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Paget’s Disease Breast Cancer

Treatment For Pagets Disease

What causes breast pain with itchy nipples? – Dr. Shailaja N

You have surgery to remove either the whole breast or just the affected area . Further treatment depends on:

  • whether you have DCIS or a cancer
  • how abnormal the cells look under the microscope
  • whether the cancer cells have receptors for particular hormones
  • whether the cells have receptors for targeted cancer drugs

Hormone Treatment Targeted Therapy And Chemotherapy

Depending on the type of cancer, a doctor may recommend drug therapy with either hormones or medications that target genes specific to cancerous cells.

These treatments can reduce the risk of the cancer spreading.

Chemotherapy may help prevent the cancer from returning after treatment, especially if:

  • the tumor was large
  • the cells had spread to the lymph nodes
  • the cells are of an aggressive type

After treatment finishes, it is essential to attend all follow-up appointments and to continue to monitor for changes.

The outlook will depend on various factors, including:

  • whether there is a tumor in the breast
  • the type of cancer, if a tumor is present
  • the stage of the cancer, if the cancer is invasive

Lymph node swelling can also affect a persons outlook.

What Pagets Disease Of The Breast Is

This condition develops in the nipple or the darker area of skin around it .

Pagets disease is a sign that there might be breast cancer in the tissues behind the nipple. It is possible for someone to have Pagets of the breast with no underlying cancer but this is less common.

About half of the people diagnosed with Paget’s disease have a lump behind the nipple. In 9 out of 10 cases, this is an invasive breast cancer. Invasive breast cancer can also be present in some people with Paget’s disease who have no lump.

Paget’s disease is rare. It is found in around 1 to 4 out of every 100 breast cancers . It can happen in men but this is even more rare.

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Paget’s Disease Of The Breast Treatment

The treatment depends on the underlying breast cancer. You might have one or more these:

  • Mastectomy. Your surgeon removes your entire breast.
  • Lumpectomy. If the disease affects only your nipple and the area around it, your doctor could suggest this treatment to save your breast. They might call it breast-conserving surgery. The surgeon will remove your nipple, your areola, and the part of the breast where they think the cancer is.
  • Radiation. High-energy radiation can kill cancer cells. It might come from a machine outside your body or from a small implant in your breast .
  • Chemotherapy. Certain drugs also kill cancer cells. You can get them in a pill that you swallow or in a liquid that goes into your vein .
  • Hormonal therapy. These drugs keep estrogen from reaching cancer cells so cancer doesnt grow or come back. They work on cancers that are positive on a hormone receptor test. You could get a selective estrogen receptor modulator or an aromatase inhibitor . They come in pills.

Our Approach To Benign Conditions Of The Nipple

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There are a variety of conditions that can mimic Pagets disease such as atopic dermatitis, nipple eczema, psoriasis, nipple adenoma or contact dermatitis. Our medical team will answer your questions about these topics in during an office visit.

In the collective experience of our breast-dedicated medical team, most patient referrals with a suspicion of a Pagets disease diagnosis have similar changes in both nipples. Pagets disease tends to affect only one side. Patients demonstrating bilateral nipple change are usually referred to a dermatologist who will evaluate the underlying cause of the nipple change if the mammogram is normal.

The majority of patients who have a skin punch biopsy end up with a benign result. These patients simply require reassurance there is no cancer present at the time of the office visit. Follow-up observation with the referring doctor is indicated.

Sometimes a moisturizing cream is helpful to control nipple dryness. Patients with persistent symptoms following a negative biopsy are also referred to a dermatologist for treatment.

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Can Pagets Disease Be Invasive

Some people with Pagets disease will also have developed an invasive breast cancer.

Invasive breast cancer has the potential to spread from the breast to other parts of the body.

In many cases this will mean a breast lump has also developed in the affected breast.

Even if theres no lump, some people may still have an invasive cancer.

