Paget's disease of the breast (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
Paget's disease of the breast is first reported by Dr. James Paget in 1874. It is one type of breast cancer. Paget's disease of the breast is eczematoid changes in the breast. Usual symptoms include redness and flaking of the nipple skin, tingling, itching, increased sensitivity, burning, and pain of the nipple skin, nipple flattened against the breast, a lump or mass in the breast. Treatments involve surgery, radiation therapy, or a combination of them.

How do I know if I have Paget's disease of the breast and what are the symptoms of Paget's disease of the breast?
Early signs of Paget's disease of the breast does nmake the patient's attention. As the tumor grows, people may notice one or more of the following symptoms:


 * Redness and flaking of the nipple skin


 * Tingling, itching, increased sensitivity, burning, and pain of the nipple skin


 * Nipple flattened against the breast


 * A lump or mass in the breast

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

Who is at risk for Paget's disease of the breast?
The risk factor of Paget's disease of the breast is not clear at present.

How to know you have Paget's disease of the breast?

 * Biopsy: Biopsy is the most important test for the diagnosis. During this peroid, the doctors remove a small amount of tissue for examination under a microscope. Then the pathologists may analyze the samples and tell whether the tissues is benign or cancerous.


 * Breast ultrasonography: This is an painless test which uses sound waves to create a picture of the internal organs. Because tumors generate different echoes of sound waves than normal tissue, the doctor can locate a mass inside the body.


 * Computed tomography (CT) scan and biopsy: CT scans are often used to diagnose Paget's disease of the breast. It can confirm the location of the cancer and show the organs nearby, as well as lymph nodes and distant organs where the cancer might have spread. These are helpful for determining the stage of the cancer and in determining whether surgery is a good treatment option. CT scans can also be used to guide biopsy and a biopsy sample is usually removed and looked at under a microscope.


 * Magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) and produces detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.


 * Chest X-ray: This plain x-ray of your chest may be done to see if the cancer has spread to your lungs.


 * Whole Bone Scan: The goal of a whole body bone scan is to show if a cancer has metastasized to your bones.

When to seek urgent medical care?
Call your health care provider if symptoms of Paget's disease of the breast develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:


 * Development of a lump or swelling in the breast or underarm area


 * Skin irritation or dimpling, nipple pain or retraction, redness or scaliness of the nipple or breast skin


 * A discharge other than breast milk

Treatment options
Patients with Paget's disease of the breast have many treatment options. The selection depends on the stage of the tumor. The options are surgery, radiation therapy, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.


 * Surgery: The goal of surgery is to remove the tumor and some surrounding tissue to make sure that the entire tumor is removed. The indication of surgery depends on the stage of the cancer and the patient's general health.


 * Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.

Diseases with similar symptoms

 * Breast eczema

Where to find medical care for Paget's disease of the breast?
Directions to Hospitals Treating Paget's disease of the breast

Prevention of Paget's disease of the breast
For the risk factors are not clear, the preventive measure is unknown.

What to expect (Outook/Prognosis)?
The prognosis of Paget's disease of the breast depends on the following:


 * Whether or not the tumor can be removed by surgery


 * The stage of the cancer: the size of the tumor, whether the cancer has spread outside the breast


 * The patient’s general health


 * Whether the cancer has just been diagnosed or has recurred