Women Health Info Blog

Breast Self-Awareness (BSA)

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 17:33:00 +0000

1-Know your risk

Talk to your family to learn about your family health history
Talk to your doctor about your personal risk of breast cancer

2. Get screened

Ask your doctor which screening tests are right for you if you are at a higher risk
Have a mammogram every year starting at age 40 if you are at average risk
Have a clinical breast exam at least every 3 years starting at 20, and every year starting at 40

3. Know what is normal for you

See your health care provider right away if you notice any of these breast changes:

Lump, hard knot or thickening
Swelling, warmth, redness or darkening
Change in the size or shape of the breast
Dimpling or puckering of the skin
Itchy, scaly sore or rash on the nipple
Pulling in of your nipple or other parts
Nipple discharge that starts suddenly
New pain in one spot that does not go away

4. Make healthy lifestyle choices

Maintain a healthy weight
Add exercise into your routine
Limit alcohol intake

Source:www.cancerquest.org

Professional Advisory Board

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 16:06:00 +0000

Members of the Professional Advisory Board (PAB) provide advice and guidance to the organization as we fulfill our mission: making sense of the complex medical information about breast cancer so women can make the best decisions for their lives. Breastcancer.org relies on the PAB to help with the conception, creation and revisions of our award-winning content. They bring their professional voice to our Web site.Many PAB members participate in our Ask-the-Expert Online Conferences as they answer questions on important topics about breast cancer. PAB members also aid in our understanding of patient needs and behaviors based on what they see in their medical practices.

Your Diagnosis

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 16:01:00 +0000

Expert Quote

“As soon as you're diagnosed with breast cancer, you desperately try to figure out how it could have happened. You analyze your life a thousand times over, rack your brains searching for THE reason, beat your head against the wall, experience endless guilt. All you get is a headache. Drop it! Save your precious energy for your health and well–being. ”

Marisa Weiss M.D., president and founder, breast radiation oncologist, Philadelphia, PA

Meet our Medical Experts »

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Breast cancers are as varied as the women affected by them. By looking at the many different characteristics of the cancer, you can size up its "personality" almost the way you analyze another person. Is the tumor small and low-key? Angry, aggressive, and fast-moving? Or is it very large but easy-going? Is its behavior wild and unpredictable, or does it play by the rules?
Many tests and analyses will be done over several weeks to figure out your diagnosis. The most critical test results—for your treatment and your long-term health—will tell you and your doctor:

whether the cancer is non-invasive or invasive
whether lymph nodes are involved and if so, how many?

In addition, be sure that your medical team looks at these features of the cancer:

size
tumor grade
hormone receptor status
HER2/neu oncogene overexpression
margins of resection

You can get this information at any time, and you should always ask for it. The laboratory keeps your tissue samples for a long time after surgery, so these tests can be done later in the process of diagnosis if you insist on it. You may have to wait a few days or weeks for some of these results. The wait can be long and nerve-wracking. But remember: no matter what the doctors find, they can do something to help you. In this section of Breastcancer.org, you'll learn how your many different test results add up to your unique diagnosis—and what that means for your treatment and your future.
For more help understanding your diagnosis, you can also use My Breast Cancer Coach. My Breast Cancer Coach is a questionnaire designed to help you better understand your type of breast cancer so you can focus on the information that's most relevant to you.
The medical expert for Your Diagnosis is Marisa Weiss, M.D., breast radiation oncologist, Main Line Health System.
Dr. Weiss is a member of the Breastcancer.org Professional Advisory Board, including more than 60 medical experts in breast cancer-related fields.

Getting Your Pathology Results After Lumpectomy

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:55:00 +0000

In the days following lumpectomy, you’ll receive a pathology report. This report will explain the characteristics of the breast cancer. The size of the cancer as well as other diagnostic factors, such as tumor margins and hormone receptor status, will help you and your doctor to decide on a treatment plan that’s appropriate for you. Learn more about the factors that determine your treatment in Your Diagnosis.

Lumpectomy as Part of Experimental Treatment

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:51:00 +0000

Lumpectomy can sometimes be a part of treatment that is directed only to the tumor area. This type of treatment is still considered "non-standard" or "experimental" for most people diagnosed with early breast cancer. The current standard of care is to treat whole breast with radiation after lumpectomy. However, for people who fit certain criteria, two treatment options may be available for partial-breast treatment:

Lumpectomy plus internal radiation: In this experimental treatment, lumpectomy is followed by “internal” radiation, which involves implanting small pieces of radioactive substances, called “seeds,” into the breast in a tiny tube or balloon device. This way, treatment is concentrated only to the area where the tumor was. After treatment, there is close medical follow-up and surveillance of the remainder of the breast tissue with regular mammography and physical examination.
Lumpectomy and close observation: This experimental treatment means having only lumpectomy and no radiation. The remainder of the breast tissue is then closely watched with regular mammography and physical examination.

