCN Guidelines for Patients: Ductal Carcinoma hereditary cancer community, FORCE is pleased to In Situ with the knowledge that these tools will endorse the NCCN Guidelines for Patients: Ductal help to equip patients with many of the educational Carcinoma In Situ. This guide provides valuable, resources, and answers to questions, they may seek. evidence-based, expert reviewed information on the breastcanceralliance.org standard of care, empowering patients to make informed decisions about their treatment. facingourrisk.org Breastcancer.org Breastcancer.org is a leading resource for people to Sharsheret make sense of the complex medical and personal Sharsheret is proud to endorse this important resource, information about breast health and breast cancer. Our the NCCN Guidelines for Patients: Ductal Carcinoma In mission is to engage, educate, and empower people Situ. With this critical tool in hand, women nationwide with expert information and our dynamic peer support have the knowledge they need to partner with their community to help everyone make the best decisions for healthcare team to navigate the often complicated world their lives. breastcancer.org of breast cancer care and make informed treatment decisions. sharsheret.org DiepCFoundation DiepCFoundation applauds the National Comprehensive Cancer Network (NCCN) for their ongoing work in the development of Patient Guidelines. We endorse the NCCN Guidelines for Patients: Ductal Carcinoma In Situ for patients seeking information about all options for breast reconstruction after cancer. The Principles of Breast Reconstruction Following Surgery in the NCCN Guidelines directly aligns with the mission of the Foundation to educate and empower more patients with the information needed to make an informed decision about breast reconstruction after surgical treatment for breast cancer. diepcfoundation.org With generous support from • Benjamin Anderson, MD, in honor of Joan McClure • Kristina Griffin • Patricia Andrews • Kate Townsend To make a gift or learn more, please visit NCCNFoundation.org/donate or e-mail [email protected]. NCCN Guidelines for Patients®: Ductal Carcinoma In Situ, 2020 3 NCCN Guidelines for Patients®: Ductal Carcinoma In Situ, 2020 4 Ductal Carcinoma In Situ Contents 6 Breast cancer basics 11 Testing for DCIS 22 Treating DCIS 33 Breast reconstruction 37 Making treatment decisions 46 Words to know 49 NCCN Contributors 50 NCCN Cancer Centers 52 Index NCCN Guidelines for Patients®: Ductal Carcinoma In Situ, 2020 5 1 Breast cancer basics 7 The breast 8 Ductal carcinoma in situ 8 How breast cancer spreads 9 Cancer stages 10 Review NCCN Guidelines for Patients®: Ductal Carcinoma In Situ, 2020 6 1 Breast cancer basics The breast Ductal carcinoma in situ (DCIS) is a type Breast tissue contains glands that can make of cancer of the cells that line the ducts. milk. These milk glands are called lobules. Ducts are thin tubes that carry milk in the Lobules look like tiny clusters of grapes. Small breast. DCIS is stage 0 or noninvasive tubes called ducts connect the lobules to the cancer. This means the cancerous nipple. cells are in place (in situ) and have not spread to other areas. DCIS is treated to The ring of darker breast skin is called the areola. The raised tip within the areola is called prevent a more serious form of cancer. the nipple. The nipple-areola complex is a term that refers to both parts. Lymph is a clear fluid that gives cells water and The breast food. It also helps to fight germs. Lymph drains from breast tissue into lymph vessels and The breast is an organ and a gland found on travels to lymph nodes near your armpit (axilla). the chest. The breast is made of milk ducts, fat, Nodes near the armpit are called axillary lymph nerves, lymph and blood vessels, ligaments, nodes (ALNs). and other connective tissue. Behind the breast is the pectoral muscle and ribs. Muscle and ligaments help hold the breast in place. Adipose tissue Rib Suspensory ligament The breast Lactiferous sinus Muscle Pectoralis minor The breast is a Nipple glandular organ made Muscle Areola up of milk ducts, Pectoralis maor Alveoli fat, nerves, blood Lobe and lymph vessels, Milk duct ligaments, and other connective tissue. Basement membrane Basal cells Epithelial cells NCCN Guidelines for Patients®: Ductal Carcinoma In Situ, 2020 7 1 Breast cancer basics DuctalDCIS | carcinomaHow breast in cancer situ spreads Ductal carcinoma in situ Primary tumor Over time, cancer cells form a mass called a Ductal carcinoma in situ (DCIS) is a type of primary tumor. cancer of the cells that line the ducts. Ducts are thin tubes that carry milk in the breast. DCIS is Invasive noninvasive. Noninvasive means the cancerous Cancer cells can grow into surrounding tissues. cells are in place (in situ) and have not spread. Invasive breast cancer is breast cancer that Anyone can have this kind of breast cancer, has spread from the milk ducts or milk glands including men. Ductal carcinoma in situ is also (lobules) into the breast tissue or nearby lymph called intraductal carcinoma. You may hear that nodes. DCIS is preinvasive or pre-cancerous. DCIS is treated to prevent a more advanced form of cancer. Metastasis Unlike normal cells, cancer cells can spread and form tumors in other parts of the body. Cancer that has spread is called a metastasis. How breast cancer spreads In this process, cancer cells break away from the first (primary) tumor and travel through Cancer cells don’t behave like normal cells. blood or lymph vessels to distant sites. Once Cancer cells differ from normal cells in the in other sites, cancer cells may form secondary following ways. tumors. Axillary lymph nodes Lymph nodes Lymph is a clear fluid. It drains from breast tissue into lymph vessels where it travels to lymph nodes. Most of the breast lymph Cancer nodes are located near the armpit. These are called Nipple axillary lymph nodes. NCCN Guidelines for Patients®: Ductal Carcinoma In Situ, 2020 8 1 Breast cancer basics Cancer stages Cancer stages Numbered stages Number stages range from stage 1 to stage 4, The American Joint Committee on Cancer with 4 being the most advanced. Doctors write (AJCC) created a way to determine how much these stages as stage I, stage II, stage III, and cancer is in your body, where it is located, and stage IV. what subtype of cancer you have. This is called staging. Based on testing, your cancer will be Stage 0 is noninvasive assigned a stage. Staging is needed to make Noninvasive breast cancer is rated stage 0.
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