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Treatments and drugs
By Mayo Clinic staffPaget's disease of the breast usually requires surgery. Which type of surgery you need depends on the condition of the skin around your nipple and how advanced the underlying cancer is.
Surgical options include:
- Simple mastectomy. This procedure involves removing your entire breast, but not the lymph nodes in your armpit (axillary lymph nodes). Simple mastectomy might be recommended in cases in which an underlying noninvasive breast cancer exists but hasn't spread to the lymph nodes.
- Lumpectomy. Breast-conserving surgery (lumpectomy) involves removing only the diseased portion of your breast. Your surgeon removes your nipple and areola along with a wedge- or cone-shaped section of your breast. The surgeon focuses on removing as little breast tissue as possible, while ensuring that the tissue removed includes an outer margin free of cancer cells so that only healthy cells remain. Lumpectomy to treat Paget's disease of the breast almost always requires follow-up radiation therapy as adjuvant treatment. Lumpectomy wouldn't be recommended if you can't have radiation therapy for some reason. Nipple reconstruction may be an option after your treatment.
Sentinel lymph node biopsy
Anytime invasive breast cancer is present, the lymph nodes under your arm (axillary lymph nodes) need to be checked to see if the cancer has spread to this area. This can be done in a procedure known as a sentinel lymph node biopsy.
During the biopsy, your surgeon locates the sentinel nodes — the first lymph nodes to receive the drainage from breast tumors and therefore the first place cancer cells will travel. If a sentinel node is removed, examined and found to be normal, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed. If the sentinel node tests positive for the presence of cancer cells, you may need to have more lymph nodes removed.
Adjuvant therapy
After your operation, your doctor may recommend additional treatment (adjuvant therapy) with anti-cancer drugs or hormone therapy to prevent a recurrence of your breast cancer. This depends on the extent of your breast cancer and whether the tumor tests positive for certain characteristics, such as having estrogen or progesterone receptors.
