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NCCN Guidelines for Patients


Breast Cancer - Carcinoma in Situ

(stage 0)

, Version 1.2016



Breast cancer treatment

There are other methods that can be used to spare

normal tissue. Moreover, there are ways to protect

your heart if radiation will be given in that area.

Ask your doctor what methods will be used for your

treatment. Some methods are:

• Directing the beam not toward the heart,

• Lying face down during treatment,

• Holding your breath at times during treatment,

• Use of devices that keep you from moving

during treatment,

• Radiation machines that give treatment only

when the tumor is in the right spot, and

• Radiation machines that deliver very precise

radiation beams.

During treatment, you will be alone while a technician

operates the machine from a nearby room. He or

she will be able to see, hear, and speak with you. As

treatment is given, you may hear noises. A session

can take between 15 to 30 minutes. Radiation therapy

is given 5 days a week for 5 to 7 weeks.

Toward the end of treatment, you may receive extra

radiation called a boost. A boost is advised if you are

50 years of age or younger. Also, a boost may be

given if your doctor thinks the cancer is likely to return

in your breast. The boost may be given with EBRT or

by internal radiation. Internal radiation is also called

brachytherapy. It involves placing radioactive seeds in

the area where the tumor was. The seeds are placed

using multiple small tubes (catheters) or one small

catheter with a balloon at its end.

For multiple-catheter boost radiation, the seeds may

remain in your body for a short time. If the seeds

release a small dose of radiation, the catheters and

seeds are left in your body for a few days. During

this time, you must stay in the hospital. If the seeds

release high doses of radiation, the seeds will remain

in your body for 10 minutes twice a day for 5 days.

You may get side effects from radiation although not

everyone does. Often, the skin around the radiation

site will look and feel as if it has been sunburned.

Another common problem is extreme tiredness

despite sleep (fatigue). Women sometimes have pain

in their armpit or chest after radiation and, rarely,

heart and lung problems. Ask your treatment team for

a complete list of rare and common side effects.

Total mastectomy with or without

sentinel lymph node biopsy

Some women with DCIS can’t have or don’t want a

lumpectomy. A lumpectomy may not be an option

because of your health, the tumor size, cancer in the

surgical margins, and your chances of having another

breast tumor. You may refuse to have a lumpectomy.

Some women refuse because of how they want their

breast to look after treatment. Others refuse because

they will worry less about the cancer returning in that


If a lumpectomy isn’t an option, a total mastectomy

is advised. This surgery is also called a simple

mastectomy. Your whole breast will be removed but

not any chest muscle. Following the mastectomy, or

in some cases at the same time as the mastectomy,

you may want to have breast reconstruction. Breast

reconstruction is described in more detail later in this


If not treated, breast cancer most often spreads

outside the breast through lymph. Lymph is a clear

fluid that gives cells water and food and helps to fight

germs. Lymph drains from tissues into vessels. As

lymph travels in vessels, it will pass through and be

filtered by small structures called lymph nodes.