Oncological diseases are an actual problem of modern medicine. Until now, no drug has been found that could stop the growth of malignant cells with 100% efficiency. In hospitals, doctors continue to make terrible diagnoses for their patients.
There are quite a lot of oncological diseases. Any organ and any tissue of the human body can be suddenly covered by a pathological process. One of the possible places of localization is the nipple on the female breast. Such an oncological disease in medicine is called Paget's disease.
General information about the disease
The first information about Paget's disease appeared in the 19th century. It is known that in 1856 the French anatomist and surgeon S. Velpeau discovered pathological changes in the nipple-areolar complex. In 1874, J. Paget, who is a British surgeon and pathologist, studied the disease in more detail. That is why the disease was named after him.
J. Paget in the study of the disease revealed an association between pathological changes in the nipple-areolar complex and breast carcinoma. He made this conclusion based on the results of 15 observations. The specialist noticed superficial inflammatory changes in women. During the year, all patients developed breast nipple cancer. J. Paget also suggested that superficial inflammation affects adjacent tissues, and degenerative changes in them ultimately cause the development of neoplasia.
Modern data on the disease and symptoms of the disease
Information about the disease in 2011 was collected by the Mayo Clinic (USA). Experts have determined that initially, in almost all cases, the nipple undergoes pathological changes. With further progression of the disease, the surrounding skin is involved in the process. Also, according to the data provided by the clinic, it can be noted that collecting a history of Paget's cancer of the breast before making a correct diagnosis can take from 6 to 8 months.
What are the symptoms of this cancer? Women who have nipple cancer notice a change in the sensitivity of this area. In most cases, patients complain of itching, burning sensation. Due to clothing, redness occurs on the nipple and areola. The affected surface may even begin to bleed. In the later stages, abundant bloody discharge from the nipple appears (this is a common occurrence in cancer). The nipple retracts. Most often, its flattening is observed due to the growth of a malignant tumor.
Prevalence and causes of the disease
In the structure of all existing breast neoplasia, Paget's cancer has a share of 0.5-5%. Fortunately, this is a rare disease. Young peoplepeople, it usually does not come to light. Most often, pathology is diagnosed in adult postmenopausal women (at 50–60 years old). The average age of sick people is 54.
The causes of Paget's cancer cannot be named. As with other oncological diseases, they have not yet been studied. However, there are assumptions. Previously, the theory was put forward that cancer developed due to the migration of atypical cells along the basement membranes of the ducts into the epidermis of the nipple.
Pathological changes
Nipple cancer can progress in one of the following ways:
- In the first variant, the course of pathological processes is observed only in the area of the nipple and areola. Other changes are not detected.
- In the second variant of the development of oncological disease, suspicious symptoms are found in the area of the nipple-areolar complex. What visible signs can indicate nipple cancer? Photos of the disease, which can be seen in various textbooks and medical articles, reflect redness, peeling, ulceration. In addition to these symptoms, a lump is felt, a neoplasm in the chest.
- In the third variant, skin changes are not observed. Clinical examination reveals a tumor in the breast, and histological examination reveals Paget's cancer (as an incidental finding).
Nipple cancer: signs depending on the forms of the disease
Cancer can present with a variety of symptoms. Depending on the clinicalpaintings, Paget's cancer can be classified as follows:
- chronic eczematid;
- acute eczematid;
- psoriatic form;
- pigment form.
What does the nipple look like in breast cancer? The answer to this question depends on the form of the disease. In chronic eczematitis, a woman has eczema of the nipple for a long period of time. Crusts form on and around it. When they fall off, a weeping surface becomes noticeable in their place. In acute eczematitis, hyperemia is noted. Fine granularity on the surface, weeping, ulceration are also characteristic of such an ailment as Paget's disease (or nipple cancer). Symptoms in the psoriatic form on the skin appear in the form of flaky scales, and in the pigmented form - in the form of spots that extend beyond the areola.
