Materiały źródłowe

• #1 Paget Disease of the Breast | Details, Diagnosis and Signs | American Cancer Society

  https://www.cancer.org/cancer/types/breast-cancer/about/types-of-breast-cancer/paget-disease-of-the-nipple.html

  Paget disease of the breast is a rare type of breast cancer involving the skin of the nipple and the areola (the dark circle around the nipple). […] Paget disease can be treated by removing the entire breast (mastectomy) or breast-conserving surgery (BCS) followed by whole-breast radiation therapy. If BCS is done, the entire nipple and areola area also needs to be removed. […] If no lump is felt in the breast tissue, and your biopsy results show the cancer has not spread within the breast tissue, the outlook (prognosis) is excellent. […] If the cancer has spread within the breast tissue (is invasive), the outlook is not as good, and the cancer will be staged and treated like any other invasive ductal carcinoma.

• #2 Paget’s disease of the breast: Causes, symptoms, treatment, and more

  https://www.medicalnewstoday.com/articles/192362

  Pagets disease of the breast or nipple involves dry skin, flaking, or changes in the color or shape of the nipple. It may look like eczema or psoriasis, but it can be a sign of breast cancer. […] Pagets disease of the breast typically occurs as a manifestation of a type of precancerous lesion known as ductal carcinoma in situ (DCIS) or an underlying invasive cancer. […] The symptoms of Pagets disease of the breast can resemble those of a skin condition, such as eczema or psoriasis. This sometimes delays diagnosis, increasing the risk of the condition advancing. […] Pagets disease of the breast causes skin symptoms on the breasts or nipples because of underlying breast cancer. In 80% to 90% of people with Pagets disease of the breast, the underlying cancer is either ductal carcinoma in situ (DCIS) or invasive breast cancer.

• #3 Paget Disease of the Breast – NCI

  https://www.cancer.gov/types/breast/paget-breast-fact-sheet

  Paget disease of the breast is a rare type of cancer involving the skin of the nipple and, usually, the darker circle of skin around it, which is called the areola. Most people with Paget disease of the breast also have one or more tumors inside the same breast. These breast tumors are either ductal carcinoma in situ or invasive breast cancer. […] The symptoms of Paget disease of the breast are often mistaken for those of some benign skin conditions, such as dermatitis or eczema. These symptoms may include the following: Itching, tingling, or redness in the nipple and/or areola; Flaking, crusty, or thickened skin on or around the nipple; A flattened nipple; Discharge from the nipple that may be yellowish or bloody. […] A nipple biopsy allows doctors to correctly diagnose Paget disease of the breast.

• #4 Mammary Paget disease. Paget disease of the nipple

  https://dermnetnz.org/topics/mammary-paget-disease

  Mammary Paget disease is an uncommon form of breast cancer, comprising 13% of all breast cancer presentations. It is also called Paget disease of the breast or nipple. […] Mammary Paget disease is nearly always associated with an underlying intraductal breast cancer located near the areola. […] Mammary Paget disease typically starts as an eczema-like change of one nipple, extending with time over the areola, and often associated with an underlying breast lump. It is rarely bilateral. […] Common cutaneous features of mammary Paget disease include: Eczematous or psoriasis-like change, Well-defined but irregularly shaped red patch that slowly enlarges and can reach up to 15 cm in diameter, May be scaly and/or crusted, Initially asymptomatic, the nipple can become itchy, painful, or feel a burning sensation, With time, the nipple may become thickened and/or retracted, Ulceration, bleeding, and discharge may develop.

• #5 Paget’s disease of the breast: Causes, symptoms, treatment, and more

  https://www.medicalnewstoday.com/articles/192362

  Pagets disease of the breast may resemble other common skin issues, such as wounds, breastfeeding-related injuries, or eczema. […] Pagets disease of the breast is a rare type of breast cancer. […] This disease can affect anyone, but it occurs more commonly in postmenopausal females in their 50s. […] According to the American Cancer Society, Pagets disease usually appears in one breast or nipple. The most common symptoms include: itching, tingling, or burning around the nipple and areola; skin discoloration; flaking, thickening, or scaling of the skin around the nipple that does not heal over time; nipple discharge, which may be yellow or contain blood; flattened or inverted nipples; a crusted lesion with irregular edges; a mass in the nipple; ulceration, in some cases. […] If a person has any nipple or skin changes on the breast, they should tell a doctor right away, even if they think Pagets is unlikely.

• #6 Mammary Paget disease. Paget disease of the nipple

  https://dermnetnz.org/topics/mammary-paget-disease

  Despite the visible lesion, a delay in presentation or diagnosis is common. On average, diagnosis is made 12 months after onset in women and 89 months in men. Prognosis is therefore not as good as for more common forms of breast cancer. It is particularly poor for males, with a 20-30% five-year survival.

