Ductal Carcinoma in Situ (DCIS)

Wide local excision for DCIS: pathology results

After a WLE, the breast tissue that has been removed is sent to the laboratory to be examined under the microscope by a pathologist. The pathologist looks to see whether there is an area of healthy cells all around the cancer – this is known as a clear margin. If there is not a clear margin, i.e. there are DCIS cells at the edge of the area of breast tissue that has been removed, there is a higher chance that the cancer will come back in the breast. More breast tissue then needs to be removed a few weeks later. Sometimes, the results from the laboratory after a WLE show that taking away more tissue from the area is unlikely to remove all the DCIS cells completely. In this situation, a mastectomy needs to be done.
 
A few weeks after surgery, the women we spoke with had an outpatient’s appointment with the doctor, who checked that the breast was healing well and talked to them about their pathology results. Some women found waiting for these results difficult. Many were pleased and relieved to hear that they needed no further treatment. One woman said she was calm on the day she went for her pathology results and, though the news was good, it took her a while to get used to it.
Women who had no further treatment were usually able to get on with life as normal. With hindsight, some said that their surgery had been an ‘interruption’ but they had got back to their routine soon afterwards.
Some women were told by the doctor that there weren’t clear margins and they would need further surgery. This came as a huge shock and disappointment. One woman said she ended up having three excisions but was grateful not to have a mastectomy. During one of the operations, some invasive breast cancer was also removed. Some women were also told they would need radiotherapy or hormone therapy (see Radiotherapy and our Breast Cancer section).
Several women who did not have clear margins after their WLE were given a choice of having more breast conserving surgery or a mastectomy (see Mastectomy: The operation).
 
DCIS does not generally spread to the lymph nodes in the armpit (axilla) but, sometimes, if the area of DCIS is large or widespread, the lymph nodes may be removed during the surgery and checked for cancer cells. This is because, for some women, there may be an area of invasive cancer cells within the DCIS which could spread into the lymph nodes. Before surgery, the doctor will discuss whether it is necessary to remove any lymph nodes. After having a WLE, one woman was told that the DCIS she’d been diagnosed with had turned out to be invasive breast cancer. She then had surgery to check for any more cancer cells and later had radiotherapy and hormone therapy.
For most women, the appearance of their breast after WLE is good. Women first looked at their healing breast either in the hospital or when they were back home, and most were very pleased with how it looked once it had healed.

Last reviewed July 2017.
Last updated October 2013.

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