Paget’s Disease of Nipple

December 10th, 2010 admin Women's Health 0

Paget’s disease of nipple is a special type of breast cancer, which is not very common. However, it is the one which can be misdiagnosed easily. It is frequently thought to be a skin inflammation or infection, leading to unfortunate delays in detection and care.

I have seen few patients who had their treatment as nipple eczema for certain length of time and eventually searched for help, as the treatment for eczema did not help at all, instead got worse. After doing punch biopsy of nipple, diagnosis was confirmed as Paget’s disease of nipple with underlying invasive breast cancer and had mastectomy(removal of whole breast)!

What is it?
It is an eczema-like change in the skin of the nipple, and 9 out of 10 women who have it have an underlying breast cancer. The underlying breast cancer may be an invasive breast cancer or ductal carcinoma in situ (DCIS). In DCIS, the cancer cells are completely contained within the milk ducts. It is seen in 1-4% of cases of female breast cancer.

How does it present?
* Presents as chronic eczematous change of the nipple with iItching, erythema, scale formation, erosions, nipple discharge including bleeding

* Underlying palpable breast lump (usually indicates an invasive nature).

Investigations
* Punch Biopsy of nipple with immuno-histochemistry and special stains

* Investigation of breast lump if palpable

* Investigations looking for underlying malignancy if no lump palpable, e.g. mammography or MRI (may be more useful) and core biopsy.

Management
The treatment of Paget’s disease of the breast will depend on:

* whether or not there is an underlying breast cancer

* whether it is DCIS or an invasive tumour

* how much of the breast is affected.

Surgery
Surgery is the main treatment for Paget’s disease. This may involve an operation to remove all of the breast (a mastectomy) or an operation to remove the affected area of breast, including the nipple and areola, and some surrounding normal breast tissue (breast-conserving surgery). Some of the lymph nodes in the underarm may also be removed.

A mastectomy may be recommended if the cancer is affecting a wide area. It may be possible to have breast reconstruction at the same time as a mastectomy or as a second operation some months later.

Some people don’t need any further treatment after surgery. Others may need radiotherapy, hormonal therapy or chemotherapy and or immuno-therapy. These treatments may be given separately or together.

Prognosis
Paget’s disease of the breast is associated with a poor prognosis, which is worse if the lesion is associated with an underlying palpable mass.

Dr Tasmia Tahmid

Breast Cancer Awarenes

October 23rd, 2010 admin Women's Health 0

Breast cancer is the 2nd most cause of cancer death in women. Most of the deaths from the disease are due to late diagnosis, lack of screening and self examination.

The news of being diagnosed with cancer is not all bad. Most women who diagnosed at early stage are living like normal after surgical resection of breast tumor and other interventions to completely eradicate cancer cells from body.

In the month of October, which is observed as breast cancer awareness month, we need to tie up to spread the message that early diagnosis is the key to survival. Here are the key messages that need to be disseminated among mass population for early diagnosis, prevention and reduces large death toll.

Warning signs of breast cancer:

* New lump/swelling in the breast or underarm.

* Thickening or swelling of part of the breast

* Irritation or dimpling of breast skin.

* Redness or flaky skin in the nipple area or the breast

* Pulling in of the nipple or pain in the nipple area

* Nipple discharge (e.g. bloody) other than breast milk

* Any change in the size or the shape of the breast

* Pain in any area of the breast

Breast self-examination
Breast self-examination (BSE) is a method that involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling in front of a mirror. It should be done at regular interval.

So all women should check themselves or go to nearby centres for a screening examination in this month and should keep continue checking at regular interval.

The writer is Prof Dr Md Mizanur Rahman

Breast Lump Does Not Always Mean Breast Cancer

May 10th, 2010 admin Women's Health 0

Breast lump or swelling in the breast is a complaint frequently encountered by general surgeons. It is a common reason for the female patients to seek surgical consultation.

In my surgical practice the most common question that I face from the patient — “Is it cancer?” Breast lump has become synonymous with breast cancer. The fact is only 20 percent of breast tumours turn out to be malignant or cancerous!

Commonest benign (non-cancerous) breast lump is called fibroadenoma which is typically found in young women. It is generally smooth, spherical, painless and very mobile without any attachment to skin or surrounding breast tissue. More than one lump may be present. It gradually increases in size and may eventually fill the whole. During pregnancy fibroadenoma may increase in size, but returns to the original size after delivery of the baby.

Fibroadenoma is usually treated by surgical removal. It is a minor operation commonly done under short general anaesthesia. It is possible to plan the cut in the breast skin in such a way that there is almost no post-operative scar marks. In case of unavoidable large cuts, it is placed in such a way that the scar is hidden under the clothing.

The other common breast lump is due to an abnormality in female hormone level. In this condition, multiple lumps of various sizes are found in the breast. Typically both breasts are involved, although patients may complain about one breast only. Lump size maybe somewhere between a size of grain to 3-4 cm. The breasts are painful and tender. The pain may become intense at or near the time of menstruation. The pain may radiate to the arm or back, and may be so severe to interfere normal life.

In most patients it is the pain that brings them to a surgeon and not the lump. There may be nipple discharge in the form of clear sticky fluid.

The disease called Fibroadenosis is a disease of the reproductive age. It may be self-limiting, usually disappearing after the first pregnancy. In most patients the disease is of mild form and simple painkiller with adequate explanation usually brings about a relief.

More resistant cases are treated with hormone therapy. Surgery is reserved for extreme cases. A particularly painful cyst or lump is removed under general anaesthesia. As in fibroadenoma, it is possible to plan the skin cut to provide best cosmetic results. The most important point to remember from the patient’s point of view is the possibility of recurrence, and more than one operation may be required.

A breast lump is particularly a concern in women with risk factors. Risk factors include age, family history, early onset of menstruation, late menopause, late first pregnancy, obesity, hormone replacement therapy etc. More than 66 percent of women with breast cancer are above the age of 50 years and 80 percent are at least 40 years old. The chances of developing cancer are two to three times higher in case of women with a close female relative (mother, sister) who had breast cancer.

Early diagnosis is the key to effective treatment for breast cancer. Most breast cancers are detected by the patient herself. This is why, self-examination by the patient is important.