Stage 0 Breast Cancer
Dr Pramod Kumar Julka, Senior Director – Oncology Daycare Centre and Dr Harleen Nayyar – Resident Medical Officer at Max Institute of Cancer Care, Lajpat Nagar talk about non-invasive breast cancer, how is it diagnosed and the precautions that need to be taken for early detection
Breast cancer is a fatal and serious disease, which can vary in terms of types and stages. Based on these differences, the diagnosis and treatment of a patient is planned. While most of us are aware about the significance of stage 1, stage 2, stage 3, what does a stage 0 breast cancer really imply?
What is “stage 0” breast cancer?
Stage 0 breast cancer is defined as TisN0M0 disease, where Tis denotes carcinoma in situ or simply put as non-invasive breast cancer. This particular stage of cancer implies that the size of the tumor of the abnormal cells are confined within the place of origin or the source. Furthermore, the cells have not spread outside of the ducts or lobules into the surrounding breast tissue. Therefore, Stage 0 cancers are called “carcinoma in situ” where carcinoma means cancer and “in situ” means “ in the original place.” The most common kind of breast cancer is ductal carcinoma in situ (DCIS), indicating the cancer cell growth starts in the milk ducts.
What are the types of non-invasive breast cancer?
Three possible types of “in situ carcinoma” of the breast tissue are:\
- DCIS (Ductal carcinoma in situ) – It is an early form of cancer that is highly treatable. Ductal carcinoma in situ (DCIS) is the presence of abnormal cells inside a milk duct in the breast. DCIS is considered the earliest form of breast cancer. DCIS is non-invasive as the cells have not spread out of the milk duct. Mostly, DCIS is diagnosed through a mammogram as a part of breast cancer screening in order to investigate a breast lump. While DCIS isn’t an emergency, it definitely requires an evaluation and planned treatment. DCIS doesn’t typically have any signs or symptoms. While DCIS does not have many symptoms, sometimes an individual might observe signs such as a breast lump or a bloody nipple discharge.
- LCIS (Lobular carcinoma in situ) – Lobular carcinoma in situ (LCIS) is an uncommon condition in which abnormal cells form in the milk glands (lobules) in the breast. Though it is not a cancer, but it indicates the growth of abnormal but non-invasive cells. However, being diagnosed with LCIS means that one has an increased risk of developing breast cancer. The condition is generally treatable with the help of clinical breast exams, mammograms or even Tamoxifen, a hormone therapy medication.
- Paget disease of the nipple – It is a rare form of breast cancer in which cancer cells collect in or around the nipple. This type of cancer generally affects the ducts of the nipple first, followed by the nipple surface and finally, the areola. The symptoms include the nipple and areola becoming scaly, red, itchy, and irritated.
How is the diagnosis made?
In case of non-invasive breast cancer, the diagnosis is made on the basis of history of the patient and physical examination, bilateral mammography and pathology review. Self-breast examination is of utmost importance and must be done in the correct positions i.e. upright and lying down and examining all the parts of the breast including the armpits. It is also an important way to identify early stage invasive cancer so that proper treatment could be given according to the stage of the disease. It is imperative to get genetic counselling in case the cancer is found to be of high risk for hereditary breast cancer.
How can we reduce the risk of breast cancer?
Risk reduction of breast cancer counselling is as important as the screening and detection of early stage breast cancer. Balanced diet, regular exercise and weight loss are proven to reduce the risk of breast cancer. Smoking and alcohol intake cessation are other factors to work upon to reduce the risk of development of breast cancer. Breast feeding is shown to have protective effect from developing breast cancer. It is advised not to take hormonal treatment with combined oestrogen and progesterone for long durations (ie, less than three years).
Is non-invasive breast cancer curable? What are the treatment options?
Many a times surveillance or simple excision of the lesion is the cure. A few may require radiation therapy or hormonal therapy post excision. One is advised for regular 6 monthly to yearly follow up once treatment is over. Annual mammography/ Ultrasound breast forms a part of regular follow up along with physical examination by the physician.
What is your advice?
To conclude is it important to be aware of what your body talks to you and listen to its needs. Get yourself examined by your doctor as soon as you detect anything suspicious. Eat healthy, exercise regularly and remain positive and happy.