Lumpectomy for DCIS: what is different

DCIS, or ductal carcinoma in situ, means abnormal cells are growing inside the milk ducts but have not broken through the duct wall into the surrounding breast tissue. It is often called stage zero or pre-invasive breast cancer. Because it has not invaded, DCIS cannot spread to other parts of the body while it stays in the ducts. The operation itself, a lumpectomy or wide local excision, is much the same as for invasive cancer, but several things around it are different. DCIS rarely forms a lump, so it is usually found as tiny calcium specks on a mammogram and needs to be marked with a wire, seed or other guide before surgery. It can spread along the ducts in ways that are hard to see on scans, so getting clear margins can be more challenging, and a second operation is a little more common. Lymph nodes in the armpit usually do not need to be checked, because pure DCIS does not reach them, although this may change if invasive cancer is suspected or a mastectomy is planned. After surgery, the whole removed area is examined, and sometimes a small invasive cancer is found that the biopsy missed. Chemotherapy is not used for DCIS. Radiation is often recommended to lower the chance of DCIS or invasive cancer returning in the breast, and hormone therapy tablets may be discussed for hormone-sensitive DCIS. The overall outlook for DCIS is very good.

DCIS stays inside the ducts

It has not invaded surrounding tissue, which is why the outlook is so favourable.

Finding and clearing it takes care

It is usually marked before surgery, and margins can be harder to judge.

Less treatment is often needed

Lymph node surgery and chemotherapy are usually not part of the plan.

DCIS has a very good outlook, but there are uncertainties worth knowing about.

The biopsy does not always show everything

Some women's final report shows a small area of invasive cancer. This can change the plan and may mean lymph node surgery is added.

Doctors cannot yet tell which DCIS will become invasive

Some DCIS might never cause harm, but there is no reliable way to know, so treatment is usually advised.

Extensive DCIS may need mastectomy

When DCIS covers a large part of the breast, lumpectomy may not remove it all with a good appearance.

What this page cannot tell you

It cannot say how your own DCIS will behave. Your team uses its grade, size and margins to guide you.

Knowing a few practical points can make the day easier.

Expect an extra step before theatre

Localisation happens in the imaging department, often on the same morning, so allow extra time.

Ask about margins and second surgery

Understanding in advance that a second operation is possible can make it less upsetting if needed.

Recovery is usually quick

Without armpit surgery, most women go home the same day and return to light activity within days.