DCIS TREATMENT

What is Lumpectomy?
Lumpectomy is a surgical procedure that removes the breast lump or suspicious tissue seen on the mammogram and some surrounding tissue as well. Lumpectomy is also called "breast sparing", "breast conserving" or "segmental mastectomy".

    Generally, lumpectomy is the first step in breast-conservation therapy. Lumpectomy is usually performed in an outpatient setting using local anesthesia. However, general anesthesia can be used for greater patient comfort. If cancer cells are present at the margin (the edge of the biopsied tissue), a re-excision needs to be done to remove the remaining cancer. If you are large-breasted, most of your breast can be preserved and you will still have the image you are accustomed to. If you are small-breasted and need additional surgery, lumpectomy may not result in a good cosmetic result; mastectomy with reconstruction can be a good option.

 Lumpectomy alone is adequate treatment if:

• Only one area of abnormality is found on exam or on a mammogram.
• The area of abnormality is very small.
• The surgeon is able to remove the DCIS completely and no DCIS is left behind in the breast.
• The mammogram of the breast shows no more suspicious findings after the lumpectomy.
• The woman is elderly or has other serious illnesses and would not be able to tolerate more extensive surgery or breast radiation therapy.
• The type of DCIS is a less aggressive, or non-comedo, type.
• The woman consents to close follow-up and surveillance.

 Lumpectomy alone carries special concerns and considerations. Because the remaining breast tissue is not treated with any other intervention, there is the possibility that if the woman lives many more years, she can develop cancer — either DCIS or invasive cancer in the same breast. This option is only effective for carefully selected patients with early, small DCIS lesions with very easily interpreted mammograms. Comedo-type DCIS tends to be more aggressive and careful judgment needs to be used in offering lumpectomy alone in women with this cell type of DCIS. 

Simple (total) mastectomy
this is a surgical procedure in which the entire breast is removed but not the lymph nodes under the arm or the muscle tissue from beneath the breast. The nipple will be removed in this procedure, but much of the original skin of the breast may be preserved.

Simple mastectomy is used to treat noninvasive breast cancer, and is one way to remove DCIS that is multifocal (appears in many places within the breast). The surgeon does not need to remove lymph nodes from under the arm, because DCIS does not spread to the axiliary lymph nodes.

If the DCIS is high grade and larger, your surgeon may suggest a sentinel node biopsy at the time of lumpectomy or mastectomy. This is because of the possibility of invasive cancer. By doing the sentinel node biopsy at this time, the need for additional surgery may be eliminated.

If invasive cancer is found, the surgeon will remove the entire breast tissue and some lymph nodes, which is important to determine spread of the disease. This is called a modified radical mastectomy. When lymph nodes are removed, there is a small risk of lymphedema, or swelling in the arm.

Simple mastectomy is appropriate management for all kinds of DCIS. It is the only recommended treatment for multifocal DCIS, extensive DCIS, or DCIS that has recurred after lumpectomy and radiation therapy. This procedure is a relatively short surgery, requires general anesthesia, with a short hospital stay followed by a quick recovery. Reconstructive surgery to recreate the breast can be done immediately at the time of mastectomy or at a later date. The recurrence rate and overall chance of dying from cancer after simple mastectomy is between 0 and 2%.

Women who have the simple mastectomy procedure rarely have difficulties with shoulder movement or arm swelling after surgery. As compared to a modified radical mastectomy, the surgery time is shorter and the recovery period faster.

If a simple mastectomy is chosen as treatment for DCIS, radiation therapy is not needed following surgery.

Modified radical mastectomy
Modified radical mastectomy is a surgical procedure in which the entire breast and some or all of the nearby lymph nodes are removed. Underlying muscles are left intact. This procedure is not usually used for treatment of DCIS, but may be used if invasive breast cancer is found.

Postoperative radiation therapy
If lumpectomy is chosen as the surgical method, the remainder of the breast is usually treated with radiation to minimize the chances of having a recurrence of DCIS in the breast. If, after biopsy, there are cancer cells present at the margin (the edge of biopsied tissue), an excision can usually be done again to remove the remaining cancer cells. Radiation treatment is usually begun three to four weeks after the lumpectomy or when the wound has healed.

     Sourced from http://www.dcis.info/treatment