Oncological diseases are an urgent problem of modern medicine. No medicine has yet been found that could with 100% effectiveness stop the growth of malignant cells. In hospitals, doctors continue to make terrible diagnoses to their patients.
Oncological diseases exist quite a lot. Any organ and any tissue of the human body can be suddenly embraced 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 ailment information
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, a British surgeon and pathologist, studied the disease in more detail. That is why his name was called an ailment.
When studying the disease, J. Paget revealed a connection between pathological changes in the nipple-areolar complex and breast carcinoma. He made such a 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 eventually cause the development of neoplasia.
Current data on the disease and symptoms of the disease
In 2011, Mayo Clinic (USA) collected information about the disease. Specialists 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 it may take from 6 to 8 months to collect a history of Paget's cancer of the breast before making the correct diagnosis.
What are the symptoms characteristic of this cancer? Women who have nipple cancer have noticed a change in the sensitivity of this area. In most cases, patients complain of itching, burning sensation. Due to clothes on the nipple and in the areola area, redness occurs. The affected surface may even begin to bleed. In the later stages, profuse spotting from the nipple appears (with cancer this is a common occurrence). 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 neoplasias, Paget's cancer is allocated a share of 0.5-5%. Fortunately, this is a rare disease. In young people, as a rule, it is not detected. Most often, pathology is diagnosed in adult postmenopausal women (50-60 years old). The average age of sick people is 54 years.
The reasons for the development of Paget's cancer can not be called. As with other oncological diseases, they have not yet been studied. However, assumptions do exist. Earlier, a 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.
Options for pathological changes
Nipple cancer can progress in one of the following options:
- In the first embodiment, the course of pathological processes is observed only in the nipple and areola. No other changes are detected.
- In the second variant of the development of oncological disease, suspicious symptoms are detected in the area of the nipple-areolar complex. What visible signs may 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, palpation, a tumor in the chest is felt.
- In the third option, skin changes are not observed. During a clinical examination, a tumor is detected in the mammary gland, and during a histological examination, Paget's cancer is detected (as an accidental find).
Nipple cancer: signs depending on the form of the disease
With cancer, a variety of symptoms can occur. Depending on the clinical presentation, Paget's cancer can be classified as follows:
- chronic eczematide;
- acute eczematide;
- psoriatic form;
- pigment form.
What does a nipple look like for breast cancer? The answer to this question depends on the form of the disease. In chronic eczematide, a woman has an eczema of the nipple for a long period of time . Crusts form on and around it. When they fall away, a wet surface becomes noticeable in their place. In acute eczematide, hyperemia is noted. Fine granularity on the surface, weeping, ulceration is also characteristic of such an ailment as Paget's disease (or nipple cancer). Symptoms with a psoriatic form on the skin appear in the form of peeling scales, and with a pigmented form - in the form of spots that extend beyond the areola.
Cancer Diagnosis
If you suspect malignant processes in the mammary gland, doctors prescribe a mammogram. This is a non-invasive study of the mammary gland, for which X-ray, ultrasound can be used. During it, neoplasms can be detected. Another diagnostic method is magnetic resonance imaging. Thanks to her, specialists identify changes in the nipple that are clinically impossible to detect.
Those women who suspect breast nipple cancer have a clinical picture of Paget's disease, and a full thickness nipple and areola biopsy is prescribed. This study will allow you to make an accurate diagnosis, confirm or deny the presence of cancer.
Features of the treatment of nipple cancer
Treatment is determined by a specialist, depending on the diagnostic results obtained. When the biopsy is negative, the patient is monitored dynamically. If the disease makes itself felt, manifests itself in symptoms, a second biopsy is performed.
When confirming Paget's disease, an operation is performed to remove the tumor and surrounding tissues or the entire mammary gland. Subsequently, additional treatment is prescribed, which allows to finally destroy the atypical cells.
More about surgical treatment
The operation is an important and necessary step in the combination therapy of an oncological disease such as breast nipple cancer. For a long time, specialists could not come to a single conclusion as to which treatment methods are most effective. Various studies have been conducted. At the University of Michigan, treatment outcomes for 36 patients were analyzed. All organ-preserving surgical interventions were performed. Subsequently, patients were followed up for an average of 113 months. 11% of women developed relapse.
A South Korean study was also conducted. The treatment results of 104 women with nipple cancer were analyzed. Specialists prescribed a mastectomy to 92 patients, 12 people performed organ-preserving operations. In the future, 3 relapses were detected after mastectomy and 1 after the second treatment option. Studies have shown that organ-preserving surgery does not increase the likelihood of women developing relapse. This method of treatment is prescribed for patients with resection of the nipple-areolar complex.
Radiation therapy
An effective cancer treatment 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 healthy cells. Due to the negative effects on the body, side effects appear:
- local - radiation burns form, 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 inhibit the growth of malignant cells and have a detrimental effect on them. Such treatment for nipple cancer is designed to solve the following problems:
- prevention of metastatic disease;
- effective effect on the tumor for the subsequent use of local treatment options (surgical or radiation).
Chemotherapy, like radiation therapy, is accompanied by 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, taste habits change.
Hormone therapy
Such treatment helps in the presence of hormone-dependent tumors in the body. However, Paget's cancer for a long time did not belong to such neoplasms. In 1949, it was first suggested that the disease could respond to hormone therapy, but under certain conditions. Further research has proven this. Hormone therapy for a disease such as nipple cancer has proven effective in the presence of progesterone and estrogen receptors in the malignant neoplasm.
Currently, if it is necessary to use hormonal therapy, patients are prescribed Tamoxifen, Zitazonium, and 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 steroid hormone receptors (> 10 fmol / mg protein). The need for treatment with hormonal drugs is determined by specialists.
Prognosis for Nipple Cancer
Oncological diseases are very serious and dangerous ailments. Breast cancer of the nipples is no exception. What will be the result of the treatment? The forecast depends on a combination of factors:
- stage of the disease;
- age of a sick person;
- the number of affected lymphatic vessels;
- degree of malignancy;
- the presence of adverse morphological factors.
Doctors know many cases when people died of nipple cancer. Fatal outcome, as a rule, is possible in the later stages, in advanced cases and with the biological aggressiveness of a malignant neoplasm. Thus, when suspicious symptoms appear, you should not delay a visit to the doctor. The sooner the specialist examines you, the faster he will make the correct diagnosis and prescribe the necessary treatment.