Breast Investigators

Source: BreastCancer.org

DCIS – Ductal Carcinoma In Situ

Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means "in its original place." DCIS is called "non-invasive" because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue. DCIS isn’t life-threatening, but having DCIS can increase the risk of developing an invasive breast cancer later on.

When you have had DCIS, you are at higher risk for the cancer coming back or for developing a new breast cancer than a person who has never had breast cancer before. Most recurrences happen within the 5 to 10 years after initial diagnosis. The chances of a recurrence are under 30%.

Women who have breast-conserving surgery (lumpectomy) for DCIS without radiation therapy have about a 25% to 30% chance of having a recurrence at some point in the future. Including radiation therapy in the treatment plan after surgery drops the risk of recurrence to about 15%. If breast cancer does come back after earlier DCIS treatment, the recurrence is non-invasive (DCIS again) about half the time and invasive about half the time. (DCIS itself is NOT invasive.)

According to the American Cancer Society, about 60,000 cases of DCIS are diagnosed in the United States each year, accounting for about 1 out of every 5 new breast cancer cases.

There are two main reasons this number is so large and has been increasing over time:

• People are living much longer lives. As we grow older, our risk of breast cancer increases.
• More people are getting mammograms, and the quality of the mammograms has improved. With better screening, more cancers are being spotted early.

Signs and Symptoms of DCIS:

DCIS generally has no signs or symptoms. A small number of people may have a lump in the breast or some discharge coming out of the nipple. According to the National Cancer Institute, about 80% of DCIS cases are found by mammography.

IDC- Invasive Ductal Carcinoma

Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. About 80% of all breast cancers are invasive ductal carcinomas.

Invasivemeans that the cancer has “invaded” or spread to the surrounding breast tissues. Ductal means that the cancer began in the milk ducts, which are the “pipes” that carry milk from the milk-producing lobules to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. All together, “invasive ductal carcinoma” refers to cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body.

According to the American Cancer Society, more than 180,000 women in the United States find out they have invasive breast cancer each year. Most of them are diagnosed with invasive ductal carcinoma.

Although invasive ductal carcinoma can affect women at any age, it is more common as women grow older. According to the American Cancer Society, about two-thirds of women are 55 or older when they are diagnosed with an invasive breast cancer. Invasive ductal carcinoma also affects men.

Signs and Symptoms of IDC

At first, invasive ductal carcinoma may not cause any symptoms. Often, an abnormal area turns up on a screening mammogram (x-ray of the breast), which leads to further testing.

In some cases, the first sign of invasive ductal carcinoma is a new lump or mass in the breast that you or your doctor can feel. According to the American Cancer Society, any of the following unusual changes in the breast can be a first sign of breast cancer, including invasive ductal carcinoma:

• swelling of all or part of the breast
• skin irritation or dimpling
• breast pain
• nipple pain or the nipple turning inward
• redness, scaliness, or thickening of the nipple or breast skin
• a nipple discharge other than breast milk
• a lump in the underarm area

 

Less Common Types of IDC

There are some types of invasive ductal carcinoma that happen less commonly than others. In these cancers, the cells can look and behave somewhat differently than invasive ductal carcinoma cells usually do. If you’re diagnosed with one of these cancers, talk with your doctor about how this could affect your treatment plan. You can read more about these cancers on the following pages:

•           Tubular Carcinoma of the Breast

•           Medullary Carcinoma of the Breast

•           Mucinous Carcinoma of the Breast

•           Papillary Carcinoma of the Breast

•           Cribriform Carcinoma of the Breast

The medical experts for Less Common Subtypes of Invasive Ductal Carcinoma are:

• Jennifer J. Griggs, M.D., medical oncologist/hematologist, Division of Hematology/Oncology at the University of Michigan, Ann Arbor, MI
• Clifford Hudis, M.D., Chief, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY

These experts are members of the Breastcancer.org Professional Advisory Board, including more than 70 medical experts in breast cancer-related fields.



