Paget Disease Of The Breast
up to 4 percent of all breast cancer cases.
Paget disease is a rare cancer that forms in the milk ducts and spreads to the skin of the nipple and areola, the skin around the nipple. According to the National Cancer Institute, this type of breast cancer is usually accompanied by DCIS or an invasive tumor within the breast.
The symptoms of Paget disease are often mistaken at first for skin conditions, like eczema or dermatitis. However, the symptoms wont respond to topical treatments.
The typical symptoms of Paget disease include:
- redness, flaking or crusting around the nipple and areola
- a tingling or itching sensation around the nipple area
- thickened skin on or near the nipple
- a flattened nipple
What Are The Treatments For Ibc
- Chemotherapy: Because IBC presents in advanced stages, the initial treatment is chemotherapy, sometimes in combination with other medications. This may include a clinical trial.
- Mastectomy: Once chemotherapy treatment is completed for locally advanced IBC, surgery is recommended to remove the affected breast. Since IBC involves the lymphatic system channels that carry lymph throughout the breast a modified radical mastectomy that removes the whole breast and lymph nodes under the armpit is the only way surgical option to remove the cancer. Breast-conserving surgery is not an option for patients with IBC, regardless of the response obtained with chemotherapy.
- Radiation therapy: Radiation therapy is used following surgery to address any cancer left behind in the skin or lymph nodes.
- Additional treatments after surgery: Often additional chemotherapy, hormone therapy, or other medications are recommended after surgery.
- Treatment for IBC that has spread to other parts of the body: For IBC that has spread to other parts of the body, such as bone, the liver, or lungs, the main treatment is chemotherapy or other drugs that work throughout the body, as well as on the IBC in the breast.
Other Symptoms And Signs Of Breast Cancer
Other signs which may be noticed in the affected breast include:
- Changes in the size or shape of a breast.
- Dimpling or thickening of some of the skin on a part of a breast.
- The nipple turning in .
- Rarely, a discharge occurring from a nipple .
- A rare type of breast cancer, causing a rash around the nipple, which can look similar to a small patch of eczema.
- Rarely, pain in a breast. Note: pain is not a usual early symptom. Many women develop painful breasts and this is not usually caused by cancer.
The first place that breast cancer usually spreads to is the lymph glands in the armpit . If this occurs, you may develop a swelling or lump in an armpit. If the cancer spreads to other parts of the body then various other symptoms can develop.
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What Are The Symptoms Of Ibc
Symptoms of IBC can include:
- Swelling or enlargement of the skin of the breast
- Redness over more than one-third of the breast
- Pain or itchiness of the breast
- Pitting or thickening of the skin of the breast, giving it the appearance and texture of an orange peel
- Flattening or turning inward of the nipple
- A feeling of unusual warmth or heaviness in the affected breast
- Swelling of the lymph nodes in the armpit or near the collarbone
Some of these symptoms, particularly tenderness, redness, warmth, and itching, also can be caused by infection or inflammation of the breast, which are more common than IBC. If you experience any of these symptoms, have them examined by your doctor right away.
Because swelling and redness of the breast are more likely to be caused by an infection than by IBC, doctors may initially prescribe a course of antibiotics. If these dont lead to the complete resolution of your symptoms, its critical that you return to your doctor for further tests.
Invasive Breast Cancer Symptoms
Most breast cancers start in the ducts, or the tubes that carry milk to the nipple, or in the lobules, the little clusters of sacs where breast milk is made. Invasive breast cancer refers to breast cancer that spreads from the original site to other areas of the breast, the lymph nodes or elsewhere in the body. In these cancers that form in the ducts or lobules, invasive ductal carcinoma or invasive lobular carcinoma , the cancer spreads from the ducts or lobules to other tissue. Depending on the stage, you may notice symptoms.
Invasive breast cancer symptoms may include:
- A lump or mass in the breast
- Swelling of all or part of the breast, even if no lump is felt
- Skin irritation or dimpling
- A lump or swelling in the underarm lymph nodes
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Predictors For Breast Cancer Survival Rates
It has to be remembered that every single breast cancer patient has itsown , unique scenario. Thus, prognosis and breast cancer survival rates are a rough guide ONLY.
However, there are consistent predictors for breast cancer survival rates and these include:-
- The stage of breast cancer at the time of diagnosis
- The Grade of the breast cancer
- A patients age at diagnosis
Questions About Inflammatory Breast Cancer Answered
Inflammatory breast cancer accounts for only about 2-4% of new breast cancer diagnoses each year. But because its so aggressive, it makes up a disproportionate number of breast cancer-related deaths annually, even though its rare.
IBC has been called both the silent killer and the master metastasizer, because its often misdiagnosed and it spreads so quickly, explains Wendy Woodward, M.D., Ph.D. Thats why speed is so critical in both the diagnosis and treatment of inflammatory breast cancer.
