Medical News Today: Carcinoma in situ: What is it and how is it treated?

Carcinoma in situ is a cancer designation where a person has abnormal cells that have not spread beyond where they first formed. The words “in situ” translate to “in its original place.”

These in situ cells have the potential to become cancerous cells and spread to other nearby locations. Other names for carcinoma in situ are stage 0 disease, non-invasive cancer, or pre-invasive cancer.


This article will focus on some of the more common areas where doctors diagnose carcinoma in situ and the treatment approaches that can follow a diagnosis.







Where does carcinoma in situ occur?


Some of the most common types of carcinoma in situ are listed below:


Carcinoma in situ of the urinary bladder


Bladder cancer
Carcinoma in situ commonly occurs in the bladder.


The bladder is a common location where doctors detect carcinoma in situ. According to the Journal of the National Comprehensive Cancer Care Network, an estimated 3 percent of all first-time bladder cancers are carcinoma in situ.


Carcinoma in situ of the bladder is very common in those who have a history of bladder cancer that was previously in remission. Nearly 90 percent of people with bladder cancer see a recurrence.


This cancer type is most commonly detected among male smokers who are between the ages of 60 to 70 years old.



Cervical carcinoma in situ


Doctors may identify cervical carcinoma in situ as pre-cancerous cells that rest on the surface layer of the cervix.


Doctors can treat this pre-cervical cancer type, but the cancer can sometimes recur. For this reason, doctors recommend continued Pap smear tests to check for any further pre-cancerous cells.



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Ductal carcinoma in situ (DCIS)


Doctors also call this type of carcinoma in situ intraductal carcinoma. It is one of the most common types of breast cancer, according to the American Cancer Society.


Ductal means that cells are growing in the milk ducts of the breasts. According to BreastCancer.org, an estimated 20 percent of breast cancers diagnosed annually in the United States are DCIS, equivalent to about 60,000 cases.



Squamous cell carcinoma in situ or Bowen disease


This skin cancer type is one of the earliest-known forms of squamous cell skin cancers. Again, according to the American Cancer Society, an estimated 2 out of 10 skin cancers are squamous cell skin cancers.


The cells in this type of carcinoma in situ most commonly appear on areas of the skin exposed to the sun, such as face, ears, and neck. They are more likely to grow deeper into the skin, as well as spread to other areas of the body.


The disease types listed above are just a few examples of the different areas where carcinoma in situ can occur. 




How is carcinoma in situ treated most effectively?


Some of the common treatments for each type of carcinoma in situ include:


Carcinoma in situ of the urinary bladder


surgeons at work in surgery
Surgery is recommend in the majority of cases for carcinoma in situ of the urinary bladder.


Almost all people with carcinoma in situ of the urinary bladder will undergo surgery to remove the pre-cancerous cells.


Examples of surgical procedures include transurethral resection or biopsy with electrical or laser cautery.


If doctors still detect cancerous cells after these procedures, they may recommend radical cystectomy or surgical removal of the bladder.


However, because older individuals are the most likely to present with this condition, doctors may recommend watchful waiting, as the time it could take for the cancer to progress may be longer than a person’s life expectancy.



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Cervical carcinoma in situ


In this type, doctors will often recommend removal of the precancerous cells to prevent them from turning cancerous and to reduce the likelihood of them spreading.


A doctor can remove the cells using cryosurgery, laser surgery, cold knife conization, or loop electrosurgical excision procedure (LEEP/LEETZ).


If a woman is no longer in her childbearing years, a doctor may recommend a hysterectomy.



Ductal carcinoma in situ (DCIS)


With cases of DCIS, a doctor will discuss treatment options with a woman, depending upon where in the breast the cancerous cells are.


One option is breast-conserving surgery (BCS), where the surgeon removes the cancerous cells, as well as a portion of normal breast tissue surrounding the tumor.


In some instances, a doctor may remove lymph nodes as well. A doctor may also recommend follow-up radiation therapy, to reduce the risk pre-cancerous cells could come back in the breast.


If the area of DCIS is large, a doctor may recommend a mastectomy, which involves removing the entire breast.



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Squamous cell carcinoma in situ or Bowen disease


Doctors will usually recommend removing the pre-cancerous cells in this type of carcinoma in situ. In some instances, a doctor may also recommend radiation to reduce the risk for cancer cell recurrence.


Choosing the right treatments


People should always discuss their treatment options carefully with their doctor.


Questions to ask include:


  1. “What are the chances this treatment will be successful?”

  2. “What are the side effects of this treatment?”

  3. “What happens if cancerous cells are still present afterward?”

Carefully weighing all options can help a person determine what is best for their individual health.




Outlook for carcinoma in situ


While a diagnosis of carcinoma in situ does not always mean the cells will become cancerous, the chances are usually so high the cells will one day be malignant that doctors recommend treatment.


By treating the cells before they become cancerous and can spread, a person will ideally have the greatest likelihood of being cancer-free.


The medical capabilities of identifying carcinoma in situ underlie the importance of a person engaging in preventive visits, such as women getting Pap smear tests and people going to a dermatologist for annual skin checks.

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