Who is a candidate for treatment to partial-breast treatment?

Partial-breast treatments such as lumpectomy and internal radiation may be considered for people with a relatively small, non-invasive cancer that has all three of the following characteristics:

the cancer cell formation is low-grade or “non-comedo”
the tumor has been completely removed (resected)
the removed tissue had wide (about 1 centimeter), clear margins of resection

Partial-breast treatment may be offered in a clinical trial or on an individual basis by your physician. Occasionally, partial-breast treatment may be offered to people with a relatively small, low-grade, invasive cancer that has been completely removed (resected) with wide, clear margins of about 1 centimeter. Usually, this treatment is offered within the context of a clinical trial.

For more information about breast cancer grade and margins, please visit the Your Diagnosis section.

Questions to Ask Your Surgeon About Lumpectomy

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:46:00 +0000

Here are some questions to ask your surgeon as you plan for lumpectomy surgery:

How many times have you performed lumpectomy?
What are the risks of lumpectomy?
How should I prepare for surgery?
How long will surgery take?
How much tissue will be removed?
Will you remove any underarm lymph nodes (axillary node dissection) along with the lump?
Will I have anesthesia? If so, what kind?
Will I need blood transfusions? Should I donate my own blood before surgery?
How will my breast look after lumpectomy?
Will I need to stay in the hospital after surgery?
How long will it take to recover?
Are there any precautions I should take as I recover? Will you give me written instructions to follow?
Are there exercises I need to do after surgery?
When can I return to my normal routine and activities?
Will I be at risk for lymphedema after surgery?

Lumpectomy Risks

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:44:00 +0000

Like all surgeries, lumpectomy carries certain risks:

Loss of sensation: There is usually some numbness and loss of sensation in part of the breast after lumpectomy, depending on the size of the lump removed. Some or most of this ability to feel can return.
Breasts that don’t match exactly: Your breasts may not match precisely in size and shape after surgery. This is because removing breast tissue during surgery usually makes the affected breast appear smaller. You may not know this right away, because swelling in response to surgery may make your breast appear temporarily larger.

Re-excision Lumpectomy

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:42:00 +0000

After lumpectomy, all the tissue removed from the breast is examined carefully to see if cancer cells are present in the margins — the normal tissue surrounding the tumor. If cancer cells are found in the margins extending out to the edge of the breast tissue that was removed, your surgeon will perform additional surgery (called re-excision) to remove the remaining cancer.

Re-excision lumpectomy, or simply re-excision, means surgically re-opening the lumpectomy site to try to remove a larger margin of cancer-free tissue. When cancer cells are found close to the edge of the lumpectomy margin, re-excision is necessary to ensure that all the cancer is gone. You may hear your surgeon refer to re-excision as "clearing the margins."

Lumpectomy: What to Expect

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:39:00 +0000

Before lumpectomy surgery

In the hospital on the day of surgery, you’ll change into a hospital gown and wait in a preoperative holding area.

If the tumor cannot be seen or felt, the surgeon will use a procedure before surgery to locate and mark the tumor using mammogram or ultrasound.

Your surgeon or a nurse may draw markings on your breast that show where the incision will be made. Usually this is done with a felt-tip marker.

You will be taken into the anesthesia room, where a nurse will insert an intravenous infusion (IV) line into your hand or arm and tape it into place. Soon after this, you’ll be given relaxing medication through the IV line. Most people who have lumpectomy choose to have a local anesthetic to numb the surgery area, but some have general anesthesia.

What happens during lumpectomy surgery

The lumpectomy surgery itself should take about 15-40 minutes.

Your surgeon will probably operate with a kind of electric scalpel that uses heat to minimize bleeding (an electrocautery knife). Most surgeons use curved incisions (like a smile or a frown) that follow the natural curve of your breast and allow for better healing. If the tumor can be seen or felt, the surgeon will remove it along with a rim of healthy tissue around it.

Sometimes, but not always, a rubber tube called a drain will be surgically inserted into your breast area or armpit to collect excess fluid that can accumulate in the space where the tumor was. The drain is connected to a plastic bulb that creates suction to help remove fluid. Finally, your surgeon will stitch the incision closed and dress the wound.

