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  Last-Modified:  05/21/06 09:40         

There is an E-Mail doing the rounds, sent by women of all ages to all their friends and female colleagues. A problem that might not be that new, as the e-mail has been circulating the globe for years, but this does not reduce the importance of women knowing about it.

 

----- Original Message -----

" New kind of Breast Cancer - DO NOT DELETE - Please forward to all of the women in your lives . Mothers, daughters, sisters, aunts, friends, etc. In November 2004, a rare kind of breast cancer was found. A lady developed a rash on her breast, similar to that of young mothers who are nursing. Because her mammogram had been clear, the doctor treated her with antibiotics for infections. After 2 rounds, it continued to get worse, so her doctor sent her for another mammogram. This time it showed a mass. A biopsy found a fast growing malignancy. Chemo was started in order to shrink the growth; then a mastectomy was performed; then a full round of Chemo; then radiation. After about 9 months of intense treatment, she was given a clean bill of health. She had one year of living each day to its fullest. Then the cancer returned to the liver area. She took 4 treatments and decided that she wanted quality of life, not the after effects of Chemo. She had 5 great months and she planned each detail of the final ! days! . After a few days of needing morphine, she died. She left this message to be delivered to women everywhere:

Women, PLEASE be alert to anything that is not normal, and be persistent in getting help as soon as possible. Paget's Disease: This is a rare form of breast cancer, and is on the outside of the breast, on the nipple and aureole It appeared as a rash, which later became a lesion with a crusty outer edge. I would not have ever suspected it to be breast cancer but it was. My nipple never seemed any different to me, but the rash bothered me, so I went to the doctor for that. Sometimes, it itched and was sore, but other than that it didn't bother me. It was just ugly and a nuisance, and could not be cleared up with all the creams prescribed by my doctor and dermatologist for the dermatitis on my eyes just prior to this outbreak. They seemed a little concerned but did not warn me it could be cancerous. Now, I suspect not many women out there know a lesion or rash on the nipple or aureole can be breast cancer. Mine started out as a single red pimple on the aureole.

One of the biggest problems with Paget's disease of the nipple is that the symptoms appear to be harmless. It is frequently thought to be a skin inflammation or infection, leading to unfortunate delays in detection and care.

What are the symptoms?

1. A persistent redness, oozing, and crusting of your nipple causing it to itch and burn  - As I stated, mine did not itch or burn much, and had no oozing I was aware of, but it did have a crust along the outer edge on one side.

2. A sore on your nipple that will not heal. - Mine was on the aureole area with a whitish thick looking area in center of nipple.

3. Usually only one nipple is effected. How is it diagnosed? Your doctor will do a physical exam and should suggest having a mammogram of both breasts, done immediately. Even though the redness, oozing and crusting closely resemble dermatitis - inflammation of the skin, your doctor should suspect cancer if the sore is only on one breast. Your doctor should order a biopsy of your sore to confirm what is going on.

This message should be taken seriously and passed on to as many of your relatives and friends as possible; it could save someone's life.

My breast cancer has spread and metastasized to my bones after receiving mega doses of chemotherapy, 28 treatments of radiation and taking Tamaxofin. If this had been diagnosed as breast cancer in the beginning, perhaps it would not have spread.

TO ALL READERS:

This is sad as women are not aware of Paget's disease. If, by passing this around on this e-mail, we can make others aware of it and its potential danger, we are helping women everywhere.

Please, if you can, take a moment to forward this message to as many people as possible, especially to your family and friends. It only takes a moment, yet the results could save a life. "

Read on.

Paget's Breast Disese 

Everyone should read this!

Paget's disease of the breast

Paget’s disease of the breast, or Paget's Breast Disease, is an eczema-like change in the skin of the nipple, and statistics show that 90% of women who have it, also have an underlying breast cancer. It can also affect men, but this is very rare.

The breast cancer may be an invasive breast cancer or DCIS - Ductal Carcinoma in Situ. DCIS, is a condition where the cancer cells are completely contained within the milk ducts.

Around half of the women who have Paget’s Breast Disease, will have a breast lump that can be felt at the time of diagnosis.

Paget’s Breast Disease occurs only in around 1 or 2%  of women with breast cancer. Moreover, the disease occurs mainly in women / mothers in their fifties, but it can occur at any age, and is on the increase, the average of the patient gets lower as time goes on.

Generally, it first appears as a scaly, red rash affecting the nipple, and sometimes the the areola, the darker area of skin surrounding the nipple. The rash always affects the nipple first, and then may affect the areola. It does not go away, it gets worse and may become very sore; leading to a slight bleeding.

Sir James Paget, pronounced PAJET, lived between 1814 and 1899. He was a British Surgeon and pathologist, best remembered not only for the medical conditions named after him but also for the success in his professional life. In 1854 he was appointed the personal surgeon to Queen Victoria, and in 1863 the personal surgeon to the then Prince of Wales.

Sir James Paget was born in Great Yarmouth, Norfolk, UK, and was a surgeon at St Bartholomew's Hospital, London, in the late 19th century. The main general hospital serving Lowestoft and Great Yarmouth is named after him - James Paget Hospital. Tel: 01493 - 452452

He wrote an early and very clear description of a condition of the bones, which now bears his name, Paget's Bone Disease - Paget's disease of the bone is a chronic disorder of the skeleton, where areas of bone undergo abnormal turnover, resulting in areas of enlarged and softened bone.

Paget's disease of the nipple, Paget's Breast Disease, was another of his discoveries, but there is no other connection between these two conditions.