Tubular Carcinoma of the Breast

Tubular carcinoma of the breast is a rare subtype of invasive ductal carcinoma (cancer that begins inside the milk duct and spreads beyond it). Tubular carcinoma accounts for about 1-2% of all breast cancer cases. In this type of cancer, the tumor is usually small and made up of tube-shaped cells that are low grade. “Low grade” means they look somewhat similar to normal, healthy cells and tend to grow slowly.
Tubular carcinoma of the breast is less likely to spread outside the breast than other types of breast cancer. It’s also easier to treat.
Studies have found that the average age of diagnosis for tubular carcinoma ranges from the mid-40s to late 60s.


Medullary Carcinoma of the Breast

Medullary carcinoma of the breast is a rare subtype of invasive ductal carcinoma (cancer that begins in the milk duct and spreads beyond it), accounting for about 3-5% of all cases of breast cancer. It is called “medullary” carcinoma because the tumor is a soft, fleshy mass that resembles a part of the brain called the medulla.

Medullary carcinoma can occur at any age, but it usually affects women in their late 40s and early 50s. Medullary carcinoma is more common in women who have a BRCA1 mutation. Studies have shown that medullary carcinoma is also more common in Japan than in the United States.

Medullary carcinoma cells are usually high-grade in their appearance and low-grade in their behavior. In other words, they look like aggressive, highly abnormal cancer cells, but they don’t act like them. Medullary carcinoma doesn’t grow quickly and usually doesn’t spread outside the breast to the lymph nodes. For this reason, it’s typically easier to treat than other types of breast cancer.

Mucinous Carcinoma of the Breast

Mucinous carcinoma of the breast — sometimes called colloid carcinoma — is a rare form of invasive ductal carcinoma (cancer that begins in the milk duct and spreads beyond it). Mucinous carcinoma of the breast accounts for about 2-3% of all breast cancer cases. In this type of cancer, the tumor is formed from abnormal cells that “float” in pools of mucin, a key ingredient in the slimy, slippery substance known as mucus.

Normally, mucus lines most of the inner surface of our bodies, such as our digestive tract, lungs, liver, and other vital organs. Many types of cancer cells — including most breast cancer cells — produce some mucus. In mucinous carcinoma, however, the mucus becomes a main part of the tumor and surrounds the breast cancer cells.

Mucinous carcinoma tends to affect women after they’ve gone through menopause. Some studies have found that the usual age at diagnosis is 60 or older.

Mucinous carcinoma is less likely to spread to the lymph nodes than other types of breast cancer. It’s also easier to treat.


Papillary Carcinoma of the Breast

Invasive papillary carcinomas of the breast are rare, accounting for less than 1-2% of invasive breast cancers. In most cases, these types of tumors are diagnosed in older women who have already been through menopause. An invasive papillary carcinoma usually has a well-defined border and is made up of small, finger-like projections. Often it is Grade 2, or moderate grade, on a scale of 1 to 3 — with Grade 1 describing cancer cells that look and behave somewhat like normal, healthy breast cells, and Grade 3 describing very abnormal, fast-growing cancer cells. In most cases of invasive papillary carcinoma, ductal carcinoma in situ (DCIS) is also present. (DCIS is a type of cancer in which the carcinoma cells are confined to the breast duct.)


Cribriform Carcinoma of the Breast

In invasive cribriform carcinoma, the cancer cells invade the stroma (connective tissues of the breast) in nestlike formations between the ducts and lobules. Within the tumor, there are distinctive holes in between the cancer cells, making it look something like Swiss cheese. Invasive cribriform carcinoma is usually low grade, meaning that its cells look and behave somewhat like normal, healthy breast cells. In about 5-6% of invasive breast cancers, some portion of the tumor can be considered cribriform. Usually, some ductal carcinoma in situ (DCIS) of the cribriform type is present as well.