Paget's disease of the nipple
Paget's disease of the nipple is a
rare type of breast cancer
It is usually only on one breast
It is characterised by the nipple
burning, scaling and being itchy
Can easily be mistaken for a rash
It is
linked to underlying breast cancer
What is
Paget's disease of the nipple
Paget’s disease of the nipple is a rare type of breast cancer, which
occurs mainly in older women, and appears as a rash on the nipple.
The
changes in the nipple usually indicate that there is an underlying cancer in the
breast ducts. This is often just under the nipple and has extended into the
nipple.
This
sign of breast cancer may indicate a non-invasive area of ductal carcinoma in
situ (DCIS).
In other
cases, Paget’s disease of the nipple may indicate an invasive cancer in another
part of the breast. Some women who come to the doctor with a nipple rash will
have a lump in the breast which can be found by physical examination or
mammogram.
Paget's
disease of the nipple should not be confused with Paget's Disease - which is a
bone disorder.
Who gets
Paget's disease of the nipple?
One to four percent of breast cancers involve Paget’s disease of the
nipple.
The
disease affects groups ranging from forty to eighty years of age, with an
average age of sixty years.
What are
the symptoms and signs of Paget’s disease of the nipple?
Most women notice this disease themselves since it starts with:
Persistent crustiness, scaling and
redness of the nipple
The nipple may itch or burn
There may be oozing or bleeding from
the nipple area
This
disease may look like eczema of the nipple at first. Eczema should respond to
simple treatment with corticosteroid creams. If a rash on the nipple does not
disappear with such treatment, then Paget’s disease is suspected. In an older
woman who goes to the doctor with a nipple rash, Paget’s disease should be
thought of without waiting to see if the rash responds to steroid creams.
Usually,
only one nipple is affected and the underlying nodules may surface, become
crusted, exudative, very hard, itchy, ulcerative and can bleed. The Paget's
growth is slow and it may become painful.
How is
Paget's disease of the nipple diagnosed?
If Paget’s disease is suspected, then the next step is often a
mammogram to see if there is any definite area of cancer within the breast.
However, if nothing is found, this is no reason to assume that further cancer is
not present.
A biopsy
of the nipple tissue will provide a definite diagnosis. If a lump or other
suspicious area of breast was found on mammogram, then this area will also be
biopsied.
Biopsy
The main test, which will help to check for evidence of cancer below
the skin surface. A small piece of skin and underlying breast tissue is taken
and sent to the laboratory to be examined under a microscope. The biopsy is
usually done using a local anaesthetic, which numbs the area.
Imprint or scrape cytolopgy
Cells from the affected area are scraped or pressed into a slide and
examined under a microscope.
Mammogram (breast x-ray)
Mammograms may be used to look for changes in the affected breast and
to check the other breast.
Can
Paget's disease of the nipple be prevented?
Although there is no known cause, the disease cannot be prevented. At
best it could be detected at an early stage which could guarantee proper
treatment and recovery.
How is
Paget's disease of the nipple treated?
Since Paget’s disease of the nipple is essentially a diagnosis of
breast cancer per se, the treatment is the same as that for any other form of
breast cancer which has been diagnosed early enough for surgery.
The
location of any cancer within the breast will determine the type of surgery
which is preferred.
If the
cancer is non-invasive, that is, DCIS, then a lumpectomy followed by
radiotherapy may be performed.
If the
cancer is far from the nipple, then a mastectomy may be needed to remove the
breast lump and the entire nipple.
Drug
therapy may be necessary after the mastectomy.
What is
the outcome of the disease?
Since Paget’s disease of the nipple is essentially a diagnosis of
breast cancer per se, the outcome is the same as that for any other form of
breast cancer which has been diagnosed early enough for surgery.
What
other conditions are similar to Paget's disease?
Fungal infections of the nipple (e.g. thrush) and eczema.
When to
call a doctor
Seek medical attention the moment you notice any skin changes,
especially around the breast.
Check
monthly for lumps, sores or oozing from your breast and report any changes
immediately to a physician.
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