Breast Cancer

What is angiosarcoma?

Literally translated as “fleshy growth of the blood vessels,” angiosarcoma is a very rare type of cancer that starts in the tiny cells that line the inside of your blood vessels. These cells are called vascular endothelial cells. The human body has thousands and thousands of blood vessels, so angiosarcoma can occur in any part of the body. This can make it tough to locate a tumor, and it can also make it easier for angiosarcoma to spread from one part of the body to another.

Early detection is key

In more than half of angiosarcoma cases, the tumor starts on the skin, which is called cutaneous angiosarcoma. That's good news because it means you can see that there's an issue and get it diagnosed and treated quickly. The face and scalp are common places for angiosarcoma lesions to appear. If you have a bruise that hasn't healed, a reddish or veiny-looking area on the skin, or a bump or nodule, don't wait — get it checked by a doctor as soon as possible. Other common places where angiosarcoma can occur are the breasts, the liver and deep tissues of the body. These tumors are often more difficult to detect than a visible spot on the skin, but you may feel a lump or mass under the skin. Sometimes an angiosarcoma tumor can go undetected until it gets large enough to push against other organs and cause other symptoms. If you notice a change in your health, even a small one, don't hesitate to get it checked out by a doctor. It's better to have a doctor confirm that it's nothing to worry about than to ignore symptoms that could signal a larger problem.

Know your risk factors for angiosarcoma

Sometimes angiosarcoma develops de novo (without any specific cause), but there are some factors that can increase the risk of developing a tumor. You may have a slightly higher risk if you have:

• Undergone radiation treatments for cancer
• Had a mastectomy, especially if the lymph nodes were removed along with the breast
• Had lymph nodes removed as part of a cancer treatment surgery
• Experienced chronically swollen lymph nodes
• Been exposed to toxic chemicals like arsenic, vinyl chloride or thorium dioxide
• If you've had surgery or radiation to treat a previous cancer, check the area regularly for any masses or changes to your skin.

Diagnosis, treatment and life after angiosarcoma

Diagnosing angiosarcoma is a multi-step process that can include:

• Physical exam
• Imaging studies like an X-ray, MRI or CT scan
• Biopsy

This process lets your care team confirm the diagnosis, check the size of the tumor and see whether it has spread to other parts of the body. Once the diagnosis is confirmed, treatment will likely involve surgery to remove the tumor. You may also need chemotherapy and/or radiation . After treatment, you'll need regular follow-up care from an oncologist (doctor that specializes in cancer) for several years. Since angiosarcoma can spread throughout the body, it's important for your care team to keep close track of your health to watch for signs of recurrence.

Ductal carcinoma in situ: a non-invasive form of breast cancer

You know that it is important to have regular mammogram screenings. Mammograms can detect breast cancer well before you have any symptoms or feel a lump. Early detection offers you the best chance at being cured.

Ductal carcinoma in situ (DCIS) is breast cancer that develops in the lining of the milk ducts in your breasts. Women who have ductal carcinoma in situ do not usually have any symptoms and do not know they have breast cancer until it is found during a routine mammogram. The good news is that ductal carcinoma in situ does not normally spread beyond the ducts, therefore it is considered a non-invasive cancer and not life-threatening. However, surgery is necessary to remove the tumors.

Treating non-invasive breast cancer

There are two types of ductal carcinoma: non-invasive, or ductal carcinoma in situ, and invasive ductal carcinoma, which means the cancer has spread beyond the milk ducts. If your mammogram shows signs of suspicious cells inside your ducts, your doctor will order a biopsy to determine if the cells are cancerous and if they are invasive or non-invasive.

If you have ductal carcinoma in situ or non-invasive breast cancer, you will need a surgical procedure called lumpectomy to remove the tumor or tumors found in the ducts. During lumpectomy, only the cancerous tumor and a small amount of the surrounding breast tissue is removed. Most women who have ductal carcinoma in situ do not need chemotherapy or radiation. However, depending on the type cancer cells found, your doctor may recommend hormone therapy.

Prevention for the future

Although ductal carcinoma in situ is non life-threatening, women who have ductal carcinoma in situ are at greater risk of having cancer again. It is important to follow your doctor’s instructions on having mammogram screenings so if cancer does return, you have the best chance of finding it early.