• #7 Understanding Paget’s Disease Accompanied by Invasive Breast Cancer – Journal of Oncology Navigation & Survivorship

  https://jons-online.com/issues/2020/december-2020-vol-11-no-12/understanding-paget-s-disease-accompanied-by-invasive-breast-cancer

  Pagets disease of the breast is named after the 19th-century British doctor Sir James Paget, who, in 1874, noted a distinct connection relationship between cancer of the breast and the nipple. It is considered one of the rare forms of breast cancer and is often misdiagnosed when first noted. Typically noted in older, postmenopausal women, it comprises approximately 5% of all breast cancer cases diagnosed. The eczematous presentation of Pagets disease of the nipple is the most misleading feature of this disease. Such patients are usually mistakenly treated by the primary care physician for eczema. The initial skin changes of Pagets disease of the breast may appear relatively benign, and many individuals may overlook such symptoms, mistakenly attributing them to an inflammatory skin condition or infection. As a result, diagnosis may be delayed, often up to 6 months or more. Most individuals with the condition eventually seek medical attention, but generally only after other topical modalities have been used. This may lead to progression of disease, eventually resulting into an associated lump with enlarged axillary lymph nodes.

• #8 Paget’s Disease of the Breast: Symptoms, Treatment, and More

  https://www.healthline.com/health/breast-cancer/pagets-disease-of-the-breast

  Pagets disease of the breast, or of the nipple, is a rare form of breast cancer. The symptoms are different from other breast cancer types, and the condition affects the surface skin of the nipple and areola. […] If you have any of these signs and symptoms, see your doctor as soon as possible. […] Diagnosis begins with a physical examination. Your doctor will observe the appearance of your breasts, especially around the nipples, and check for lumps or unusual thickening. […] The only way to confirm breast cancer is with a biopsy. This is a procedure in which a needle is used to obtain a small sample of breast tissue from a nipple, areola, or tumor. […] Your oncologist will come up with a treatment plan that takes many factors into account, such as the size and grade of the breast tumor, if any, and if the cancer has spread (stage).

• #9 Paget’s Disease | Breast Cancer 101 | Breastlink

  http://breastlink.com/breast-cancer-101/rare-breast-cancer-types/pagets-disease

  If Paget’s disease is diagnosed, the next step is to identify the location of the underlying breast cancer. […] More than 50 percent of patients with Paget’s disease will have an abnormality on their mammogram. […] Careful follow-up is always necessary with a potential diagnosis of Paget’s disease. […] The traditional, standard treatment for Paget’s disease of the breast was a mastectomy. However, advancements in surgical techniques and equipment have led modern medical practice to favor breast-conserving procedures. A Breastlink surgeon will remove the affected nipple and surrounding breast tissue containing cancer. Once clear surgical margins are secured, the affected breast tissue is irradiated. […] In rare cases, more extensive involvement of the breast tissue may require a mastectomy, which is typically followed by immediate breast reconstruction.

• #10

  https://www.nursingcenter.com/journalarticle?Article_ID=5555113&Journal_ID=849729&Issue_ID=5555089

  ABSTRACT: Paget’s disease of the breast (PDB) is a rare disorder of the nipple-areola complex that may present clinically as a unilateral, eczematous, or ulcerated papule or plaque. This case highlights the importance of either punch or incisional wedge biopsy to establish a diagnosis of PDB for patients who present with chronic cutaneous changes of the nipple, areola, or skin of the breast, regardless of any previous normal mammogram or breast ultrasound. Mammography alone cannot rule out a diagnosis of PDB in a patient with cutaneous changes of the breast. […] PDB is characterized histologically by Paget cells in the nipple epidermis, which are thought to migrate there from breast carcinoma present in deeper ductal structures. […] Treatment and prognosis of PDB depend on the type of underlying associated breast carcinoma and presence or absence of axillary lymph node involvement. Treatment of PDB is typically composed of surgery, chemotherapy, or radiation therapy, either alone or in combination. Patients with PDB should be promptly referred to oncology for staging and treatment.

• #11 Paget Disease of the Breast | Susan G. Komen®

  https://www.komen.org/breast-cancer/diagnosis/pagets-disease-of-the-breast/

  Paget disease of the breast (Paget disease of the nipple) is a rare carcinoma in situ in the skin of the nipple or in the skin closely surrounding the nipple. Its usually found with an underlying breast cancer. […] Paget disease of the breast can also be diagnosed from a biopsy of the nipple skin and the tissue just below the skin. This may be done with a punch biopsy (removal of a small circle of skin to be tested for cancer cells) or other nipple biopsy procedure. […] Paget disease of the breast can be found with invasive breast cancer or ductal carcinoma in situ (DCIS), a non-invasive breast cancer. Treatment and prognosis (chances for survival) of Paget disease of the breast depend on the underlying breast cancer.

• #12

  https://www.nursingcenter.com/journalarticle?Article_ID=5555113&Journal_ID=849729&Issue_ID=5555089

  This case illustrates a delayed diagnosis of PDB associated with IDC because a negative mammogram was interpreted as absence of breast cancer despite presence of suspicious cutaneous changes of the breast. It is important for all individuals who provide healthcare to women to be aware of all of the cutaneous signs of breast cancer. A full-thickness surgical punch or wedge biopsy is the gold standard to confirm or exclude a diagnosis of PDB.

