Paget's Disease by hanna O'Brien

Paget's disease of the nipple is the name given to an eczematous-like condition of the surrounding skin that most often occurs in women aged 50-60 and is almost always associated with an underlying breast cancer. Doctors are not yet completely sure how Paget's disease develops. One possibility is that the cancer cells start growing inside the milk ducts within the breast and then make their way out to the nipple surface. This would appear to explain why so many people with Paget's disease of the nipple have a second area of cancer within the breast. Another theory is that the cells of the nipple itself become cancerous.

Symptoms -Itching, tingling or redness in the nipple and/ or areola -Flaking, crusty, or thickened skin on or arou nd the nipple -A flattened nipple -Discharge from the nipple that may be yellowish or bloody

How is it Diagnosed?

Surface biopsy: A glass slide or other tool is used to gently scrape cells from the surface of the skin. Shave biopsy: A razor- like tool is used to remove the top layer of skin. Punch biopsy: A circular cutting tool called a punch is used to remove a disk shaped piece of tissue. Wedge biopsy: A scalpel is usd to remove a small wedge of tissue.

Treatment

Simple mastectomy: This procedure involves removing your entire breast but not the lymph nodes in your armpit. A simple mastectomy might be recommended in cases in which an underlying breast cancer exists but hasn't spread to the lymph nodes. Lumpectomy: Breast conserving surgery involves removing only the diseaed portion of your breast.

Paget's disease of bone interferes with your body's normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time the disease can cause affected bones to become fragile. Paget's disease of bone most commonly occurs in the pelvis, skull, spine and legs.

The cause is not known being most common in men over the age of 40 and more likely to occur in those with a positive family history of the condition.

Symptoms

Most people who have Paget's disease of bone have no symptoms. When symptoms occur the most common complaint is bone pain.

Skull- An overgrowth of bone in the skull can cause hearing loss or headaches. Pelvis- Paget's disease of bone in the pelvis can cause hip pain. Spine- If your spine is affected, nerve roots can become compressed. This can cause pain, tingling and numbness in an arm or leg. Leg- As the bones weaken they may bend causing the legs to become bowlegged. Enlarged and misshapen bones in your legs can put extra stress on joints, which may cause osteoarthritis in your knee or hip.

Paget's disease in spine
Paget's disease in hip

In most cases Paget's disease of bone progresses slowly. The disease can be managed effectively in nearly all people. Possible complications include:

Fractures and deformities- Affected bones break more easily. Extra blood vessels in these deformed bones cause them to bleed more during repair surgeries. Leg bones can bow, which can affect your ability to walk.

Osteoarthritis- Misshapen bones can increase the amount of stress on nearby joints, which can cause osteoarthritis.

Heart Failure- Extensive Paget's disease of bone may force your heart to work harder to pump blood to the affected areas of your body. In people with pre-existing heart disease, this increased workload can lead to heart failure.

Bone cancer- Bone cancer occurs in less than 1 percent of people with Paget's disease of bone.

Diagnosis-  based on the patient's symptoms, history and examination findings, X-rays, blood tests and urine samples.

Treatment- If you don't have symptoms you might not need treatment. However if the disease is active indicated by an elevated alkaline phosphatase level and is affecting high-risk sites in your body such as your skull or spine, your doctor might recommend treatment to prevent complications even if you don't have symptoms.

Medications- Osteoporosis drugs are the most common treatment for Paget's disease of bone. Some bisphosphonates are taken by mouth, while others are given by injection. Oral bisphosphonates are generally well-tolerated, but may irritate your gastrointestinal tract. Examples include: Alendronate (Fosamax) Ibandronate (Boniva) Pamidronate (Aredia) Risedronate (Actonel) Zoledronic acid (Zometa, Reclast)

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