Making A Pagets Disease Diagnosis

The diagnosis of Pagets disease is actually quite easy. Breastlink breast-dedicated physicians use a simple skin punch biopsy technique to remove a small piece of tissue from the area of the nipple affected by the abnormal changes. This procedure is painless and takes a few minutes to perform under local anesthesia. A small amount of skin and underlying tissues is removed and sent to a pathologist. In our experience, with hundreds of cases, it has proved to be highly accurate.

The first step to evaluate a patient with a change in the skin of the nipple is to obtain a detailed history and perform a careful breast examination, followed by a diagnostic mammogram. If Pagets disease is diagnosed, the next step is to identify the location of the underlying breast cancer.

More than 50 percent of patients with Pagets disease will have an abnormality on their mammogram. When performing a diagnostic mammogram, the mammogram technologist is informed about the possibility of a Pagets disease diagnosis. Special films look for fine calcifications behind the nipple.

If the mammogram is negative, and our clinical suspicion is low, we usually suggest the patient use a cortisone cream on the nipple for two weeks. If the symptoms persist, or there is a clinical concern, additional imaging techniques such as a breast ultrasound and/or MRI can be ordered. Careful follow-up is always needed with a potential diagnosis of Pagets disease.

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Diagnosis Of Paget Disease Of The Breast

Paget disease of the breast is usually found when an underlying breast cancer is diagnosed. In these cases, the tumor grows from underneath the nipple and breaks out onto the skin surface of the nipple.

Paget disease of the breast can also be diagnosed from a biopsy of the nipple skin and the tissue just below the skin. This may be done with a punch biopsy or other nipple biopsy procedure.

Causes Of Paget’s Disease Of The Nipple

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The cause of Paget’s disease of the nipple is unknown. Some women appear to be more at risk of developing breast cancer, but not specifically Paget’s disease. There are no known causes that lead to a specific type of breast cancer.

In terms of risk factors, you’re more likely to develop breast cancer if you:

  • are older the risk of developing breast cancer increases with age
  • have close relatives with breast cancer
  • have had breast cancer before
  • have had a type of benign breast disease before certain types of benign breast disease may be associated with an increased risk of breast cancer, but this is only seen in a very small number of women
  • are overweight particularly if you’ve been through the menopause
  • drink a lot of alcohol your risk can increase with the amount of alcohol you drink

Read more about the risk factors for breast cancer.

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What Are The Symptoms Of Pagets Disease

In most cases, Pagets disease affects one breast, and the symptoms may come and go. This means symptoms may cycle through, appearing to improve and then worsen again. The symptoms may look similar to eczema or other such skin conditions.

Patients may notice:

  • Patches of thickened skin on the nipple or surrounding skin
  • Itching or tingling in the nipple or areola
  • Yellow or bloody discharge in the nipple or areola
  • A nipple that looks flaky, crusty or red
  • A nipple that appears to be flattened or inverted, meaning it caves inward

Diagnosis Of Paget Disease Of The Nipple

The redness, oozing, and crusting closely resemble dermatitis, but physicians should suspect carcinoma because the lesion is sharply marginated, unilateral, and unresponsive to topical therapy. Biopsy shows typical histologic changes.

Because this tumor is associated with underlying cancer, systemic evaluation is required.

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Pagets Disease Of The Nipple Diagnosis

Your doctor will use one or more of the following tests to diagnose Pagets disease of the nipple:

  • Breast exam – your doctor will begin by performing a breast exam, in which he or she uses the pads of the fingers to carefully check your breasts for abnormalities.
  • Biopsy – during this test, your doctor removes a biopsy from the suspicious area. The biopsy is sent to the lab for close analysis, where technicians can determine if there are any abnormalities present.
  • Breast magnetic resonance imaging – an MRI uses magnets and radio waves to generate detailed images of the inside of the body. Before undergoing the breast MRI, you will receive an injection of a contrast dye to your vein. Contrast dye helps the images show up brighter and more clearly.
  • Breast ultrasound – this type of imaging test uses sound waves to create detailed images of the inside of your body. Your doctor can use ultrasound images to determine if there are any abnormalities present.
  • Mammogram – this type of imaging test is a specialized X-ray used to screen the breasts for abnormalities.

