Paget’s disease of the nipple: Treatment strategies
Paget’s disease of the nipple (also known as Paget’s disease of the breast) can be treated through the mastectomy surgery. The nature of this operation depends on the typical characteristics of the underlying breast cancer.
The Treatments for Paget’s Disease of the Nipple
The four treatments recommended for patients suffering from Paget’s disease of the nipple are the following:
(1) Radical mastectomy;
(2) Axillary node dissection;
(3) Lumpectomy; and
(4) Adjuvant treatment
Let’s check out each of these surgeries.
Simple & Modified Radical Mastectomy
Radical mastectomy is especially prescribed for patients suffering from an invasive form of Paget’s disease of the nipple which is basically cancerous. Notably, invasive breast cancer spreads rather fast. It moves outside the milk ducts into the tissues of the breast. In severe instances, the abnormal cancerous cells also travel into the lymph nodes throughout the body. These cancerous cells generally target the region under the arms.
Radical mastectomy is also done in the extensive or DCIS form of Paget’s disease of the nipple. DCIS is also termed as ‘Intraductal carcinoma’. The acronym ‘DCIS’ stands for ‘Ductal carcinoma in situ’.
The DCIS syndrome of the ailment is not only invasive but also quite nondescript. The syndromes may appear to subside subsequently. Hence, the patients tend to overlook. Ultimately, the DCIS syndrome takes deep root with diabolical effect at times. During the DCIS phase, the cancerous or abnormal cells remain in the milk ducts of the breast. As a result, the lymph nodes or the tissues of the surrounding portion around the affected area still remain unaffected.
It is important that these ‘Paget cells’ (affected cells) are diagnosed at this very initial stage for effective treatment. In such cases of non-invasive breast cancer, a simple mastectomy can resolve the problem. It entails the removal of only the afflicted breast and the lining over the chest muscles.
Else, the Paget cells may spread and cause complicacies. Then, the patient will have to undergo a modified radical mastectomy. The surgery is done to remove some lymph nodes under the arm, the lining over the chest muscles, and the affected breast.
Axillary node dissection
Axillary node dissection is carried out as a part of modified radical mastectomy to remove the lymph nodes in the region under the arm. The lymph nodes are analyzed to determine whether cancer has affected them or not. On the other hand, a sentinel node biopsy is carried to take out just one or a limited number of lymph nodes.
Lumpectomy
Lumpectomy is done to preserve the breast. This alternative surgery is done to ensure that the breast is not removed. However, Lumpectomy requires the total removal of all the affected parts of the breast besides the areola, and the nipple.
Lumpectomy is ideal for only those patients whose range of affliction is confined just to the nipple or the surrounding portions.
The patient suffering from Paget’s disease of the nipple needs to subsequently go through a therapy of radiation to obviate any possibility of recurrence of the ailment.
Adjuvant Treatment
Adjuvant treatment is the radiation phase. It is done after the completion of either lumpectomy or the breast preservation surgery. Adjuvant surgery is recommended depending on the extent of cancer as to whether it has spread to the lymph nodes or not and also on the typical nature of the disease.
Adjuvant treatment is done also with the prescription of hormone therapies or anticancer drugs. Of course, such recommendations depend on the prognostic factors (a rough estimate of recovery or recurrence chances) as well as the extent of damage following the affliction of Paget’s disease of the nipple.
