Nipple cancer

Cancer of the breast gland, also known as Paget's cancer, — a malignant neoplasm that is localized in the area of ​​the nipple-areolar complex. Neoplasia is rare: its prevalence among cases of oncological diseases of the mammary glands according to various sources is from 0.5 to 5%.

Men and women older than 50 years fall into the risk group. The average age of patients diagnosed with breast cancer is 62 years for women and 69 years for men. However, in clinical practice there have been cases of the disease in 20-year-olds.

Reliable causes of pathology have not been determined. At the same time, there are two theories according to which Paget's cancer can occur.

According to the epidermotropic theory, atypical cells (Paget cells) in breast cancer of deeper localization migrate along the milk ducts to the nipple, where they implant and grow. This theory is based on observations that indicate that Paget's cancer in 95% of cases is combined with other forms of breast cancer, more often with intraductal carcinoma. Paget tumor cells infiltrating the epidermis in breast cancer originate from the epithelium of the milk ducts and are glandular cells.

According to the transformative theory, the development of Paget's cancer occurs as a result of the spontaneous transformation of epithelial cells of the nipple and areola into malignant ones. This hypothesis is based on those cases in which breast cancer of another location is not detected.

Among the provoking factors for the development of Paget's disease, injuries and long-term irritation of the nipple, exposure to carcinogenic factors, excessive insolation, etc. are distinguished.

The risk factors that increase the likelihood of developing neoplasia and complicate its course include:

The concomitant symptoms of this type of cancer are characterized by a weak onset and non-specific manifestations. At the initial stages of the disease, a person encounters the following manifestations:

The initial stages of Paget's cancer are characterized by the subsidence of the first symptoms followed by relapse and rapid progress. At the later stages, the patient already encounters other manifestations of the disease:

• 0  - It is characterized by a non-invasive flow. Cancer cells are limited exclusively to the primary tumor, pathogenic processes do not affect neighboring tissues and lymph nodes. The patient is rarely bothered by any discomfort and symptoms.
• I - In the first stage, cancer cells begin to move into nearby breast tissue, reaching sizes up to 2 centimeters in the widest area. There are still no signs of the pathological process in the lymph nodes. Starting from this stage, breast cancer is accompanied by the first mild manifestations of the disease: skin discoloration, wrinkling, peeling.
• II - The neoplasm continues to grow and develop, the size is from 2 to 5 centimeters. Cancer cells are no longer limited to the primary tumor: movable axillary lymph nodes can be palpated from the side of the damaged nipple-areolar complex. Previous symptoms are supplemented by a feeling of discomfort, light pain.
• III - Stage 3A is accompanied by the accumulation of cancer cells in the axillary lymph nodes. On the side of the affected nipple, the lymph nodes are fused to each other and to the surrounding tissues, metastases are often found in them. The size of the neoplasm may exceed 5 centimeters. At stage 3B, the growth of the tumor is observed in the neighboring tissues, in particular on the chest wall. At the penultimate stage of the disease, the pain syndrome becomes pronounced and the patient is regularly disturbed by bloody discharge.
• IV - At the last stage, a tumor of any size is possible, affecting all surrounding tissues. This stage is characterized by the growth of cancer in the subclavian, supraclavicular, perithoracic, axillary lymph nodes from the side of the lesion. Distant metastases appear in the liver, lungs, and brain. The form of the disease becomes inflammatory, typical swelling develops.

Without painkillers, it is impossible to maintain the quality of life at an acceptable level.

In men, Paget's cancer has similar manifestations: itching of the skin in the area around the nipple, visible erythema (redness), peeling, thickening, erosions, maceration of the skin, in the later stages – retracted nipple.

Since the initial symptoms of breast cancer are almost invisible, it is difficult to diagnose the disease in time. When the first signs of Paget's disease are detected, a person needs to make an appointment with a mammologist: the doctor will listen to complaints the patient and will collect anamnesis. In the future, to confirm or refute the previous diagnosis, the patient is sent for examinations.

• Breast examination. At the III and IV stages of cancer, the changes in the affected nipple or areola are quite pronounced and characteristic, which simplifies and speeds up further diagnosis.
• Smear. Research is carried out in the presence of secretions from mammary glands typical for pathology. The biological material obtained during the procedure is examined under a microscope, which makes it possible to unambiguously answer the question of the presence or absence of oncological abnormalities.
• Mammography. Research at the Onco Consulting Center is conducted in three projections on the most modern low-dose mammogram in order to rule out other types of cancer localized in the breast. It is an effective and informative method for diagnosing neoplasias.
• Ultrasound of the breast. In some cases, it indicates changes that are not visible on a mammogram, and also makes it possible to assess the condition of the milk ducts.
• Scintigraphy. The procedure makes it possible to detect the development of neoplasms of benign and malignant nature even in the initial stages with small tumors.
• Biopsy. The cells and tissue obtained during the study (biopsy) give a reliable answer about the nature, type, stage and localization of the neoplasm, if it is present. The results of the analysis provide comprehensive information necessary for drawing up a correct and effective therapy scheme.
• KT/MRI. Reveals pathological changes not manifested externally; used for the purpose of differential diagnosis

Paget cancer therapy involves a comprehensive approach that includes surgical intervention and hormonal, gamma, chemotherapy. Depending on the stage of the disease , the patient is shown one of operations:

• Radical mastectomy. It is a complete removal of the breast and adjacent tissues: pectoral muscles, fatty tissue and lymph nodes. It is used in the late stages of invasive forms of breast cancer.
• Mastectomy. Removal of gland tissue and pectoralis minor muscle is justified in case of non-invasive type of cancer.
• Resection. During the procedure, the surgeon removes the areola, the nipple and a fragment of the mammary gland with localized neoplasia with a one-time reconstruction of the breast shape. It is also possible to perform reconstructive mammoplasty in the future.

With all types of operations, it is possible to restore the volume and shape of the breast both immediately and with a delay.

It is impossible to completely protect yourself from Paget's cancer. However, following these recommendations will reduce the likelihood of a malignant tumor in the nipple-areolar complex to a minimum.