After lumpectomy

You’ll be moved to the recovery room after lumpectomy surgery, where staff will monitor your heart rate, body temperature, and blood pressure. Staying overnight in the hospital is not usually necessary with lumpectomy, unless you're also having lymph nodes removed.

As you start to feel more awake, your surgeon or nurse will give you information about recovering at home:

Taking pain medication: You may be given pain medication in the recovery room, and your surgeon will probably give you a prescription to take with you when you leave the hospital. You might want to get it filled on your way home or have a friend or family member get it filled for you as soon as you are home. You may not need the medication, but it’s good to have it on hand in case you do.
Caring for the bandage (dressing) over your incision: Ask your surgeon how to take care of the lumpectomy bandage. Sometimes, the surgeon will ask that you wait until your first follow-up visit so that he or she can remove the bandage.
Caring for a surgical drain: If you have a drain in your breast area or armpit, the drain might be removed before you leave the hospital. Sometimes, however, a drain stays inserted until the first follow-up visit with the doctor, usually 1-2 weeks after surgery. If you’re going home with a drain inserted, you’ll need to empty the fluid from the detachable drain bulb a few times a day. Make sure your surgeon gives you instructions on caring for the drain before you leave the hospital.
Stitches and staples: Most surgeons use sutures (stitches) that dissolve over time, so there's no longer any need to have them removed. But occasionally, you'll see the end of the suture poking out of the incision like a whisker. If this happens, your surgeon can easily remove it. Surgical staples — another way of closing the incision — are removed during the first office visit after surgery.
Exercising your arm: Your surgeon may show you an exercise routine you can do after surgery to prevent arm and shoulder stiffness on the side where you had the lumpectomy. Usually, you will start the exercises the morning after surgery. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises.
Recognizing signs of infection: Your surgeon should explain how to tell if you have an infection in your incision and when to call the office.

At-home recovery from lumpectomy

You’ll recuperate at home for a few days after lumpectomy surgery. Here are some guidelines to follow:

Rest. When you get home from the hospital, you might be fatigued from the experience. Allow yourself to get enough rest so that you can return to your normal routine in a few days. There are a number of ways to manage fatigue.
Take pain medication as needed. You might feel a mixture of numbness and pain around the surgery area in the breast (and the armpit incision, if you had lymph nodes removed). If you feel the need, take pain medication according to your doctor’s instructions. Learn more about managing pain and armpit discomfort.
Take sponge baths until your doctor has removed your drains and/or sutures. You can take your first shower when your drains and any staples or sutures have been removed. A sponge bath can refresh you until showers or baths are approved by your doctor.
Wear a good sports or support bra. You’ll want a supportive bra to wear both day and night for a while to minimize any movement that could cause pain. If you have larger breasts, you may find it more comfortable to sleep on the side that has not been operated on, with your healing breast supported by a pillow in front of you.
Begin doing arm exercises. The morning after surgery, begin doing arm exercises if your surgeon has advised you to do so.

Weeks and months after lumpectomy

As nerves regrow, you may feel a weird crawly sensation, you may itch, and you may be very sensitive to touch. Your discomfort may go away by itself, or it may persist but you adapt to it. Acetaminophen or NSAIDs (pronounced EN-seds) such as ibuprofen usually can address the pain related to this type of nerve injury. Opioids (pronounced OH-pee-oydz) also can be used to treat this type of pain.

Is Lumpectomy Plus Radiation Right for You?

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:37:00 +0000

While lumpectomy plus radiation is an excellent option for many women with breast cancer, it's not the best treatment for everyone.

Lumpectomy plus radiation may NOT be right for you under the following circumstances:

You have already had radiation to the same breast for an earlier breast cancer. Radiation cannot be given twice to the same area.
You have extensive cancer in the breast or have two or more separate areas of cancer in the same breast. If cancer is extensive or in multiple areas, a mastectomy may be required.
You have a small breast and a large tumor and removing the tumor would be extremely disfiguring.
Your surgeon has already made multiple attempts to remove the tumor with lumpectomy, but has not been able to completely remove the cancer and obtain clear margins.
You have a connective tissue disease, such as lupus or vasculitis, which would make you sensitive to the side effects of radiation.
You are pregnant. If you're pregnant, it's not safe to have radiation therapy.
You are not willing to commit to the daily schedule of radiation therapy, or distance makes it impossible.
You believe you would have greater peace of mind with a mastectomy.

Lumpectomy Plus Radiation

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:34:00 +0000

Most people receive 5 to 7 weeks of radiation therapy shortly after lumpectomy in order to eliminate any cancer cells that may be present in the remaining breast tissue. The combination of lumpectomy and radiation therapy is commonly called breast-conserving therapy. If chemotherapy is also part of the plan, radiation therapy happens after chemotherapy.

