Duct Cell Carcinoma

Duct carcinoma in situ (DCIS), also referred to as intraductal carcinoma, is a non-invasive breast cancer characterized by a proliferation of abnormal epithelial cells confined within the basement membrane. Disruption of the basement membrane layer would change the diagnosis from DCIS to invasive breast cancer. DCIS is considered to be a precursor for invasive breast cancer.[rx] Specifically, the World Health Organization defines the term DCIS as “a neoplastic proliferation of epithelial cells confined to the mammary ductal-lobular system and characterized by subtle to marked cytologic atypia and an inherent but not necessarily obligate tendency to progression to invasive breast cancer.”[rx]

Although grouped, DCIS is, in reality, a heterogeneous group of lesions that varies in the clinical presentation, genetics, biomarkers, morphologic features, as well as the clinical potential to progress to invasive breast cancer. Rates of diagnosis have been increasing with the use of screening mammography that detects pre-clinical microcalcifications. However, the diagnosis of DCIS does require a tissue biopsy. The treatment for DCIS is multidisciplinary and may include surgery, hormone therapy, and radiation therapy.

Types of Ductal Carcinoma

There are several types of Ductal Carcinoma, and each varies in characteristics, symptoms, and treatment.

Ductal Carcinoma in Situ (DCIS)

This type of breast cancer starts in the milk ducts. Here, the cancer cells are still contained within the ducts (hence “in situ”) and haven’t spread to surrounding tissue.

Invasive Ductal Carcinoma (IDC)

This is the most common type of breast cancer. In IDC, the cancer cells have broken through the wall of the milk duct and begun to invade the surrounding breast tissue.

Pancreatic Ductal Adenocarcinoma

This is the most common type of pancreatic cancer and starts in the ducts of the pancreas.

Ductal Carcinoma of the Prostate

Although less common, this aggressive type of prostate cancer also starts in the ducts of the prostate.

Causes

Causes that contribute to this disease.

1. Age: As we grow older, our risk of developing Ductal Carcinoma increases. It’s most commonly diagnosed in people aged 55 or older.
2. Gender: Although men can get Ductal Carcinoma, it is significantly more common in women due to their more extensive breast tissue.
3. Genetics: If you have close relatives (like a mother or sister) with this type of cancer, your risk increases. Certain gene mutations like BRCA1 and BRCA2 also raise the risk.
4. Hormonal Factors: Long-term exposure to estrogen, such as early menstruation or late menopause, can increase the risk.
5. Childbirth: Women who’ve never given birth or had their first child after 30 may have a slightly higher risk.
6. Radiation Exposure: Exposure to radiation therapy to the chest, especially at a young age, increases the likelihood of Ductal Carcinoma.
7. Obesity: Being overweight or obese raises the risk, particularly after menopause due to higher estrogen levels.
8. Alcohol Consumption: Regular or heavy drinking can increase your risk.
9. Smoking: Tobacco use is linked to an elevated risk of many cancers, including Ductal Carcinoma.
10. Hormone Replacement Therapy (HRT): Certain types of HRT, particularly combined estrogen and progesterone therapy, may raise the risk.
11. Breast Density: Women with dense breasts have a higher risk as there are more ducts where cancer can develop.
12. Lack of Physical Activity: An inactive lifestyle can contribute to obesity and hormone imbalances, both of which increase the risk.
13. Previous Breast Disease: Non-cancerous breast diseases like atypical hyperplasia can increase the risk.
14. Late Pregnancy: Having your first pregnancy after the age of 30 can slightly increase the risk.
15. Breastfeeding: Not breastfeeding may increase the risk slightly.
16. Certain Medications: Some drugs, like diethylstilbestrol, taken by pregnant women may increase the risk in their daughters.
17. Diet: High-fat diets or diets low in fruits and vegetables may contribute to the risk.
18. Stress: Long-term high stress levels might contribute to hormonal changes that can increase the risk.
19. Environmental Factors: Exposure to certain chemicals or pollutants may increase the risk.
20. Ethnicity: White women have a slightly higher risk, but African-American women are more likely to die from the disease.
21. Chemotherapy: Certain chemotherapy drugs may increase the risk.
22. Previous Cancer Treatments: If you’ve had radiation therapy or certain drug therapies for other cancers, you may have a higher risk.
23. Lack of Sunlight: Vitamin D, produced in our skin with sunlight exposure, may protect against breast cancer.
24. Night Shift Work: Some studies suggest that working night shifts may disrupt body rhythms and increase the risk.
25. Menopause after Age 55: Women who experience menopause later in life have been exposed to estrogen longer, which could increase the risk.
26. Oral Contraceptives: Certain types of birth control pills might slightly raise the risk.
27. Dense Breast Tissue: This makes it harder to detect cancers on mammograms.
28. Exposure to Diethylstilbestrol (DES): Women exposed to DES in the womb may have an increased risk.
29. Postmenopausal Hormone Therapy: This therapy may increase the risk.
30. Alcohol and Tobacco Use: Both can increase your risk of breast cancer.

