Breast Carcinoma In Situ

Introduction

Breast Carcinoma In Situ are neoplasms that are contained within the breast ducts and have not spread into the surrounding breast tissue.

These carcinoma types represent a precursor to invasive breast cancer, they are typically identified solely on imaging, and are rarely symptomatic at presentation. The two main types of in situ breast carcinoma types are Ductal Carcinoma In Situ (DCIS) and Lobular Carcinoma In Situ (LCIS).

Ductal Carcinoma in Situ

Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast malignancy and currently comprises around 20% of all breast cancers diagnosed. It is a malignancy of the ductal tissue of the breast that is contained within the basement membrane (Fig. 1).

DCIS is is categorised into five major types based upon histological features; these subtypes are comedo, cribriform, micropapillary, papillary, and solid types, however most lesions are mixed.

Investigations

DCIS is often detected during screening. Around 90% of patients with DCIS will have suspicious microcalcifications seen on mammography, with the diagnosis then subsequently confirmed via biopsy (Fig. 2).

Management

Any detected DCIS should be treated with surgical excision. This is done with breast conserving surgery (wide local excision) or (in cases of widespread or multifocal DCIS) with mastectomy.

Lobular Carcinoma In Situ

Lobular Carcinoma in Situ (LCIS) is a non-invasive lesion of the secretory lobules of the breast that is contained within the basement membrane (Fig. 3).

They are much rarer than DCIS however individuals with LCIS are at greater risk of developing an invasive breast malignancy. LCIS is usually diagnosed before menopause, with only 10-20% of women diagnosed being post-menopausal.

Investigations

LCIS is usually asymptomatic, much like DCIS, however LCIS is not associated with microcalcifications; LCIS is usually diagnosed as an incidental finding during biopsy of the breast (Fig. 4)

Key Points

  • Carcinoma-in-situ are premalignant conditions
  • Typically found on imaging and are rarely symptomatic at presentation
  • Two main subtypes are Ductal Carcinoma In Situ (DCIS) and Lobular Carcinoma In Situ (LCIS)
  • Management depends on subtype and extent of the disease
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Self Breast Examination

Breast self-exam

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A breast self-exam is something a woman does at home to look for changes or problems in the breast tissue. Many women feel that doing this is important to their health.

However, experts do not agree about the benefits of breast self-exams in finding breast cancer or saving lives. Talk to your health care provider about whether breast self-exams are right for you.

Information

The best time to do a monthly breast self-exam is about 3 to 5 days after your period starts. Do it at the same time every month. Your breasts are not as tender or lumpy at this time in your monthly cycle.

Begin by lying on your back. It is easier to examine all breast tissue if you are lying down.

  • Place your right hand behind your head. With the middle fingers of your left hand, gently yet firmly press down using small motions to examine the entire right breast.
  • Next, sit or stand. Feel your armpit, because breast tissue goes into that area.
  • Gently squeeze the nipple, checking for discharge. Repeat the process on the left breast.
  • Use one of the patterns shown in the diagram to make sure that you are covering all of the breast tissue.
  • Next, stand in front of a mirror with your arms by your side.
  • Look at your breasts directly and in the mirror. Look for changes in skin texture, such as dimpling, puckering, indentations, or skin that looks like an orange peel.
  • Also note the shape and outline of each breast.
  • Check to see if the nipple turns inward.
  • Do the same with your arms raised above your head.
  • Your goal is to get used to the feel of your breasts. This will help you to find anything new or different. If you do, contact your provider right away.

Dr.Ramjee Bastola

Breast Onco-Surgeon

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