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Paget's Breast Disease Of The Nipple (With Pictures)

Sir James Paget in 1874 was the first person to explain about the Paget's disease of the breast. He described the disease to be a chronic eczematous rash affecting the skin of the nipple and areola. Paget''s disease is a rare form of skin cancer that begins in the glands in or under the skin. Characterized by inflamed, red patches on the skin, Paget''s disease often originates from breast duct cancer. The patches can occur in sweat glands, in the groin, or near the anus. Paget's disease of the breast, also known as Paget's disease of the nipple, is a condition that outwardly may have the appearance of eczema - with skin changes involving the nipple of the breast. Usually only affecting one nipple, there may be redness, oozing and crusting and a sore that does not heal.

Causes of Paget's breast disease

The cause of Paget's disease is unknown, but certain women seem to be at a higher risk of developing breast cancer. This includes women who have never had children, or had them late in life, women who started their periods at a young age or who had a late menopause, and women who have a strong family history of breast cancer.

Signs and symptoms of Paget's breast disease

Most patients go to their doctor complaining of an itchy, burning rash on and around the nipple area. Sometimes the skin may be broken and sore from itching. Other symptoms include:

Redness Swelling Oozing nipple discharge Scaling Bloody nipple discharge Ulceration Inversion of the nipple

Diagnosis of Paget's disease

Paget's disease can be confused with other skin conditions such as eczema, dermatitis or psoriasis, as they can look very similar. This can make Paget's disease difficult to diagnose.

A sample of any nipple discharge may be examined under a microscope for Paget cells, or a biopsy of the nipple will be done. In a biopsy, the doctor removes a small sample of nipple tissue. A pathologist examines the tissue under a microscope to see if Paget cells are present.

Most people with Paget's disease of the breast also have an underlying breast cancer. That is why the health care provider usually orders a mammogram (x-ray of the breast). However, women with symptoms of Paget's disease who do not have a lump that can be felt often have normal mammograms. These women may need to have other breast imaging techniques, such as ultrasound or MRI (magnetic resonance imaging). In an ultrasound, high-frequency sound waves that humans cannot hear are bounced off tissues and internal organs. Their echoes produce a picture called a sonogram. In an MRI, a magnet linked to a computer creates detailed pictures of areas inside the breast.

Treatment of Paget's breast disease

The treatment of Paget's disease of the breast will depend on:

• whether or not there is an underlying breast cancer
• whether it is DCIS or an invasive tumour
• how much of the breast is affected.

Surgery is the main treatment for Paget's disease of the breast. Removal of the breast (mastectomy) may be recommended if the cancer is seen in a wide area away from the nipple or appears to be deep into the breast tissue. Breast conservation surgery, aimed at keeping as much of the breast as possible, may be recommended in cases where the disease is diagnosed early enough and the cancer has not spread far from the surface of the nipple.

Radiotherapy :- Radiotherapy treats cancer by using high-energy rays that destroy the cancer cells. Radiotherapy to the remaining breast tissue is usually recommended after breast-conserving surgery.

Chemotherapy is the use of anti-cancer ( cytotoxic ) drugs to destroy cancer cells. It is not used to treat an underlying DCIS, but may be given if the cancer is invasive.

Alternative treatments for Paget's disease of the breast include: the use of cartilage from cows or sharks; a diet known as Gerson therapy; administration of the chemicals hydrazine sulfate or laetrile; and, the injection of solutions derived from the mistletoe plant.

Prevention of Paget's breast disease

Prevention of this disease is not possible beacuse cause of Paget's disease is unknown. In instances where this conditions arises from other underlying cancers of the breast, it may be possible to prevent Paget's disease of the breast from occurring if the underlying cause is diagnosed and successfully treated prior to the development of Paget's disease of the breast.