We spoke with Woodward to learn more. Heres what she wants people to know about inflammatory breast cancer.
What are the symptoms of inflammatory breast cancer, and how do they differ from other types?
Classic inflammatory breast cancer symptoms develop fairly quickly , and can include swollen breasts, red skin and nipple inversion. Unlike other types of breast cancer, inflammatory breast cancer doesnt usually show up as a lump or appear in a screening mammogram, which is why its often misdiagnosed.
Is there a genetic component to this disease? Are any screening tests available?
Are some people more likely to develop inflammatory breast cancer than others?
Yes. IBC tends to occur most in two groups: post-menopausal women and young mothers. In the latter, its development seems to be influenced by normal changes that take place in breast tissue after childbirth .
Why is getting an accurate diagnosis so important with inflammatory breast cancer?
How Is Inflammatory Breast Cancer Diagnosed
Inflammatory breast cancer can be difficult to diagnose. Often, there is no lump that can be felt during a physical exam or seen in a screening mammogram. In addition, most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram more difficult. Also, because inflammatory breast cancer is so aggressive, it can arise between scheduled screening mammograms and progress quickly. The symptoms of inflammatory breast cancer may be mistaken for those of mastitis, which is an infection of the breast, or another form of locally advanced breast cancer.
To help prevent delays in diagnosis and in choosing the best course of treatment, an international panel of experts published guidelines on how doctors can diagnose and stage inflammatory breast cancer correctly. Their recommendations are summarized below.
Minimum criteria for a diagnosis of inflammatory breast cancer include the following:
- A rapid onset of erythema , edema , and a peau d’orange appearance and/or abnormal breast warmth, with or without a lump that can be felt.
- The above-mentioned symptoms have been present for less than 6 months.
- The erythema covers at least a third of the breast.
- Initial biopsy samples from the affected breast show invasive carcinoma.
Imaging and staging tests include the following:
When To Consider Joining A Clinical Trial
If youre newly diagnosed with IBC, consider joining a clinical trial before starting treatment. For most people, treatment doesnt usually start right after youve been diagnosed. So, theres time to look for a clinical trial.
Once youve begun treatment for IBC, it can be hard to join a clinical trial.
Susan G. Komen® Breast Care Helpline
If you or a loved one needs information or resources about clinical trials, call the Komen Breast Care Helpline at 1-877 GO KOMEN or email .
The Helpline offers breast cancer clinical trial education and support, such as:
Learn more about clinical trials.
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.
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The Breast Cancer Centers At Ctca
At the Breast Cancer Centers at each of our CTCA® hospitals, located across the nation, our cancer experts are devoted to a single missiontreating breast cancer patients with compassion and precision. Each patients care team is led by a medical oncologist and coordinated by a registered oncology nurse, who helps track the various appointments, follow up on tests and answer questions that come up along the way. Your care team also may include a breast surgeon, radiation oncologist, radiologist, pathologist and a plastic and reconstructive surgeon with advanced training in helping patients restore function and appearance. Fertility preservation and genetic testing are also available for qualifying patients who need them.
Our pathologists and oncologists are experienced and trained in tools designed to diagnose, stage and treat different types of breast cancer, from early-stage ductal carcinoma in situ to complex diseases such as triple-negative and inflammatory breast cancer. As part of our patient-centered care model, which is designed to help you keep strong during treatment, your multidisciplinary care team may recommend various evidence-informed supportive therapies, such as naturopathic support, psychosocial support, nutritional support, physical and occupational therapy and pain management. The entire team works together with a whole-person focus, which is at the heart of our centers dedication to personalized and comprehensive care.
About The Medical Reviewer
Dr. Lynce received her medical degree from the Universidade Nova de Lisboa, Portugal in 2004. She completed her residency in Internal Medicine and fellowship in Hematology and Medical Oncology at MedStar Washington Hospital Center/MedStar Georgetown University Hospital in Washington, DC. She was faculty at MedStar Georgetown University Hospital from 2015 to 2020 where she served as the institutional PI for Alliance and the co-PI for the National Capital Area Minority/Underserved NCORP. In 2020, she joined the staff of Dana-Farber Cancer Institute and Brigham and Women’s Hospital, where she is a medical oncologist and clinical investigator in the Breast Oncology Center. Her research focuses on inflammatory breast cancer, triple-negative breast cancer, BRCA-associated breast cancers and novel therapies in the treatment of breast cancer.
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Cutting Off Cancers Escape Route
The scientist looked at a type of immunotherapy called checkpoint inhibitors. These immune-boosting treatments became a breakthrough cancer treatment in the last decade, approved to treat some lung cancers, melanomas and head and neck cancers, among others. But despite their promise, not everyone responds to checkpoint inhibitors, something scientists are keen to change.
When the researchers treated tumours growing in mice using a checkpoint inhibitor, less than 30% of the mice responded to treatment.
