The breast is mainly made up of lobules ( milk – producing glands ) and ducts ( tubes that carry milk to the nipple). Breast cancer is a disease of cells and starts when the cells in the breast begin to divide and grow in an abnormal way.
Breast cancer can be invasive or non- invasive. Non- invasive cancers are also described as in situ. Non-invasive cancer has not yet developed the ability to spread either within the breast or elsewhere.
The two kinds of carcinoma in situ are:
DCIS (ductal carcinoma in situ) – DCIS is cancer that started in ductal cells and hasn’t grown outside the milk ducts. DCIS is sometimes described as a pre-invasive or intraductal carcinoma.
DCIS is usually given a grade, which is based on what the cells look like under the microscope, and how quickly the cells divide. It can be graded as high, intermediate or low grade DCIS.
If DCIS is left untreated , the cancer cells may eventually develop the ability to spread outside the ducts into the surrounding breast tissue or to other parts of the body. This is known as invasive breast cancer.
Most patients with DCIS have no symptoms and usually only find out they have it when it is seen on a mammogram.
The aim of treatment is to remove all the DCIS from within the breast and surgery is usually the first treatment for DCIS. After surgery you may need further treatment and this may include radiotherapy and in some cases hormonal therapy. Chemotherapy is not used as treatment for DCIS.
LCIS (lobular carcinoma in situ) – Although called a carcinoma, LCIS isn’t cancer but abnormal cell growth within the lobules
LCIS has been shown to be a marker (a signal) of an increased risk of developing invasive breast cancer in the future in both breasts, not just the breast in which lobular neoplasia is found.
The extent of the risk depends on several factors, including:
The vast majority of women diagnosed with ALH or LCIS will never get breast cancer. However, people diagnosed with either condition do have a slightly higher risk than the general population of developing breast cancer at some point in their lives.
There is no recommended standard treatment for LCIS. It’s important that you are able to discuss treatment options with your specialist based on your particular situation.
If your LCIS is diagnosed by a core biopsy, your doctor may recommend a small operation called an excision biopsy to remove further tissue from the area where the LCIS was found. This is to confirm that there aren’t any cancer cells in the area.
Regular follow up with annual mammograms is required after a diagnosis of LCIS, and sometimes further scans like Magnetic Resonance Imaging ( MRI ) may be recommended. Research has shown that treatment of women who have lobular neoplasia with tamoxifen (a hormonal therapy treatment for breast cancer) can reduce the risk of breast cancer developing. However, any possible benefit of taking tamoxifen needs to be considered against the risks and side effects of this treatment. Your specialist will talk to you if this might be an option for you. Rarely, some women may choose to have bilateral prophylactic mastectomy if they feel they cannot cope with the uncertainty and anxiety of having LCIS.
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