Understanding these factors is the first step in reducing your risk of Ductal Carcinoma. While some are uncontrollable, like age and genetics, many are lifestyle-related and can be managed. Regular check-ups and self-examinations are also crucial for early detection and effective treatment.

Symptoms

Symptoms of Ductal Carcinoma in plain,

1. A Lump or Mass in the Breast: The first sign that could hint at Ductal Carcinoma is a lump in the breast that feels different from surrounding tissue. Think of it as finding a pebble in a bag of cotton.
2. Breast Pain: Regular, unexplained pain in your breast can be another symptom. Imagine this as if something inside your breast is continuously poking you.
3. Changes in Breast Shape or Size: If your breast starts to look or feel differently, like growing or shrinking without any known reason, pay attention. It’s as if your favourite outfit suddenly feels too tight or loose.
4. Skin Dimpling: This is when your breast skin looks similar to an orange peel. It’s puckered, just like when you squeeze a soft ball and it doesn’t immediately bounce back.
5. Nipple Retraction: If your nipple starts to pull inward, sort of like a turtle pulling its head into its shell, that’s nipple retraction.
6. Nipple Discharge: This isn’t related to breastfeeding. It’s more like finding a leak where there shouldn’t be one.
7. Red or Scaly Skin: If your breast skin turns red or scaly, like a mild sunburn, this could be a sign.
8. Unusual Breast Swelling: If one or both of your breasts enlarge and it’s not linked to your menstrual cycle, this could be a symptom. Imagine blowing air into a balloon – that’s what the swelling is like.
9. A Lump in the Armpit: This feels like finding a tiny pebble stuck in your armpit.
10. Itchy Breasts: Persistent itchiness in your breasts, similar to a mosquito bite that won’t stop itching, could be a sign.
11. Visible Veins on the Breast: When veins on your breast suddenly become more prominent, like roads on a map that weren’t there before, pay attention.
12. Nipple Pain: Continuous, unexplained pain in your nipple, like getting a small electric shock, may be a symptom.
13. Hardening of the Breast: This feels as though your breast tissue is firming up, similar to when a soft piece of fruit starts to harden and spoil.
14. Nipple Changes: Any changes in your nipple, such as a different shape or size, are something to note. It’s like when your regularly rounded doughnut looks more like an oval.
15. Breast Rash: A rash, similar to what you get from poison ivy or an allergic reaction, might appear on your breasts.
16. Nipple Eczema: This is when your nipple skin becomes dry, itchy, and cracked, like your hands might feel in the middle of winter.
17. Darker Areolas: If the area around your nipple (the areola) darkens, like a tan that doesn’t fade, this could be a symptom.
18. Peeling, Flaking, or Scaling of Skin: This is when skin on your breast or nipple starts to peel or flake, like paint chipping off an old house.
19. Breast Heaviness: A sudden heavy feeling in your breast, as though it’s being weighed down, could be a symptom.
20. Breast Asymmetry: If your breasts suddenly look uneven when they weren’t before, like when a pair of matching shoes suddenly don’t match, take note.