But when the mice were given the checkpoint inhibitors along with a common anti-inflammatory called celecoxib , up to 70% of the mice responded to the combined treatment with many having their tumours fully eradicated. Celecoxib targets a protein called COX-2, which helps cancer cells escape the immune system and grow aggressively. By cutting off the cancers escape route, the drug can help make checkpoint inhibitors more effective.
Similar results were also achieved when combining checkpoint inhibitors with steroid anti-inflammatory drugs a surprising finding, as steroids are widely considered to suppress the immune system.
Zelenay said: Improving the efficacy of the immune checkpoint blockade remains a major clinical need, so our progress in this area is very exciting.
Our study has identified mechanisms by which anti-inflammatory drugs can rapidly enhance an immune response in tumours that can prevent their growth.
Phyllodes Tumors Of The Breast
In about 75 percent of cases, phyllodes tumors arent cancerous, so they usually dont spread beyond the breast. But they can grow quickly and some can be considered borderline, which means they have properties that could make them cancerous at a later stage.
Phyllodes tumors form in the connective tissue of the breast. The most common symptoms include:
- a smooth lump in or around the breast
- a lump that grows quickly and stretches the skin
- breast skin that looks red and feels warm
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Can Breast Cancer Be Prevented
A lot of breast cancers are detected at an early stage, by breast screening. However, a small number are not. Some women may have developed breast cancer before they have their first mammogram and some may develop breast cancer between mammograms. All women of every age should be breast aware. That is, get to know how your breasts and nipples normally look and feel. Try to recognise any changes that occur before and after your periods. See your GP if you notice any changes, lumps, or other abnormalities in your breasts or nipples. Don’t wait until your next scheduled screening appointment.
There is some evidence that regular exercise may reduce your risk of breast cancer by as much as a third. If you have been through the menopause, it is particularly important you are not overweight or obese. This is because being overweight causes more oestrogen to be produced, which can increase the risk of breast cancer.
Studies have shown that women who breast-feed their children are less likely to develop breast cancer than those who do not. The most likely reason for this is that women do not produce an egg as regularly while they are breast-feeding and oestrogen levels remain stable.
If You Experience Pain Along With Any Of The Following Symptoms You Should Contact Your Physician
- Bloody or clear discharge from your nipple
- A new lump with the onset of the pain lump does not go away after your menstrual period
- Persistent, unexplained breast pain
- Signs of a breast infection, including local redness, pus, or fever
- Redness of the skin of the breast that may appear as a rash, with dilated pores, and possibly skin thickening.
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Are There Different Types Of Ibc
Like more common forms of breast cancer, IBC can be classified by whether it grows in response to estrogen and progesterone, whether it carries a surplus of the HER2 protein, and whether like triple-negative breast cancer it lacks receptors for progesterone and estrogen and doesnt produce excess HER2. Each of these factors can influence the treatment patients receive.
Types Of Breast Cancer
There are many types of breast cancer, and many different ways to describe them. Its easy to get confused over a breast cancer diagnosis.
The type of breast cancer is determined by the specific cells in the breast that are affected. Most breast cancers are carcinomas, which are tumors that start in the epithelial cells that line organs and tissues throughout the body. When carcinomas form in the breast, they are usually a more specific type called adenocarcinoma, which starts in cells in the ducts or the lobules .
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What Are The Symptoms Of Ibc And When Do They Develop
IBC symptoms can develop in three to six months. They are a result of lymph vessels becoming blocked and white blood cells building up. These symptoms include:
- Large patches of redness
- Swelling and warmth on your breast
- Dimpling or a thickness to the skin, giving it the texture and appearance of an orange peel
- Flat, inverted, bruised-looking nipple
- Generalized pain
These blockages may also cause the lymph nodes under your arm or around your collarbone to become swollen. If youre pregnant or breastfeeding, some of these symptoms might be mistaken for a common breast infection called mastitis. This is caused by breast tissue inflammation that usually affects people who are lactating, and they may or may not have an infection. You may initially be diagnosed with this condition and sent home with antibiotics. Its important to talk to your doctor if your symptoms dont go away in seven to 10 days.
Oncogene Expression May Negatively Affect Breast Cancer Outcome
A relatively new addition to the discussion of breast cancer survival statistics and prognosis is oncogene expression.
An oncogene is a tiny fragment of genetic material which is carried in a chromosome and can cause normal cells to become malignant.
The oncogene HER-2, in particular, has been linked to more aggressive breast cancers.
Around one-third of all breast tumours produce the HER-2 oncogene, and these patients tend to have higher rates of recurrence and lower overall breast cancer survival rates.
According to a 2013 Canadian scientific study, the overall 5-year survival rate of HER-2 positive breast cancer is 88.6%. Furthermore, the relapse-free survival rate for 5 years is 79.4%.
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