Paget's Disease of The Nipple (cont.)
What are the possible causes of Paget's disease of the nipple?
Scientists do not know exactly what causes Paget's disease of the nipple, but
two major theories have been suggested for how it develops (1, 2). One theory
proposes that cancer cells, called Paget cells, break off from a tumor inside
the breast and move through the milk ducts to the surface of the nipple,
resulting in Paget's disease of the nipple. This theory is supported by the fact
that more than 97 percent of patients with Paget's disease also have underlying
invasive breast cancer or ductal carcinoma in situ (DCIS) (1). DCIS, also called
intraductal carcinoma,
is a condition in which abnormal cells are present only in the lining of the
milk ducts in the breast, and have not invaded surrounding tissue or spread to
the lymph nodes. DCIS sometimes becomes invasive breast cancer. Invasive breast
cancer is cancer that has spread outside the duct into the breast tissue, and
possibly into the lymph nodes under the arm or into other
parts of the body.
The other theory suggests that skin cells of the nipple spontaneously become
Paget cells. This theory is supported by the rare cases of Paget's disease in
which there is no underlying breast cancer, and the cases in which the
underlying breast cancer is found to be a separate tumor from the Paget's
disease (1).
What are the symptoms of Paget's disease of the nipple?
Symptoms of early Paget's disease of the nipple include
redness and mild scaling and flaking of the nipple skin (1). Early symptoms may
cause only mild irritation and may not be enough to prompt a visit to the doctor
(3). Improvement in the skin can occur spontaneously, but this should not be
taken as a sign that the disease has disappeared. More advanced disease may show
more serious destruction of the skin (1). At this stage, the symptoms may
include tingling, itching, increased sensitivity, burning, and pain. There may
also be discharge from the nipple, and the nipple can appear flattened against the
breast (1, 2).
In approximately half of patients with Paget's disease of the nipple, a lump
or mass in the breast can be felt during physical examination (1). In most
cases, Paget's disease of the nipple is initially confined to the nipple, later
spreading to the areola or other regions of the breast (1, 2). The areola is the
circular area of darker skin that surrounds the nipple. Paget's disease of the
nipple can also be found only on the areola, where it may resemble eczema, a noncancerous
itchy red rash (1). Although rare, Paget's disease of the nipple
can occur in both breasts (2).
Next: How is Paget's disease of the nipple diagnosed? »
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