Cancer Diagnosis
When malignant processes in the mammary gland are suspected, doctors prescribe mammography. This is a non-invasive examination of the breast, for which X-ray, ultrasound can be used. In the course of it, neoplasms can be detected. Another diagnostic method is magnetic resonance imaging. Thanks to it, specialists identify changes in the nipple that are clinically impossible to detect.
Those women who are suspected of breast nipple cancer, have a clinical picture of Paget's disease, are prescribed a full-thickness biopsy of the nipple and areola. This study will allow you to make an accurate diagnosis, confirm or refutethe presence of cancer.
Features of nipple cancer treatment
Treatment is determined by a specialist depending on the diagnostic results obtained. When the biopsy is negative, dynamic monitoring of the patient is carried out. If the disease makes itself felt, manifests itself with symptoms, a second biopsy is performed.
When Paget's disease is confirmed, an operation is performed to remove the tumor and surrounding tissues or the entire breast. Subsequently, additional treatment is prescribed to finally destroy the atypical cells.
More about surgical treatment
Surgery is an important and necessary step in the combined therapy of such an oncological disease as breast nipple cancer. Experts for a long time could not come to a single conclusion as to which methods of treatment are most effective. Various studies have been carried out. The University of Michigan analyzed the results of treatment of 36 patients. All underwent organ-preserving surgery. Patients were followed up for a mean of 113 months. 11% of women relapsed.
There was also a South Korean study. The results of treatment of 104 women with nipple cancer were analyzed. Specialists prescribed mastectomy to 92 patients, 12 people underwent organ-preserving operations. Subsequently, 3 recurrences were detected after mastectomy and 1 after the second treatment option. Studies have shown that organ-preservingsurgery does not increase the likelihood of a relapse in women. This method of treatment is prescribed for patients with resection of the nipple-areolar complex.
Radiation therapy
An effective method of treating cancer is radiation therapy. Its task is to destroy the cells that make up the pathological focus. Radiation therapy copes with it, but as a result of treatment, not only the tumor suffers, but also he althy cells. Due to the negative impact on the body, side effects appear:
- local - radiation burns are formed, small focal hemorrhages appear due to increased fragility of blood vessels;
- systemic - patients complain of nausea, vomiting, weakness, fatigue.
Chemotherapy for nipple cancer
Chemotherapy involves the introduction into the body of special antitumor drugs that prevent the growth of malignant cells and have a detrimental effect on them. This treatment for nipple cancer aims to:
- prevention of metastatic disease;
- effective effect on the tumor for the subsequent application of local treatment options (surgical or radiation).
Chemotherapy, like radiation therapy, comes with side effects. In 80% of cases, nausea and vomiting are observed. Also, due to chemotherapy, hair begins to fall out, nails become more brittle, appetite worsens, and taste habits change.
Hormone Therapy
This treatment helps in the presence of hormone-dependenttumors in the body. However, Paget's cancer did not belong to such neoplasms for a long time. In 1949, it was first suggested that the disease can respond to hormone therapy, but under certain conditions. Subsequent studies have proven this. Hormone therapy for a disease such as nipple cancer has been effective in the presence of progesterone and estrogen receptors in a malignant neoplasm.
Currently, if hormone therapy is required, patients are prescribed Tamoxifen, Zitazonium, Nolvadex. They are considered the "gold standard" for such treatment. However, there is one condition under which these drugs can be used: the tumor must have receptors for steroid hormones (> 10 fmol/mg of protein). The need for treatment with hormonal drugs is determined by specialists.
Prognosis for nipple cancer
Oncological diseases are very serious and dangerous illnesses. Breast cancer is no exception. What will be the outcome of the treatment? The prognosis depends on a combination of factors:
- disease stage;
- age of the sick person;
- number of affected lymphatic vessels;
- grade of malignancy;
- presence of unfavorable morphological factors.
Doctors know many cases when people died from nipple cancer. A lethal outcome, as a rule, is possible in the later stages, in advanced cases and with the biological aggressiveness of a malignant neoplasm. Thus, upon the appearancesuspicious symptoms should not be delayed with a visit to the doctor. The sooner a specialist examines you, the sooner he will make the correct diagnosis and prescribe the necessary treatment.
