Breast Cancer and Ductal Carcinoma in situ

Typically, breast cancer screenings are performed to catch the disease in the early stages. If the disease is found, either through screening or recognized signs and symptoms, further tests are performed to determine the extent of the disease.
In 2011, 288,130 new cases of invasive breast cancer were diagnosed in women in the U.S. Almost 25% of all new breast cancers diagnosed in the United States are Ductal carcinoma in situ.
What is Ductal carcinoma in situ?
Ductal carcinoma in situ (DCIS) is also known as intraductal carcinoma. DCIS is a relatively new diagnosis and is a term used to describe cells that are growing inappropriately inside the ducts of the breast.  Those cells look like cancer cells under the microscope.  They are abnormal cells that have not spread into the surrounding fatty breast tissue or to any other part of the body.  They are totally confined to the duct and therefore non-invasive.
DCIS began being diagnosed more readily when mammography became a routine part of medical care.   More than 24% of all new breast cancers diagnosed in the United States are DCIS.
How do cancer cells work?
Most breast cancers arise in cells that line the ducts and lobules of the breast.  When cells in the lining of breast ducts are growing inappropriately, it’s called hyperplasia.  When they grow inappropriately and do not appear normal under the microscope, they are called atypical hyperplasia.
Are DCIS cells the same as cancer cells?
DCIS cells are different than actual cancer cells.  They lack the biological capacity to metastasize or spread elsewhere in the body, like cancer cells do.  So are you wondering why DCIS cells fall into the category of cancer cells?
Some DCIS cells can change genetically and become true cancers, and you should not ignore a DCIS diagnosis because science doesn’t know yet which DCIS cells will change and become invasive–and which will remain DCIS.
Are you diagnosed DCIS?
If you are diagnosed with DCIS it is important to know how aggressive or risky your cell type is because there are different kinds of DCIS.  For example, Comedo-carcinoma considered to be an early stage of breast cancer, is considered more aggressive and high-grade than cribiform, which is considered low-grade.  By defining the type of DCIS, it’s easier to define your treatment options, which in turn affects whether DCIS becomes invasive breast cancer.
A diagnosis of DCIS depends on the pathologist, and the diagnosis may be controversial.  Therefore, second, independent opinions are always important.
Whether your doctor refers to DCIS as cancer or pre-cancer, it requires careful treatment and follow-up to avoid the possibility of an invasive breast cancer developing.
Stay abreast of your health with daily self examination and regular check-ups.

What Is The Difference Between IBC and Recurrent Breast Cancer?

What is inflammatory breast cancer?  The breast looks red and swollen and feels warm when inflammatory breast cancer occurs.  The redness and warmth occur because the cancer cells block the lymph vessels in the skin.  The skin of the breast may also show a pitted appearance. Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.  Treatment of inflammatory breast cancer may include the following:  Systemic chemotherapy.  Or systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy.  Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.  Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment may also be a treatment.
What is recurrent breast cancer?  Recurrent breast cancer is cancer that has recurred (come back) after it has been treated.  The cancer may come back in the breast, in the chest wall, or in other parts of the body.
Treatment of recurrent breast cancer in the breast or chest wall may include surgery (radical or modified radical mastectomy), radiation therapy, or both.  Systemic chemotherapy or hormone therapy may also be applied and a clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy may be used.