Who Gets Paget Disease Of The Breast

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Paget disease of the breast occurs in both women and men, but most cases occur in women. Approximately 1 to 4 percent of all cases of breast cancer also involve Paget disease of the breast. The average age at diagnosis is 57 years, but the disease has been found in adolescents and in people in their late 80s .

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Pagets Disease Of The Nipple

Paget’s disease is a rare cancer of the nipple and areola, the darker skin around the nipple. It affects both men and women.

The symptoms include irritation around the nipple, flaky or crusty skin and nipple discharge. The majority of people with Paget’s disease also have another type of cancer, so it’s important to see your doctor if you notice these signs.

Can Paget’s Disease Of The Breast Be Cured

Breast cancer survival is based on the stage of the cancer when its detected. If you only have Paget’s disease of the nipple or ductal carcinoma in situ that hasnt spread beyond the milk ducts, your prognosis is excellent. Most people who discover and treat these conditions early will make a full recovery. Once breast cancer begins to spread, it becomes progressively harder to beat.

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Pagets Disease Of The Nipple Treatment

Depending on your personal health history, the extent of your Pagets disease of the nipple and other factors, your oncologist may recommend one or more of the following treatment options:

  • Surgery – if you are diagnosed with Pagets disease of the nipple, you will likely need to undergo surgery. Your surgeon will advise you on the type of surgery you will need to undergo, which will typically depend on the extent of your condition. Your surgeon will work to preserve as much surrounding healthy tissue as possible. In some cases, you may opt to undergo reconstructive surgery following surgery to treat breast cancer.
  • Chemotherapy – you may need to undergo chemotherapy after your surgical treatment. During this treatment, medication is used to destroy cancerous cells. Chemotherapy can be taken via an oral pill or intravenously . Chemotherapy can help destroy any cancerous cells that your surgeon was not able to remove surgically.
  • Hormone therapy – your doctor may prescribe hormone medications, which can reduce your chance of recurrence of Pagets disease of the nipple after you have undergone surgery to remove the affected area.
  • Radiation therapy – you may need to undergo radiation therapy after your surgery for Pagets disease of the nipple. During this treatment, radiation is used to destroy any microscopic cancerous cells that could not be removed surgically.

Risk Factors Causes And Symptoms

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Per , most cases of Paget’s disease of the breast occur in females, although males can get the disease too. While the average age at which a person is diagnosed is 57, it has been diagnosed in teenagers and people in their 80s.

According to , some risk factors include being age 55 or older, having a family or personal history of breast cancer, and having inherited a genetic defect. You may also be more likely to develop the condition if you drink excessive amounts of alcohol or are overweight, have breast tissue that is considered denser than average, or have experienced radiation exposure to the chest.

lists several common symptoms of this cancer. Symptoms include flaky or scaly skin on your nipple. In addition, the skin on the nipple, areola, or both may be crusty and resemble eczema. There may also be itching or redness. Discharge from the nipple may be present and either straw-colored or bloody. Also, the nipple may be inverted. Additionally, there may be a thickening of the skin on the breast and feelings of tingling or burning on the breast. Generally, symptoms are only present on one breast.

It is unknown precisely what causes Paget’s disease of the breast. Per NCI, a leading theory is that cancer cells from inside the breast travel through the breast’s milk ducts to the nipple and areola. Another theory is that cancer originates on the nipple and areola themselves.

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What Type Of Breast Cancer Causes Itching

If your breasts itch, it typically does not mean that you have cancer. Most often the itch is caused by another condition, such as dry skin. There is a chance, however, that persistent or intense itching could be a sign of an uncommon type of breast cancer, such as inflammatory breast cancer or Pagets disease.

