BREAST CANCERS

The information outlined below on the most common breast cancer symptoms, conditions and treatments is provided as a guide only and it is not intended to be comprehensive.

As with the common non-cancerous conditions on this website, discussion with Michelle is important to answer any questions that you may have.

What is ductal carcinoma in situ (DCIS)?

DCIS is an early form of breast cancer, where the cancer cells have developed within the milk ducts but remain there (so called ‘in situ’ ) as the cells don’t have the ability to spread outside the ducts into the surrounding breast tissue or to other parts of the body. So it is usually described as a pre-invasive, intraductal or non-invasive cancer. Both men and women can develop DCIS, however it is very rare in men. As a result of being confined to the breast ducts, a diagnosis of DCIS has a very good outlook.

What are the symptoms of DCIS?

DCIS often has no accompanying symptoms and it is usually identified on a mammogram. The image of the breast appears as though it has irregular microcalcifications. However, some people may notice a change in the breast such as a lump, discharge from the nipple or more rarely, a type of rash involving the nipple (called Paget’s disease)

How is DCIS diagnosed?

If the radiologist who read your mammogram suspects you have DCIS, he or she will arrange for you to have a mammographically guided (stereotactic) biopsy. The biopsy can often be done the same day, you will be given an idea of the most likely diagnosis and the biopsy report will follow within a few days.

What is the treatment for DCIS?

• Local excision with radiation therapy. Most patients have great success rates having a wide local excision (lumpectomy or breast conserving treatment ) and radiation treatment.

• Mastectomy. Some women have more extensive DCIS occupying several ducts or quadrants of the breast (known as extensive DCIS), or the noninvasive breast cancer is found at several areas throughout the breast, known as multicentric breast disease. For women with this presentation of the cancer, their physician may recommend a mastectomy may be the more appropriate surgical treatment instead of a lumpectomy. This would generally be accompanied with a lymph node biopsy from the armpit at the same time and is unlikely to require any additional radiotherapy afterwards. Mastectomy can often be accompanied by immediate breast reconstruction should this be required.

• Chemotherapy. Chemotherapy is not needed for DCIS, since the disease is noninvasive.

• Hormonal Therapy. Hormonal therapy is only occasionally recommended as part of a clinical trial if the DCIS has a prognostic factor of being hormone receptor positive.

What is the prognosis for DCIS?

Women with DCIS have an excellent prognosis. By treating DCIS in a specialist centre you ensure your health is in the best possible hands.

It is important to maintain a rigorous screening schedule to monitor for local recurrence in the original breast and to monitor the opposite healthy breast. By definition, there is no risk of distant recurrence since the cancer is noninvasive.

Invasive ductal carcinoma (IDC), also known as infiltrating ductal carcinoma, is cancer that began growing in the duct and has invaded the fatty tissue of the breast outside of the duct. IDC is the most common form of breast cancer, representing 80 percent of all breast cancer diagnoses.

What are the symptoms of invasive ductal carcinoma?

As with any breast cancer, there may be no signs or symptoms. A mammogram may reveal a suspicious mass, which will lead to further testing. A woman may also find a lump or mass during a breast self-exam. The following are possible signs of breast cancer and should immediately be reported to your physician for further evaluation:

• Lump in the breast
• Thickening of the breast skin
• Rash or redness of the breast
• Swelling in one breast
• New pain in one breast
• Dimpling around the nipple or on the breast skin
• Nipple pain or the nipple turning inward
• Nipple discharge
• Lumps in the underarm area
• Changes in the appearance of the nipple or breast that are different from the normal monthly changes a woman experiences

How is invasive ductal carcinoma diagnosed?

We know how quickly patients want results from a biopsy or scan if there is a suspicion of breast cancer. We follow strict guidelines for biopsies and pathology reports. Most of our patients will receive the probability of cancer immediately following their biopsy procedure and a pathology confirmation within 24 hours.

Steps of diagnosis include:

• Digital mammography
• Ultrasound
• MRI
• Staging workup
• Biopsy
• Pathology

What is the treatment for invasive ductal carcinoma?

Treatment for all types of IDC is determined by the exact type of cancer and staging. Depending on the size and spread of the tumor(s), most women will undergo a combination of any of the following treatments:

• Lumpectomy
• Mastectomy
• Sentinel node biopsy
• Axillary node dissection
• Breast reconstruction
• Radiation
• Chemotherapy
• Hormonal therapy
• Biologic targeted therapy

What is the prognosis for invasive ductal carcinoma?

Based on individual markers and prognostic factors, including the staging of your tumor, your physician will work to give you a prognosis. Michelle and her team of breast cancer specialists are dedicated to developing cutting-edge techniques for surgery, breast reconstruction, chemotherapy, biologic targeted therapy, radiation therapy and other hormonal therapies. Our research allows us to make great strides forward for patients with breast cancer.

Additional types of invasive ductal carcinoma:

There are four types of invasive ductal carcinoma that are less common:

• Medullary Carcinoma – This type of cancer is rare and only three to five percent of breast cancers are diagnosed as medullary ductal carcinoma. The tumor usually shows up on a mammogram and it does not always feel like a lump; rather it can feel like a spongy change of breast tissue.

