Papillary breast cancer, also known as Papillary carcinoma of the breast, is a very rare type of breast cancer, and accounts for less than 1% of all diagnosed cases of invasive breast cancer. It is mostly diagnosed in older women who have gone through menopause, and it’s commonly mixed with other types of breast cancer. Papillary breast cancer occurs in different types which include:
- Invasive micropapillary breast cancer
- Invasive papillary breast cancer
- Papillary ductal carcinoma in situ
- Intracystic/encapsulated/encysted papillary cancer
Symptoms of Papillary Breast Cancer
Papillary breast cancers usually have a large lump that can be felt or seen during a routine mammogram or breast screening.
Some of the symptoms of Papillary breast cancer include:
- Breast lump
- Thickening of skin on the breast
- Change in size of the breast
- Inverted nipple
- Nipple discharge
Diagnosis of Papillary Breast cancer
Papillary breast cancer is diagnosed during a routine breast screening or mammogram after which you’ll be referred to a breast specialist for further examination. Other tests are also ordered to confirm the presence of breast cancer cells. These range of tests include:
- An ultrasound scan
- Core Biopsy where a tissue sample is removed from breast for analysis
- Fine Needle Aspiration (FNA) whereby a fine needle and syringe are used to take samples of the cancer cells for examination.
Treatment of Papillary Breast cancer
Based on the test results of the Papillary Breast cancer, the breast doctor will customize the treatment plan according to the features of the breast cancer. This treatment plan is dependent on certain criterion including:
- The aggressiveness of the cancer
- Grade of the cancer
- Tumor size and location
- Age and overall health
- History of breast cancer in the family
- Gene mutation test results
The first form of treatment for Papillary Breast cancer is surgery, which is used to remove the tumor. There are two types of surgeries that are done. These are:
1. Breast-conserving surgery (BCS)
Also known as a lumpectomy, the surgeon removes the cancer cells, as well as a minimal amount of healthy breast tissue surrounding the tumor.
This is the surgical removal of the entire breast including the nipple, and it would be recommended if:
- The area of the cancer is large
- The cancer cells are in multiple areas of the breast
- There is a gene mutation which increases the likelihood of breast cancer
- There’s a history of breast cancer in the family
- The patient cannot stand radiation
Before the surgery, the patient is always given the option of having a breast reconstruction. This can happen immediately (immediate breast reconstruction) after the tumor is removed, or at a later date (delayed breast reconstruction). After a mastectomy, some women may be unable to have a breast reconstruction procedure, at which point a prosthesis breast is recommended.
Lymph Node Removal
If the Papillary Breast cancer is invasive, the breast specialists might want to ensure it hasn’t spread to the lymph nodes under the arm (axilla). This is done through a lymph node biopsy, where a small sample of the lymph nodes are removed and tested for cancer cells. If they are found to be affected by the cancer, then these lymph nodes are surgically removed – a procedure known as lymph node clearance – and radiotherapy treatment might be recommended.
Sentinel Lymph Node Biopsy
If tests before the surgery show that the lymph nodes are not affected by the cancer, then the sentinel lymph node biopsy is introduced. This identifies the most immediate lymph nodes that the cancer cells are most probable to spread to. If they are cancer-free, then no surgery is required. On the other hand, if they are affected by the cancer, then surgery is required, with the possibility of radiotherapy treatment.
Additional Treatments for Papillary Breast Cancer
After a lumpectomy or mastectomy, you may need additional treatments for Papillary Breast cancer, also known as adjuvant treatments. The goal is to give the best promising outcome, and to reduce the chances of the cancer returning. Each treatment recommended depends on the state of the breast cancer and differs from one case to the next. These treatments include:
- Radiation therapy: If you go through a lumpectomy, you may need radiation therapy to destroy any cancer cells and reduce the chances of it recurring on the same breast. It might be done for the chest wall as well, if the lymph nodes under the arm are also affected by the cancer.
- Chemotherapy: If the Papillary Breast cancer has spread to the lymph nodes, then the patient is offered the option of undergoing chemotherapy. Chemotherapy is an anti-cancer drug therapy that is done before surgery to reduce the size of the tumor with the aim of making it operable. The treatment is also given after surgery to minimize the chances of the cancer spreading or returning. Its recommendation depends on different factors such as the grade and size of the tumor, estrogen receptor (ER) status, and human epidermal growth factor receptor 2 (HER2) status.
- Hormone therapy: This treatment is considered if the cancer cells have receptors that bind to estrogen. Administration of hormone therapy reduces the chance of the cancer returning or progressing further.
- Targeted therapy: If the breast cancer cells have human epidermal growth factor receptor 2 gene (HER2), treatment drugs to specifically target it may be given.
- Bisphosphonates: Bisphosphonates are drugs that are given orally or intravenously to either slow down or prevent bone damage. When used for cancer treatment in post-menopausal women, they reduce the risk of the Papillary Breast cancer
Triple Negative Breast Cancer
A triple negative breast cancer occurs when the breast cancer is estrogen receptive negative, HER2 negative, and progesterone receptive negative. This means that you may not be able to have Papillary Breast cancer treatments such as hormone therapy and trastuzumab.
Recovery After Papillary Breast cancer
After the successful treatment of Papillary Breast cancer, your doctor will keep a close watch on you. Follow-up appointments are required and should be followed as agreed with the breast doctor, where he/she will do tests for signs of recurrence. A mammogram and screening might be required every 6 to 12 months.
At King’s College Hospital London Dubai, our Breast Care Clinic caters to every type of breast cancer and breast conditions. If you are facing any kind of abnormal changes to your breast, regardless how small, get in touch for a consultation with one of our breast doctors. For more information on breast cancer and breast care, book an appointment below.
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