Ductal carcinoma

Question 1

Define a ductal carcinoma.

Answer 1

Breast cancer in situ is confined to the duct or lobule in which it originated and doesn’t extend beyond the basement membrane.

Question 2

What are the 2 types of in situ carcinomas of the breast?

Answer 2

· DCIS -comprises 85%

· LCIS (lobular) comprises 15%

Question 3

What is the prognosis of a ductal carcinoma?

Answer 3

· DCIS can recur if inadequately treated.
· Mastectomy carries the lowest risk of recurrence.
· Age <60 increases risk of recurrence.
· Presence of receptors or not doesn’t change the risk of recurrence.

Question 4

What is the aetiology of a ductal carcinoma?

Answer 4

· DCIS is proliferation of malignant-appearing epithelial cells that have not penetrated the basement membrane.
· The terminal duct lobular unit is the origin of most lesions.
· DCIS is part of a continuum of progression from benign disease to invasive cancer.
· 2/3 of DCIS specimens express oestrogen receptors - HER2.

Question 5

Suggest the possible risk factors of a ductal carcinoma.

Answer 5

· FH of breast cancer. Increases risk of DCIS 1.5-fold.
· Benign breast disease on prior biopsy.
· Hereditary breast ovarian cancer syndrome. BRCA 1 and 2.
· Li-Fraumeni syndrome. Mutations in the TP53 gene, early onset breast cancer (<40) and other cancers.
· Klinefelter’s syndrome in men.

Question 6

What are the most common presenting symptoms of a ductal carcinoma?

Answer 6

· Nipple discharge is the most common finding.
· Breast lump.
· Eczema-like rash on breast.
· Ulceration .

Question 7

What investigations would you request if you suspected a patient had a ductal carcinoma?

Answer 7

· Mammography - calcifications. 
· FNA or core biopsy. 
· Sentinel node biopsy. 
· MRI. 
· Hormone receptor testing.

Question 8

List some differential diagnoses.

Answer 8

· Locally invasive breast cancer.
· Atypical hyperplasia.
· Fibroadenoma.
· Breast cyst.

Question 9

What is the treatment for a women <70yo with low Van Nuys score?

Answer 9

· Clear surgical margin - Surgical excision +/- radiotherapy.
· Without clear surgical margin - Excision + radiotherapy.

Question 10

What is the treatment for a · women <70yo with high Van Nuys score?

Answer 10

Excision + Radiotherapy.

Question 11

What is the treatment for a women <70yo with very high score?

Answer 11

· 1st line - Mastectomy +/- reconstruction.

· Adjunct - Radiotherapy.

Question 12

What is the treatment option for men?

Answer 12

A mastectomy.

Question 13

What complications might occur?

Answer 13

· Tamoxifen-related endometrial cancer.

· Invasive breast cancer.