treatment

Paget's disease of the nipple is usually associated with breast cancer.

It's treated by removing the cancerous part of the breast, or sometimes the entire breast using a procedure called a mastectomy (see below).

You can discuss any concerns you have with your oncologist (cancer specialist) who will be able to explain each phase of your treatment.

Surgery

If you're diagnosed with Paget's disease of the nipple, surgery is often the first type of treatment you'll receive. The two main types of surgery are:

• mastectomy surgery to remove the whole breast, which can be followed by reconstructive surgery to recreate the removed breast
• breast-conserving surgery where only the cancerous lump (tumour) and a little surrounding breast tissue are removed

These types of surgery will also involve removing your nipple and the darker area of skin surrounding it (the areola).

The two different types of surgery are discussed in more detail below.

Mastectomy

During a mastectomy, all of your breast tissue, including your nipple, will be removed.You may need to have a mastectomy if:

• the tumour is large or in the centre ofyour breast
• there's more than one area of breast cancer
• breast-conserving surgery won't provide acceptable results

If lymph nodes (small glands) are removed from your armpit during a mastectomy, the scarring may block the filtering action of the lymph nodes, resulting in a condition called Lymphoedema . This is a long-term condition, but can be treated with:

• specialised massage techniques
• compression sleeves tightly fitting bandages that push excess fluid out of your arm
• exercises
• skin care

Lymphoedema can develop months or sometimes years after surgery. Contact your GP or breast care nurse if you notice any swelling in your arm or hand on the side of your operation.

You should be offered reconstructive surgery to improve the appearance of your breast after surgery (see below).

If you have breast-conserving surgery, the amount of breast tissue removed will depend on:

• the size of the tumour in relation to the size of your breast
• whether the tumour is in one place or scattered throughout your breast

Your surgeon will remove some healthy breast tissue around the cancer so it can be tested for traces of cancer. If cancer cells are found in the surrounding tissue, more tissue may need to be removed from your breast.

After having breast-conserving surgery, it's likely you'll need to have radiotherapy to destroy any remaining cancer cells.

This can be done by:

• inserting a breast implant
• using tissue from another part of your body to create a new breast

The reconstruction can be carried out at the same time as your mastectomy or at a later stage. You should fully discuss your options with your surgeon and breast nurse before making a decision.

For example, it may be possible to have reconstructive surgery after breast-conserving surgery to improve the appearance of your breast and create a nipple.

A nipple can be created by:

• having a nipple tattooed onto the skin
• using your own body tissue, such as tissue from your other nipple, although around half of these flatten out and shrink over time
• using a stick-on latex (rubber) nipple, which can be made from a mould of your other nipple so thatthey're identical; you stick it on every day with glue and it can be removed for washing

Other types of treatment for breast cancer include:

• chemotherapy where powerful medication is usedto destroy cancer cells and prevent them dividing and growing
• radiotherapy where controlled doses of high-energy radiation , usually X-rays , are used to destroy cancer cells
• biological therapy if your breast cancer is HER2 positive, biological therapy, usually a medication called trastuzumab , can be used to treat the cancer by stopping the effects of HER2 and helping your immune system fight off cancer cells
• hormone therapy if your breast cancer is hormone-receptor positive, hormone therapy can be used to treat the cancer by lowering the levels of hormones in your body or stopping their effects

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