Diagnosis

Diagnostic procedures and tests for detecting this condition,

1. Self-Breast Exam: The first line of defense, is a manual check of breasts to feel for lumps, swelling, or changes in size or shape.
2. Clinical Breast Exam: Conducted by a healthcare professional, this is a more detailed physical examination of the breasts.
3. Mammogram: An X-ray of the breast to look for abnormalities.
4. Digital Mammogram: It’s similar to a standard mammogram, but the image is viewed on a computer, enhancing the visibility of the breast tissue.
5. 3D Mammogram (Tomosynthesis): This provides a series of detailed images of the breast, offering a more comprehensive view.
6. Breast MRI: Magnetic resonance imaging captures detailed images of breast tissues and can detect cancers missed by mammograms.
7. Breast Ultrasound: Uses sound waves to create an image of the breast tissues, helpful in differentiating between fluid-filled cysts and solid masses.
8. Breast Biopsy: This involves removing a small tissue sample from the suspected area to be examined under a microscope by a pathologist.
9. Fine Needle Aspiration (FNA): A type of biopsy that uses a thin needle to remove cells from the breast lump.
10. Core Needle Biopsy: Similar to FNA, a larger needle is used to remove a ‘core’ of tissue.
11. Surgical (Open) Biopsy: Involves a surgical procedure to remove all or part of a lump for testing.
12. Vacuum-Assisted Biopsy: Uses a vacuum device to collect multiple tissue samples during one needle insertion.
13. Liquid Biopsy: A non-invasive test that detects cancer cells or their genetic material (DNA) circulating in the blood.
14. Estrogen and Progesterone Receptor Test: Identifies if the cancer cells have receptors that hormones bind to, guiding treatment options.
15. HER2/neu Test: This checks if the cancer cells are producing too much HER2 protein, which can lead to aggressive cancer growth.
16. Genomic Tests: These analyze the genes in cancer cells to predict the likelihood of cancer recurrence.
17. Full Body Bone Scan: This test checks for the spread (metastasis) of the cancer to the bones.
18. CT Scan: A computed tomography scan provides detailed images of the body to check for metastasis.
19. PET Scan: A positron emission tomography scan identifies fast-growing or aggressive cancer cells in the body.
20. Chest X-Ray: This is done to check if cancer has spread to the lungs.
21. Liver Function Test: Ascertains if the liver is working properly, indicating if cancer has spread there.
22. Blood Calcium Level Test: High calcium levels could signal that cancer has spread to the bones.
23. CBC (Complete Blood Count): Assesses general health and monitors side effects of treatment.
24. Tumor Marker Tests: These blood tests detect certain substances that are higher when cancer is present.
25. Immunohistochemistry (IHC): This test uses antibodies to identify cancer cells based on the proteins they express.
26. Fluorescence in situ Hybridization (FISH): This test maps the genetic material in a person’s cells, including cancer cells.
27. Sentinel Node Biopsy: This identifies the first few lymph nodes where cancer is likely to spread.
28. Axillary Node Dissection: Involves removing lymph nodes in the armpit area to check for cancer spread.
29. MUGA Scan or Echocardiogram: These heart tests ensure the heart is strong enough to handle certain types of chemotherapy.
30. BRCA Gene Test: This genetic test identifies mutations in the BRCA1 or BRCA2 genes, indicating a higher risk of breast cancer.

Treatment

Treatments for Ductal Carcinoma in a straightforward manner.

1. Surgery

The cornerstone of ductal carcinoma treatment is surgery, often involving removing the cancerous area and some surrounding healthy tissue, a process known as lumpectomy.

2. Mastectomy

Mastectomy is a surgical process where the entire breast is removed. It’s used when the cancer is widespread. There are different types including simple, radical, or double mastectomy.

3. Sentinel Lymph Node Biopsy

This procedure identifies the first few lymph nodes into which a tumor drains. If these are cancer-free, it’s unlikely the disease has spread further.

4. Axillary Lymph Node Dissection

When cancer is found in the sentinel lymph nodes, an axillary dissection may be performed, removing additional nodes from the underarm area.

