Diagnosis
To diagnose Paget's disease of the breast, a healthcare professional might start with a physical exam. The health professional also may ask about your symptoms. Most people with Paget's disease of the breast have cancer within the breast tissue. So you may have imaging tests to look at the breast tissue for signs of cancer. To confirm whether there is cancer, a sample of tissue is removed from the breast for testing.
Breast exam
During a clinical breast exam, a healthcare professional looks at the breasts for anything that's not typical. For Paget's disease of the breast, this might include changes in the skin or to the nipple. Then the health professional feels the breasts for lumps. The health professional also feels along the collarbones and around the armpits for lumps.
Mammogram
A mammogram is an X-ray of the breast tissue. Mammograms are commonly used to screen for breast cancer. If a healthcare professional is concerned that you might have breast cancer, that person might have you do a more detailed mammogram, called a diagnostic mammogram. It's often used to look closely at both breasts.
Receiving a mammogram
During a mammogram, you stand in front of an X-ray machine designed for mammography. A technician places your breast on a platform and positions the platform to match your height. The technician helps you position your head, arms and torso to allow a clear view of your breast.
Breast ultrasound
Ultrasound uses sound waves to make pictures of structures inside the body. A breast ultrasound may give your healthcare team more information about a breast lump. For example, an ultrasound might show whether the lump is a solid mass or a fluid-filled cyst. The healthcare team uses this information to decide which tests you might need next.
Breast magnetic resonance imaging
Magnetic resonance imaging, also called MRI, uses a magnetic field and radio waves to create pictures of the inside of the body. A breast MRI can make more-detailed pictures of the breast. Sometimes this method is used to look closely for any other areas of cancer in the affected breast. It also might be used to look for cancer in the other breast. Before a breast MRI, you usually receive an injection of dye. The dye helps the tissue show up better in the images.
Biopsy
A biopsy is a procedure to remove a sample of tissue for testing in a lab. For Paget's disease of the breast, the biopsy procedure often involves taking a sample of skin. A healthcare professional might use a cutting tool to remove some skin from the affected nipple.
If imaging tests find something worrying in the breast tissue, a healthcare professional might remove tissue from the breast for testing. To get the sample, a healthcare professional puts a needle through the skin and into the breast tissue. The health professional guides the needle using images created with X-rays, ultrasound or another type of imaging. Once the needle reaches the right place, the health professional uses the needle to draw out tissue from the breast. Often, a marker is placed in the spot where the tissue sample was removed. The small metal marker shows up on imaging tests. The marker helps your healthcare team monitor the area of concern.
Core needle biopsy
A core needle biopsy uses a long, hollow tube to obtain a sample of tissue. Here, a biopsy of a suspicious breast lump is being done. The sample is sent to a lab for testing and evaluation by doctors, called pathologists. They specialize in analyzing blood and body tissue.
Treatment
Treatment for Paget's disease of the breast often involves surgery. Other treatments may include radiation therapy and medicines, such as chemotherapy and hormone therapy. Your treatment options may depend on whether the cancer only affects the nipple or whether cancer also is in the breast tissue.
Surgery
Operations used to treat Paget's disease of the breast include:
- Removing the breast cancer. Breast-conserving surgery, also called lumpectomy, involves removing the cancer from the breast. For Paget's disease of the breast, the surgeon might remove the nipple, areola and other parts of the breast that have cancer. Most people who have this surgery also have radiation therapy.
- Removing all of the breast tissue. A mastectomy is surgery to remove all breast tissue from a breast. The most common mastectomy procedure is total mastectomy, also called simple mastectomy. This procedure removes all of the breast, including the lobules, ducts, fatty tissue and some skin, including the nipple and areola.
- Removing a few lymph nodes. A sentinel node biopsy is an operation to take out some lymph nodes for testing. When breast cancer spreads, it often goes to the nearby lymph nodes first. To see if the cancer has spread, a surgeon removes some of the lymph nodes near the cancer. If no cancer is found in those lymph nodes, the chance of finding cancer in any of the other lymph nodes is small. No other lymph nodes need to be removed.
- Removing several lymph nodes. Axillary lymph node dissection is an operation to remove many lymph nodes from the armpit. Your breast cancer surgery might include this operation if imaging tests show that the cancer has spread to the lymph nodes. It also might be used if cancer is found in a sentinel node biopsy.
