ductal carcinoma, breast
Jump to navigation
Jump to search
Introduction
See breast cancer.
Epidemiology
most frequent histologic type (70%)
Genetics
- see breast cancer
- overexpression of NEK8
- specifically implicated genes:
Laboratory
- if hormone receptor-positive, HER2-negative breast cancer with < 4 positive axillary nodes, multigene recurrence assay indicated to guide adjuvant chemotherapy decisions[1]
- Oncotype DX, MammaPrint, EndoPredict, or Prosigna
- PD-L1 can be used to determine which patients with advanced triple-negative breast cancer may benefit from immunotherapy
- has not been shown to predict the benefit of immunotherapy for patients with early-stage breast cancer
Radiology
- PET scan not indicated in asymptomatic women (see breast cancer)
Management
- ductal carcinoma in situ
- surgical excision with negative margins by histopathology
- adjuvant radiation therapy cuts recurrence rate in half
- adjuvant aromatase inhibitor for postmenopausal women[1]
- adjuvant tamoxifen for 5 years for premenopausal women[1]
- axillary node dissection is not indicated
- incidence of lymph node metastases is 2-3%
- invasive ductal carcinoma
- modified radical mastectomy (most common surgery)
- breast-conserving therapy
- lumpectomy
- partial (segmental) mastectomy or quadrantectomy
- radiation therapy
- sentinel lymph node biopsy
- if hormone receptor-positive, HER2-negative breast cancer with < 4 positive axillary nodes, multigene recurrence assay indicated to guide adjuvant chemotherapy decisions
- Oncotype DX, MammaPrint, EndoPredict, or Prosigna
- selected patients (determined from multigene recurrence assay) benefit from adjuvant chemotherapy initiated 4-8 weeks after surgery, followed by radiation therapy (if applicable)[1] & then endocrine therapy.
- if hormone receptor-positive, HER2-negative breast cancer with < 4 positive axillary nodes, multigene recurrence assay indicated to guide adjuvant chemotherapy decisions
- tamoxifen vs aromatase inhibitor for estrogen receptor-positive tumor after lumpectomy & radiation therapy to reduce risk of local recurrence &/or 2nd primary
- if HER2 positive, see HER2 positive breast cancer
More general terms
More specific terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 666
- ↑ Smith BD et al, Effectiveness of radiation therapy in older women with ductal carcinoma in situ. J Natl Cancer Inst 2006, 98:1302 PMID: https://pubmed.ncbi.nlm.nih.gov/16985249
- ↑ Fisher B, Dignam J, Wolmark N et al Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet. 1999 Jun 12;353(9169):1993-2000. PMID: https://pubmed.ncbi.nlm.nih.gov/10376613
Patient information
breast ductal carcinoma patient information