• #13 Understanding Paget’s Disease Accompanied by Invasive Breast Cancer – Journal of Oncology Navigation & Survivorship

  https://www.jons-online.com/issues/2020/december-2020-vol-11-no-12/understanding-paget-s-disease-accompanied-by-invasive-breast-cancer

  Symptoms of Pagets disease of the breast can be very similar to benign skin conditions and can include any of the following: Itching or tingling of the nipple or areola, Redness, Flaking, crusty, or thickened skin on or around the nipple, A flattened nipple, Discharge from the nipple that may be yellowish or bloody, A lump in the breast. It is not uncommon for there to be multiple symptoms with varying degrees of resolution with topical treatment. […] Because these underlying malignancies tend to be multifocal and multicentric, mammography often is not sufficient, and an MRI may be necessary to evaluate the true extent of the disease. Treatment of this form of breast cancer is typically multifactorial in that clear margins versus final cosmesis must be considered. As this is generally located in the central part of the breast, it may be difficult to preserve the nipple areolar complex, and simple mastectomy with sentinel lymph node dissection is often the best approach. It has been noted in recent literature that both total mastectomy and breast-preserving surgery followed by appropriate adjuvant therapy are acceptable treatment options for carefully selected patients with Pagets disease.

• #14 Paget’s disease of the breast – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pagets-disease-of-the-breast/diagnosis-treatment/drc-20351084

  If you have Paget’s disease of the breast, you will likely need surgery. The type of surgery depends on the condition of the skin around your nipple and how advanced the underlying cancer is. […] During a total (simple) mastectomy, the surgeon removes the breast tissue, nipple, areola and skin. Other mastectomy procedures may leave some parts of the breast, such as the skin or the nipple. […] Surgical options include: […] You may choose to have breast reconstruction after surgery. Discuss your options and preferences with your surgeon. […] After your operation, your doctor may recommend additional treatment (adjuvant therapy) with anti-cancer drugs (chemotherapy), radiation therapy or hormone therapy to prevent a recurrence of breast cancer. […] Your specific treatment will depend on the extent of the cancer and whether your cancer tests positive for certain characteristics, such as having estrogen or progesterone receptors.

• #15 Paget’s disease of the breast | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/pagets-disease-breast

  Paget’s disease of the breast is a rare form of breast cancer. Paget’s disease of the breast starts on the nipple and extends to the dark circle of skin (areola) around the nipple. Paget’s disease of the breast occurs most often after age 50. Most people with this diagnosis also have underlying ductal breast cancer, either in situ meaning in its original place or, less commonly, invasive breast cancer. Only rarely is Paget’s disease of the breast confined to the nipple itself. […] Paget’s disease of the breast affects your nipple and usually the skin (areola) surrounding it. Signs and symptoms usually occur in one breast only. The disease typically starts in the nipple and may spread to the areola and other areas of the breast. […] If you have Paget’s disease of the breast, you will likely need surgery. The type of surgery depends on the condition of the skin around your nipple and how advanced the underlying cancer is.

• #16

  https://www.nhs.uk/conditions/pagets-disease-nipple/treatment/

  Paget’s disease of the nipple is usually associated with breast cancer. […] It’s treated by removing the cancerous part of the breast, or sometimes the entire breast using a procedure called a mastectomy. […] If you’re diagnosed with Paget’s disease of the nipple, surgery is often the first type of treatment you’ll receive. […] The 2 main types of surgery are: mastectomy surgery to remove the whole breast, which can be followed by reconstructive surgery to recreate the removed breast […] breast-conserving surgery where only the cancerous lump (tumour) and a little surrounding breast tissue are removed. […] These types of surgery will also involve removing your nipple and the darker area of skin surrounding it (the areola). […] If you have Paget’s disease of the nipple, your nipple are areola will also be removed. You’ll be offered reconstructive surgery to improve the appearance of your breast after this surgery.

• #17 Paget’s disease of the breast | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/breast-cancer/pagets-disease-of-the-breast

  Pagets disease of the breast is a condition that causes a scaly rash on the skin of the nipple. This can look like eczema. […] Most people who have Pagets disease also have breast cancer. So it is sometimes called a rare type of breast cancer. […] The main treatment for Pagets disease is surgery. The type of operation you have depends on: the size of the area of Pagets disease, whether there is DCIS or invasive breast cancer, and where the affected area is in the breast. […] Some people may have other treatments after surgery. For example, you may have radiotherapy to the breast. […] Further treatment will depend on whether the cancer is DCIS or invasive breast cancer. Your cancer doctor or nurse will explain more about your treatment options.

• #18 Paget’s Disease of the Breast: Symptoms, Treatment, Survival

  https://www.verywellhealth.com/pagets-disease-of-the-breast-430628

  Paget’s disease of the breast is a rare cancer of the nipple and areola (the darkened skin around the nipple) closely associated with ductal carcinoma in situ (a cancer of milk ducts). Symptoms include flaking, cracking, discharge, and a flattening of the nipple. […] Treatments, including mastectomy, tend to be effective, with some people living normal life expectancies. […] Surgery is the primary treatment option. This can take one of two forms: […] A lumpectomy is usually followed by radiation therapy to kill any remaining cancer cells. Many people will have nipple reconstruction after lumpectomy and radiation are completed. […] After mastectomy, your oncologist may recommend additional treatments to prevent breast cancer recurrence. These may involve one or a combination of the following: […] Surgery is the standard treatment for Paget’s disease, sometimes accompanied by chemotherapy, radiation, or hormone therapy.

• #19 Paget’s disease of the breast: there is a role for breast-conserving therapy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/15915373/

  The optimal surgical management of Paget’s disease of the breast remains to be defined. […] Mastectomy has been the standard of care, but several institutions have recently advocated breast-conserving surgery, particularly for patients with minimal disease. […] Breast-conserving approaches result in local control and survival rates similar to those achieved with mastectomy.