5. Breast Reconstruction

Following mastectomy, some women opt for breast reconstruction surgery to rebuild the breast’s shape.

6. Radiation Therapy

Radiation therapy uses high-powered energy from x-rays and protons to kill cancer cells. It’s typically used after surgery to eliminate any remaining cancer cells.

7. Hormone Therapy

Some ductal carcinomas are sensitive to hormones. Hormone therapy uses drugs to block the body’s hormone production, thereby slowing or stopping cancer growth.

8. Chemotherapy

Chemotherapy uses potent drugs to kill rapidly growing cells, including cancer cells. It can be given before surgery (neoadjuvant) to shrink the tumor or after surgery (adjuvant) to kill any remaining cells.

9. Targeted Therapy

This form of therapy targets specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way.

10. Immunotherapy

Immunotherapy uses the body’s immune system to fight cancer. It boosts the immune system and helps it recognize and attack cancer cells.

11. Cryoablation

Cryoablation involves killing cancer cells by freezing them. It’s less invasive than surgery and mostly used for small tumors.

12. Breast Conserving Surgery (BCS)

Also known as lumpectomy, BCS involves removing the cancer and some surrounding normal tissue, aiming to keep as much of the healthy breast as possible.

13. Prophylactic Mastectomy

In high-risk patients, the removal of one or both breasts may be considered even before the cancer develops.

14. Oophorectomy

For women with a high risk of breast and ovarian cancer, surgical removal of the ovaries (where estrogen is produced) may be considered.

15. Anti-estrogen Therapy

This involves medications that stop the production or block the effects of estrogen in the body.

16. Aromatase Inhibitors

These are drugs that stop the production of estrogen in postmenopausal women, thereby stopping the growth of some breast cancers.

17. Selective Estrogen Receptor Modulators (SERMs)

SERMs block the effects of estrogen in the breast tissue, which can stop the growth of hormone-sensitive breast cancer cells.

18. CDK4/6 Inhibitors

These drugs block proteins called CDK4 and CD6, causing hormone-receptor-positive breast cancer cells to die.

19. Monoclonal Antibodies

These are immune system proteins designed in a lab to function as substitute antibodies that can restore, enhance, or mimic the immune system’s attack on cancer cells.

20. Biologic Therapy

This treatment uses your body’s immune system to fight cancer or to control side effects from other cancer treatments.

21. Bisphosphonates

Bisphosphonates are drugs that help strengthen and reduce bone loss, which can be beneficial in advanced breast cancer.

22. Palliative Care

This type of care is designed to relieve symptoms and improve the quality of life for people with serious illnesses, like cancer.

23. Radiation Seed Therapy (Brachytherapy)

This involves placing radioactive seeds in or near the tumor, allowing a high dose of radiation to reach the cancer cells while reducing exposure to healthy cells.

24. Intraoperative Radiation Therapy (IORT)

IORT delivers a concentrated dose of radiation during surgery, directly to the tumor site immediately after the tumor has been removed.

25. Physical Therapy

Following breast surgery, physical therapy can help improve arm motion and strength.

26. Lifestyle Changes

Healthy lifestyle habits, like regular exercise, a balanced diet, and limiting alcohol, can help reduce the risk of breast cancer recurrence.

27. Complementary and Alternative Medicine (CAM)

Techniques such as acupuncture, massage, and mindfulness can help manage cancer symptoms and side effects from treatments.

28. Genetic Counseling

Genetic counseling helps understand the risk of genetically linked cancers. If a woman has a high genetic risk, more aggressive preventive measures may be considered.

29. Support Groups and Counseling

Dealing with cancer is challenging. Support groups and counseling provide a safe space to share experiences and coping strategies.

30. Clinical Trials

Participating in clinical trials gives access to potentially effective treatments not available elsewhere.

Conclusion

When it comes to ductal carcinoma, numerous treatment options are available. While this list might seem overwhelming, remember that doctors will customize treatment plans to individual needs and circumstances. No matter the treatment path, support, and information are always available.

References