DCIS diagnosis and treatment
Dear OncoLink "Ask The Experts,"
My mother is 71 years old, and has a ductal carcinoma in situ. The doctors scheduled her for a sentinel node biopsy, and informed us that regardless of the outcome, she would have to have radiation therapy, because of the involvement of the lymph nodes. My questions are, is sentinel node biopsy useful after having had the lumpectomy? Should it be performed at the same time? And why is radiation therapy mandatory?
Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania, responds:
There are a number of different issues that have been raised. First, the issue of whether or not a sentinel lymph node biopsy need to be performed should be discussed with the patient's doctors. In general, a sentinel lymph node biopsy is not routinely done for pure ductal carcinoma in situ (DCIS), but there are some exceptions. Second, a sentinel lymph node biopsy can be done at the same time as a lumpectomy, or can be done afterwards. Both approaches should provide the right information, and some surgeons prefer one approach or the other. Third, radiation treatment is often given after lumpectomy for DCIS. Randomized trials have shown that the use of radiation after lumpectomy reduces the chance that the tumor will recur in the breast. Finally, one of the important questions that needs to be discussed is whether or not the patient is a candidate for adjuvant tamoxifen. Usually, a medical oncologist can make this recommendation. Finally, there are some clinical trials available for patients with DCIS, and these can be discussed with the patient's doctors.