• #20 Surgical treatment in Paget’s disease with invasive ductal carcinoma: an observational study based on SEER | Scientific Reports

  https://www.nature.com/articles/srep45510

  The aim is to analyse the clinical presentation, treatment and outcomes in patients with Pagets disease with invasive ductal carcinoma (PD-IDC), with special emphasis on the role of surgical treatment. […] Traditional treatment for PD-IDC has been mastectomy due to the common occurrence of sonographically and mammographically hidden multifocal and multicentric malignancies located in breast tissue far from the nipple. However, with the development of imaging technology, breast conservation surgery (BCS) has been found to be a feasible surgical option with low risk for local recurrence in selected patients. […] The results demonstrated that PD-IDC appears to alter the association between prognosis and Her2 status. Meanwhile, breast-conserving surgery with radiotherapy may be a feasible treatment alternative and sentinel lymph node biopsy should be considered as an appropriate treatment for patients with PD-IDC.

• #21 Paget Disease of the Breast – NCI

  https://www.cancer.gov/types/breast/paget-breast-fact-sheet

  For many years, mastectomy, with or without the removal of lymph nodes under the arm on the same side of chest (known as axillary lymph node dissection), was regarded as the standard surgery for Paget disease of the breast. […] Studies have shown, however, that breast-conserving surgery that includes removal of the nipple and areola, followed by whole-breast radiation therapy, is a safe option for people with Paget disease of the breast who do not have a palpable lump in their breast and whose mammograms do not reveal a tumor. […] People with Paget disease of the breast who have a breast tumor and are having a mastectomy should be offered sentinel lymph node biopsy to see whether the cancer has spread to the axillary lymph nodes. […] The prognosis, or outlook, for people with Paget disease of the breast depends on a variety of factors, including whether or not a tumor is present in the affected breast.

• #22 Surgical treatment in Paget’s disease with invasive ductal carcinoma: an observational study based on SEER | Scientific Reports

  https://www.nature.com/articles/srep45510

  In our series, there was no difference between surgical treatment subgroups. […] Surgical treatment of PD-IDC has been controversial. Historically, patients with PD were predominately treated with mastectomy for two main reasons: the high incidence of potential multifocality and contraindication for BCS patients with centrally located breast cancer. […] The previously reported techniques for BCS in patients with PD have varied widely and include nipple excision and central segmentectomy as well as resection plus radiation. There is a place for BCS in selected patients with PD of the breast, especially those with no mass. […] Although SLNB may still be considered a controversial treatment in patients with PD, SLNB has become a common approach in patients with breast cancer and appears to be a feasible treatment option.

• #23 Surgical treatment in Paget’s disease with invasive ductal carcinoma: an observational study based on SEER | Scientific Reports

  https://www.nature.com/articles/srep45510

  In the present study, patients undergoing SLNB had similar survival to those receiving ALND regardless of surgical mode of their breast cancer treatment. […] Despite these limitations, our study demonstrated that PD-IDC appears to alter the association between prognosis and HER2 status. Meanwhile, BCS with radiotherapy may be a feasible treatment alternative, as it resulted in survival rates similar to those achieved with mastectomy, and SLNB should be considered as an appropriate treatment for patients with PD-IDC.

• #24

  https://www.nhs.uk/conditions/pagets-disease-nipple/treatment/

  After having breast-conserving surgery, it’s likely you’ll need to have radiotherapy to destroy any remaining cancer cells. […] If you have a mastectomy, you may be able to have reconstructive surgery to recreate your breast. […] If you decide not to have breast reconstruction, you can wear a false breast or breast prosthesis, which is available free on the NHS.

• #25 Paget’s disease of the breast: Causes, symptoms, treatment, and more

  https://www.medicalnewstoday.com/articles/192362

  Pagets disease also will not respond to treatments for eczema. […] A person with this condition will need surgery whether or not they have underlying breast cancer. However, the type of surgery depends on each person’s situation. […] After surgery, breast reconstruction can restore the appearance of the breast. […] Depending on the type of cancer, a doctor may recommend drug therapy with either hormones or medications that target genes specific to cancerous cells. […] These treatments can reduce the risk of the cancer spreading. […] After treatment finishes, it is essential to attend all follow-up appointments and to continue to monitor for changes. […] The outlook for Pagets disease of the breast will depend on various factors, such as whether there is a tumor, which type of cancer a person has, and social and environmental factors. […] With early diagnosis and treatment, Pagets disease of the breast is typically curable.

• #26 Treatment options for Paget’s disease of the nipple | Cancer Australia

  https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment-options/treatment-options-pagets-disease-nipple

  For women with Paget’s disease of the nipple, radiotherapy is almost always recommended after breast conserving surgery. […] Radiotherapy is sometimes recommended after mastectomy. […] Radiotherapy uses X-rays (controlled doses of radiation) to destroy cancer cells. […] Once treatment is finished, regular follow-up appointments with your specialist or general practitioner are recommended. […] Follow-up after treatment for Paget’s disease of the nipple usually involves a regular physical examination and an annual mammogram with or without an ultrasound. […] Breast care nurses specialise in caring for women with breast cancer and can be a valuable source of information and support.

