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Understanding Your Diagnosis

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Understanding Your Diagnosis Understanding Your Diagnosis Ductal Carcinoma In Situ (DCIS) Not all breast cancers are the same. Ductal Carcinoma In Situ (DCIS) is a change in the There are different types of breast cancer, as cells that line the milk ducts, which are the “tubes” well as different stages. Understanding how that bring milk from the milk lobules to the nipple. cancer works and how your particular cancer Normally, a thin layer of breast epithelial cells lines affects your body will help you make decisions the inside of the milk duct. DCIS happens when the about your care and what is best for you. cells of this thin layer grow and multiply without The information in this section will help you stopping and have abnormal features that can be plan and prepare for your treatment. However, detected only under the microscope. it is not meant to replace the individual In DCIS, the abnormal breast cells are confined to attention, advice, and treatment plan of your the milk duct. They do not spread outside the milk oncologist and medical team. duct into the surrounding breast tissue, lymph nodes or other parts of the body. We What is a Cell? How Does a Cell call this a non-invasive type Become a Cancer? of cancer because it has not invaded other tissue. DCIS is Cells are the building blocks of all tissue and organs in the human body. Each cell contains genetic “Stage 0” breast cancer. That material (DNA) and other elements. DNA controls means it has been detected at the growth rate of cells. the earliest stage possible. Normal cells grow and multiply at If left untreated, sometimes a specific rate. Cells that grow and DCIS will spread outside multiply without stopping are called the milk duct and turn into cancerous or malignant. Cancerous an invasive or infiltrating cells are not detectable when they cancer. At this point in time, Normal breast with DCIS we cannot predict which shown as cross-section first start growing. At a certain point, of the duct. the cancerous cells continue to patients with DCIS will multiply and form a mass which can develop invasive or infiltrating be detected. Abnormal cell growth Breast cancers. Therefore, it is recommended that DCIS be anatomy could go on for years before it is large surgically removed before it can become an invasive enough to be detected. cancer. Radiation treatment of the breast is often recommended following removal of the affected There are two separate ideas used when describing tissue. Radiation is not recommended following a cancer: grade and stage. A cancer’s grade, along mastectomy (removal of the entire breast) to treat with stage, are important in determining your DCIS. In addition, a medication such as Tamoxifen recommended treatment. Grade refers to how much may be recommended to reduce the risk of breast your cells look like normal tissue. Stage for invasive cancer in the future. cancer is determined by how big the tumor is and if it has spread beyond the breast to the lymph nodes and other areas of the body. Ductal Carcinoma In Situ (DCIS) is not invasive, so it is always stage 0 regardless of size. More information about staging will be discussed later in this chapter. Understanding Your Diagnosis 1 DCIS is often found on a mammogram. The Surgery, radiation, hormonal therapy and mammogram may show microcalcifications that chemotherapy can all be used to treat IDC. Most are worrisome. These are small calcium deposits women will receive a combination of treatments, that form within or near the DCIS. Not all micro- although not necessarily all four types of treatment. calcifications seen on a mammogram indicate DCIS. The types of treatment recommended will depend Those that form a line, are new or have increased in upon the size of the cancer, whether the cancer number may be suspicious. Less commonly, DCIS is in the lymph nodes, features of the cancer cells may show up as a nodule or thickening of tissue on themselves and your general health. a mammogram. In rare cases, DCIS may be felt as a thickening or nodule in the breast on self-exam or Inflammatory Breast Cancer during a physical exam by a health care provider. Inflammatory breast cancer is a type of invasive ductal breast cancer. Invasive or Infiltrating Ductal Carcinoma (IDC) The cancer cells spread outside the milk duct into Invasive or infiltrating ductal the surrounding breast tissue and into the small carcinoma (IDC) is the most lymphatic vessels in the breast, particularly those common type of breast cancer. in the skin of the breast. The invasion of the cancer This may also be diagnosed as cells into the lymphatic vessels of the breast skin “invasive mammary carcinoma of no causes the breast to look inflamed, i.e., red, warm special type (ductal, not otherwise and even