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NCCN Guidelines for Patients


Breast Cancer - Carcinoma in Situ

(stage 0)

, Version 1.2016



Breast cancer treatment

Only a small group of women with DCIS are able

to have a lumpectomy without any other cancer

treatment. These women are very unlikely to have the

breast cancer return after surgery because the extent

of DCIS is so small. Your doctor will assess if the

cancer is likely to return. Breast cancer is less likely to

return if you are older than 50 years of age, the tumor

is small and low grade (grade I), and the surgical

margins are large and cancer-free. Talk with your

doctor about how likely it is the cancer will return so

that you can decide together if a lumpectomy alone is

the best treatment.

Lumpectomy overview

Before the lumpectomy, you will be asked to stop

eating, drinking, and taking some medicines for a

short period of time. If you smoke, it is important to

stop. Pain is prevented with either local or general

anesthesia. Often, breast tissue is removed through

a C-shaped cut. A lumpectomy is finished within 15 to

40 minutes. Afterward, a tube may be placed in your

breast to drain fluid.

A lumpectomy will leave a small scar and may cause

some pain and swelling for about a week. It may

also cause a dent in your breast that can be fixed

with breast reconstruction. Breast reconstruction is

described later in this chapter. Ask your treatment

team for a complete list of side effects of lumptectomy.

The tissue from the lumpectomy will be tested by a

pathologist for cancer cells at or near the margin.

You also may be given another mammogram to look

for any cancer that wasn’t removed. If it appears

that cancer remains in your breast, more surgery

is needed. The second surgery is often another

lumpectomy but sometimes a mastectomy is needed.

Lumpectomy and radiation therapy

A lumpectomy followed by radiation therapy is called

breast-conserving therapy. It is an option for many

but not all women with DCIS. Radiation therapy uses

high-energy rays to treat cancer. The rays damage

the genes in cells. This either kills the cancer cells

or stops new cancer cells from being made. Adding

radiation therapy has been shown to help stop the

return of cancer within the breast. It is given only after

cancer-free surgical margins have been removed.

Radiation therapy overview

Most of your breast will be treated with radiation.

This is called whole breast radiation. Recently, some

doctors have given radiation only to the lumpectomy

site instead of giving whole breast radiation. Radiation

only to the lumpectomy site is called partial breast

irradiation. If you’re interested in this treatment,

NCCN experts advise that you receive it only within

a clinical trial. A clinical trial is a type of research that

studies a test or treatment.

The most common type of radiation therapy used

for breast cancer is EBRT (








herapy). This type of therapy uses a machine outside

the body to deliver radiation. 3-D machines deliver

beams matched to the shape of the tumor. IMRT









herapy) uses small

radiation beams of different strengths based on the

thickness of the tissue.

A planning (simulation) session is needed before

treatment. During simulation, pictures of the tumor

site should be made with CT (





A CT scan takes many x-rays of the breast from

different angles. Your doctors will use the pictures to

decide the radiation dose and to shape the radiation

beams. Beams are shaped with computer software

and hardware added to the radiation machine. The

beams are shaped so that normal tissue is spared.

Radiation beams will be aimed at the tumor site with

help from ink marks or tiny tattoos on your skin.