Ductal carcinoma.pptx shows carcinoma in duct

ductal carcinoma

1. Ductal carcinoma investigation, treatment and prognosis By Ajeesh M.L. {BMS20106931}

2. Investigation: IDC is usually found as the result of an abnormal mammogram. To diagnose cancer, you’ll get a biopsy to collect cells for analysis. The doctor will remove a bit of tissue to look at under a microscope. They can make a diagnosis from the biopsy results. If the biopsy confirms you have cancer, you’ll likely have more tests to see how large the tumor is and if it has spread: CT scan. It's a powerful X-ray that makes detailed pictures inside your body. PET scan. The doctor injects a radioactive substance called a tracer into your arm. It travels through your body and gets absorbed into the cancer cells. Together with a CT scan, this test can help find cancer in lymph nodes and other areas. MRI. It uses strong magnets and radio waves to make pictures of the breast and other structures inside your body. Bone scan. The doctor injects a tracer into your arm. They take pictures to find out if cancer has traveled to your bones. Chest X-ray. It uses low doses of radiation to make pictures of the inside of your chest.

3. Invasive Ductal Carcinoma Stages Results from these tests will show the stage of your cancer. Tumor (T): How large is the primary tumor? Where is it? Node (N): Has the tumor spread to your lymph nodes? Where? How much? Metastasis (M): Has the cancer spread to other body parts? Which ones? How much? Stage 0: This is noninvasive cancer. It’s only in the ducts and hasn’t spread (Tis, N0, M0). Stage IA: The tumor is small and invasive, but it hasn’t spread to your lymph nodes (T1, N0, M0). Stage IB: Cancer has spread to the lymph nodes. It’s larger than 0.2 mm but less than 2 mm in size. There’s either no sign of a tumor in the breast or there is, but it’s 20 mm or smaller (T0 or T1, N1, M0).

4. Stage IIA: Any one of these: There’s no sign of a tumor in the breast. The cancer has spread to between 1 and 3 underarm lymph nodes, but not to any distant body parts (T0, N1, M0). The tumor is 20 mm or smaller and has spread to underarm lymph nodes (T1, N1, M0). The tumor is between 20 mm and 50 mm but hasn’t spread to nearby nodes (T2, N0, M0). Stage IIB: Either of these conditions: The tumor is between 20 mm and 50 mm and has spread to one to three underarm lymph nodes (T2, N1, M0). The tumor is larger than 50 mm but hasn’t spread to underarm lymph nodes (T3, N0, M0).

5. Stage IIIA: Either of these conditions: Cancer of any size has spread to four to nine underarm lymph nodes or those under your chest wall. It hasn’t spread to other body parts (T0, T1, T2 or T3, N2, M0). A tumor larger than 50 mm has spread to one to three nearby lymph nodes (T3, N1, M0). Stage IIIB: The tumor: Has spread to the chest wall Has caused swelling or breast sores Has been diagnosed as inflammatory breast cancer May or may not have spread to up to nine lymph nodes under your arm or beneath the chest wall Hasn’t spread to other body parts (T4; N0, N1 or N2; M0) Stage IIIC: A tumor of any size that has spread to 10 or more nearby lymph nodes, breast lymph nodes, and/or lymph nodes under the collarbone. It hasn’t spread to other body parts (any T, N3, M0). Stage IV (metastatic): The tumor can be any size and has spread to other organs, like your bones, lungs, brain, liver, distant lymph nodes, or chest wall (any T, any N, M1). Between 5% and 6% of the time, metastatic cancer is discovered upon first diagnosis. Your doctor may call this de novo metastatic breast cancer. More often, it’s found after a previous diagnosis of early breast cancer. Recurrent: This is cancer that comes back after treatment. It can be local, regional, and/or distant. If your cancer returns, you’ll get another round of tests to learn about the extent of the recurrence. They’ll be similar to those at your original diagnosis.

6. Local treatment for DCIS usually involves breast-conserving therapy (BCT), which consists of lumpectomy (also called wide excision or partial mastectomy) followed in most cases by adjuvant radiation therapy (RT). Alternatively, mastectomy may be considered. In some instances, sentinel lymph node biopsy (SLNB) may also be performed. Mastectomy versus BCT  — Both mastectomy and breast-conserving therapy (BCT) are reasonable options for most women with DCIS, although not all women will meet the criteria for BCT. A choice between these is a personal one and should be made after discussion between patient and provider. Breast-conserving therapy  — BCT for DCIS refers to lumpectomy to remove the tumor with negative surgical margins, generally followed by RT to eradicate any occult residual disease  Treatment: Local Treatment

7. Radiation therapy  — RT is the standard for patients treated with BCT, though it may be reasonable to omit in selected patients with advanced age, extensive comorbidities, or small foci of low-grade disease resected with wide negative margins. RT after lumpectomy reduces the risk of local invasive and noninvasive recurrences. As described below, randomized trials have shown that adjuvant RT significantly reduces the risk of in-breast tumor recurrence by 50 percent or greater compared with excision alone. However, treating all women who undergo breast-conserving surgery for DCIS with adjuvant RT may be overtreatment for some.

8. The majority of cases of DCIS do not recur when treated with excision alone, and there may be subgroups of patients with DCIS in whom the risk of local recurrence is so low that RT may be of no benefit. The difficulty, however, is in reliably predicting those patients who would not recur in the absence of RT. 

9. Benefits of treatment A lower rate of ipsilateral invasive recurrence (8.9 versus 19.4 percent) Similar overall survival (83 versus 84 percent) and cumulative all-cause mortality rate through 15 years (HR for death 1.08, 95% CI 0.79-1.48, 17.1 versus 15.8 percent)

10. Endocrine therapy   SYSTEMIC TREATMENT Approximately 75 percent of DCIS lesions express estrogen receptors (ER) and/or progesterone receptors (PR) . Of the endocrine agents approved for use as adjuvant therapy for invasive breast cancer, only  tamoxifen  is approved in the United States to prevent invasive breast cancer recurrences in women with DCIS, although data indicate that the aromatase inhibitor  anastrozole  is also an acceptable option. The addition of  tamoxifen  to BCT for DCIS reduced the recurrence risk of ipsilateral DCIS and contralateral DCIS  Toxicities associated with aromatase inhibitors include loss of bone density, fractures, and cardiovascular risk and should be discussed with the patient.

11. PROGNOSIS With appropriate treatment, the prognosis for patients with DCIS is excellent. Advancements in screening for DCIS (allowing for early detection, prior to acquisition of high-risk features, and facilitating complete excision), more rigorous and standardized pathologic review and reporting of margins, and adjuvant endocrine therapy have improved outcomes. A separate, prospective, observational study also suggested that risk of recurrence of DCIS decreased with age.