Two studies published in the October 17, 2002 issue of the New England Journal of Medicine showed that women with small breast cancers (under 4 centimeters) treated with lumpectomy plus radiation therapy were just as likely to be alive and disease-free 20 years later as women who had had mastectomies.

It’s important to know that recurrence can still happen with lumpectomy plus radiation. In the studies mentioned above, 14% of the women in one study and 9% of the women in the other study who had lumpectomy plus radiation had a recurrence in the same breast. However, local recurrences (confined to the breast area) after lumpectomy can be treated effectively with mastectomy, and these women were still disease-free 20 years after their original lumpectomies and recurrence treatments.

What is Lumpectomy?

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:33:00 +0000

Lumpectomy is the removal of the breast tumor (the "lump") and some of the normal tissue that surrounds it. Lumpectomy is a form of “breast-conserving” or "breast preservation" surgery. There are several names used for breast-conserving surgery: biopsy, lumpectomy, partial mastectomy, re-excision, quadrantectomy, or wedge resection. Technically, a lumpectomy is a partial mastectomy, because part of the breast tissue is removed. But the amount of tissue removed can vary greatly. Quadrantectomy, for example, means that roughly a quarter of your breast will be removed. Make sure you have a clear understanding from your surgeon about how much of your breast may be gone after surgery and what kind of scar you will have.

Lumpectomy

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:31:00 +0000

Lumpectomy is surgery in which only the tumor and some surrounding tissue is removed. On the following pages, you can learn more about lumpectomy surgery, lumpectomy followed by radiation therapy, what to expect from lumpectomy surgery, and questions to ask your surgeon.

In this section:

What is Lumpectomy?
Lumpectomy Plus Radiation
Is Lumpectomy Plus Radiation Right for You?
Lumpectomy: What to Expect
Re-excision Lumpectomy
Lumpectomy Risks
Questions to Ask Your Surgeon About Lumpectomy
Lumpectomy as Part of Experimental Treatment
Getting Your Pathology Results after Lumpectomy

Follow-up Care for DCIS

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:20:00 +0000

After surgery and radiation therapy, you and your doctor will work together to develop a plan for your follow-up care. If you had a mastectomy and are undergoing breast reconstruction, you will have a series of office visits to check on your healing. If you are taking tamoxifen or another form of hormonal therapy, this usually continues for a period of about 5 years, so your doctor will want to monitor you throughout that time.

Although follow-up care plans can vary from person to person, your plan is at least likely to include:

a checkup and physical exam by your doctor every 6 to 12 months for 5 years and then once a year after that
a mammogram every 12 months and possibly other screening methods depending on your doctor’s recommendations

Treatment for DCIS

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:19:00 +0000

Standard treatment options for DCIS include:

Lumpectomy followed by radiation therapy: This is the most common treatment for DCIS. Lumpectomy is sometimes called breast-conserving treatment because most of the breast is saved.
Mastectomy: Mastectomy, or removal of the breast, is recommended in some cases.
Lumpectomy alone
Hormonal therapy: These treatments, which block or lower the amount of estrogen in the body, are typically used if the DCIS tests positive for hormone receptors.

Chemotherapy, a form of treatment that sends anti-cancer medications throughout the body, is generally not needed for DCIS. DCIS is non-invasive and remains within the breast duct, so there is no need to treat cancer cells that might have traveled to other areas of the body.

Each individual situation is different. You and your doctor will decide what treatment is best for your situation. If the DCIS is large, high-grade, and comedo type, for example, it is likely to be more aggressive, and your doctor may recommend more extensive treatment. The same holds true if you are under age 40, since younger age may increase the risk of recurrence.

At a Glance

Before surgery: Finding the exact location of DCIS
Before surgery, you may need to have a diagnostic test to "localize" the tumor. When DCIS can only be seen by a mammogram or ultrasound and cannot be felt, the exact location of the tumor has to be pinpointed before the surgeon can remove it. A localizing needle is placed near the area of concern and then guided to the cancer with the aid of mammogram or ultrasound. If the DCIS is only seen by MRI (magnetic resonance imaging), it may need to be localized with the help of an MRI machine.

Lumpectomy followed by radiation therapy

Most people with DCIS have a lumpectomy followed by radiation therapy. This is usually a very good option if the DCIS only appears in one area of the breast and can be completely removed with clear margins of healthy tissue. A clear margin is a rim of healthy tissue around the tumor that is completely free of cancer cells. How wide do these margins need to be? Doctors are still debating the answer, but a width of 2 to 3 mm is common.