• #27 Breast Paget’s disease. Symptoms, diagnosis and treatment. Clínica Universidad de Navarra

  https://www.cun.es/en/diseases-treatments/diseases/breast-paget-disease

  „Chemotherapy given before surgery may allow some patients with underlying disease to opt for breast-conserving surgery, avoiding a mastectomy.” […] „In addition, after breast conserving surgery, various reconstructive techniques can be performed on the breast to achieve favorable aesthetics and a better quality of life for patients.” […] „For those with an underlying malignancy or multicentric disease, mastectomy remains the standard treatment.” […] „After surgery, most of these patients receive radiation therapy, administered throughout the breast.” […] „Our nursing staff is specialized in breast pathology and performs patient education, telephone follow-up and advice, before and after surgery.”

• #28 Paget’s Disease of the Breast: Stages, Symptoms & Prognosis

  https://my.clevelandclinic.org/health/diseases/17913-pagets-disease-of-the-breast

  Paget’s disease of the breast is a rare type of breast cancer that develops in the skin of the nipple. The primary treatment is surgery. […] Treatment involves surgery and sometimes additional cancer therapies. […] If you only have Paget’s disease of the breast, and no other tumors, you may have more minimal, breast-conserving surgery. […] After surgery, you’ll likely have additional, complementary treatments to prevent cancer from recurring. Adjuvant therapies may include: Radiation therapy, Chemotherapy, Hormone therapy, Immunotherapy. […] Breast cancer survival is based on the stage of the cancer when it’s detected. If you only have Paget’s disease of the nipple or ductal carcinoma in situ (stage 0) that hasn’t spread beyond the milk ducts, your prognosis is excellent. […] Always see your healthcare provider if you notice any changes in your breast, including skin conditions and changes under the skin. […] The best way to take care of yourself is to begin treatment as soon as possible.

• #29 Paget’s disease of the breast | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/diagnosis/types-of-breast-cancer/pagets-disease-of-the-breast

  If you have invasive breast cancer in addition to Pagets disease, you may be given some treatments before surgery. This is known as neo-adjuvant or primary treatment. […] You’ll usually continue to be monitored for 5 years after your hospital-based treatments (such as surgery or radiotherapy) finish. This is known as follow-up. […] It’s important to be aware of any changes to your breast, chest or surrounding area. […] Most breast cancers dont come back after treatment. But sometimes it can return, so its important you know what signs and symptoms to look out for.

• #30 Paget’s Disease of the Nipple | Cancer Care & Oncology | Bon Secours

  https://www.bonsecours.com/health-care-services/cancer-care-oncology/conditions/pagets-disease-of-the-nipple

  Pagets disease of the nipple is a rare breast cancer that begins in the nipple and spreads to the areola. […] Treatment for Pagets disease of the nipple typically includes surgery, followed by other therapies such as chemotherapy, radiation therapy or hormone therapy. […] Depending on your personal health history, the extent of your Pagets disease of the nipple and other factors, your oncologist may recommend one or more of the following treatment options: […] Surgery – if you are diagnosed with Pagets disease of the nipple, you will likely need to undergo surgery. […] Chemotherapy – you may need to undergo chemotherapy after your surgical treatment. […] Hormone therapy – your doctor may prescribe hormone medications, which can reduce your chance of recurrence of Pagets disease of the nipple after you have undergone surgery to remove the affected area. […] Radiation therapy – you may need to undergo radiation therapy after your surgery for Pagets disease of the nipple.

• #31 Mammary Paget disease. Paget disease of the nipple

  https://dermnetnz.org/topics/mammary-paget-disease

  Mammary Paget disease is almost always a skin sign of an underlying breast cancer. This may be an in-situ or invasive intraductal carcinoma. Metastases to lymph nodes and beyond may be present. […] Mammary Paget disease should be suspected clinically when a longstanding, slowly progressive, unilateral nipple change is seen. […] The usual treatment of mammary Paget disease is surgical excision. Although mastectomy was routine, especially in males, consideration is now given to breast-conserving surgery (removing the nipple, areola, and underlying breast tissue with a margin of healthy tissue). […] Further treatment may include: Radiotherapy, if the primary cancer was large or could not be completely excised, or lymph nodes were positive, Tamoxifen, if oestrogen receptor positive, Trastuzumab (Herceptin), if HER2 positive, Chemotherapy, if the breast cancer is rapidly progressive or advanced.

• #32

  https://www.advocatehealth.com/health-services/cancer-institute/cancers-we-treat/breast-cancer/pagets-disease-breast

  Paget’s disease of the breast, often referred to as Pagets disease of the nipple, is a rare type of breast cancer that affects the skin on your nipple. […] Early detection and treatment are crucial for managing this disease effectively. […] Paget’s disease of the breast is a rare form of breast cancer that primarily affects the skin of the nipple and often spreads to the areola, the darker area around the nipple. […] However, Paget’s disease of the breast often indicates an underlying breast cancer, such as ductal carcinoma in situ (DCIS) or invasive breast cancer. […] Regular self-exams and monitoring for any changes in the skin of your nipple and areola can aid in early detection, improving the chances of successful treatment. […] The progression of Paget’s disease of the breast can vary widely. It can develop slowly over several months or years. It can also progress more quickly, especially if associated with underlying invasive breast cancer.