swollen. It often looks like there is an specified)” in your report. IDC infection in the breast. A biopsy of the breast and occurs when the cells that line the the skin is necessary to diagnose inflammatory milk duct become abnormal. The breast cancer. ductal cancer cells look different Infiltrating ductal from normal milk duct cells, and the carcinoma Inflammatory breast cancer behaves differently body produces than other invasive ductal breast cancers and must too many of them. They spread be treated differently. It is important to control the outside the milk duct into the growth of the inflammatory breast cancer cells, and surrounding breast tissue. IDC chemotherapy is often recommended first. Once does not mean that the cancer chemotherapy is completed, the need for surgery has traveled to other parts of the and radiation will be determined. body beyond the breast, but it has the ability to do so. It is not uncommon to have DCIS along with IDC. IDC shown on a When the pathologist examines cross section of the cells under the microscope, duct. a grade is assigned. The cancer will be graded from 1 to 3. Grade 1 means that the cancer cells are very similar to the normal cells. Grade 3 indicates that the cancer cells are very different from the normal cells in breast tissue. Higher grade tumors are generally more aggressive than lower-grade tumors. Understanding Your Diagnosis 2 Invasive or Infiltrating Lobular Carcinoma (ILC) Interpreting Your Pathology Report Invasive or infiltrating lobular breast cancer (ILC) Tissue removed from the breast, lymph nodes or occurs when the cells in the milk lobule become other parts of the body are sent to a laboratory to abnormal. The lobular cancer cells look different be viewed by a pathologist, (a doctor who identifies from normal lobular cells and multiply without diseases by studying cells and tissues under a micro- stopping. They spread outside the lobule into the scope). The pathologist’s written report of his or her surrounding breast tissue. ILC does not mean that findings is called a pathology report, which usually the cancer has traveled to other parts of the body includes: beyond the breast, but it has the ability to do so. A detailed record of the specimens received and When the pathologist examines the cells under the examined microscope, a grade is assigned. A complete description of the appearance of the The cancer will be graded from Infiltrating tissue cells, such as size, grade, color and the 1 to 3. Grade 1 means that the lobular carcinoma presence of any visible abnormality cancer cells are very similar to the normal cells (classic). Grade A report of all of the diagnostic findings after 3 indicates that the cancer cells microscopic examination are very different from the A complete documentation of all of the studies normal cells in breast tissue performed on the tissue (pleomorphic). Higher grade Lobules A copy of the pathology report is sent to your doctor tumors are generally more and becomes part of your medical record. aggressive than lowergrade Breast carcinoma tumors. (ILC) The next two pages describe some common terms routinely used in breast cancer pathology reports. Surgery, radiation, hormonal therapy and chemo- therapy can all be used to treat ILC. Most women will receive a combination of treatments, although not necessarily all four types of treatments. The types of treatment recommended will depend upon the size of the cancer, whether the cancer is in the lymph nodes, features of the cancer cells themselves and your general health. Understanding Your Diagnosis 3 Final microscopic diagnosis Margins: the area of normal This section summarizes the pathologist’s findings. tissue around the tumor that is removed during surgery. Ideally Infiltrating/invasive ductal breast carcinoma (IDC): there are no cancer cells at the cancer that started in the milk duct of the breast and margin (clear or negative margin), has spread into surrounding breast tissue. In the final only a rim of normal tissue. pathology report, the diagnosis may be more specific. The pathologist will measure Negative and positive Infiltrating/invasive lobular breast carcinoma (ILC): the distance between the cancer margins are the distance and the edge of normal tissue. If between the tumor and cancer that started in the milk lobule of the breast and the edge of the tissue. has spread into surrounding breast tissue cancer cells are detected at the The bottom example edge of the tissue removed, it shows where there is Ductal carcinoma in situ (DCIS): early cancer cells still some tumor at the is called a positive margin, and margins. growing in the lining of the milk duct in the breast. more surgery may be required. Grade: describes how much the cancer cells look like Calcification: notes whether calcium deposits were their normal cell counterparts.
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