Staging and grading of DCIS

In breast cancer, DCIS is described as stage 0, which is the earliest stage and means there is no invasive breast cancer. DCIS can be of any size but is still always stage 0.

Grade Back to top

The grade shows how closely the DCIS cells resemble normal breast cells when they’re examined under the microscope. In DCIS the grade of the cells is important. It shows how likely DCIS is to come back in the breast or to develop into an invasive cancer.

 

There are three grades: low grade, moderate or intermediate grade, and high grade.

Low grade DCIS

The cells look similar to normal cells or to cells seen in a benign condition known as atypical ductal hyperplasia. This is where cells are being over produced (hyperplasia) but they are only slightly abnormal or atypical.

Moderate grade DCIS

The cells grow faster than normal cells and look a little less like normal cells.

High grade DCIS

The cells grow more quickly and look quite different from normal breast cells.

High grade DCIS is more likely to come back or develop into an invasive cancer than low grade DCIS. This information helps your doctors decide on the most appropriate treatment for you.

Cell type Back to top

The breast cells in DCIS also have a particular appearance and pattern that can be seen when they’re looked at under the microscope. The cells can be classified as either comedo or non-comedo.

Comedo cells are fast-growing (high grade) cells. Because the cells grow quickly, they don’t get enough nourishment and die off, leaving a build-up of dead cells in the middle of the duct.

Non-comedo cells types are papillary, cribiform and solid. There aren’t areas of dead cells because they aren’t fast-growing cells. This means it’s low grade or moderate grade DCIS.

DCIS with microinvasion Back to top

The pathologist will examine the tissue closely to see if there are areas where the cells have just started to spread through the duct walls. These very small areas where this occurs are called microinvasion.

Hormone receptors Back to top

Some DCIS cells have receptors on them that allow hormones, such as oestrogen, to attach to the cancer cell. The tissue that’s removed is tested to see if it has oestrogen receptors (ER positive). If your tests show the DCIS is ER positive, you may be given treatment with hormonal therapy| but usually only within a research trial.