The strategic fight against HER2-positive breast cancer

Breast cancer is an abnormal growth of cells in the breast tissue. Some breast tumors have too much of a special protein called HER2. This protein controls cell growth, so tumors that have a lot of it — called HER2-positive or HER2+ tumors — tend to grow faster and spread more quickly than tumors that don't. These tumors also have an increased chance of coming back after treatment.

Targeted therapy can stop HER2 in its tracks

Fortunately, treatment is available to help beat HER2-positive breast cancer. Targeted therapy (sometimes also called immunotherapy or monoclonal antibody therapy) uses drugs that specifically target certain molecules and proteins — including the HER2 protein — to stop cancer cells from growing and spreading.

These targeted therapy drugs include:

• Herceptin (trastuzumab). Given through an IV, this drug targets the HER2 protein in cancer cells to slow or stop their growth.
• Perjeta (pertuzumab). This drug works the same way as trastuzumab and is also given through an IV, but it targets a different section of the HER2 protein. The two may be used together with chemotherapy.
• Tykerb (lapatinib). Rather than attacking the protein itself, this drug stops the HER2 protein from working inside tumor cells. It stops the growth reactions that HER2 triggers, before they can start. Taken orally as a pill, it may be used if chemotherapy and trastuzumab aren't working.

These drugs can be combined with chemotherapy treatments or used on their own.

Is targeted therapy right for me?

Talk to your doctor to see if targeted therapy for HER2-positive breast cancer is right for you. There can be some side effects and interactions with other medicines, so let your doctor know about any other medicines you're taking.

Inflammatory breast cancer is rare

Cells in your breasts, just like cells throughout your body, grow and divide when you need new cells. When they divide, they create copies of your DNA. If these copies have an error, new cells may grow out of control. When breast cells have these DNA errors, you may develop breast cancer.

Different types of breast cancer cause different symptoms and start in different cells. The most common breast cancer, ductal carcinoma, starts in milk duct cells. Sometimes these cancer cells spread to other parts of the breast.

Inflammatory breast cancer is a rare form of breast cancer that occurs when cancer cells spread and block lymphatic vessels in your breast. Lymphatic vessels carry cells that fight infections throughout your body.

What are the signs of inflammatory breast cancer?

Instead of causing you to develop a lump in your breast, the skin on your breast can get swollen, red and warm. It can also start to look like an orange peel — thick with small dimples. These symptoms may come on fast, so if you notice changes in your breasts, talk to your doctor.

Your doctor will examine your breast and may ask you to have a mammogram (breast X-ray) or other imaging test, like a breast ultrasound. These images can help your doctor spot cancerous cells.

How is inflammatory breast cancer treated?

Because inflammatory breast cancer is in the lymph vessels, it also means it's in nearby lymph nodes and may have spread to other parts of your body. You'll work with an oncologist (cancer doctor) to create a complete treatment plan, including chemotherapy, surgery and radiation therapy, to destroy cancer cells no matter where they are in your body.

Breast cancer treatment has advanced greatly in the last 30 years. Treatments are now more effective with fewer side effects.

Steps in inflammatory breast cancer treatment

The first step in treating inflammatory breast cancer is chemotherapy. Chemotherapy uses medicine to kill cancer cells throughout your body. You may get chemotherapy through pills, injections or an IV.

Chemotherapy helps shrink the cancer cells that are blocking the vessels in your breast. It also helps kill cells that are in other parts of your body and stop cancer from growing and spreading. You might get chemotherapy for a few months.

After chemotherapy, you'll have surgery to remove your breast (mastectomy). Your surgeon will also remove some of the lymph nodes near your breast to test them for cancer cells. If cancer cells are in your lymph nodes, your doctor may have to remove more lymph nodes to make sure the cancer is gone.

You'll have a few weeks to heal after surgery before you have radiation therapy. Radiation therapy uses powerful, high-energy beams to destroy any cancer cells around your breast or lymph nodes that may be left after surgery.

Two out of three breast cancers use estrogen to cause them to grow. To help keep your cancer from coming back, you may have hormone therapy. During hormone therapy, you either take pills to stop your breasts from absorbing estrogen, or pills that stop your body from making estrogen. You'll need to take the pills for five to ten years after surgery. Hormone therapy is a popular way to help keep women cancer-free.

