Help With DCIS Terminology

hmr

I've read several posts with many of you reporting a detailed diagnostic description of your DCIS. Can someone direct me to a site that would define and explain such terms so I can better understand and classify my mother's DCIS diagnosis ? Maybe somebody could post a crash course of key diagnostic terms ? For example, my mother's lumpectomy pathology report states :

 Final diagnosis ( microscopic ) :

 " Ductal carcinoma in situ, intermediate grade, scattered through the area of 4.0 cm. and is 0.1 mm to 1 mm. from the excisional margins. Diffuse atypical ductal hyperplasia and atypical flat epithelial lesion. Radial scars. Previous biopsy site changes identified. "

 Other entries in the report include :

 the specimen size as 9.0 x 3.0 x 1.5 cm.

Size of in situ : 4.0 cm.

Final margins : DCIS is 0.1 mm. to 1 mm. from the excisional margins

Nuclear grade : low to intermediate

Architecture type : Cribiform

Necrosis : not present

Pathologic staging : pTis, pNX, pMX

Lymph node sampling : not done

 Prognostic markers : performed on block F

Proliferative Lesions : atypical flat epithelial lesion and atypical ductal hyperplasia, diffuse. Radial scars. Fibroadenoma.

Microcalcification : present in one fibroadenoma

Any guidance to help me better understand her DCIS status would be greatly appreciated. BTW, lumpectomy # 2 is scheduled for next week.

ladyod

One of the best sites I have found is UptoDate.com which my breast surgeon referred me to.  It has all the terminology and is very easy to read and understand.  I also like the article on Dana-Farber.com.   I don't know all of the terms myself, but I do know that the fact it is low to intermediate grade is good:  it means it isn't the most aggressive (fast growing).  DCIS is good because it is contained in the milk gland and is non invasive and therefore doesn't leave the breast to go to other body parts.  The microcalcification was a calcium deposit they found near a separate benign lesion, a fibroadenoma.  Atypical lesions and hyperplasia can be a precurser to DCIS:  it just means the cells are not normal and have changed in appearance, but not yet considered cancer.  The margins identify if they got all of the cancer and if there are "clear margins"  I am unsure of what the guidelines are to having clear margins:  once they are met, the patient can procede with radiation.  Until then, they will continue to take more tissue:  ie the second lumpectomy.  Wishing you and your mom well!  Hope this helped!

IronJawedBCAngel

There is  website called dcis.info that I got some good info from when I was first diagnosed. The American Cancer Society has a really good pamphlet titled Breast Cancer, Treatment Guidelines for Patients.  In trying to break it down for you, it is positive for your Mom that her cancer is low to intermediate grade.  This is reflected in the fact that the cells are cribiform and there is not necrosis, which means the inside of the cells have died, its not as aggressive as my grade 3, comedo cell with necrosis.  It is a fairly large area and the margins are not what most would want. The diffuse atypical hyperplasia is a concern as it is more likely to turn into more DCIS or even an invasive cancer.  I now have some hyperplasia without atypia that is not as much of a concern but will cause them to watch that area more closely.  They have used the  TNM staging system.  Tis means a carcinoma in situ, DCIS, or LCIS.  The N category indicates lymph nodes, so she has not had any testing done as they do not believe there is any risk of spread, therefore the X, same with the M, which refers to metastases, or spread to other organs, so no distant cancer, all of this is good.  I can not remember from your post about tamoxifen if they are doing radiation with her lumpectomy.  They definitely should be doing it.  With the diffuse atypical hyperplasia, it is possible that a mastectomy would eliminate some risk of the cancer returning and in all probability would remove the need for radiation.  However, if her cancer is hormone positive, tamoxifen would still be required.  I'm not sure that a second opinion would not be a good idea for both of your peace of mind.  My email is sassyj22000@yahoo.com if you need to chat.  I take care of my Dad with advanced stage colon cancer and don't get on here  frequently.  God bless you and your family.  It is wonderful that you are advocating for your Mom.