When people think about breast cancer, they usually think of a tumor inside the breast. Another very rare type of breast cancer, called Paget’s disease of the nipple, develops in or around the nipple instead of deep inside the breast.
What is cancer?
Cancer is a disease that results when normal cells in the body start to grow out of control and become abnormal cells. These abnormal cells multiply into tumors and sometimes invade or grow into other tissues. Some cancers can be inherited, but in most cases, cancer grows because of a mistake that happens at random when a normal cell is reproducing. As they continue to multiply, cancer cells can migrate to other parts of the body and form new tumors.
Breast cancer is typically a tumor that is malignant, or harmful, that grows in the tissue of the breast. Most breast cancer patients are women, but it is possible for men to develop breast cancer. A normal female breast has lobules which are glands that produce milk and ducts which are the tubes that carry milk from the lobules to the nipple so a baby can nurse. These ducts and lobules are surrounded by fatty tissue that gives the breast its size and shape.
What is Paget’s disease?
Paget’s disease of the nipple is a type of breast cancer that starts in the ducts of the breast then spreads out onto the skin of the nipple. From there it can also spread onto the skin of the areola, which is the darker circle around the nipple. Symptoms of Paget’s disease can include:
• Crust or scaling on the skin of the nipple and areola
• Itching or burning
• Pain or increased sensitivity
• Thickening of the skin
• Flattening of the nipple
• Yellow or bloody discharge from the nipple
Paget’s disease of the nipple is a very rare type of breast cancer which is found in less than 5 percent of all breast cancer cases. Paget’s disease is most common in patients who are over age 50, but some cases have been diagnosed in patients in their 20s. More than 95 percent of all Paget’s disease patients also have another type of breast cancer.
Most people who have Paget’s disease of the nipple also have the most common type of breast cancer which is known as ductal carcinoma in situ or DCIS. This cancer occurs when abnormal cells are found in the lining of the milk ducts. The term in situ means the cancer is still in its original location and has not spread out into the tissue of the breast. Some scientists believe these cells can break away and travel through the milk ducts to the nipple where they become Paget’s disease. Depending on how quickly Paget’s disease is diagnosed, it may also be found along with more invasive breast cancer that has spread into the tissue and formed a tumor.
Treatment for Paget’s disease
If the doctor suspects Paget’s disease, a small sample of tissue from the nipple will be sent to the lab to confirm the diagnosis. The standard treatment for Paget’s disease is surgery. The type of surgery depends on the type and severity of other cancer cells found in the breast. Paget’s disease is normally found in only one breast. A mastectomy may be done to remove the breast, or a radical mastectomy may include removal of the breast and the lymph nodes in the arm pit. In cases where no other cancer is present, treatment may be limited to a lumpectomy which removes only the nipple and areola. Sample lymph nodes from the area may also be removed to make sure the cancer is not spreading. Surgery for breast cancer is often combined with radiation or chemotherapy to reduce the chances that the cancer could come back.
Because it is so rare, Paget’s disease can easily be mistaken for a severe skin rash or inflammation. Symptoms of Paget’s may seem to come and go, but get progressively worse over time. If topical creams to treatment skin rash symptoms are not effective, you may want to schedule an appointment with a doctor who specializes in breast health.
Paget’s disease of the nipple should not be confused with Paget’s disease of the bone, or Paget’s disease of the vulva, although all three conditions were discovered by Sir James Paget.
Sources:
BreastCancer.org
National Cancer Institute
American Cancer Society
American Cancer Society: Breast Cancer Fact Sheet