Very few women sometime notice dermatitis or eczema like condition affecting one nipple and occasionally spreading to areola but they may ignore it considering that it may heal at its own and no consultation is needed from doctor.
If you ever notice such type of condition affecting your either nipple, don’t neglect it. It’s not merely a simple dermatitis but may be an alarming sign of hidden malignancy inside the respective breast and the condition is known as ‘paget’s disease of nipple ‘or ‘paget’s disease of breast.’
Paget disease of nipple (or breast) is rare type of cancer that gets developed in or around the nipple .Though mostly associated (95%) with underlying breast cancer, paget’s disease is not found in all cases of breast cancer. Disease is named after Sir James Paget, who discovered the disease.
Exact cause for disease is not identified yet but relationship does exist with an underlying breast cancer. Occurrence of disease is generally above 62 years and sometimes at 20 years of age and may be bilateral in few cases.
How to Identify and Manage Paget’s Disease of Nipple
Symptoms of Paget’s Disease
At initial stages of disease symptoms are much more similar to dermatitis or eczema and hence misdiagnosed by patient as well as physician. Patient presents with redness, irritation and itching of skin of nipple. With passage of time skin over nipple starts scaling and flecking.
With advancement of disease nipple starts oozing straw-coloured or bloody discharge, becomes crusty and hard in feeling. Patient may exhibit increased sensitivity and burning sensation and feeling of pain. Over the period of time tingling and itching sensations increased in nipple and nipple becomes flattened and inverted.
Skin over nipple shows fluctuating changes and may appears as a healing and hence misunderstood by patient as a recovery from disease. Almost 50% patients of paget’s disease shows lump or mass in breast on physical examination.
Diagnosis and Management of Paget’s Disease
Diagnosis of paget’s disease is mainly done with biopsy, where a sample of breast tissue is removed and tested under microscope to see paget’s cells by immunohistochemistry. Sample of nipple discharge is also examined under microscope to see presence of paget’s cells.
Biopsy is always accompanied with physical examination have a look at the appearance of skin, nipple discharge, areola and lump along with mammography to rule out underlying breast cancer.
Paget’s disease is managed by surgery depending on type of underlying cancer with adjuvant chemotherapy and radiotherapy.
Surgeries like modified radical mastectomy, simple mastectomy, breast conservative surgery or lumpectomy followed by radiotherapy are carried out depending upon type of cancer, stage of cancer, grade of cancer and spread of cancer to other organs. In surgical procedures either entire breast or only lump along with lining over the chest muscles and sometimes lymph nodes under the arm are removed by surgeon.
In addition to surgery, chemotherapy and radiotherapy is recommended to prevent recurrence of cancer. Chemotherapy generally consists of hormonal drugs like tamoxifen and anasrozole which either minimises hormonal production or prevent the hormone from stimulating cancerous cells from growth.
Survival rate can be improved with early diagnosis and better treatment.
Photo Credit: http://www.breastcancertreatment.in/paget’s_disease1.htm