Sandbox: Singlepage Maria
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Synonyms and keywords: Intraductal hyperplasia; IDH; Atypical ductal hyperplasia; Comedocarcinoma; Duct cell carcinoma; Duct carcinoma
Overview
Ductal carcinoma is the most common type of breast cancer in women. Ductal carcinoma may be classified into 2 groups: invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS).
Historical Perspective
Ductal carcinoma was first described in 1893.
Classification
- Ductal carcinoma may be classified according to the Armed Forces Institute of Pathology (AFIP) into 2 groups:
- Intraductal hyperplasia (most common)
- Atypical ductal hyperplasia
- Other variants of ductal carcinoma include, non-DCIS entities.
Pathophysiology
- The pathogenesis of ductal carcinoma is characterized by the microinvasion of cancer cells to the ducts of the breast.
- The mutation on HER2/neu has been associated with the development of ductal carcinoma.
- On gross pathology, characteristic findings of ductal carcinoma, include:
- On microscopic histopathological analysis, characteristic findings of ductal carcinoma, include:
Causes
- Common causes of ductal carcinoma, may include:
Differentiating ductal carcinoma from other Diseases
- Ductal carcinoma must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
- [Differential dx1]
- [Differential dx2]
- [Differential dx3]
Epidemiology and Demographics
- The prevalence of ductal carcinoma is approximately 32.5 per 100,000 women worldwide.
- In [year], the incidence of ductal carcinoma was estimated to be [number or range] cases per 100,000 individuals in [location].
Age
- Ductal carcinoma is commonly observed among females between 40 to 80 years old
- Ductal carcinoma is rarely observed among males between 60 and 70 years of age
- Ductal carcinoma is more commonly observed among postmenopausal women
Gender
- Ductal carcinoma affects men and women equally.
- [Gender 1] are more commonly affected with ductal carcinoma than [gender 2].
- The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
Race
- There is no racial predilection for ductal carcinoma.
Risk Factors
- Common risk factors in the development of ductal carcinoma, include:
- Family history of breast cancer
- Mutations in BRCA1/BRCA2 genes
- Previous exposure to radiation therapy
- Increased breast density
- Hormonal therapy
- Nulliparity
- Obesity
Natural History, Complications and Prognosis
- The majority of patients with ductal carcinoma remain asymptomatic for years.
- Early clinical features include skin color change or nipple discharge.
- If left untreated, the majority of patients with ductal carcinoma may progress to develop lymph node invasion, and metastasis.
- Common complications of ductal carcinoma include [complication 1], [complication 2], and [complication 3].
- Prognosis generally depends on the histological subtype.
- In general, the [1/5/10year mortality/survival rate] of patients with ductal carcinoma is approximately [#%].
- Factors related with worse prognosis, include: young age at diagnosis, black ethnicity, and high grade cancer.
Diagnosis
Diagnostic Criteria
- The diagnosis of ductal carcinoma is made when at least [number] of the following [number] diagnostic criteria are met:
- [criterion 1]
- [criterion 2]
- [criterion 3]
- [criterion 4]
Symptoms
- Ductal carcinoma is usually asymptomatic.
- Symptoms of ductal carcinoma may include the following:
- [symptom 1]
- [symptom 2]
- [symptom 3]
- [symptom 4]
- [symptom 5]
- [symptom 6]
Physical Examination
- Patients with ductal carcinoma usually appear [general appearance].
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings
- There are no specific laboratory findings associated with ductal carcinoma.
- A [positive/negative] [test name] is diagnostic of ductal carcinoma.
- An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of ductal carcinoma.
- Other laboratory findings consistent with the diagnosis of ductal carcinoma include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Imaging Findings
- Mammography is the imaging modality of choice for ductal carcinoma.
- On mammography, findings of ductal carcinoma, include:
Other Diagnostic Studies
- Ductal carcinoma may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- The mainstay of therapies for ductal carcinoma are divided into 2 groups: hormonal therapy and targeted therapy.
Hormonal Therapy
- Selective estrogen receptor modulators, such as:
- Tamoxifen
- Raloxifene
Targeted Therapy
- HER2-directed therapy
- Trastuzumab
- The primary goal of medical therapy is to reduce the risk of ipsilateral or contralateral breast invasion.
- Response to medical therapy can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for ductal carcinoma.
- Surgical approaches for ductal carcinoma, include: mastectomy or breast-conserving therapy
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of ductal carcinoma.
- [Surgical procedure] can only be performed for patients with [disease stage] ductal carcinoma.
Prevention
- There are no primary preventive measures available for ductal carcinoma.
- Effective measures for the primary prevention of ductal carcinoma include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with ductal carcinoma are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].