Diagnosis and Treatment of Paget’s Disease of the Nipple

Paget’s disease of the nipple is a rare form of breast cancer. Less than 4 percent of patients with breast cancer will have this form of the disease.

In Paget’s disease the tumor grows from ducts beneath the nipple onto the surface of the nipple. Symptoms commonly include itching and burning and an eczema-like condition around the nipple, sometimes accompanied by oozing or bleeding. Paget’s disease may be a sign of underlying ductal carcinoma in situ (DCIS), or it may be associated with invasive cancer.

Stanford Expertise

When you are being treated for cancer you want a physician who is familiar with your particular disease. However, because Paget’s disease of the nipple is so rare it can be difficult to find a doctor who has treated patients with the disease.

Our specialists at the Stanford Cancer Center not only treat Paget’s disease, but also offer the most advanced diagnostic technologies and treatments available today, and take a multidisciplinary approach that ensures you will receive the most appropriate care for your condition. For example, our multidisciplinary teams include surgical oncologists, medical oncologists, and radiation oncologists, all working together to provide you with the very best care.

Advanced Diagnostic Techniques

Pathology

Physicians from our Department of Dermatology have experience pinpointing the diagnosis of difficult cases of Paget’s disease using advanced immunohistochemical techniques.

Imaging

Although a mammogram is usually the first kind of diagnostic test given when a doctor suspects a patient has Paget’s disease, women with symptoms of Paget's disease who do not have a lump that can be felt often have normal mammograms. In this case a breast ultrasound or a digital MRI can give a clearer picture of the extent of cancer in the affected breast.

The Cancer Center breast imaging group has exceptional experience providing and reading all three types of scans. Furthermore, our workstations allow doctors to directly compare and integrate results from the different types of scans. In fact, our group routinely helps physicians from other institutions to interpret difficult cases, so you can be assured that you are receiving the most accurate diagnosis possible. 

Biopsies

If imaging studies suggest that you have breast cancer, the next step will be for your doctors to biopsy the suspicious region and examine the cells. The Cancer Center offers some of the most advanced and least invasive biopsy techniques available, including stereotactic core needle biopsies and sentinel node biopsies.

Treatment

Treatment for Paget’s disease usually starts with surgery. Treatment may also include radiation therapy and chemotherapy, depending on how far the cancer has advanced. Whenever possible Cancer Center physicians use methods that give patients the best opportunity to choose breast conserving surgery.

Paget’s Disease of the Bone

Paget’s disease of the nipple is not to be confused with Paget’s disease of the bone, another area where Stanford physicians have significant expertise. The only commonality between the two conditions is that they were originally discovered by the same physician.