Question about DCIS

MiraclesHappen10

So today I was just diagnosed with DCIS. My doctor has prescribed an MRI, PET Scan, Core Biopsy and  Neo-Adjuvant Chemotherapy to shrink the tumor before surgery.  Is all that necessary for just DCIS? I am so confused and reading conflicting things on the net. Has anyone else had to go through this type of regimen?

agada

Hello,

Can you post more pathology information about your diagnosis? This might help you get a better answer to your question as to everything being necessary for the DCIS you have been diagnosed with.  I have heard of these things being done before but it depends on what the doctor has found regarding your condition.

Much luck to you.

Agada

Kitchenwitch

I've never heard of anyone using chemotherapy in conjunction with DCIS. And how do you know have DCIS? Usually the actual diagnosis comes after the biopsy, doesn't it? I would think you are looking at a biopsy to see what the site actually has, and then a treatment decision. Some doctors are in favor of MRIs and some are not. I always like the idea of more imaging. It seems to me the unreliable imaging is one of the linchpins making DCIS such a difficult condition to treat accurately. Good luck!

  

mom3band1g

I hope you are seeing a breast specialist and not a general surgeon.  DCIS is never treated with chemo.  Good luck.

Beesie

Miracles, are you sure that your diagnosis from your biospy was just DCIS?  Often DCIS and IDC (invasive cancer) are found together; if you have both, then because the IDC is the more serious condition, the staging and treatment will all be based on the amount and pathology of the IDC.  The DCIS needs to be removed but otherwise is not factored into the diagnosis and treatment.

The tests and treatments that you mention all make sense for IDC (depending on the pathology of the cancer) but some make no sense at all for a diagnosis of pure DCIS.  Some women with DCIS get PET scans but this is unusual, particularly these days with the awareness of the amount of radiation exposure from a PET scan.  PET scans are used to look for cancer in parts of the body outside of the breast, and with DCIS there is no possibility that there can be cancer outside fo the breast. Simiarly, chemo is simply not done for DCIS, either prior to surgery (to shrink a tumor) or after surgery.

As mom3band1g said, if you are currently working with a general surgeon, you need to find a breast specialist, and an oncologist.  And you should get a copy of your pathology report from your biopsy so that you have complete clarity on your preliminary diagnosis. (No diagnosis is finalized until after the final surgery.)  Then you will be in a position to better understand your treatment options and what may be most appropriate in your situation.

Anonymous

Miracles- I wanted to add to what Beesie said and tell you that, if in fact, you have pure DCIS then you have time to research all of this.  I was diagnosed with DCIS in December and did not make any treatment decisions until the end of February.  Please make sure you have all the information you need to make an informed decision.  Don't let anyone rush you into treatment until you have all the facts about your particular kind of cancer.  There are pros and cons about every type of test, treatment and surgery and, unfortunately, you now need to become a scholar of breast cancer.  Good luck!

NadineEspana2003

At the age of 29 I went through everything you are facing.  I was diagnosed on May 20 of this year after a core biopsy with DCIS III (phase not stage).  The tumor was 3 cm so I did not need to have it shrunk before surgery which was June 7 of this year.  I had an MRI and CAT scan done before surgery.  At which time it suggested that the cancer had not spread.  During surgery they did a node biopsy and found 2/13 nodes positive.  Before surgery I was told as long as it had not gone any where else I would not need chemo.  After suregry I was told I was going to have chemo and maybe radiation, it would be up to the oncologist.  Path report came back as Stage IIB.   After surgery I had a bone scan and another CAT Scan done.  I had reconstrution started at the same time as the mastectomy.  It looks like they are trying to get all of the information they can about the tumor and the disease to develop a battle plan.   I am currently undergoing dose dense AC/T  + Herceptin chemo.  Halfway through it now.   Positive attitude and arming myself with lots of information helped the process.  I knew what the doctors were going to suggest before going to meetings because I read and read and read. 