Lumpectomy, and in some cases a second procedure called re-excision lumpectomy, is used to completely remove the cancer.

Lumpectomy removes the entire area of DCIS as well as a margin of normal, healthy breast tissue around it. The whole area that contained cancer cells is removed, even when there's no lump present.
Re-excision lumpectomy is a second surgery that may be necessary after lumpectomy to remove extra tissue in order to ensure that there is a clear margin of healthy tissue around the tumor. If your doctor finds that the margins of healthy tissue taken were too narrow, or there is even some cancer present in the margins, a re-excision may be recommended.

If the DCIS has been removed with lumpectomy, radiation is usually given to reduce the risk of cancer returning. Your doctor may discuss a couple of radiation options with you:

External radiation is given to the entire breast by a machine called a linear accelerator. Radiation treatment is usually given as daily treatments 5 days per week over 5 to 7 weeks. Treating the whole breast with radiation after lumpectomy remains the standard of care. In cases of DCIS, radiation therapy can reduce the risk of the cancer coming back by about 60%. For example, after lumpectomy alone, the risk of the cancer returning is about 30%, although it may be lower or higher, depending on the situation. Radiation can reduce that risk to 10% or less for a return of invasive cancer and to about 15% for a return of DCIS.
Internal partial-breast irradiation is a form of treatment in which radioactive materials such as seeds or pellets are temporarily placed in the breast. There’s a lot of interest in partial breast radiation for DCIS, because treatment is shorter and side effects occur in a smaller part of the breast. However, its effectiveness is still being studied.
External partial-breast irradiation is a method of therapy that zeroes in on the area around where the cancer was. This area is at highest risk of recurrence. Partial-breast radiation takes only 5 to 10 days for treatment, versus 5 to 7 weeks for whole breast radiation. Researchers are studying partial-breast radiation for use after lumpectomy to see how the benefits compare to the current standard of radiation to the whole breast.

Women may be able to take part in a clinical trial studying external partial-breast radiation if they have only one area of DCIS that's completely removed with clear margins. The trial is called NSABP B-39 and is available in many cancer centers. Ask your doctor for more information about this trial if you feel you might qualify. You can also visit our Clinical Trials section to learn more about how trials work.

Mastectomy

Mastectomy removes the entire breast. Although many cases of DCIS are treated with lumpectomy, your doctor might recommend mastectomy if the DCIS covers a large area or appears in multiple areas of the breast. In most DCIS cases requiring mastectomy, simple or total mastectomy (removal of breast tissue but no lymph nodes) is performed. Radiation is usually not necessary after mastectomy for DCIS.

Some situations in which doctors might recommend mastectomy for DCIS:

There is a large area of DCIS.
There is more than one area of DCIS in the breast (called multifocal disease).
A biopsy shows DCIS cells near or at the margin of healthy tissue, in which case taking more tissue to achieve acceptable margins would result in poor cosmetic outcome.
If you have a strong family history of breast cancer, or you have tested positive for a gene mutation that increases breast cancer risk, you might choose mastectomy to guard against your higher risk of developing future breast cancers.

Not being a candidate for radiation therapy: Most of the time, people treated with lumpectomy for DCIS also receive radiation therapy. If you’ve had previous radiation to the chest or breast, if you have a condition that makes you more sensitive to radiation, or if you are in your first trimester of pregnancy when diagnosed, you might not be eligible to receive radiation therapy.

If you are thinking about mastectomy for DCIS, you may also want to consider breast reconstruction options as you’re planning your surgery.

Checking the lymph nodes for any signs of cancer spread is not a standard part of treatment for DCIS, although it does happen in some cases. Early research shows that in some DCIS cases, there may be a benefit in having sentinel node biopsy (removing only the first 1 to 3 nodes closest to the cancer). Some factors that may lead to sentinel or underarm lymph node biopsy:

The breast has widespread areas of DCIS.
There is a significant amount of high-grade DCIS in the breast.
microinvasion (small amounts of cancer have spread beyond the milk duct)
Diagnosis of DCIS happened at a young age (under 40).

Lumpectomy alone

Having no radiation after lumpectomy may be an option for you if your risk of recurrence is very low after lumpectomy alone. In this situation, adding radiation may offer only minimal benefit. This may be true if:

You have a very small area of low-grade DCIS (just a few millimeters) that was completely removed with wide negative margins of resection (1 centimeter or more).
You are over 70 with other active medical problems that are more serious than DCIS. Radiation to be sure the DCIS is completely gone may be a relatively low priority.