• Mucinous Carcinoma – This occurs when cancer cells within the breast produce mucous, which also contains breast cancer cells, and the cells and mucous combine to form a tumor. Pure mucinous ductal carcinoma carries a better prognosis than more common types of IDCs

• Papillary Carcinoma – This cancer looks like tiny fingers under the microscope. It is only in rare cases that this kind of cancer becomes invasive. Common among women age 50 and older, this kind of cancer is treated like DCIS, despite being an invasive cancer.

• Tubular Carcinoma – This is a rare diagnosis of IDC, making up only two percent of diagnoses of breast cancer. Tubular ductal carcinoma is more common in women older than 50 and are usually small, estrogen-receptor positive cancers, which means they respond to hormones. The name comes from how the cancer looks under the microscope; like hundreds of tiny tubes.

Invasive Lobular Carcinoma (ILC), also known as infiltrating lobular carcinoma, is the second most common form of breast cancer diagnosed in the UK, representing 10-15 percent of diagnosed invasive breast cancers. This type of cancer is more difficult to see on imaging because of the way it grows with spreading branches.

How is invasive lobular carcinoma (ILC) diagnosed?

Michelle and her team of breast specialists understand how quickly patients want results from a biopsy or scan if there is a suspicion of breast cancer, so we follow strict guidelines for biopsies and pathology reports. Patients are told the probability of cancer immediately following their biopsy procedure, and receive pathology confirmation within 24 hours.

Steps of diagnosis include:

• Digital mammography
• Ultrasound
• MRI
• Staging workup
• Biopsy
• Pathology

What is the treatment for invasive lobular carcinoma?

Women with a diagnosis of ILC must choose their surgeon carefully. For any breast cancer surgery to be a success, it’s important that the cancerous area is surrounded by clear margins. The branch-like growth pattern of ILC makes this difficult. To be sure cancer the cancer has been removed, the surgeon must clear the cancer from the tissue all the way around the tumor, including any growth that may not be evident on imaging. In some cases, re-excision is necessary.

ILC is treated with a lumpectomy or mastectomy, depending on the size and location of the tumor. In addition, your medical oncologist and radiation oncologist may recommend chemotherapy and/or radiation, hormonal therapy or biologic targeted therapy.

What is the prognosis for invasive lobular carcinoma?

Based on individual markers and prognostic factors including the staging of your tumor, your physician will provide you with information about your prognosis. Early stage breast cancers carry a higher survival rate than advanced stages.

While lobular carcinoma in situ (LCIS) sounds like a type of breast cancer, it is really a risk factor or marker for an increased risk of developing breast cancer.

What can I do if I have LCIS cells in my breast?

First, there is no need to panic. LCIS simply means that we have identified that you may be at higher risk for developing breast cancer. The most important thing to do now is to contact Michelle where your breast health can be closely monitored.

Paget’s disease is a rare type of breast cancer that occurs in the ducts adjacent to the nipple and areola and spreads to the skin of the nipple and the areola. Accounting for only one percent of breast cancers, it is a rare presentation.

Paget’s disease is usually associated with ductal carcinoma in situ (DCIS) and is limited to the nipple and areola area of the breast. It accounts for only one percent of all breast cancer cases.

What are the symptoms of Paget’s disease?

• Redness and irritation of the nipple and/or areola
• Crusting and scaling of the nipple area
• Bleeding from the nipple/areola
• Oozing from the nipple/areola
• Burning and/or itching of the nipple/areola

How is Paget’s disease diagnosed?

Most women can learn within 24 hours of being seen by our breast cancer specialists if they have breast cancer or not. We follow strict guidelines for biopsies and pathology reports. Our patients are given the probability of cancer immediately following their biopsy procedure, and receive a pathology confirmation usually within 24 hours.

Because of the skilled expertise of Michelle we are able to accurately diagnose Paget’s disease. As with any cancer, early detection and diagnosis results in better outcomes for the patient. Despite the rarity of this type of breast cancer, the specialists at our Breast Center are experienced in managing the evaluation and treatment of this disease.

What is the treatment for Paget’s disease?

If the breast cancer is limited to Paget’s disease, treatment includes the surgical removal of the nipple and areola, as well as a margin of healthy tissue around the areola. This can usually be accomplished through lumpectomy, or mastectomy if preferred. Michelle may recommend a combination of any of the following:

• Wide Local Excision – Due to the location of this cancer, some women will opt to have the nipple and areola removed along with a sufficient amount of tissue underneath to ensure removal of the cancer cells. This is known as a central excision. It is followed by radiotherapy.
• Mastectomy
• Radiotherapy
• Hormonal therapy

What is the prognosis for Paget’s disease?

If the biopsy shows DCIS, stage 0 cancer and no invasive cancer, the prognosis is excellent.

Discussion with Michelle is important to answer any questions that you may have. For information about any additional conditions not featured within the site, please contact us for more information.

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