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Diagnosing Paget's disease of the nipple often involves more than one diagnostic test. Since this condition is often coupled with an underlying cancer, other diagnostic tests are often done to make a complete diagnosis. Once a proper and complete diagnosis is done, treatment can begin.
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A physical examination along with a clinical breast exam is typically the first step. The doctor will pay special attention to any abnormal areas in each breast, noting how the skin around and on the nipples appears. She will also be feeling for any areas of thickening or lumps.
A mammogram is a diagnostic imaging technique used to examine breast tissue. It may be used to determine if an underlying breast cancer is the cause of skin and nipple changes. If this test does not show any signs of breast cancer, magnetic resonance imaging may be done to look for signs that may not have been detected with a mammogram.
A breast biopsy for diagnosing this condition involves getting a sample of nipple skin and then evaluating it under a microscope. If nipple discharge is present, a sample may be obtained and analyzed. Any breast lumps will also be biopsied.
A sentinel lymph node biopsy involves biopsying the axillary lymph nodes in cases of invasive breast cancer. If the sentinel node is determined normal after removal and examination, there is only a small chance that cancer will be found in other nodes.
An ultrasound of the breast and nipple may be done to look for any abnormal changes or growths.
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Diagnosing Paget's disease of the nipple is followed by treatment once diagnosis is confirmed. Treatment is tailored specifically to the stage and size of the cancer. Surgery is the most common treatment method, and there are several different surgeries that may be done. These include a simple mastectomy, modified radical mastectomy, and a lumpectomy. A sentinel lymph node biopsy may also be done as part of the treatment process.
Adjuvant therapy may also be done after the patient has had a surgery. These therapies may include one or more of the following: radiation therapy, chemotherapy, or hormone therapy. Whether a patient's tumor tests are positive for specific characteristics and the extent of the patient's cancer will determine which specific adjuvant therapies are used. The certain characteristics of a positive tumor test may include progesterone or estrogen receptors. Whether chemotherapy is used will depend on the cancer's stage. Radiation may be used to try and prevent the cancer from recurring.
The patient's oncologist will help him or her design the best treatment for them and their specific cancer and its characteristics.
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National Cancer Institute. (2010). Paget Disease of the Nipple. Retrieved on November 21, 2010 from the National Cancer Institute: http://www.cancer.gov/cancertopics/factsheet/sites-types/paget-breast
MayoClinic.com. (2010). Paget's Disease of the Breast. Retrieved on November 21, 2010 from MayoClinic.com: http://www.mayoclinic.com/health/pagets-disease-of-the-breast/DS00771