If you decide on lumpectomy only, then close follow-up and observation will be particularly important. This involves visiting your doctor regularly for breast examination and imaging studies such as mammograms, ultrasound, or MRIs.

The decision not to have radiation treatment must be considered very carefully with your medical team. It can also be helpful to seek a second opinion.

Hormonal therapy

People with DCIS have a slightly higher risk of developing another breast cancer in the future than people who have not had DCIS. Adding hormonal therapy to surgery and radiation for DCIS can reduce this risk if the tumor tests positive for hormone receptors.

Not all hospitals automatically test DCIS for hormone receptors, so make sure to ask your doctor to have the DCIS tested this way.

Tamoxifen (brand name: Nolvadex) can be used for early-stage cancers that are hormone-receptor-positive, instead of or following radiation treatment after lumpectomy. Tamoxifen "pretends" to be estrogen and attaches to the receptors on the breast cancer cells, taking the place of real estrogen. As a result, the cells don't receive the signal to grow. People with hormone-receptor-positive cancer who take tamoxifen can lower their risk of having an invasive cancer or a non-invasive cancer come back.
Aromatase inhibitors such as Arimidex (chemical name: anastrozole), Femara (chemical name: letrozole), and Aromasin (chemical name: exemestane) are being studied in clinical trials to find out if they are effective in reducing the risk of recurrence in people with DCIS. These medications reduce the amount of estrogen produced in a woman's body after she goes through menopause. The main sources of the hormone for those women are the adrenal glands and fat tissue, not the ovaries.

Edited

Diagnosis of DCIS

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 15:03:00 +0000

Diagnosing DCIS usually involves a combination of procedures:

Physical examination of the breasts: Your doctor may be able to feel a small lump in the breast during a physical examination, although a noticeable lump is rare with DCIS. In cases when DCIS cannot be felt during a physical exam, it can often be detected using mammography.
Mammography: DCIS is usually found by mammography. As old cancer cells die off and pile up, tiny specks of calcium (called "calcifications" or "microcalcifications") form within the broken-down cells. The mammogram will show the cancer cells inside the ducts as a cluster of these microcalcifications, which appear either as white specks or as a shadow.
Biopsy: If you do have a suspicious mammogram, your doctor will probably want you to have a biopsy. There are two ways to get a biopsy done with only a little bit of surgery (more invasive biopsies are rarely needed for DCIS):
- Fine needle aspiration biopsy: A very small, hollow needle is inserted into the breast. A sample of cells is removed and examined under the microscope. This method leaves no scars.
- Core needle biopsy: A larger needle is inserted to remove several bigger samples of tissue from the area that looks suspicious. In order to get the core needle through the skin, the surgeon must make a tiny incision. This leaves a very tiny scar that is barely visible after a few weeks.
If a needle biopsy is not able to remove cells or tissue, or it does not give definite results (inconclusive), a more involved biopsy may be necessary. These biopsies are more like regular surgery than needle biopsies:
- Incisional biopsy: Incisional biopsy removes a small piece of tissue for examination.
- Excisional biopsy: Excisional biopsy attempts to remove the entire suspicious lump of tissue from the breast.

Biopsies are done only to make the diagnosis. If DCIS is diagnosed, more surgery is needed to ensure all of the cancer is removed along with "clear margins," which means that a border of healthy tissue around the cancer is also removed. Usually this means having lumpectomy, or in some cases (a large area of DCIS, for example), mastectomy.

After the biopsy, the pathologist analyzes the piece of breast tissue and reports back on the:

type and grade of the DCIS: how abnormal the cells look when compared with normal breast cells, and how fast they are growing
hormone-receptor status: Whether or not the cancer cells have receptors (proteins in a cell that receive messages from hormones) for the hormones estrogen and/or progesterone. If estrogen and/or progesterone receptors are present, this means that the cancer cells' growth is fueled by these hormones.

Type and grade of DCIS

All DCIS is considered stage 0 breast cancer — the earliest stage possible. "Stage" describes how far the cancer has spread beyond the site of the original tumor. Even though DCIS is always considered stage 0, it can be any size and be located in any number of areas inside the breast.

Knowing the type and grade of DCIS can help you and your doctor decide on the best treatment for you.

When a pathologist looks at the tissue removed during the biopsy, he or she determines whether or not any abnormal cells are present. If abnormal cells are present, the pathologist will note how different the cells look compared with normal, healthy breast cells. The image shows the range of possible findings, from normal cells all the way to invasive ductal cancer.