• #33

  https://111.wales.nhs.uk/encyclopaedia/p/article/pagetsdiseaseofthenipple/

  Paget’s disease of the nipple, also known as Paget’s disease of the breast, is a rare condition associated with breast cancer. […] Paget’s disease of the nipple is usually a sign of breast cancer. […] Surgery is the main treatment for Paget’s disease of the nipple. Depending on whether the cancer has spread, surgery will either involve removing the whole breast (a mastectomy), or the nipple and areola with the breast tissue underneath them (a central excision). […] If Paget’s disease is detected and treated in its early stages, there’s a good chance of a full recovery. […] You should see your GP if you notice any changes in the skin of your nipple or areola. […] Paget’s disease of the nipple can sometimes be confused with eczema, a skin condition that also causes red, itchy and dry skin.

• #34 Understanding Paget’s Disease Accompanied by Invasive Breast Cancer – Journal of Oncology Navigation & Survivorship

  https://jons-online.com/issues/2020/december-2020-vol-11-no-12/understanding-paget-s-disease-accompanied-by-invasive-breast-cancer

  The nurse navigator was an essential part of her cancer care team and was available for support, resources, and information. With the assistance of the navigator, the patient was prepared for surgery, referred to a support group, and given information on financial assistance. […] Patients with Pagets disease are no different. However, there are times when a patient may first be shaken by a diagnosis of cancer that might have been primarily treated as a dermatologic issue. After an introduction, the navigator should begin to establish a relationship of trust and empathy. This early introduction will allow for the coordination of care with the multidisciplinary team and give the patient confidence that the navigator will act as her advocate in all areas of treatment, which could lead to improved adherence to the care suggested.

• #35 Understanding Paget’s Disease Accompanied by Invasive Breast Cancer – Journal of Oncology Navigation & Survivorship

  https://www.jons-online.com/issues/2020/december-2020-vol-11-no-12/understanding-paget-s-disease-accompanied-by-invasive-breast-cancer

  There is abundant literature about the navigation role and the positive impact it can have on patient outcomes and continuity of care. Despite the rarity of Pagets disease of the breast, the breast care navigators can validate their essential role as partner and advocate for patients at the most vulnerable of times.

• #36 Understanding Paget’s Disease Accompanied by Invasive Breast Cancer – Journal of Oncology Navigation & Survivorship

  https://jons-online.com/issues/2020/december-2020-vol-11-no-12/understanding-paget-s-disease-accompanied-by-invasive-breast-cancer

  Treatment of this form of breast cancer is typically multifactorial in that clear margins versus final cosmesis must be considered. As this is generally located in the central part of the breast, it may be difficult to preserve the nipple areolar complex, and simple mastectomy with sentinel lymph node dissection is often the best approach. It has been noted in recent literature that both total mastectomy and breast-preserving surgery followed by appropriate adjuvant therapy are acceptable treatment options for carefully selected patients with Pagets disease. […] After surgery, radiation therapy and perhaps chemotherapy, targeted therapy, and/or hormone therapy may be recommended. About 97% of people diagnosed with Pagets disease of the nipple also have ductal carcinoma in situ or invasive cancer somewhere else in the breast. The exact treatment plan will depend on the characteristics of the underlying breast cancer such as stage, grade, and whether the cancer is hormone receptor-positive and/or HER2-positive.

• #37 Paget’s disease of the breast | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/diagnosis/types-of-breast-cancer/pagets-disease-of-the-breast

  Pagets disease of the breast is an uncommon type of breast cancer. […] Treatment aims to remove the area of Pagets disease from your breast and reduce the risk of it coming back or spreading to other parts of the body. […] Surgery is usually the first treatment for Pagets disease of the breast. Its often the only treatment youll need if you have Pagets disease without DCIS or invasive breast cancer. […] If youve been diagnosed with Pagets disease alone, youre most likely to be offered surgery to remove your nipple and areola. This is known as a central excision. […] You may be offered other types of surgery if you have also been diagnosed with DCIS or invasive breast cancer, such as breast-conserving surgery or a mastectomy. […] Depending on the features of your Pagets disease, you may also be offered radiotherapy after your surgery.

• #38

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh4323

  Call your doctor or nurse advice line now or seek immediate medical care if: You have a fever or chills. Or you may be sweating. You have abnormal bleeding. You have new or worse pain. You think you have an infection. You have new symptoms, such as a cough, belly pain, vomiting, diarrhea, or a rash. You have signs of a blood clot, such as: Pain in your calf, back of the knee, thigh, or groin. Redness and swelling in your leg or groin. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if you have any symptoms that the cancer has come back or spread. These symptoms include: New lumps. Bone pain. Chest pain. Shortness of breath. Belly pain. Headaches that don’t go away.

• #39 Paget’s disease of the nipple | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/pagets-disease-of-the-nipple/

  Exercising regularly and eating a healthy, balanced diet are known to help prevent many forms of cancer, as well as other serious health conditions, such as heart disease and diabetes. […] Studies have shown that women who breastfeed are statistically less likely to develop breast cancer than those who dont. […] Breast screening can pick up breast cancer before it forms a lump.

