STAGE 0 BREAST CANCER (DCIS, OR DUCTAL CARCINOMA IN SITU, OR INTRADUCTAL CANCER)

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(This stage is not an invasive cancer, but is included here in case you found your way to this section because you know what the stage of your cancer was.)

Although no one ever wants to be told that they have cancer, the finding of ductal carcinoma in situ (DCIS) is one of those situations where we truly have found a cancer at a stage where it can be nipped in the bud.  (In fact, some would even argue that it is not really a cancer “yet”, if it has not actually invaded into the surrounding tissue.) The “in situ” phrase means that we can tell for sure that these cells have the POTENTIAL to do their cancer thing (which means, to invade into surrounding tissue and eventually spread elsewhere), but that they have not yet invaded even the tissue right around the DCIS cells. You can think of these cells as “cancer seeds”, which haven’t yet sprouted, but have all the capability of doing so if left in place.

When DCIS is seen on a biopsy, you will usually need to have more tissue removed from your breast (usually the additional tissue removed is about the size of an ice cream scoop). This is almost always done as on open surgical excision in the operating room, either with sedation or general anesthesia, though sometimes under local anesthesia. This surgical excision is the most important treatment, and it is necessary to remove enough tissue so that none of the DCIS is seen along any of the margins of the removed tissue.

This is not always as simple as it might seem, because the DCIS can only be seen under the microscope, and the tissue is not usually examined under the microscope until after preserving the removed tissue in formalin overnight. This method gives more reliable information than trying to examine the tissue immediately (called a frozen section). This means that there are some women in whom the margins will show some more DCIS, and this will require another trip to the operating room to remove more tissue. This return to the operating room is necessary more often than you might think, as often as 50% of the time at some centers. At DeKalb Surgical, this is only necessary about 10% of the time. I wish it would never happen, but sometimes even the non-invasive cancer cells can extend along the breast ducts in various directions. Obtaining clear margins is a matter of experience, compulsion with orientation of the tissue for the pathologist, and to some extent, how much additional breast tissue is removed.

In some cases, when the surgical excision is done, there may be some actual invasion seen in an adjacent area, not removed with the initial biopsy. In such cases, the situation changes a bit. In most cases of invasive cancer, even if only a tiny area, it is usually recommended to also surgically check some of the lymph nodes under your arm, to be sure there are no cancer cells seen there. You will find more information about this on the invasive cancer page.

Although surgical excision for clear margins is the most important treatment for DCIS, radiation therapy AND 5 years of anti-hormonal therapy (with tamoxifen) is fairly standard additional treatment, with the intention of minimizing the possibility that you might ever develop another cancer in your breast. There is no need for chemotherapy in these very early stage cases. Your surgeon should discuss these issues with you in more detail. Probably the most important thing to remember if you have DCIS is that essentially all women are cured of their cancer when it is found at this stage.

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