Invasive ductal carcinoma is the most common breast cancer

Your breasts are made of different types of tissues, including fat, ducts and lobules. Breast ducts are the part of the breast that take milk from the lobules, where it's made, to the nipple.

Cells in the breast duct have to divide and grow like every cell in your body. When duct cells become cancerous, it's called ductal carcinoma, the most common form of breast cancer.

If the cancer cells from your breast ducts spread to other types of tissues, such as other areas of your breast or into the nearby lymph nodes in your armpit, it's called invasive ductal carcinoma.

What are the signs of invasive ductal carcinoma?

Invasive ductal carcinoma can cause a lump to develop in your breast. The lump may or may not be painful. You may be able to feel the lump or see it during a mammogram (an X-ray of your breasts).

Swollen lymph nodes in your armpits may also be a sign of invasive ductal carcinoma. If you have swollen lymph nodes or a lump (or lumps) in your breast, you should talk to your doctor.

How is invasive ductal carcinoma treated?

Your doctor will help you decide what cancer treatments are best for you. Your treatment may depend on where the cancer has spread (metastasized). Most people with invasive ductal carcinoma will have surgery, radiation therapy and chemotherapy.

Over the years, treatment for breast cancer has greatly improved. These treatments are often more effective, with fewer side effects than in the past, and give patients a good outlook, especially when cancer is caught early.

What surgeries are used to fight breast cancer?

The first step in treating invasive ductal carcinoma is to remove the lump in your breast through a surgery called a lumpectomy. If you have more than one lump, or if cancer cells have spread to other parts of your breast, the entire breast may be surgically removed, which is called a mastectomy.

During surgery, your surgeon performs a sentinel node biopsy, which shows the lymph nodes that could be affected by cancer and need to be removed.

What happens after surgery?

After surgery, your doctors will know more about whether your cancer has spread and may adjust your treatment. After a few weeks of healing, you'll start the next step of treatment.

Many women will receive radiation therapy where they had surgery. Radiation therapy uses powerful beams of energy to kill any cancer cells that may have been left behind after surgery.If cancer cells have spread to your lymph nodes, you'll likely need chemotherapy. If cancer cells are in your lymph nodes, it means that they may have also spread to other parts of your body.

During chemotherapy, you take medicines that kill cancer cells no matter where they are in your body. Chemotherapy helps keep you cancer-free in the future.

Hormone therapy can prevent cancer from coming back

If estrogen (a hormone) helped cancer grow in your breasts, hormone therapy for five to ten years after your cancer treatment can help keep cancer from coming back. For this therapy, you'll take a daily pill to keep your breasts from absorbing estrogen. You may also take a pill that stops your body from making estrogen.

Since two out of three breast cancers are affected by estrogen, hormone therapy has become a popular therapy to help keep cancer from returning.

Invasive lobular carcinoma starts in breast glands

Lobules are glands in your breasts that create breast milk. The cells in the lobules grow and divide like normal cells. Each time they divide, they create a copy of the cell's DNA. Sometimes the copy has errors, making the new cell grow out of control. When this happens, you develop lobular carcinoma, a less common form of breast cancer.

If the cancer is only in lobular cells, it's called lobular carcinoma in situ. If cancer cells in the lobules spread to other areas of the breast, such as into breast ducts, or into nearby lymph nodes, it's called invasive lobular carcinoma.

What are the signs of invasive lobular carcinoma?

While most people associate breast cancer with finding a lump, lobular carcinoma doesn't form lumps. Instead, it causes part of your breast to become thicker or fuller than other areas. It may also change how the skin on your breast looks or cause your nipple to become dented in (inverted).

If your breasts begin to look or feel differently, you should speak to your doctor. Typically, breast magnetic resonance imaging (MRI) offers the best picture of invasive lobular carcinoma.

How is invasive lobular carcinoma treated?

Depending on how far invasive lobular carcinoma has spread in your breast, you may have a lumpectomy or a mastectomy. During a lumpectomy, the doctor will remove just the areas affected by cancer, which lets you keep most of your breast tissue. During a mastectomy, your entire breast is removed.

Your surgeon will also remove nearby lymph nodes to test for cancer cells during a sentinel node biopsy. A pathologist, a doctor who specializes in identifying diseases from cells and tissues, checks your lymph nodes for cancer cells. If the pathologist finds cancer cells, your surgeon will remove more lymph nodes. If there are no cancer cells, you won't need any more lymph nodes removed.