• #40 Paget’s disease of the breast | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/diagnosis/types-of-breast-cancer/pagets-disease-of-the-breast/

  Pagets disease of the breast is an uncommon type of breast cancer. […] Surgery is usually the first treatment for Pagets disease of the breast. Its often the only treatment youll need if you have Pagets disease without DCIS or invasive breast cancer. […] Treatment aims to remove the area of Pagets disease from your breast and reduce the risk of it coming back or spreading to other parts of the body. […] Depending on the features of your Pagets disease, you may also be offered radiotherapy after your surgery. […] You’ll usually continue to be monitored for 5 years after your hospital-based treatments (such as surgery or radiotherapy) finish. This is known as follow-up. […] It’s important to be aware of any changes to your breast, chest or surrounding area. […] Most breast cancers dont come back after treatment. But sometimes it can return, so its important you know what signs and symptoms to look out for.

• #41

  https://step2.medbullets.com/oncology/120426/paget-disease-of-the-breast

  Paget disease of the breast is a chronic, eczematous rash on the nipple and adjacent areolar skin. […] Symptoms include erythema, scaling, itching and burning sensation, ulceration, oozing, and bleeding. […] Physical exam shows an eczematous lesion involving the nipple and areolar areas. […] Surgical treatment includes mastectomy and lymph node dissection for patients with Paget disease of the breast and underlying invasive breast carcinoma. […] Prognosis is dependent upon the presence of the underlying invasive ductal carcinoma or axillary node metastases. […] Paget disease of the breast that presents with a palpable mass is usually associated with a worse prognosis than cases without a palpable mass.

• #42 What Is Paget’s Disease of the Nipple? – Iowa Radiology

  https://www.iowaradiology.com/what-is-pagets-disease-of-the-nipple/

  Pagets disease, also called Pagets disease of the nipple or mammary Pagets disease (not to be confused with Pagets disease of the bone), is a rare form of breast cancer that accounts for about 1% of all breast cancer cases. […] Patients diagnosed with Pagets disease are usually found to have tumors in the same breast either ductal carcinoma in situ or invasive breast cancer. […] Depending on the extent of the cancer, the presence or absence of additional cancers, and lymph node involvement, the treatment for Pagets disease can range from breast-conserving surgery, which includes removal of the nipple and areola followed by radiation treatment, to mastectomy. […] After mastectomy, radiation treatment, chemotherapy, and/or hormone therapy may also be recommended. […] The prognosis for Pagets disease patients depends largely on whether an additional palpable breast tumor is present. Among patients with no palpable tumor prior to surgery, the survival rate is very high reported at 92-94% at 5 years and 82-91% at 10 years. The presence identifiable underlying tumors has a significant impact on prognosis, however, with patients surviving five years at a rate of 38-40% and 22-33% surviving 10 years. As with any type of breast cancer, early detection, prompt treatment, and healthy habits are the keys to having the best possible chance of long-term survival.

• #43 Paget’s Disease of the Breast: Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/breast-cancer/guide/paget-disease/

  If Pagets disease is detected alongside other tumors of the breast, your doctor may recommend more extensive surgery, such as a mastectomy, a procedure which removes the entire breast, and lymph node removal surgery, in which the lymph nodes are removed. After a mastectomy, you may choose to have breast reconstruction surgery. […] After the surgery, you may also need to have other treatments, called adjuvant therapy, to prevent the cancer from recurring. This may include radiation therapy, chemotherapy, and hormone therapy. […] If Pagets disease hasnt spread to the surrounding breast tissue, the prognosis is excellent. […] According to the NCIs Surveillance, Epidemiology, and Ends Results (SEER) program, the overall five-year survival rate for women with Pagets was 82.6 percent. The five-year survival rate tends to decrease as the stage of the cancer increases; for women with stage 1 Pagets disease, the survival rate is 95.8 percent; stage 2 is 77.7 percent; stage 3 is 46.3 percent; stage 4 is 14.3 percent.

• #44 What Is Paget’s Disease of the Breast | Breast Care Center Miami

  https://www.toplinemd.com/breast-care-center-of-miami/blog/what-is-pagets-disease-of-the-breast/

  Paget’s disease of the breast, a rare form of breast cancer, can often be misunderstood or misdiagnosed due to its uncommon nature and unique symptoms. […] Treatment for Paget’s disease of the breast usually depends on the underlying breast cancer’s nature and extent. Common treatment options include: […] Being diagnosed with Paget’s disease of the breast can be challenging. It’s essential for patients to seek support from healthcare professionals, support groups, and loved ones. Regular follow-ups and adherence to treatment plans are crucial for managing the condition effectively. […] The diagnosis of Paget’s disease can have a significant psychological impact on patients. Dealing with the diagnosis, treatment, and physical changes to the breast or nipple can be emotionally challenging. It’s important for patients to have access to psychological support, such as counseling or support groups, where they can share their experiences and feelings. Emotional and psychological support is as crucial as the physical treatment of the disease.

• #45 Paget’s Disease of the Nipple | Magee-Women’s Hospital

  https://www.upmc.com/locations/hospitals/magee/services/magee-womens-cancers/breast-cancer-program/types-of-breast-cancer/pagets-disease

  If you have cancer in areas of your breast or body, your doctor may recommend other treatments. The goal is to kill cancer cells and reduce the odds that cancer spreads. […] Your recovery from Paget’s disease of the nipple will depend on the type of treatment you received. It usually takes several months to recover from surgery. […] It can take months to recover from chemotherapy and radiation, too. These treatments may make you tired and weak and cause side effects like nerve damage and swelling (lymphedema).