- Removing both breasts. Some people who have cancer in one breast may choose to have their other breast removed even if it doesn't have cancer. This procedure is called a contralateral prophylactic mastectomy. It might be an option if you have a high risk of getting cancer in the other breast. The risk might be high if you have a family history of cancer or have DNA changes that increase the risk of cancer. Most people with breast cancer in one breast do not get cancer in the other breast.
Complications of breast cancer surgery depend on the procedures you choose. All operations have a risk of pain, bleeding and infection. Removing lymph nodes in the armpit carries a risk of arm swelling, called lymphedema.
You may choose to have breast reconstruction after mastectomy surgery. Breast reconstruction is surgery to restore shape to the breast. Options might include reconstruction with a breast implant or reconstruction using your own tissue. Consider asking your healthcare team for a referral to a plastic surgeon before your breast cancer surgery.
Mastectomy
During a total mastectomy, the surgeon removes the breast tissue, nipple, areola and skin. This procedure also is known as a simple mastectomy. Other mastectomy procedures may leave some parts of the breast, such as the skin or the nipple. Surgery to create a new breast is optional. It may be done at the same time as mastectomy surgery or it can be done later.
Sentinel node biopsy
Sentinel node biopsy identifies the first few lymph nodes into which a tumor drains. The surgeon uses a harmless dye and a weak radioactive solution to locate the sentinel nodes. The nodes are removed and tested for signs of cancer.
Other treatments
After surgery, your healthcare team may recommend additional treatments. These treatments may help lower the chances that the cancer will come back. Whether you need these other treatments may depend on your cancer.
Other treatments for Paget's disease of the breast may include:
- Radiation therapy.
- Chemotherapy.
- Hormone therapy.
Coping and support
Some people who have been diagnosed with Paget's disease of the breast say their diagnosis felt overwhelming at first. It can be stressful to feel overwhelmed at the same time you need to make important decisions about your treatment. In time, you'll find ways to cope with any feelings you have. Until you find what works for you, here are some ideas that might help.
Learn enough about your cancer to make decisions about your care
If you'd like to know more about your breast cancer, ask your healthcare team for the details of your cancer. Ask for good sources of information where you can learn more about your treatment options. As you learn more about your condition, you might feel more confident about making decisions about your care.
Talk with other breast cancer survivors
You may find it helpful and encouraging to talk with others who have been diagnosed with breast cancer. Contact a cancer support organization in your area to find out about support groups near you or online. In the United States, you might start with the American Cancer Society.
Find someone to talk with about your feelings
Find a friend or family member who is a good listener. Or talk with a clergy member or counselor. Ask your healthcare team for a referral to a counselor or other mental health professional who works with people who have cancer.
Keep your friends and family close
Your friends and family can provide a crucial support network for you during your cancer treatment.
As you begin telling people about your breast cancer diagnosis, you'll likely get many offers for help. Think ahead about things you may want help with. Examples include listening when you want to talk or helping you with preparing meals.
Preparing for your appointment
Make an appointment with a doctor or other healthcare professional if you have symptoms that worry you. If your healthcare professional thinks you might have Paget's disease of the breast, that person may refer you to a specialist. This may be a doctor who treats breast conditions or a doctor who treats cancer.
Appointments can be short and being prepared can help. Here's some information that may help you get ready.
What you can do
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:
- Your symptoms, including any that seem unrelated to the reason for your appointment.
- Key personal information, including major stresses, recent life changes and family medical history.
- All medicines, vitamins and other supplements you take, including the doses.
- Questions to ask your healthcare team.
Take a family member or friend along, if possible, to help you remember the information you're given.
For Paget's disease of the breast, some basic questions to ask include:
- Do I have cancer?
- Do I need more tests?
- What are my treatment options?
- What are the potential risks of these treatment options?
- Do any of the treatments cure my cancer?
- Can I have a copy of my pathology report?
- How much time can I take to consider my treatment options?
- Are there brochures or other printed materials that I can take with me? What websites do you recommend?
- What would happen if I chose not to have treatment?
Don't hesitate to ask other questions.
What to expect from your doctor
Your healthcare professional is likely to ask you several questions, such as:
- What skin changes have you noted in your nipple?
- Have you experienced any nipple discharge, bleeding, burning or itching?
- Do you have any other breast symptoms, such as a breast lump or area of thickening?
- Have you experienced any breast pain?
- When did your symptoms begin?
- What, if anything, seems to make your symptoms better?
- What, if anything, seems to worsen your symptoms?
