how dcis becomes invasive

weety

Thank you for the article.  Interesting and informative!  That's why we need each other--to keep information like this coming!

Anonymous

Here's the link to the study of autopsies to find cases of DCIS

http://www.annals.org/content/127/11/1023.full

Hope it works. You might have to cut and past.

Anonymous

Bump

desdemona222b

Thanks, Double!

Mantra

My oncologist said that DCIS must mutate to learn how to survive outside the duct. He said it has nothing to do with size of tumour. My tumours were grade 3, comedo necrosis and he said in all likelyhood, my tumours were well on their way to mutating and becoming invasive. He said someone with an 8 cm, grade 1, may never become invasive yet someone with grade 3 and <1 cm is a good indication it would become invasive. I had 8 tumours and even though they were aggressive and spreading rapidly within the duct, I was very fortunate they did not become invasive. I had a lumpectomy with a 1.5 mm margin. Tumour Board recommended a mastectomy. I agreed. Yet no additional cancer was found during the mastectomy; the lumpectomy got it all. People often ask me if I'm upset. NOT AT ALL!! How could "no additional cancer found" be anything but good news. Maybe if I was younger, I may have been upset. But as my husband says "whatever we need to do to keep you around for a very long time, we do." I have not regretted my decision to have a mastectomy. Sure, it would be nice not to have to go through reconstruction but I'd rather be going through reconstruction than find out too late that I really did have cancer outside of the lumpectomy area.

rascal_gal

I know my onco was upset I put my surgery off by 3 weeks. She said no more than 3 weeks or it could get dangerous. Scared the bejeebers out of me. She was also very clear that they can't remove all the breast tissue, as hard as they might try, they do the best they can. So she told me to be vigilant about knots, or discoloration.

I wish I knew the answer to your question because it would clear things up for me as to why she felt it might be dangerous to wait. I never thought to ask her why. I think I was in shock at the time even thinking I was having a bmx.

geebung

I am finding this discussion very interesting. I had a mastectomy for DCIS (multicentric, grades 2 & 3) just over 2 years ago and I still have so many questions.  I was told that the cells in my ducts would be extremely nasty and aggressive if they broke through the duct walls. DCIS was not mentioned on the day I was diagnosed. I was told that it was ok to wait a few weeks without surgery but certainly not months. I don't understand why some DCIS is picked up when it is only a few mm in diameter while other types (like mine) are not picked up until it has spread right through the breast and medium and high grade. Surely it should have been seen 12 months earlier...? Perhaps, due to my being premenopausal, my breasts were denser then and the microcalcs couldn't be seen? Although I don't recall being told that I had dense breasts.

I don't lose any sleep over this but at times I do wonder if there is something brewing in my remaining breast that still cannot be seen.

sweatyspice

From what I understand, in the majority of cases of invasive cancer (90%?) there is also a DCIS component.  I haven't heard about large areas of DCIS turning into a single concentrated mass. 

Even if it did happen that way, I think it would be unlikely to find evidence of it b/c anyone diagnosed with a large diffuse area of DCIS would likely have had it removed.

Hindsfeet

Sweatyspice, what do you mean when you say dcis component? Isn't it consider a component when the dcis eats through the ducts? What makes it a component?

geebung...I'm in my 60's and I have very dense breast to the point the technicians say its like trying to look through a wall. I think dcis can only be picked up when they see calcifications. Only the biopsy can tell for sure if there is an invasive component, or if its dcis. All high grade dcis is nasty and aggressive.  

sweatyspice

I spent a large part of the holiday weekend watching the NIH State of the Science Consensus Conference on DCIS, again.

http://consensus.nih.gov/2009/dcis.htm 

At least one, and possibly more, of the physicians used the word "component."  Frankly, I don't know exactly what they meant.  I understood them to be saying that if you looked at an IDC lesion, for example, there would usually be DCIS persent as well.

So, let's break that down.  What would that mean?  When the DCIS breaks through the duct wall, it becomes IDC. I suppose there's a section where the disease has broken through and a section where it hasn't.  I suppose it's possible that the cell wall need only break down in one place to relieve the pressure of accumulating cells, not that the entire cell wall, or duct, needs to disintegrate. 

So, to your question "Isn't it considered a component when the DCIS eats through the duct?"  Well, yes, that's exactly what I think they mean.  When DCIS eats through the duct, it's no longer DCIS, it's IDC.  But, again, I think there are probably parts of the duct the DCIS has not eaten through.  Therefore, it could be thought of as IDC with a component of DCIS.

Generally, I'd think it would only be referred to as IDC, because the IDC trumps everything else in terms of treatment.  But if you were looking back to see where the IDC came from, you might say there was a DCIS component.

While I'm just making this up, that's what I took the physicians to mean.  If you're really interested, you can watch the videos as well, and possibly email the physician(s) who used the term.

From my personal experience, I also think that DCIS can only be picked up on mammogram if there are calcifications, but it can be picked up on MRI with or without calcifications.

annie7216

I agree with you that an IDC is a component of DCIS but what I don't understand is where the dcis goes once an IDC becomes well established. I know many women with IDC have DCIS present in their breast as well, but many do not, and therefore are able to have a lumpectomy. If all breast cancer begins as dcis (but not all dcis becomes breast cancer) where did the rest of the dcis go?

sweatyspice

If there's no residual DCIS, perhaps all the DCIS became IDC.  Other than that, I have no idea.

redsox

Many women have more than one type of cancer (often DCIS and IDC) and the different types are called components.  For example, one person may have DCIS with an invasive component and someone else may have invasive ductal carcinoma with extensive intraductal component.  The first would have mostly DCIS but also some part of the tumor that is invasive.  The second would have IDC but also a noticeable amount of DCIS.  In either case IDC trumps the DCIS in staging because it is more serious but the DCIS may make it more difficult to surgically remove all of the cancer with clear margins. 

As cells change from normal to cancer they undergo several changes.  One change makes the cells proliferate uncontrollably.  Another change makes the cells invade other structures.  DCIS cells have undergone the first change but not the second.  IDC cells have undergone both changes. As long as the cells are DCIS they spread throughout the milk ducts and may become widespread but they do not invade.  If they happen to fall out of the duct through an opening or tear that does not make them invasive.  To invade the wall of the ducts or other structures the cells themselves have to change and become invasive. 

If the tumor remains DCIS for a while it may become large but still be all DCIS.  If the tumor starts as DCIS but quickly changes to invasive then it may be all IDC but be pretty much contained and small. 

Ductal tumors usually go along the spectrum from normal cells to hyperplasia to DCIS to IDC but the speed of changes in the cells varies and that affects whether the result when the tumor is diagnosed shows any or much of the earlier stages such as DCIS or hyperplasia.

sweatyspice

Thank you!