• #46 Paget’s Disease of the Breast: Symptoms, Treatment, and More

  https://www.healthline.com/health/breast-cancer/pagets-disease-of-the-breast

  Surgery might be followed by radiation therapy to target any cancer cells that were missed. […] One potential complication of this type of breast cancer is that symptoms can be easily dismissed or misdiagnosed, delaying treatment. […] Breast cancer treatment can increase your long-term risk of a variety of conditions, such as lymphedema, due to removal of lymph nodes.

• #47

  https://www.nhs.uk/conditions/pagets-disease-nipple/

  Paget’s disease of the nipple, also known as Paget’s disease of the breast, is a rare condition associated with breast cancer. […] Surgery is the main treatment for Paget’s disease of the nipple. Depending on whether the cancer has spread, surgery will either involve removing the whole breast (a mastectomy), or the nipple and areola with the breast tissue underneath them (a central excision). […] If Paget’s disease is detected and treated in its early stages, there’s a good chance of a full recovery.

• #48 Paget’s Disease of the Breast: Causes, Symptoms, and Treatments | SELF

  https://www.self.com/story/pagets-disease-of-the-breast

  Lumpectomy. Breast-conserving surgery (lumpectomy) involves removing only the diseased portion of your breast. Your surgeon removes your nipple and areola along with a wedge- or cone-shaped section of your breast. The surgeon focuses on removing as little breast tissue as possible, while ensuring that the tissue removed includes an outer margin free of cancer cells so that only healthy cells remain. […] Lumpectomy to treat Paget’s disease of the breast requires follow-up radiation therapy. Lumpectomy wouldn’t be recommended if you can’t have radiation therapy for some reason. Most women have nipple reconstruction after their treatment. […] After your operation, your doctor may recommend additional treatment (adjuvant therapy) with anti-cancer drugs (chemotherapy), radiation therapy, or hormone therapy to prevent a recurrence of breast cancer. Your specific treatment will depend on the extent of the cancer and whether your tumor tests positive for certain characteristics, such as having estrogen or progesterone receptors.

• #49 Natalie’s Stage 0 ER+ DCIS & Paget’s Disease Breast Cancer Story – The Patient Story

  https://thepatientstory.com/patient-stories/breast-cancer/combination-types/natalie-w/

  You have to advocate for yourself because you have to feel confident. If you don’t feel confident with your doctor, find a new one. […] You’re not just a number. These doctors have a lot of patients, but you’re a human. You go in there and let them know you’re not a number. You have concerns about your health, and your doctors should be concerned about you. […] Research, ask questions, [and] tell them you want all your information so you can take it to another doctor if they’re not meeting your needs. […] If you don’t understand the lingo, tell them. Say, “I don’t understand what you’re saying. I’m not a doctor. Can you explain that to me?”

• #50 Understanding Paget’s Disease Accompanied by Invasive Breast Cancer – Journal of Oncology Navigation & Survivorship

  https://www.jons-online.com/issues/2020/december-2020-vol-11-no-12/understanding-paget-s-disease-accompanied-by-invasive-breast-cancer

  After surgery, radiation therapy and perhaps chemotherapy, targeted therapy, and/or hormone therapy may be recommended. About 97% of people diagnosed with Pagets disease of the nipple also have ductal carcinoma in situ or invasive cancer somewhere else in the breast. The exact treatment plan will depend on the characteristics of the underlying breast cancer such as stage, grade, and whether the cancer is hormone receptor-positive and/or HER2-positive. As in other breast cancer diagnoses and treatment, a consultation with a medical oncologist would be prudent. […] As with any breast cancer patient, the navigator plays an important role in the support and coordination of care. Patients with Pagets disease are no different. However, there are times when a patient may first be shaken by a diagnosis of cancer that might have been primarily treated as a dermatologic issue. After an introduction, the navigator should begin to establish a relationship of trust and empathy. This early introduction will allow for the coordination of care with the multidisciplinary team and give the patient confidence that the navigator will act as her advocate in all areas of treatment, which could lead to improved adherence to the care suggested.

• #51 Paget’s disease: A therapy update

  https://www.myamericannurse.com/pagets-disease-a-therapy-update/

  Caring for patients with Pagets disease Nurses can help patients and their families understand Pagets disease and its treatment. Increasing concerns about skeletal health, complications, and safety of drug therapy can cause stress and anxiety. Education and counseling help allay these concerns. Keep in mind that while bisphosphonates can relieve bone pain, they dont ease pain caused by such complications as arthritis or nerve compression. Be sure to assess the source of your patients pain to help identify appropriate therapies. Besides analgesics, pain management might include physical therapy, hydrotherapy, acupuncture, or orthotics (such as canes or shoe lifts). Some patients also may need surgical repair of fractures or surgical joint realignment or replacement. […] Patient teaching Inform patients that bisphosphonates dont cure the disease, but they can control it. Tell them complete biochemical remission is less likely in patients with the greatest disease severity. Encourage patients to follow their individualized treatment plan to help minimize symptoms, improve physical functioning, slow disease progress, and limit disability. An excellent resource for patient and family education is available online from The Paget Foundation (www.paget.org).

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