Cause of Paget's Breast Disease

The cause of Paget's Breast Disease is not clear, but certain groups of women seem to be at a higher risk of developing it; women who have never had children, or had them late in life, women who started their periods pre-teen, or who had a late menopause. There is also a propensity , where breast cancer runs in the family.

Signs and symptoms

The first symptom is usually an eczema-like rash, the skin of the nipple and then the areola may be reddened and inflamed. There may also be crusting, bleeding and in some cases, ulceration, and there may be a discharge. Some have an itching or burning sensation.  The nipple may even turn inwards, that is become inverted. A lump may or may not develop in the actual breast.

eczema

Inflammatory skin condition, a form of dermatitis, marked by dryness, rashes, itching, the formation of blisters, and the exudation of fluid. It may be allergic in origin and is sometimes complicated by infection.

When pre-cancerous cells are seen in the breast, it is called DCIS, or Ductal Carcinoma in Situ. When these cells are found in the nipple, it is called Paget's Breast Disease. Paget's Disease was named after a British surgeon named James Paget - 1814 - 1899, who revealed and named two other unrelated conditions: Paget's Bone Disease, and Paget's Eyelid Disease.

Diagnosis

Paget’s disease can be confused with other skin conditions such as eczema, dermatitis or psoriasis, as they can look very similar. This can make Paget’s Breast Disease difficult to diagnose.

However, this condition typically  affects the nipple first, and then spreads to surrounding tissue. Other skin conditions usually affect the areola, the darker area of skin around the nipple first, and then spread to the nipple.

Several tests may be carried out to determine any diagnose:

Mammogram, a breast x-ray.   Mammograms are used to look for changes in the affected breast, and to check and compare the other breast.

Ultrasound Scan.  A gel is applied to breast and a small emitter, which sends out sound-waves is moved over the area. The sonic-waves are bounced off the different parts of the internal workings of the body, and there are minuscule differences, in between each bounce. These echoes are converted into a picture of the breast tissue, by a computer at the speed of light. Scans are totally painless, and it takes just a few minutes.

Speed of Light or sometimes referred to as C - The Constant.  The speed with which all electromagnetic radiation travels through a vacuum, is  186,282 miles per second, or 299,792,458 meters per second. It is one of the fundamental constants; according to the special theory of relativity, and it is independent of the speed of the observer.

Biopsy  This is the principle test for any cancer diagnosis; usually done using a local anaesthetic, a sample of skin / tissue is taken and sent to a laboratory to be examined under a microscope. It is common to be taken at the same time, or just before, an ultrasound, so that it is certain the biopsy is taken from the abnormal area.

Imprint or Scrape Cytology  Cells from the affected area can be scraped or placed onto a slide and examined under a microscope. Microbiologists and Pathologists are highly trained to look at microbial samples, and quickly spot different  micro-organisms, and anomalies. It is just like you putting 50 children into a room, and you picking out your own child. You would do it instinctively in seconds.

 Possible Treatments

The treatment of Paget's Breast Disease will depend on, whether or not there is underlying evidence of breast cancer or whether it is a Ductal Carcinoma in Situ. [DCIS]   Also whether it is an invasive tumor and  how much of the breast is affected.

A tumor is an abnormal growth that can be benign, which means gentle or mild; not harmful. Non-cancerous.  We can have many growths in our body or on our skin, that spring up, and for the main part, are quite harmless. Sometimes, especially on our skin, growths or polyps grow due to some miscoding within the skin-cells. Polyps are common under our arms and or around the anus. Rubbing here can damage the skin slightly and instead of the skin just growing back normally it grows haphazardly producing an abnormal increase in cells. Or this abnormal growth can be malignant. Benign tumors do not threaten life, and do not spread to other parts of the body. Malignant tumors are basically cancers and can threaten life and can spread to other parts of the body, by cell relocation. A malignant tumor that grows into surrounding tissues is called invasive. Invasive tumors are more likely to spread to other parts of the body than non-invasive tumors.

Surgery

Surgery is the foremost treatment for Paget’s Breast Disease. Removal of the breast, or mastectomy, may be recommended, but is avoided at all costs. Moreover, any surgery will thus attempt to conserve as much of the breast tissue as possible, especially if the affected area is just the nipple, and a small area close to the underlying cancer. Consequently only this part will be taken; generally the nipple, areola, and the other close area detected. Extensive tests will ensue, to determine a clean bill of health, and hopefully no further treatment.

But if the cancer is extensive and affects a wider area around the nipple, or if there is DCIS in a number of areas, a mastectomy maybe unavoidable, in order to save the life of the patient. This is why early diagnosis is essential. This is why close and regular examination of our bodies, is crucial to see any possible abnormalities, that may appear.

An early diagnosis may need no more than Radiotherapy, Chemotherapy, or just some hormonal therapy, or a combination.

Radiotherapy, is the use of X-rays, high-energy rays and other radiation waves to treat disease, by destroying cells. The radiation may be directed at the target organ from outside. Alternatively, radioactive needles, pellets, etc., may be placed inside the body. Radiation is used in treating various forms of cancer and over activity of the thyroid gland. Chemotherapy, is the use of anti-cancer or cytotoxic drugs that destroy cancer cells. It is not used to treat an underlying DCIS, but may be given if the cancer is invasive. Hormones are chemicals that occur naturally in the body. They act as messengers and strongly influence the growth and activity of cells. Hormones are produced by several of our organs, or glands and together are known as the endocrine system.  Hormonal therapies are commonly used for treating breast cancer and prostate cancer, what therapy depends on the type of cancer being treated. The regimen produce results by altering the production or activity of a particular hormones, in the body, that might be detrimental to our wellbeing.

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