Are there treatments after surgery?

After surgery, you'll spend a few weeks healing before you start the next part of treatment. If cancer has spread to your lymph nodes, cells may also have moved to other areas of your body.

Chemotherapy uses medicine to kill cancer cells no matter where they are in your body. Undergoing chemotherapy helps keep cancer from coming back. You'll take chemotherapy by pill or shots, or through an IV.

Your doctor may also recommend that you have radiation therapy. Radiation therapy uses precisely aimed, powerful beams of energy to destroy cancer cells. You may need radiation therapy on your whole breast and on nearby lymph nodes.

It's not breast cancer, but what is it?

Lobular carcinoma in situ, also known as lobular neoplasia, is a cluster of abnormal cells that grow in the milk glands in the breast. It usually happens in both breasts, and while it's much more common in women, men can also have it.

Lobular carcinoma in situ is not breast cancer, but having it can increase your risk of getting breast cancer later.

Some breast disease can be diagnosed by accident

Lobular carcinoma in situ doesn't cause any symptoms, and it doesn't show up on a mammogram. In many cases, you may not know that you have it unless:

• You have a biopsy for something else on your mammogram that looked abnormal
• You have a breast lump removed for different reasons

In both of these cases, a tissue sample taken for a different reason may show that you have lobular carcinoma in situ.

What should I do if I have lobular carcinoma in situ?

Since lobular carcinoma in situ isn't cancer, it doesn't need treatment. If you're using hormone replacement therapy for menopause, your doctor may suggest that you switch to a different type to help lower your risk of developing breast cancer.

Since women with lobular carcinoma in situ are at a higher risk for getting breast cancer later, you'll need regular breast cancer screenings like a yearly mammogram and regular breast exams.

Luminal A breast cancer responds well to treatment

Breast cancer occurs when cells in your breast have errors in DNA. Each time a cell in your body divides into two new cells, it makes a copy of your DNA. If the copy has an error, then the new breast cell can grow out of control, becoming cancer.

Doctors put breast cancer into different categories according to how they react to the hormones estrogen and progesterone, and if it has a HER2 gene. HER2 genes cause your cells to have too much protein that makes cancer grow quickly. By knowing what category your breast cancer is, your doctor can provide better, more accurate treatment.

Luminal A breast cancer, the most common type of breast cancer, reacts to hormones and uses them to grow, but doesn't have a HER2 gene. Luminal A breast cancer grows very slowly and doesn't often spread to other cells. Women with luminal A breast cancer have the best chance for a cure and least chance of cancer coming back than any other type of breast cancer.

Hormone therapy keeps luminal A breast cancer from coming back

When you are diagnosed with luminal A breast cancer, you will first have surgery to remove any cancer tumors in your breast. You may have a lumpectomy, when a surgeon removes just the lump or tumor, or a mastectomy, when your entire breast is removed.

After you've healed from surgery, you may have radiation therapy. Radiation therapy uses high-energy particles or beams to burn away cancer cells left behind after surgery.

In addition, you may have chemotherapy. Chemotherapy uses medicine to kill any remaining cancer cells no matter where they're located in your body. Though it does have side effects, it can keep cancer from coming back or spreading to other parts of your body.

Because luminal A breast cancer is receptive to estrogen, you'll also take hormone therapy after your treatment is done. During hormone therapy, you take a pill each day that keeps the cells in your breasts from absorbing estrogen. If you're past menopause, you might take a pill that keeps your body from making estrogen instead.

You may take hormone therapy for five to ten years after treatment. Hormone therapy is effective at keeping luminal A breast cancer from coming back.

Advanced treatments help you fight luminal B breast cancer

Doctors put breast cancer into different categories based on how the tumors react to hormones called estrogen and progesterone, as well as if they have the HER2 gene. Estrogen and progesterone can help cancers grow. In addition, the HER2 gene causes cells to have too much HER2 protein, which also makes cancer grow.

Luminal B breast cancer is a type of breast cancer that responds to the hormone estrogen in addition to having the HER2 gene (called HER2 positive). Due to this combination, luminal B breast cancer can grow very fast and is more likely to spread compared to other types of breast cancers.

Fortunately, new treatments offer women a targeted, effective way to kill cancer cells and keep them from coming back.

