Paget's cancer: symptoms, diagnosis, treatment
One of the forms of malignant tumors of breast cancer is Paget's.
Cancer Paget's breast cancer is formed in the nipple or around the nipple of the breast (lesion of the nipple-areola complex). This disease is considered a rare form of cancer that occurs mainly in women older than 50 years.
Cancer Paget's can hurt men. And for the latter characterized by more aggressive course, due to the fact that the mammary glands in men are smaller and the tumor cells can easily penetrate further into the body.
In addition this disease can attack other parts of the body in areas where there are apocrine sweat glands. This can be the penis in men, vulva in women or the crotch region.
The mechanism of development
Cancer Paget's breast cancer is only 3% of all registered cases of cancer to date. In rare cases this disease can occur in young people aged 20 years and older. In men cancer Paget is most likely to occur around 70 years, women 60 years.
The name of the disease occurred after the scientist Paget, in 1874, found a relationship between changes the nipple and breast cancer. He suggested that a superficial change entails degenerative changes, with subsequent neoplasia. Piaget described the mechanism of the disease and its clinical manifestations, which formed the basis for the definition of Paget's cancer of the breast.
The exact causes leading to the development of this form of malignancy is not fully understood. In this respect there are several theories:
1) epidermotropic theory. According to this theory, it is believed that atypical cells migrate through the milky ducts directly to his nipples, where then they are implanted and begin to grow. This theory is supported by the practice, which shows that 95% of cases of Paget's cancer combined with vnutripolostnoe form of breast cancer. Tumor cells are glandular cells originating from the epithelium of the ducts.
2) transformative theory. According to this theory, it is believed that the malignant tumor arises from transformation of normal epithelial cells of the areola or nipple in the atypical cells. This hypothesis is based on cases when you do not detect breast cancer with a different localization.
There is also a certain genetic predisposition to development of malignancy in men. Aggravating factors to the development of Paget's cancer include nipple trauma, the action of carcinogenic substances.
Types of cancer Paget's
Cancer Paget is divided into three main forms:
1) psoriatic form;
2) acute eczematoid;
3) chronic eczematoid.
When psoriatic arise form small pink papules covered by dry scales on top. Acute eczematoid proceeds with the formation of the fine-grained skin rashes, ulcerations and weeping of the nipple. For chronic eczematoid are characterized by crust that formed on top of the skin and leave behind areas soak. There may also be ulcerated or tumor forms. The skin form of tumor in the gland or the depth of the crater ulceration.
In 50% of cases in cancer Paget's mostly affects the nipple-alveolar complex. In 40% of cases along with changes to the nipple and areola also identifies a malignant node around them, which is well palpated. Accidentally detect cancer nipple can cytological examination or in 10% of cases.
Signs of Paget's cancer
Paget's cancer of the breast manifests itself by nonspecific symptoms. Often, these signs do not give cause for concern and appeals to the doctor, sothe symptoms of Paget's cancer can go unnoticed.
Primarily occurs on the skin redness and peeling, irritated area around the nipples and the nipple. Such characteristics can, over time, fade under the action of the corticosteroid ointments.
Then after a certain period the increase of the clinical picture and the symptoms are worse. Around the nipples occurs itching, burning, pain, tingling. The skin becomes very sensitive and starts, serous-hemorrhagic discharge from the nipple. Can change its configuration, the nipple may be retracted or compacted.
With the progression of malignant tumors arise infiltrates and redness in the nipple area, the surface is covered with sores, scabs and non-healing erosions. When you remove the crust, you can see the wet weeping surface of the nipple.
Usually Paget's cancer of the breast affects only one gland, but may be bilateral in nature, although in very rare cases.
On clinical examination, the doctor notes the formation of lumps in the breast in about half of patients. With the development of the disease malignant process goes on for all to see. The affected area with this disease has a well-defined outline, and slightly raised above the surface of the unaffected skin. There is an increase in nearby lymph nodes. At the later stages appear bloody discharge from the nipple. In men, the symptoms of Paget's cancer consist of maceration of the skin, formation compaction or erosion, as well as accompanied by itching and peeling.
For the diagnosis of Paget's cancer of the breast used such methods:
2) breast ultrasound;
7) laboratory methods.
In cases of suspected malignancy of the breast, the patient must undergo a consultation with a mammologist-oncologist. He will examine the mammary glands, nipple and directs for further investigation. During the inspection of the nipples it takes a special smear-imprint for the presence of Paget's cells and biopsy or PAP smear.
Ultrasonic breast examination allows to detect malignancy and to determine its exact location, and to inspect the condition of the ducts. Mammography gives the opportunity to determine the node in the breast, the shape of the nipple and skin thickness. It is performed in three projections.
MRI allows to identify the disease at early stages of development, when clinical manifestations are erased the character. Thus, it is possible to identify a variety of mammary tumors. To highly informative methods of diagnostics of mammary glands refers scintigraphy. With the help of histological examination of tumor is determined by the content and form of Paget's cancer. Laboratory methods of analysis allow to identify inflammatory process in the body and to suspect the disease. In General, cancer Paget is very easy to diagnose even at the earliest stages and can be treated successfully.
Treatment of Paget's cancer
The main treatment of Paget's cancer of the breast is considered radical removal. This operation is called radical mastectomy.
Surgical intervention is performed if invasive cancer or carcinoma vnutriportovaya. During the surgery is removed mammary gland with tissue, lymph nodes and pectoral muscles. When non-invasive form of Paget's cancer by simple mastectomy: removes the small pectoral muscle and the breast tissue.
At the earliest stages of the malignant processis radical resection: removes the breast, nipple, areola. After surgery, patients do reconstructive breast surgery.
Combined with surgical methods of treatment is a course of chemotherapy, hormonal therapy and gamma therapy. Such precautions will help to avoid recurrence and formation of metastases.
Cancer Paget's is not always detected in the early stages, the further prognosis depends on timely diagnosis and treatment. There is a high probability of recurrence even in the postoperative period, in connection with particular aggressiveness of the tumor. The average life expectancy is approximately 3 years. When metastasis and infiltrates the life expectancy is 1 year.
Prevention of Paget's cancer involves regular visits to the doctor mammologist and periodic examinations of mammary glands of different diagnostic methods. This will allow time to identify the onset of the disease and significantly improve the prognosis.