Carcinoma In Situ

Question 1

What are carcinomas in situ?

Answer 1

Contained within basement membrane tissue

They are seen as pre-malignant condition

They rarely symptomatic at presentation and found incidentally

Question 2

Two main types

Answer 2

Ductal carcinoma in situ DCIS

Lobular Carcinoma in situ LCIS

Question 3

What is the most common type of non-invasive breast malignancy?

Answer 3

DCIS

Around 20% of all breast cancers are this

Question 4

Explain DCIS

Answer 4

Malignancy of the ductal tissue of the breast that is contained within the basement membrane

20-30% of cases will develop invasive disease

Question 5

Sub types of DCIS

Answer 5

Comedo

Cribriform

Micropapillary

Solid types

Most lesions are mixed though

Question 6

Investigations of DCIS

Answer 6

Most often detected during screening, there it appears as microcalcifications on mammography

They can be localised or widespready

Confirmed on biopsy

Question 7

Management

Answer 7

Complete wide excision if localised

If widespread or multifocal -> complete mastectomy

Question 8

Explain LCIS

Answer 8

Malignancy of the secretory lobules of the breast

Contained within the basement membrane

Greater risk of developing an invasive breast malignancy.

Usually diagnosed before menopause

Question 9

Investigations of LCIS

Answer 9

Usually asymptomatic

No microcalcifications so usually diagnosed as incidental finding during biopsy

Question 10

Management of low grade LCIS

Answer 10

Monitoring rather than excision

Question 11

Management of high grade LCIS (invasive)

Answer 11

Bilatreal prophylactic mastectomy especially if BRCA1/2 +ve