Targeted therapies take aim at luminal B cancers

Along with traditional cancer treatments such as surgery to remove cancer cells, chemotherapy and radiation therapy, your doctor may recommend that you have targeted therapy, sometimes called immunotherapy, biotherapy or monoclonal antibody therapy.

Targeted therapies give you man-made antibodies, which are special immune system cells, to attack HER2 proteins that cause cancer to grow. Without these proteins, cancer cells stop growing and spreading. You can take targeted therapy through an IV or as a pill. Though targeted therapy does have side effects, they are often less severe than chemotherapy side effects.

Hormone therapy keeps luminal B breast cancer at bay

Luminal B breast cancer also reacts well to hormone therapy. For hormone therapy, you take a pill each day that keeps your breast cells from absorbing hormones. Hormone therapy can help keep cancer from growing back years after surgery. After you've completed other treatments, you'll take hormone therapy for five to ten years.

Medullary carcinoma responds well to treatment

Your breasts are made up of many different types of cells that grow and divide. Sometimes when cells divide, they make a bad copy of your DNA and that cell can grow out of control and into a cancerous tumor.

Medullary carcinoma is a rare form of breast cancer that starts in the milk duct cells of your breast. It's called medullary carcinoma because the tumors look similar to a part of your brain called the medulla. The tumors are soft and gray.

Medullary carcinoma cells make up small tumors, but they can grow quickly into large tumors. However, medullary carcinoma cells don't spread quickly and often don't leave your breast at all. The cancer cells tend to stay very separate from your healthy cells. This makes medullary cancer easier to treat than many other breast cancers.

Medullary carcinoma can be caught early

If you develop medullary carcinoma, you may feel like part of your breast has become thicker and almost spongy. You may also notice swelling in your breast. You should always talk to your doctor about changes in your breast.

Because medullary carcinomas create tumors with definite sides, you or your doctor may be able to feel them during a breast exam. Medullary carcinomas also show up well on mammograms, helping your doctor identify cancer early.

Comprehensive treatment can lead to a cure

Medullary carcinoma is often treated similarly to invasive ductal carcinoma. Your doctor will first remove the tumors using surgery. If your tumor is small, you may be able to have just the tumor removed (lumpectomy), or if the tumor is large, your whole breast may be removed (mastectomy).

You may also have radiation therapy to kill any remaining cells after surgery. Radiation therapy uses high-powered particles or X-ray beams to burn away cancer cells and leave healthy cells unharmed.

You may also need chemotherapy, which uses medicine to kill cancer cells no matter where they are in your body. Medullary carcinoma responds very well to surgery, radiation therapy and chemotherapy. These treatments are typically able to get rid of cancer completely.

Though medullary carcinoma is considered a triple-negative breast cancer, women with medullary carcinoma have a better outlook than other types of triple-negative breast cancers. Triple-negative breast cancer cells don't respond to hormones and don't have a HER2 gene that make them grow and spread rapidly. Special therapies like hormone therapy and targeted therapy don't help fight medullary carcinoma.

Metaplastic carcinoma transforms breast cancer

Breast cancer occurs when cells in your breast divide and grow, and make copies of your DNA with errors in it. These DNA errors cause that specific type of cell to grow out of control and into a tumor. Usually, breast cancer tumors are made up of only one type of cell, such as ductal cells or lobule cells.

Rarely (less than one percent of the time) women develop a type of breast cancer called metaplastic carcinoma. Metaplastic carcinomas start out as tumors that contain one type of cell, but transform into tumors made up of different types of cancer cells. For instance, the cancer may start out as cells that line the glands in your breast and then change into skin cancer cells.

Metaplastic carcinomas are also a type of breast cancer called triple-negative breast cancer. This type of breast cancer doesn't use hormones to grow and doesn't have a HER2 gene that makes the cells grow out of control.

Does metaplastic carcinoma have any symptoms?

Metaplastic breast cancer shares the same symptoms as other types of breast cancer, including:

• Skin of the breast becomes red, scaly or dimpled
• Breast is warm or swollen
• Nipple becomes dented, has discharge or changes shape or size
• Breast tissues become thicker or lumpier than normal

If you have any of these symptoms, you should speak to your doctor.

Personalized treatments fight metaplastic carcinoma

Though it's a rare cancer, metaplastic carcinoma can be treated in the same ways as other types of breast cancer: with surgery, radiation therapy and chemotherapy. However, your doctor will need to personalize the treatment to your specific type of cancer.

