Breast CIS

Question 1

What is the progression of breast cancer?

Answer 1

Normal ⇒ Hyperplasia ⇒ Atypical Hyperplasia ⇒ Carcinoma in Situ ⇒ Invasive cancer

Question 2

Ductal Carcinoma In Situ (DCIS):

Clinical Features

Answer 2

• Mean age: 50 - 59 years
• 10 - 20% bilateral
• 15 - 35% multicentric
• Palpable mass < 20%
• Represents 30-40% of carcinomas found by mammography screening compared to only 5% in unscreened population

Question 3

What are the different types of DCIS?

Answer 3

• Comedo
• Non-comedo
  
  • Cribriform
  • Micropapillary
  • Papillary
  • Solid
  • Flat/clinging

Question 4

What is Paget’s Disease of the Nipple?

Answer 4

• A form of DCIS extending to the skin of the nipple and areola
• Ulcerated, eczematous skin
• Carcinoma cells in the epidermis
• Usually high grade or comedo type

Question 5

**DCIS **

• Treatment:
• What happens if DCIS is left untreated?

Answer 5

• Treatment
  
  • Surgery
  • Radiation –intermediate and high grade
  • Hormonal
• Untreated: progression to invasive carcinoma
  
  • 25 - 30% of low grade DCIS
  • Majority of high grade DCIS

Question 6

What is the clinical presentation of Lobular Carcinoma In Situ (LCIS)?

Answer 6

• Average age: 44 -54 years
• 70% multicentric
• 50-70% bilateral
• Rarely associated with calcifications
• Does not form a mass or density

Question 7

• Explain how LCIS is a marker of risk for carcinoma and a direct precursor of some cancers:
• How are these patients managed?

Answer 7

• In 20 years, 25 - 35% will develop cancer
  
  • Both breasts are at equal risk
• Follow-up, tamoxifen