After looking at some of the main causes of breast carcinoma and the symptoms of the Paget’s disease of the breast, we shall further expand our view on the diagnosis and treatment of Paget’s disease of the nipple.
Diagnosis of Mammary Paget’s Disease is based upon effective clinical examination, identifying characteristics, physical findings, a complete history of the patient, and a series of specialized tests. Since the disease is usually mistaken for other skin infections like eczema, this delays diagnosis.
Various tests used in diagnosis include:
This is an X-ray of the breast tissue used to indicate the pr3esence of Paget cells. Mammography can be used to detect or rule out underlying cancer if present. When results from mammography in both breasts fail to produce satisfactory signs of breast carcinoma, physicians may likely go in for more specialized imaging techniques like Ultrasound or Magnetic Resonance Imaging (MRI) which detect cancer that invisible on a mammogram.
Clinical Breast Exams.
Here, the Health Care Provider physically examines the unusual sections or areas in both breasts. He/she takes special note on the appearance of the skin and try to identify any areas of thickening or lumps.
Here, a small sample of breast tissue is taken and examined under a microscope to track Paget cells. Ladies with nipple discharge, a small sample of the discharge may also be collected for examination. After examination, women whose breasts have Paget or cancer cells are referred to a breast surgeon to deliberate on the options and mode of treatment.
Sentinel Lymph Node Biopsy.
Ladies with underlying invasive breast cancer may have a Sentinel Lymph Node Biopsy. Here, a tissue sample is taken from the lymph nodes under the armpits (axillary nodes) to verify if cancer cells have invaded this area. During this process, the physician locates and removes sentinel nodes (first lymph nodes) where cancer cells are most likely to invade. If the removed sentinel node is examined and found to be normal, then the chances of finding cancer in any of the other nodes are minimal and there is no need to remove any other node. The surgeon uses a harmless dye and a weak radioactive solution to tract the sentinel nodes.
Core Needle Biopsy.
This makes use of a long hollow tube to extract a tissue sample. A biopsy of a suspicious breast lump is done and samples are taken to the laboratory for testing.
Ladies with Mammary Paget Disease often go for surgery and the type of surgery depends on the severity of cancer and the skin condition around the nipple.
Mastectomy is the removal of the entire breast and usually the first line of treatment for Paget’s Disease of the Breast. Mastectomy was the most common form of treatment for this disorder because breast cancers were found in other parts of the same breast. And even when a single tumor may be present, the tumor may be found many inches away from the nipple and areola. Ladies going in for mastectomy are requested to do a sentinel lymph node biopsy. This checks the spread of cancer to the axillary nodes in the body. Generally, one of the lymph nodes is removed and examined to tract where the cancer is most likely to invade. And if the result proves positive, there is a need for a more efficient surgery that would target the axillary lymph node.
Sometimes, lymph node removed from the armpit during a mastectomy may generate to scars which tend to block the filtering action of the lymph nodes, leading to a long-term disorder called lymphoedema. However, lymphoedema can be treated through the following ways: skincare, specialized massage techniques, exercises, compression sleeves-tightly fitting bandages that force excess fluid from your arm. You may book an appointment with your Health Care Provider in case you find any swelling in your arm.
A recent and safer option, usually known as Breast-Conserving Surgery (BCS), which removes the disease portion of the breast. Here, the surgeon removes only a section of the breast, like the areola and nipple, and probably a minute breast tissue making sure that the removed tissue makes up an outer margin free of cancer or Paget’s cells thus retaining only healthy cells. However, if the removed or surrounding tissue has Paget’s cells, more tissue will be removed from the breast. Since nipple is often disabled, nipple reconstruction most often follows after lumpectomy, hence improving the appearance of the breast after the operation.
This is usually a supportive and additional treatment done after operation. After surgery for Paget’s Disease of the Breast, radiation therapy follows suit in which case radiation supplies powerful X-rays to breast tissues to wipe out leftover Paget’s cells.
Some physicians, after surgery, recommend chemotherapy or anti-cancer drugs to patients. These drugs eliminate leftover cancer cells after surgery and also prevent them from dividing and growing. These medications are given into the vein or with a pill.
For women with breast cancer as a result of naturally produced hormones in their body, physicians would recommend hormone therapy. These ladies are usually diagnosed with hormone receptor-positive breast cancer. This condition is treated by minimizing hormonal secretion in the body or blocking these hormones from reaching the tumor thereby inhibiting tumor growth.
Ladies may decide to undertake a reconstructive surgery after a mastectomy to recreate their breasts. This is often done by inserting a breast enlargement where implants are fitted into the lady’s breast to increase its size, modifies its shape, and make it more even. Alternatively, this can be done by using tissue removed from other parts of the lady’s body to make a new breast. Breast Reconstruction can be done at the same moment of Mastectomy or later on depending on the mutual agreement between the woman and her Health Care Provider.
Some ladies go in for breast reconstruction after lumpectomy (BCS) to modify the breast appearance and create a new nipple.
A nipple can be made by:
- Making a nipple tattooed on the breast skin.
- Making use of their body tissue, say from the other nipple. This is not usually the case since some flatten out and shrink after some time.
- Utilizing a rubber nipple. These stick-on latex nipples are made or molded to look identical as the other nipple, stuck on the breast daily using glue, and can be removed for cleaning.
Prosthesis or prosthetic implant is an artificial device that takes the place of a lost body part. Ladies who aren’t fans to breast reconstruction most times prefer breast prosthesis and would decide to wear a false breast. The false breast could be temporary fiber-filled prosthesis and a permanent silicone-made prosthesis replaced every 2 years.
This is for women whose breast cancer is HER2 positive. Physicians usually recommend Trastuzumab for the treatment of this cancer since the drug stops the effects of HER2 and empower their immune system to combat cancer cells.