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    Default Carcinoma-in-situ Pictures - Atlas of Colon and Ileum

    Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means "in its original place." DCIS is called "non-invasive" because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue. DCIS isn’t life-threatening, but having DCIS can increase the risk of developing an invasive breast cancer later on.

    When you have had DCIS, you are at higher risk for the cancer coming back or for developing a new breast cancer than a person who has never had breast cancer before. Most recurrences happen within the 5 to 10 years after initial diagnosis. The chances of a recurrence are under 30%.

    Women who have breast-conserving surgery (lumpectomy) for DCIS without radiation therapy have about a 25% to 30% chance of having a recurrence at some point in the future. Including radiation therapy in the treatment plan after surgery drops the risk of recurrence to about 15%. Learn what additional steps you can take to lower your risk of a new breast cancer diagnosis or a recurrence in the Lower Your Risk section. If breast cancer does come back after earlier DCIS treatment, the recurrence is non-invasive (DCIS again) about half the time and invasive about half the time. (DCIS itself is NOT invasive.)

    According to the American Cancer Society, about 60,000 cases of DCIS are diagnosed in the United States each year, accounting for about 1 out of every 5 new breast cancer cases.

    Treatment of CIS Versus TCC
    Treatment of carcinoma in situ (CIS) differs from that of papillary transitional cell carcinoma (TCC). Endoscopic surgery, which is the initial treatment of papillary cancers, is not effective for CIS because the disease is often so diffuse and difficult to visualize that surgical removal is not feasible. When a combination of papillary tumor and CIS is present, the papillary tumor is removed before treatment of the CIS is initiated.
    Carcinoma-in-situ Pictures Atlas Colon Ileum attachment.php?s=29c41193d64633dd2e13c51f41266772&attachmentid=2039&d=1442165505

    Bacillus Calmette-Guérin
    Bacillus Calmette-Guérin (BCG) is the most common intravesical agent used to treat carcinoma in situ (CIS).[1, 2] Approximately 70% of patients have an initial response to BCG vaccine. Rates of tumor progression vary according to the particular study, but more than 75% of patients who initially have a complete response remain disease free for more than 5 years. This is equivalent to 45-50% of those who initially respond. At 10 years, approximately 30% of patients with CIS who are treated with BCG are disease free.

    A failure to respond to BCG vaccine may be defined as persistent or recurrent tumor when a BCG vaccine reaction is evident. If this occurs within the course of a year, an alternative strategy is to combine BCG with interferon-alfa (IFN-alfa). In this situation, 50 million units of IFN-alfa can be instilled into the bladder, with the BCG vaccine administered 1 hour later. The IFN-alfa up-regulates the major histocompatibility complex/BCG vaccine antigen complex, which enhances the immunologic response.

    With this combination, doses of BCG vaccine as small as one tenth of a vial have been shown to be effective. IFN-alfa is well tolerated, and the lower doses of BCG vaccine are usually associated with decreased adverse effects.

    Mitomycin-C
    Mitomycin-C is the most commonly used chemotherapeutic agent. It is used in both the perioperative and the treatment periods. Immediately following a transurethral resection of a papillary tumor, mitomycin-C, 40 mg in 20 mL of saline, is instilled into the bladder and held there for an hour. In the treatment phase, the same dosing is used, but the patient's urine should be alkalinized for maximum effect. The treatments are administered weekly for at least 6 weeks before a maintenance program is started, consisting of monthly instillations for one year.

    Mitomycin-C is usually well tolerated, but excess use can cause symptoms of cystitis; if this occurs, the instillation frequency should be reduced. A bladder retention time of 2 hours is usually advised, although this practice has never been thoroughly studied.

    With the use of this protocol, a recurrence-free incidence rate of 41% has been reported. These data demonstrate that although intravesical chemotherapy does not match the results obtained with BCG vaccine, this is an effective agent, and its benefits can be maximized by following these recommendations.

    Gemcitabine
    Gemcitabine is the most recent addition to the list of effective intravesical agents. This chemotherapy drug is administered according to the same protocol as BCG (ie, 6 weekly treatments followed by maintenance for 1 y). This agent has caused very few side effects.

    Gemcitabine is a prodrug that requires activation by intracellular phosphorylation. It has shown selective killing in human transitional cell carcinoma (TCC) cell lines and does not affect normal fibroblast cell lines. Serial administration of weekly doses of 1500-2000 mg in 50 mL of saline has shown complete responses in 50% of patients with CIS.
    Carcinoma-in-situ Pictures Atlas Colon Ileum attachment.php?s=29c41193d64633dd2e13c51f41266772&attachmentid=2040&d=1442165523

    Doxorubicin
    Doxorubicin (Adriamycin) is a chemotherapy agent that can be effective, although comparison studies indicate that it is not as effective as mitomycin-C or BCG. It is administered in a dose of 50 mg in 50 mL of saline.

    Valrubicin
    Valrubicin has been approved as intravesical chemotherapy for CIS that is refractory to BCG. In patients whose conditions do not respond to BCG, the overall response rate to valrubicin is approximately 20%. In some patients, valrubicin chemotherapy can delay time to cystectomy. Valrubicin is currently not commercially available.

    Thiotepa and cisplatin
    Thiotepa was the original chemotherapeutic agent used for bladder cancer. It is now rarely used because of its limited efficacy. Cisplatin also provides limited benefit and is rarely used to treat CIS.

    Mycobacterial Cell Wall-DNA Complex
    Morales et al treated 55 patients with 6 weekly instillations of either 4 mg or 8 mg of mycobacterial cell wall-DNA complex following endoscopic tumor resection, and the complete response rate for the 4-mg group at 12 and 18 months was 38%, while the 8-mg group had response rates of 38% and 62% at 12 and 18 months, respectively. Morales et al have been studying the effects of intravesical mycobacterial cell wall–DNA complex as an alternative to standard BCG and as therapy following failure of BCG instillations. The 25 patients in the 4-mg group had received prior therapy and had tumor recurrence.

    Additional Therapies
    Photodynamic therapy has been shown to be effective, but it has limited usefulness because of adverse effects. This treatment involves the intravenous injection of a porphyrin derivative followed 24 hours later with exposure of the bladder surface to laser light. The laser is introduced through a cystoscope; its light activates the cytotoxic agent, which has preferentially concentrated within the cancer cells. The major adverse effect is severe photosensitivity, which can last for several months.

    Colombo et al have reported beneficial results using a combination of intravesical mitomycin-C and local microwave-induced hyperthermia. They compared a group of these patients with patients receiving only mitomycin-C and found a significant improvement in survival in the patients receiving combined therapy.
    Carcinoma-in-situ Pictures Atlas Colon Ileum attachment.php?s=29c41193d64633dd2e13c51f41266772&attachmentid=2041&d=1442165537

    Consider patients with recurrent carcinoma in situ (CIS) for an early cystectomy. Recurrent CIS, despite intravesical bacillus Calmette-Guérin (BCG), is associated with a 63% risk of progression to muscle-invasive bladder cancer. Recurrence after BCG treatment may also occur in the upper urinary tract or prostatic urethra. Excellent long-term survival outcomes have been reported in patients with CIS who receive radical cystectom

    References:
    DCIS — Ductal Carcinoma In Situ
    http://emedicine.medscape.com/articl...47-overview#a5











    Last edited by Medical Photos; 09-13-2015 at 05:32 PM.

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    Default Carcinoma in situ Pictures Atlas of Colon and Ileum

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