Everyone is different, and the treatments recommended for Paget's disease of the nipple may vary according to individual circumstances.
Treatment for Paget’s disease of the nipple will depend on how much of the nipple, areola and breast is involved.
Where Paget’s disease of the nipple is the only cancer in the breast, treatment usually involves:
- breast surgery and/or
- radiotherapy.
If invasive breast cancer or DCIS is present in the same breast the recommended treatment options may be different and may involve additional treatments depending on the type and extent of that cancer.
Breast surgery
Surgery for Paget’s disease of the nipple usually involves removal the nipple and some surrounding tissue. If the nipple is the only area of the breast affected, it’s possible that only the nipple and an area of healthy tissue around it will be removed. This is known as breast conserving surgery.
Removal of the whole breast (mastectomy) and/or removal of one or more lymph nodes from the armpit may be needed for some patients.
As the nipple is likely to be removed, there are a number of options to recreate a nipple. These include having a nipple tattoo or having a nipple made from your own tissue.
Radiotherapy
For women with Paget’s disease of the nipple, radiotherapy is almost always recommended after breast conserving surgery. Radiotherapy is sometimes recommended after mastectomy. Radiotherapy uses X-rays (controlled doses of radiation) to destroy cancer cells. Radiotherapy is usually given once a day, 5 days a week for 3–6 weeks.
For some women with Paget’s disease of the nipple, radiotherapy may be the only treatment needed after the biopsy used during diagnosis.
What are the possible side effects of various treatments?
All treatments for breast cancer carry some risk of side effects. Most side effects can be managed and will improve with time. It is important to consider the benefits of treatment and possible side effects when making decisions about treatment. Talk to your doctor about any side effects that are concerning you.
Side effects of surgery
Side effects of surgery may include pain, discomfort and/or numbness in the breast or in the armpit if lymph nodes have been removed. Some people who have surgery to the armpit may develop lymphoedema (swelling in the arm).
Side effects of radiotherapy
Common side effects of radiotherapy include tenderness or a feeling of tightness in the treated breast, and changes to the skin of the breast such as redness or swelling – a bit like sunburn. It is also common to feel tired during radiotherapy.
Follow-up care
Once treatment is finished, regular follow-up appointments with your specialist or general practitioner are recommended. Follow-up after treatment for Paget’s disease of the nipple usually involves a regular physical examination and an annual mammogram with or without an ultrasound. Other tests such as blood tests or bone scans are not done routinely during follow-up unless there is concern that the cancer has spread outside the breast.
Support during and after treatment
The experience of a diagnosis of breast cancer is different for everyone. It is usual to feel anxious, frightened or confused. Sharing thoughts and feelings with others can be helpful. Members of your treatment team, friends and family can provide emotional, psychological and practical help. Breast care nurses specialise in caring for women with breast cancer and can be a valuable source of information and support. Talk to doctors, your breast care nurse or other members of the treatment team about any fears or concerns you may have.
The Cancer Council Support line (13 11 20) can advise on the huge range of support available throughout Australia.
My Journey provides accessible online, high quality, evidence-based information and insights from others diagnosed with breast cancer. Access My Journey via the Breast Cancer Network Australia website https://www.bcna.org.au/my-journey/
For more information about management of breast cancer in general see Guide to Best Cancer Care - Breast cancer