Causes Of The Dangers Of Piaget S Disease Of The Breast

Piaget’s disease of the breast is a rare and benign condition that affects the ductal system of the breast. It is characterized by the formation of benign cysts and ductal hyperplasia, which can lead to breast pain, breast lump, and breast tissue thickening.

The exact cause of Piaget’s disease of the breast is not known, but several factors have been suggested to contribute to its development.

Hormonal factors: Hormonal changes in the body, such as those that occur during pregnancy, menopause, or the use of hormonal medications, have been linked to the development of Piaget’s disease of the breast. The disease is more common in women who have had multiple pregnancies, and it is also more likely to occur in women who are taking hormone replacement therapy or birth control pills.

Genetic factors: Piaget’s disease of the breast can run in families, suggesting that there may be a genetic component to the condition. Studies have identified genetic mutations in the BRCA1 and BRCA2 genes that are associated with a higher risk of developing the disease.

Environmental factors: Exposure to certain chemicals and toxins, such as pesticides and pollutants, has been linked to an increased risk of Piaget’s disease of the breast.

Other factors: Certain lifestyle factors, such as obesity, smoking, and alcohol consumption, have been linked to an increased risk of Piaget’s disease of the breast.

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What Are The Symptoms Of Paget Disease Of The Breast

The symptoms of Paget disease of the breast are often mistaken for those of some benign skin conditions, such as dermatitis or eczema . These symptoms may include the following:

  • Itching, tingling, or redness in the nipple and/or areola
  • Flaking, crusty, or thickened skin on or around the nipple
  • A flattened nipple
  • Discharge from the nipple that may be yellowish or bloody

Because the early symptoms of Paget disease of the breast may suggest a benign skin condition, and because the disease is rare, it may be misdiagnosed at first. People with Paget disease of the breast have often had symptoms for several months before being correctly diagnosed.

Pagets Disease Of The Breast Prevention

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Theres no definite way to prevent cancer, but some lifestyle changes can help make it less likely.

  • Keep a healthy weight.
  • Get regular exercise. Moderate to high-intensity activity is best.
  • Limit how much alcohol you drink. Experts recommend no more than one drink a day for women and two for men.
  • Breastfeeding may also lower your risk of breast cancer.

If you have one or more breast cancer risk factors, talk to your doctor about further steps, including:

  • Testing to look for changes in your genes
  • More frequent checkups or screening tests
  • Medicines to block estrogen such as raloxifene and tamoxifen
  • Breast removal surgery

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Paget Disease Of The Breast

Paget disease is a rare form of breast cancer, making up 1-4% of all breast cancer cases, according to the National Cancer Institute. The disease first appears on the nipple and often extends to the areola. In many patients, Paget disease may also be associated with a tumor or tumors in the affected breast.

Symptoms of Paget disease of the breast include:

  • Eczema-like skin changes of the nipple and/or areola, including skin crusting, thickening and flakiness
  • An ulcer on the nipple and/or areola
  • Tingling or burning of the nipple and/or areola
  • A flattened or inverted nipple
  • Yellow or bloody nipple discharge
  • A lump or lumps in the same breast as the affected nipple.

Many of these symptoms can be confused with skin conditions like eczema or dermatitis. As a result, many people show signs of Paget disease for several months before it is diagnosed. Partly due to these later-than-normal diagnoses, the survival rate for Paget disease is slightly lower than for breast cancer overall. However, if the disease is caught early, the chances for a cure are high.

If a doctor suspects a patient has Paget disease of the breast, the breast should be imaged. This can be done by a mammogram or possibly an ultrasound. If anything suspicious shows up in the image, such as a lump or calcified tissue, a small sample of the tissue is retrieved. This is often done during the imaging exam. From there, a pathologist will study the tissue sample in order to make a diagnosis.


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