Do your research, see a breast specialist, an oncologist get second opinions.  Read as much as you can and arm yourself with information.   There are so many wonderful sites out there.  Good Luck!

Anne888

Nadine, I'm confused.  Since DCIS, by definition, doesn't spread, was your diagnosis changed from DCIS when cancer was found in the nodes?  As Mom3 said, pure DCIS isn't treated with chemo. 

Beesie

Anne, I agree with what you said. DCIS by definition is always and only Stage 0.  Anything higher than Stage 0 indicates the presence of invasive cancer.  That immediately changes the diagnosis to IDC.  This is true even if 99% of the tumor is made up of DCIS and only 1% of the tumor is IDC - even then, the diagnosis is still IDC. The DCIS needs to be removed from the breast but other than that, it's pretty much irrelevant to the diagnosis.

Because IDC usually develops from DCIS, most women who have IDC also have some DCIS.  Sometimes it's all that is initially diagnosed; other times it's written on the pathology report, along with IDC.  There is a lot of confusion about this and many women who have Stage I, Stage II or even Stage III cancer believe that their diagnosis is DCIS either because it was their preliminary diagnosis (before the invasive cancer was found) or because the letters "DCIS" tend to stick out in a pathology report (more than the words invasive or infiltrating carcinoma).  Where this becomes problematic is in those unfortunate cases where mets develops, and then women who have pure DCIS are frightened because they hear about someone diagnosed with DCIS who went on to develop mets.  That can happen, of course, if there a recurrence after the initial diagnosis and the recurrence is not found until it has become invasive.  But pure DCIS itself never can become mets without invasive cancer developing first (and the diagnosis therefore changing from being pure DCIS).   

Edited to add:  Miracles has not posted again in this thread but she did post elsewhere that her diagnosis is actually IDC.  That explains why she was getting the PET test and why pre-adjuvant cancer was being considered.

Deirdre1

Thanks for that "edit" Beesie it's a very important issue and one I don't think a lot of people who are in the throws of dx really pay much attention to..  They only hear cancer.. Best, Deirdre

NadineEspana2003

Anne, no my diagnosis did not change.   It is still DCIS Phase III

NadineEspana2003

Anne, No my diagnosis did not change.  IT is still DCIS phase III.  

lindylounz

I was diagnosed in September with high grade DCIS (6cms) with IDC of 1.2cms. I have done lots of research on SNB, because my path report returned with 1xnode involved with ITC (isolated tumour cells). We don't do the oncotype test here in New Zealand. Do you know if the grade of DCIS has any relevance when deciding if chemotherapy would be of benefit after mastectomy. I have read research that recommends axillary clearance if ANY node involvement. Because that was not done I am left wondering if I would receive benefit from chemotherapy or not. Am having a visit with an oncologist for 2nd opinion on Friday who I hope will shed som further light.

cycle-path

Lindy, chemo isn't done for DCIS, but it is done for IDC. So no, the grade of the DCIS isn't relevant. 

Recent research has indicated that there's no benefit to removing lymph nodes, whether or not any cancer is found in any sentinel nodes. Sentinel nodes are removed and biopsied to determine whether cancer has spread past the breast. In other words, sentinel node removal is a diagnostic procedure. Recent research has shown that there is no therapeutic reason to remove lymph nodes.

ginger_mea

I had my surgical biopsy on 2/1/11 after a mamo with a calcification cluster, which confirmed the DCIS, one of the samples was suspicious for invasion, so my dr. went in on 2/16/11 and removed the margins and 1 node, all were clean.  I was set to start radiation. The Radiologist/Oncologist always repeats a mamo before radiation, and during that mamo more calcifications showed up in the surgical area. He told my breast dr. he won't proceed until all are removed. I am going in on 3/22/11 for another sugical biopsy. My breast dr. said we trust the path reports, and everything thing was clear.  Has this ever happened to anyone else?