Diagnosed with high grade ductal carcinoma insitu

Basically at this point you have been diagnosed with high-grade DCIS. There is a possible micro-invasion, but that doesn’t usually change the treatment much unless it turns out to be bigger than thought. Your diagnosis is very similar to mine.

Depending on the size of the lesion, your surgical options will most likely be either mastectomy or lumpectomy with radiation (if it is small enough to be removed entirely without overly disfiguring the breast). Because of the micro-invasion, it is likely that if you choose the lumpectomy, you will have a sentinel node biopsy done at the same time (this is what I had).

You don’t mention your hormonal receptor status, but if your cancer is ER+, you will most likely be offered either Tamoxifen (if you are premenopausal) or one of the aromatase inhibitors (if you are post menopausal).

Unless the invasive portion turns out to be larger than the suspected micro-invasion, chemo would not be appropriate in your case.

Hope this helps!

Just chiming in to say prognosis is *great*. DCIS doesn't kill anybody--it just has to be dealt with. There will likely be a more complete pathology report in a few days with ER/PR status and such.

Hi Olive:

On this site, I found this page with illustrations to be helpful for understanding DCIS, which is confined to the inside of the ducts and is by definition "non-invasive" (has not broken through the wall of the duct into the surrounding breast tissue). Grade can be low (Grade1), intermediate (Grade 2), or high (Grade 3) and the higher the grade, the more different the cells look from normal cells. "Necrosis" means that some of the DCIS cells in the center of the duct have died. Farther down on the page there are explanations and illustrations of the terms used to describe how "clogged" the duct appears (e.g., solid).

http://www.breastcancer.org/symptoms/types/dcis/di...

Hormone receptors are estrogen receptor ("ER") and progesterone receptor ("PR"). Here is a short introduction:

http://www.breastcancer.org/symptoms/diagnosis/hor...

If you have only received a top-line summary of the pathology report, be sure to obtain a copy of the complete report (and any addenda or supplements with ER and PR testing). You can download and print the .pdf pamphlet "Your Guide to the Breast Cancer Pathology Report" at the bottom of this page, which can be helpful:

http://www.breastcancer.org/symptoms/diagnosis/get...

Please note that the pamphlet is very comprehensive, and not all tests are appropriate for all conditions. For example, with a biopsy, estrogen receptor ("ER") and progesterone receptor ("PR") status should be assessed for ductal carcinoma in situ ("DCIS"), but HER2 status is not routinely assessed. Also, some tests are often done later (if indicated) after full surgical pathology is available (e.g., Oncotype testing).

Many new members find these comprehensive posts from Beesie to be extremely helpful. You may wish to bookmark them, and return to them as you move forward to re-read, because it is a large amount of information to absorb!

A layperson's guide to DCIS (original post):

https://community.breastcancer.org/forum/68/topics/790992?page=1

Lumpectomy vs Mastectomy Considerations (see Jun 20, 2013 post from Beesie

https://community.breastcancer.org/forum/91/topics/806452?page=1#post_3598134

So far, this appears to have a very favorable prognosis as noted by others.

BarredOwl

Hi Olive:

The majority of DCIS patients elect to treat DCIS with surgery at a minimum. The most common surgical treatment plans for high grade DCIS are:

(a) Lumpectomy plus radiation; or

(b) Mastectomy with sentinel node biopsy, typically without radiation

Many patients with DCIS can be treated by mastectomy without radiation, and this is one factor behind this choice. In limited cases, findings from the surgical pathology or sentinel node biopsy may lead to a recommendation for radiation.

Yes, IDC is sometimes found along with the DCIS. According to the American Society of Clinical Oncologists (ASCO), in women diagnosed with apparently pure DCIS by minimally invasive biopsy (e.g., stereotactic core-needle biopsy), invasive cancer is reported in 10% to 20% of cases overall, approximately half of which are limited to microinvasive cancer.

Thus, the results of the surgical pathology are key. In my case, following mastectomy, a 1.5 mm invasion (IDC) was found, which made me Stage IA (node-negative), but it did not change my treatment plan.

I felt a lot better once I had a chance to speak with the breast surgeon, and had a better idea of what I was dealing with.

BarredOwl