When a woman is faced with breast cancer, there are two choices available: lumpectomy and mastectomy.
Lumpectomy is less invasive than mastectomy and it allows a woman to save her breast. Mastectomy involves removal of the entire breast.
Most women, when offered the choice between the two, prefer the less invasive lumpectomy Generally, lumpectomy results in a good cosmetic look. And, if you want to keep your breast, you may decide to have lumpectomy followed by radiation.  However, in rare cases, when a larger area of tissue needs to be removed, lumpectomy can cause the breast to look smaller or distorted.  There are types of reconstructive surgery available for both lumpectomy and mastectomy.  If you need to have a large area of tissue removed and two breasts of matching size are very important to you, you and your doctor will need to decide which surgery is best for your situation.
Research shows that women who live in the United States are more likely to have mastectomies than women who live in other countries.  In the Midwestern and southern parts of the U.S., mastectomies are very common.
Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for women with only one site of cancer in the breast and a tumor under 4 centimeters.  Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).
Lumpectomy has a few potential disadvantages:
Radiation therapy is likely to be scheduled for 5 to 7 weeks of radiation therapy– 5 days per week after lumpectomy surgery to make sure the cancer is gone.
Radiation therapy may affect the timing of reconstruction and possibly your reconstruction options after surgery.  Radiation therapy also may affect your options for later surgery to lift or balance your breasts.
There is a somewhat higher risk of developing a local recurrence of the cancer after lumpectomy than after mastectomy.  However, local recurrence can be treated successfully with mastectomy.
The breast cannot safely tolerate additional radiation if there is a recurrence in the same breast after lumpectomy.  This is true for either a recurrence of the same cancer, or for a new cancer.  If you have a second cancer in the same breast, your doctor will usually recommend that you have a mastectomy.
One or more additional surgeries may be needed after your initial lumpectomy.  During lumpectomy, the surgeon removes the cancer tumor and some of the normal tissue around it (called the margins).  A pathologist looks to see if cancer cells are in the margins.  If there are cancer cells, more tissue needs to be removed until the margins are free of cancer. Ideally, this is all done during the lumpectomy, but analyzing the margins can take about a week.  So sometimes after the pathology report is done, the margins are found to contain cancer cells and more surgery (called a re-excision) is needed.
Some women may want the entire breast removed because it provides a greater peace of mind regarding the recurrence of breast cancer.  Radiation therapy may still be needed, depending on the results of the pathology.
Mastectomy means that the woman will have a permanent loss of her breast and that she will have to have additional surgeries if she chooses to have her breast reconstructed. A mastectomy takes longer than a lumpectomy and is more extensive. It also has more post-surgery side effects and a longer recuperation time.
The choices are personal so be sure to weigh your decision carefully after you’ve talked with your doctor.

Inflammatory breast cancer tends to be diagnosed at younger ages when compared to other cancers; and it’s more common and diagnosed at younger ages in African-American women than in white women.  The median age at diagnosis in African-American women is 54 years, compared with a median age of 58 years in white women.  It’s also  more common in overweight women than in women of normal weight.
Often times, treatments such as tamoxifen aren’t effective against inflammatory breast tumors because they are hormone receptor negative.   Inflammatory breast cancer can strike men as well as women, but usually it strikes at an older age.    Remember that inflammatory breast cancer is a very rare, but aggressive type of cancer and it’s important to always notice any changes in your breast whether you’re a male or female.  Because this disease is so relatively rare, people with inflammatory breast cancer are encouraged to enroll in clinical trials in which new treatments are being tested simply to take any advantage such medicine or techniques may offer in conjunction with those currently in use.   This disease accounts for only one to five percent of all breast cancers diagnosed in the United States.  Typically there’s no lump to be felt, and the disease escapes diagnosis until it has progressed to stage III or IV, at which point it has already spread only to nearby lymph nodes, stage III,---or to other tissues as well, stage IV.
Inflammatory breast cancer usually progresses rapidly, often in a matter of weeks or months.  Symptoms include swelling and redness that affect a third or more of the breast.  The skin of the breast may also appear pink, reddish purple, or bruised.  In addition, the skin may have ridges or appear pitted, like the skin of an orange.  These symptoms are caused by the buildup of lymph fluid  in the skin of the breast.   This fluid buildup occurs because cancer cells have blocked lymph vessels in the skin, preventing the normal flow of lymph through the tissue.  Sometimes, the breast may contain a solid tumor that can be felt during a physical exam, but, more often, a tumor cannot be felt.
Other symptoms include a rapid increase in breast size; sensations of heaviness, burning, or tenderness in the breast, or a nipple that is inverted.   Swollen lymph nodes may also be present under the arm, near the collarbone, or in both places.
Inflammatory breast cancer can be difficult to diagnose.  Often, there is no lump that can be felt during a physical exam or seen in a screening mammogram.  In addition, most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram more difficult.   Also, because inflammatory breast cancer is so aggressive, it can arise between scheduled screening mammograms and progress quickly. The symptoms of inflammatory breast cancer may be mistaken for those of mastitis or another form of locally advanced breast cancer.
There are published guidelines to help you choose the best course of treatment and how the disease is diagnosed.