DUCTAL CARCINOMA IN SITU - LOBULAR CARCINOMA IN SITU

Treatment

Fibroadenoma is not a precancerous lesion (which precedes the tumor): it grows to a size of 2-3 cm and can subsequently regress spontaneously. Consequently, careful surveillance of the lesion and its variations over time is only indicated. The intervention is recommended when the diagnosis is not certain, the lesion grows rapidly or is greater than 4-5 centimeters, or when it creates psychological or aesthetic problems for the woman.
The treatment of large cysts (macrocysts), particularly if symptomatic, consists of aspiration with a fine needle, which causes the disappearance of the cyst and allows to examine the characteristics of the liquid. The recurrence after the first aspiration occurs in 40% of cases and is rare after menopause. Surgical excision of the lesion is indicated in particular situations, such as when the aspirated liquid is haematic (ie contains blood) or in case of multiple relapses within the same cyst.
An alternative for the treatment of multiple or recurring cysts is represented by some hormonal drugs. The danazol is the most used: it inhibits the release of LH and FSH by the pituitary, therefore it has an anti-hormonal effect. It is administered at doses of 200-400 milligrams per day for 3-6 months and determines a reduction in the number of cysts, breast pain and lumps, even if a relapse occurs in 50% of cases when treatment is discontinued.
Proliferative lesions, such as papilloma, do not need any treatment. However, in consideration of the increased tumor risk of some of them, close clinical and instrumental surveillance is indicated.
The adenoma, on the other hand, requires surgical treatment, because it easily ulcerates and bleeds.

Preinvasive Injuries

Preinvasive means a lesion formed by malignant cells which, however, has not passed the layer of epithelial cells from which it originated, and therefore has not yet invaded the surrounding area, but which will soon be able to do so in a very high percentage of cases. this category two different types of breast cancers: the lobular carcinoma in situ (CLIS) and the ductal carcinoma in situ (CDIS). Both are characterized by the proliferation of tumor epithelial cells, confined respectively to the lobules or ducts, without invasion of nearby structures.
Lobular carcinoma in situ (CLIS) is responsible for about a quarter of all forms of preinvasive breast lesions. It has no symptoms and is not seen on mammography; therefore, its diagnosis is always occasional, when it is associated with other breast diseases that require surgery. It is more frequent between the ages of 40-54, it is multicentric (ie it forms more foci of tumor cells in the same breast) in 40-85% of cases and bilateral (ie it affects both breasts) in 30%. Furthermore, it is associated with the presence of an invasive tumor in 5% of patients. Therefore, it confers a 7 to 10 times greater risk of developing invasive carcinoma than the general population and this increased risk affects both breasts. The therapy currently recommended only involves surgical removal and, subsequently, a clinical check-up every 3-6 months plus a mammogram per year.
Ductal carcinoma in situ (DCIS) is a preneoplastic lesion, as it has the potential to evolve towards the invasive form. About 60-70% of DCIS presents as a mammogram "abnormality and only 5-10% as Paget's disease (retraction of the nipple, with ulceration of the skin covering it and its bleeding), nipple discharge or palpable nodule A simultaneous presence of clinical and mammographic signs is found in 10-20% of cases, while the remaining 10% of DCIS are an occasional finding that is discovered with a biopsy performed for a benign breast lesion.