Normal cells
Ductal hyperplasia or "overgrowth" means that too many cells are present.
Atypical ductal hyperplasia means that there are too many cells (hyperplasia) and they are starting to take on an abnormal appearance (atypical or "not typical").
Ductal carcinoma in situ means that there are too many cells and they have the features of cancer, but they are still confined to the inside of the duct.
DCIS-MI (DCIS with microinvasion) means that a few of the cancer cells have started to break through the wall of the duct. This is considered to be a slightly more serious form of DCIS.
Invasive ductal cancer means that the cancer cells have broken beyond the breast duct. The breast cancer is no longer a DCIS but an invasive ductal carcinoma, the most common type of breast cancer.

There are three grades of DCIS: low or Grade I; moderate or Grade II; and high or Grade III. The lower the grade, the more closely the cancer cells resemble normal breast cells and the more slowly they grow. Sometimes it's difficult to figure out where the cells are on in the range from normal to abnormal. If the cells are in between grades, they may be called "borderline."

Grade I (low grade) or Grade II (moderate grade)

Grade I or low-grade DCIS cells look very similar to normal cells or atypical ductal hyperplasia cells. Grade II or moderate-grade DCIS cells grow faster than normal cells and look less like them. Grade I and Grade II DCIS tend to grow slowly and are sometimes described as "non-comedo" DCIS. The term non-comedo means that there are not many dead cancer cells in the tumor. This shows that the cancer is growing slowly, because there is enough nourishment to feed all of the cells. When a tumor grows quickly, some of its cells begin to die off.

People with low-grade DCIS are at increased risk of developing invasive breast cancer in the future (after 5 years), compared to people without DCIS. Compared to people with high-grade DCIS, however, people with low-grade DCIS are less likely to have the cancer return or have a new cancer develop. If more cancer does develop, it typically takes longer for this to happen in cases of low-grade DCIS versus high-grade.

There are different patterns of low-grade and moderate-grade DCIS:

Papillary DCIS: The cancer cells are arranged in a finger-like pattern within the ducts. If the cells are very small, they are called micropapillary.

Cribriform DCIS: There are gaps between cancer cells in the affected breast ducts (like the pattern of holes in Swiss cheese).

Solid DCIS: Cancer cells completely fill the affected breast ducts.

Grade III (high-grade) DCIS

In the high-grade pattern, DCIS cells tend to grow more quickly and look much different from normal, healthy breast cells. People with high-grade DCIS have a higher risk of invasive cancer, either when the DCIS is diagnosed or at some point in the future. They also have an increased risk of the cancer coming back earlier — within the first 5 years rather than after 5 years.

High-grade DCIS is sometimes described as "comedo" or "comedo necrosis." Comedo refers to areas of dead (necrotic) cancer cells, which build up inside the tumor. When cancer cells grow quickly, some cells don’t get enough nourishment. These starved cells can die off, leaving areas of necrosis.

Hormone-receptor status

In addition to figuring out the type and grade of DCIS, the pathologist also will test your biopsy tissue for hormone receptors. This test determines whether or not the breast cancer has receptors for the hormones estrogen and progesterone. A positive result means that estrogen or progesterone (or both) fuels the cancer cells' growth. If the cancer is hormone-receptor-positive, your doctor is likely to recommend treatments that block the effects of estrogen or lower estrogen levels in the body.

Testing DCIS for hormone receptors is relatively new, however. Don't assume that your hospital will automatically perform this test. Be sure to ask your doctor to have the cancer tested this way.

Source:www.breastcancer.org

Signs and Symptoms of DCIS

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 14:39:00 +0000

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.

DCIS - Ductal Carcinoma In Situ

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 14:37:00 +0000

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.

On the following pages you can learn about:

Types of Breast Cancer

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 14:29:00 +0000

Breast cancer can begin in different areas of the breast – the ducts, the lobules, or in some cases, the tissue in between. In this section, you can learn about the different types of breast cancer, including non-invasive, invasive, recurrent, and metastatic breast cancers. You can also read about breast cancer in men.

DCIS - Ductal Carcinoma In Situ
LCIS - Lobular Carcinoma In Situ
IDC - Invasive Ductal Carcinoma
Less Common Subtypes of Invasive Ductal Carcinoma
ILC - Invasive Labular Carcinoma
Paget's Disease of the Nipple
Inflammatory Breast Cancer
Male Breast Cancer
Recurrent and Metastatic Breast Cancer

Breast Cancer Detection: SPECT/CT

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 14:16:00 +0000

Sentinel node biopsy is a minimally invasive surgery performed on breast cancer patients to determine whether cancer has metastasized to the lymph nodes under the arm (axillary lymph nodes). This procedure relies on the identification and mapping of those lymph nodes most likely to contain cancer cells (sentinel nodes). The methods commonly used in sentinel node mapping- staining with blue dye or imaging techniques-have been shown to be less effective in overweight patients, possibly due to an alteration in the structure of nodal tissue and technological limits on the imaging method used, called planar imaging.

