Paget's cancer

Paget's breast cancer is a rare form of breast cancer that begins at the nipple and spreads to the areola area. Paget's disease of the breast is not related to Paget's disease of the bones (a metabolic disease of the bones).

Paget's cancer is most common in women over the age of 50. 

Reasons
The causes of Paget's cancer are not fully understood. Currently, there are two theories of occurrence:

• The most common theory is that cells from a malignancy inside the breast pass through the milk ducts to the nipple and areola. This explains why Paget's cancer and malignancies in the same breast are most often found together.
• The disease can develop independently in the nipple

Risk factors
Risk factors are those that increase the likelihood of breast cancer and include:

• Female gender. Women are much more likely than men to develop breast cancer
• Age. The risk of developing breast cancer increases with age
• Some breast diseases in the anamnesis. If you have had a breast biopsy with the detection of atypical breast hyperplasia, then the risk of developing breast cancer increases
• A history of breast cancer. If you have had cancer in one breast, you have an increased risk of developing cancer in the other breast
• Burdened family history. If your mother, sister, or daughter has been diagnosed with breast cancer, especially at a young age, your risk of breast cancer increases
• The presence of genetic mutations. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children
• Radiation exposure (radiation therapy to the chest area in childhood or at a young age in the anamnesis)
• Obesity
• Alcohol consumption 

Symptoms
Paget's cancer affects the nipple and, usually, the areola. The signs and symptoms of Paget's disease of the breast are easily confused with skin irritation (dermatitis) or other benign skin condition.

Possible signs and symptoms include:

• Flaky or scaly skin on the nipple
• Hard, oozing, or hardened skin, resembling eczema on the nipple and / or areola
• Itching in the area of the nipple and areola
• Redness of the skin in the area of the nipple and areola
• Bloody discharge from the nipple
• Nipple retraction

Diagnostic methods:

• Consultation with an oncologist-mammologist, including discussion of disturbing symptoms, examination of the mammary glands
• Digital mammography. For the purpose of further examination, a mammologist may recommend performing breast tomosynthesis
• Ultrasound examination of the mammary glands (ultrasound) and areas of regional lymph outflow
• Taking a scrape from the affected area of the skin with subsequent cytological examination
• Taking a smear-a print of the discharge from the nipple with subsequent cytological examination
• Trepan-a biopsy of the pathological areas of the breast identified as a result of the examination under ultrasound or stereotactic guidance. The guidance method is determined by the mammologist and depends on the data obtained during the examination

The above methods of examination do not require special training.

For the purpose of preoperative preparation, clarifying examinations may be required to determine the prevalence of the pathological process:

• Contrast Bi-energy Spectral Mammography (CESM)
• Breast MRI with intravenous contrast

Treatment
The oncologist determines the appropriate treatment options for you, based on your type of breast cancer, its stage and degree of malignancy, and the sensitivity of cancer cells to hormones. Your doctor also takes into account your overall health.

Breast cancer treatment can be:

• Surgical treatment
• Chemotherapeutic treatment
• Endocrinotherapy
• Radiation therapy

Most often, treatment consists of several methods (combined or complex).