Paget’s Disease of the nipple is a rare form of breast cancer where cancer originates in or around the nipple. The cancer will usually begin in the ducts, which are the milk tubes leading to the nipple and in also the areola, which is the dark area around the nipple. Paget’s disease affects less than 5 percent of women in the United States. It is important to know the signs and symptoms of Paget’s disease because other breast cancers such as invasive ductal carcinoma often accompany it.

Researchers do not fully understand how Paget’s Disease occurs, some feel that the cancer cells may originate in the breast milk ducts and travel with the breast milk to the surface of the nipple. Then there is a second theory, which postulates that the cancer cells actually starts on the surface of the nipples. This theory would justify why a small percentage of women do not have any other form of breast cancer. Some women will also have a second breast cancer, which does not have a connection with Paget’s Disease at all.

Even though Paget’s Disease is associated with women, men as well can contract the disease. This disease affects older people. According to the National Cancer institute the average onset for Paget’s disease in women is 62 and in men it jumps to 69 years of age.

Symptoms of Paget’s Disease

With Paget’s Disease, the nipple and surrounding area will become red, itchy, scaly, and sore. As the disease progresses, the symptoms will worsen, causing pain, itching, tingling, burning sensation, scaling, flat nipple, and yellow or bloody discharge from the nipple. Unfortunately doctors can mistake Paget’s disease for eczema and it may take several months before they come up with the correct diagnosis.

Diagnosis

The first step is the physical examination. Your doctor will pay particular attention to the nipple and may even be able to feel a mass. Then a mammogram is usually scheduled to check for Paget’s Disease and for any other form of cancer, which may be present. An ultra sound and or a MRI may be scheduled for more information on the cancer. The doctor will also take a biopsy of the nipple to test for cancer under the microscope. If the nipple is oozing a discharge, a sample of that fluid will be sent to the pathology lab as well. A sample of the areola will also be sent to the pathology lab for determination of the presence of and the type of cancer present.

Treatment

Surgery is the standard treatment for Paget’s Disease. Which type of surgery will depend upon if other cancers are present. The surgeon will remove the areola as well as the nipple In addition, if there is a lump it will be removed. This type of surgery for Paget’s disease is called Breast Conserving Surgery and the aim is to protect as much of the breast as possible rather than the complete mastectomy, which used to be the standard surgery. The surgeon will also remove the lymph nodes closest to the cancer. Still, the surgeon may have to perform a mastectomy especially if here is invasive cancer of some sort present. The surgeon cannot be certain that all the cancer has been removed otherwise. Women can also have reconstructive surgery to rebuilt the breast in order to look as close as they did before the surgery.

Every Paget’s patient should have a sentinel biopsy done. A sentinel biopsy tests the lymph node closest to the cancer to test for cancer. Even if the initial tests do not confirm that the disease has progressed to the lymph nodes, the sentinel biopsy may show that it has.

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