In a recent study, 220 women with invasive breast cancer were studied using both planar imaging and more advanced SPECT/CT imaging which has improved image quality and spatial resolution. In SPECT imaging a small amount of radioactive material is injected into the patient. The imaging results show the distribution of the material. It can be used to locate cancer cells and track blood flow.

Comparison of the two different image-based detection techniques revealed that planar imaging detected sentinel nodes in 78% of patients and SPECT/CT imaging detected 91%. For the 122 overweight and obese patients (body mass index >25) planar imaging was successful in 72% and SPECT/CT detected sentinel nodes in 89% of patients. From these results it appears that traditional planar imaging is less useful in patients with increasing body mass index (72% for overweight subjects compared to 78% overall). SPECT/CT detection capabilities remain more constant (89% for overweight subjects compared to 91% overall). This indicates that this new technique may be especially beneficial for overweight and obese patients. SPECT/CT also detected sentinel nodes in 36 patients for whom the intraoperative blue dye test was negative, showing the possible superiority of this new imaging technique. The results of this study are especially important since the risk of lymphedema as a complication of axillary lymph node removal is higher in overweight patients. Importantly, six of the nineteen patients with negative results on all sentinel node detection techniques were found to have metastatic involvement of sentinel nodes when axillary lymph node removal was performed; it is evident that SPECT/CT imaging is not a flawless test for breast cancer metastasis to the lymph nodes.

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Breast Cancer Detection: MRI

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 14:07:00 +0000

Research is being conducted to investigate the benefits of MRI as a screening tool for breast cancer detection (as comparison to mammography, ultrasound, and other techniques). Although MRI is not recommended as a substitute for mammography, a study done in 2004 found that in women with an inherited susceptibility to cancer (history of cancer in the family), MRI was more sensitive than mammography in detecting tumors.

Another earlier study from 2001 found that breast MRI was capable of detecting early breast cancer with 94%-100% sensitivity. Additionally, out of 196 women who were at high risk for hereditary breast cancer, MRI was able to identify six stage I invasive cancers and one non-invasive cancer, but ultrasound only detected three invasive cancers, mammography found two, and physical examination identified two. This study provided evidence that mammography may be less sensitive that MRI in detecting breast cancer for women carrying BRCA1 and BRCA2 mutations.

Hartman et al. performed a study in 2004 in which they compared MRI and mammography in women at high genetic risk for breast carcinoma. They also found that breast MRI was able to detect high-grade ductal carcinoma in situ (DCIS) and high-risk lesions that mammography missed. Malignant lesions were found with MRI in three out of forty-one women while none were identified by mammography. These studies indicate that in some women, MR imaging is a better screening method than mammography. However, it is important to remember that the low specificity of MRI (which in most studies is between 50%-70%) is a huge disadvantage because it causes unnecessary follow-up procedures.
Over the last ten years, MRI technology has significantly improved yielding better image resolution and improved biopsy potential. Because physicians have gained more experience with breast MRI, they are now more skilled at interpreting the images.

Additionally, in the past, there have been cases in which physicians would suspect that their patients' distant metastases originated from a breast tumor. However, if the physicians were unable to detect the tumor with a physical exam or mammogram, the patients may have to have mastectomies. The availability of higher resolution images from MRI means that these primary tumors can be found more easily, and patients' breasts can be conserved.

Steps to Breast Self-Exam (BSE)

noreply@blogger.com (Unknown) — Tue, 26 Jan 2010 13:34:00 +0000

BSE is a tool that may help you learn what is normal for you. BSE includes looking at and feeling your breasts. If you notice any changes in your breasts, see your health care provider right away.

Lying Down
Feel for changes:
• Lie down on your back with a pillow under your right shoulder
• Use the pads of the three middle fingers on
your left hand to check your right breast
• Press using light, medium and firm pressure in a circle without lifting your fingers
• Follow an up and down pattern
• Feel for changes in your breast, above and below your collarbone and in your armpit
• Repeat on your left breast using your
right hand
These steps may be repeated while bathing or showering using soapy hands.

In Front of the Mirror

Look for changes:
• Hold arms at your side
• Hold arms over your head
• Press your hands on your hips and tighten your chest muscles
• Bend forward with your hands on your hips

For more information visit website or call our breast care helpline.
www.komen.org

1-877 GO KOMEN
(1-877-465-6636)