Special Manifestations of Cancer
Paget's Disease of the Nipple
Paget's disease is a rare, slowly growing cancer of the nipple. Paget's disease is usually associated with in situ or invasive cancer. One of the biggest problems with Paget's disease of the nipple is that its symptoms appear to be harmless. It is frequently thought to be a skin inflammation or infection, leading to unfortunate delays in disease detection, diagnosis and treatment. Symptoms of Paget's disease include persistent redness, itching, oozing, crusting, and fluid discharge from the nipple or a sore on the nipple that does not heal. Typically, only one nipple is affected. Treatment and prognosis for the disease are directly related to the type and extent of the underlying cancer.
Inflammatory Breast Cancer (IBC)
Inflammatory breast cancer (IBC) is a rare and aggressive form of invasive breast cancer that is usually not detected by mammograms or ultrasounds. IBC usually grows in nests or sheets rather than as a confined solid tumor and can be diffuse throughout the breast with no palpable mass. The cancer cells clog the lymphatic system just below the skin, resulting in lymph node involvement. Increased breast density compared to prior mammograms should be considered suspicious.
However, the main symptoms of IBC are breast swelling, inflammation, pink, red, or a dark colored area (erythema), sometimes with texture similar to the skin of an orange (peau d'orange), ridges and thickened areas of the breast skin, an area of the breast that is warm to the touch, what appears to be a persistent bruise, itching (pruritus) that is unrelenting and unaffected by medicated creams and ointments, increase in breast size over a short period of time, nipple flattening, retraction, or discharge, breast pain that is not cyclic in nature and may be constant or stabbing, or swollen lymph nodes in the armpit or above the collar bone. Since many of these symptoms mimic a breast infection, doctors frequently treat inflammatory breast cancer merely as an infection. When symptoms do not improve after antibiotic treatment for the suspected “infection” only then is the inflammatory breast cancer diagnosed.
IBC has an extremely high risk of recurrence and a very poor prognosis. It is the most lethal form of breast cancer. To improve the chances of survival it is important that symptoms are recognized early, resulting in an immediate diagnosis and treatment. Chemotherapy is usually begun within days of diagnosis. Without treatment, chances of 5-year survival for individuals with inflammatory breast cancer are very poor. With treatment, about 50% of patients will be living 5 years after diagnosis.