Ok, I know this may be a dumb question...

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mom3band1g
mom3band1g Member Posts: 817
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

I have been wondering....if DCIS is only in the ducts why can't they just remove the ducts?  I am sure it is more complicated than that but it just makes me wonder.  It's only in the ducts why take everything?  Does that make sense?  My surgery is getting closer.  I was actually feeling pretty good with it and ready to get it over with but as it gets closer I am getting a little more anxious.  Normal, I am sure!

Thanks for putting up with all my odd questions everyone!

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  • sweatyspice
    sweatyspice Member Posts: 922
    edited March 2010

    I wonder the same thing.  The last surgeon I saw rather pompously said that everyone else took too much, they only needed to take the ducts and if he did my surgery we could do two lumpectomies and I'd never notice the difference.  He was at the extreme end (in terms of non-aggressiveness, though he strongly wanted to do a SNB which others didn't) - anyway, since everyone else wanted to take more, I was too scared to go with this guy.  Now, after definitive surgery and pathology, or - knowing what I know now - I second-guess that decision and wonder if I could have gotten away with less physical mutilation. 

    So, I mom3band1g, I don't know the answer but I still second-guess my surgical decision.  

    I wish I could have educated myself to the level of a breast surgeon within the timeframe but that wasn't possible.  When I said that to one of the surgeons I consulted, he told me I should be glad I wasn't a breast surgeon, because I'd only be frustrated at how much was still medically unknown.

    We pick what seems like the best choice at the time.

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  • Beesie
    Beesie Member Posts: 12,240
    edited March 2010

    I think the problem is that the ducts are sort of like a bowl of spaghetti, with the strands all mixed together (thank you Rose for that analogy!). 

    Most drawings that we see of breast anatomy show clearly distinct ducts, each with lots of room around it, suggesting that it would be easy to locate and remove a single duct.  I don't think in reality that's how it works.  I've been trying to find pictures that show more accurately what the breast anatomy looks like.  Most of the drawings aren't very good but the following picture of a ductography shows more clearly how the ducts are all messed together in the breast:

    Galactogram (side view)

    http://www.radiologyinfo.org/en/photocat/gallery3.cfm?pid=1&image=brst-xr-galacto1.jpg&pg=galactogram

    And here are a few pictures of mammogram images of DCIS.  These might show how difficult it would be to just remove the affected ducts:

     

    http://www.radiologyassistant.nl/en/4793bfde0ed53

    Because DCIS cancer cells are microscopic, I don't know how a surgeon would be able to identify the specific ducts that have calcifications and remove just those ducts.  As for having a total duct excision, my understanding is that when this is done, the ducts leading to the nipples are separated from the nipple, in order to stop nipple discharge.  I don't believe that a total duct excision actually removes all the milk ducts from the breast (although someone please correct me if I'm wrong), which is what would be necessary for those who have DCIS.

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  • baywatcher
    baywatcher Member Posts: 532
    edited March 2010

    Mom-

    I remember asking my surgeon that question. She said that the ducts weren't like veins so it wasn't like you could see them and pull them out.

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  • mom3band1g
    mom3band1g Member Posts: 817
    edited March 2010

    ahh, thank you!  I knew it couldn't be that 'simple' or that would be offered.  The pics on bc.org show such clear ducts it looks like that could be possible.  Thank you all for helping me. 

    Beesie - thanks for the pics!  I love to 'see' what we are talking about and that really helped.

    Clearly, grasping at straws over here!

    Thanks for helping me out.

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  • roseg
    roseg Member Posts: 3,133
    edited March 2010

    I think I swiped that phrase from Susan Love.

    They aren't plastic like that string stuff you spray on people at Halloween. You can't just find the bad one and pull it out leaving the others intact.  

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  • sweatyspice
    sweatyspice Member Posts: 922
    edited March 2010

    SIlly String and Bunny Fluffs and Pixie Dust!!!!!

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  • redsox
    redsox Member Posts: 523
    edited March 2010

    A duct excision is done to remove just one duct for a papilloma or other benign condition.  If they actually find cancer they then do more extensive surgery (lumpectomy, partial mastectomy, or mastectomy) because the cancer may have travelled beyond that one duct.  I agree with the spaghetti image. Even if they want to take just the branching structure that includes the duct(s) with cancer, it is not possible to identify and remove just that branching structure.   

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  • mbordo
    mbordo Member Posts: 253
    edited March 2010

    I remember asking the same question - so no it's not a silly idea (or it is, but I had the same one Tongue out)  Maybe someday there will be an option like this.  However, microinvasions could complicate something of that nature...

    Good luck with your surgery!

    Mary

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