The first step in your treatment is to have surgery to remove the metaplastic carcinoma tumors. Your doctor may suggest just removing the tumors (lumpectomy) or removing the entire breast (mastectomy). If the cancer has spread to your lymph nodes, those will be removed, too.

You'll also have chemotherapy, which uses different medicines to kill cancer cells no matter where they are in your body. If you have a large tumor, you may get chemotherapy before surgery to shrink the tumor and make it easier to remove (called neoadjuvant therapy).

Chemotherapy is typically used to make sure that cancer doesn't come back (adjuvant therapy). This treatment is important, since metaplastic carcinoma is made up of different cells, can grow quickly and doesn't respond to all adjuvant therapies.

Radiation therapy, another adjuvant therapy, makes sure that all cells in your breast and lymph nodes are gone after surgery. Radiation therapy uses high-powered particles or X-ray beams to destroy cancer cells. Because radiation therapy is very precisely aimed, healthy cells will not be damaged by this treatment.

Because it's a triple-negative cancer, metaplastic carcinoma doesn't benefit from other adjuvant therapies, including hormone therapy or targeted therapies.

After your entire treatment is complete, you may choose to have reconstructive plastic surgery to rebuild your breast. You'll also continue to see your cancer doctor every few months for years after your treatment to make sure the cancer doesn't come back.

Metastatic breast cancer (also called stage IV) is cancer that has spread to other parts of the body outside of the breast and lymph nodes, such as the lungs, liver, bones or brain. Many factors determine the best course of treatment, including where it has spread, your symptoms and the type of tumor (for example, if it is hormone receptor positive or negative). While metastatic breast cancer cannot be cured, there are numerous treatment options and many people are able to live long, happy lives after this diagnosis. New treatments are continually being developed.

Treatment for Metastatic Breast Cancer

Treatment may include any combination of the following therapies, either together, separately or in sequence.

Hormone therapy is often used when tumors are hormone receptor positive. Examples include tamoxifen, fulvestrant and aromatase inhibitors such as letrozole. They often can help slow or stop the growth of the cancer, and can shrink some tumors.

Targeted therapies block cancer growth by targeting specific characteristics of breast cancer cells. These treatments may be an option for women with metastatic breast cancer that is hormone receptor-positive, women with metastatic breast cancer that is HER2/neu-positive, women with triple negative breast cancer, and women with metastatic breast cancer that is HER2-negative, with mutations in the BRCA1 or BRCA2 genes.

Immunotherapy uses medications that target immune checkpoint inhibitors, which are proteins on immune cells that have turned off the body's immune response. Breast cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immunotherapy drugs target these checkpoint proteins and stimulate the body to recognize and attack breast cancer cells.

Chemotherapy may be used in women with metastatic breast cancer that is hormone receptor-negative, has not responded to hormone therapy, has spread to other organs or has caused symptoms. Chemotherapy may be given alone or in combination with immunotherapy in women with metastatic breast cancer that is hormone receptor-negative and HER2-negative.

Surgery and/or radiation therapy may be used to remove cancer that has spread to areas such as the brain, spine or lung, to support and strengthen bones, and to prevent or relieve pain or other symptoms.

Clinical trials testing new breast cancer treatments and treatment combinations are continually being developed, and we offer our patients enrollment in applicable clinical trials.

You naturally have normal, healthy cells in your breast that grow and divide into new cells. Breast cancer occurs when these new cells copy incorrectly and these bad copies grow out of control, forming a tumor.

There are many types of breast cancer. Each is unique and requires different treatment. Paget's disease carcinoma is a rare breast cancer that affects your nipple, areola and milk ducts. Usually it doesn't spread to other areas of your body, making it easier to treat.

Paget's disease carcinoma is not related to other forms of Paget's disease, such as Paget's disease of the bone.

Signs of Paget's disease carcinoma starts in your nipple

Paget's disease carcinoma tends to start in the nipple and spread to the dark skin around the nipple (areola) and other areas of your breast. Since it starts in your nipple, many of the signs of Paget's disease carcinoma also start there. Your nipple may undergo changes that look like eczema or other skin problems, so it is important to talk to your doctor if you notice any changes in your skin.

Signs of Paget's disease carcinoma may include:

• Changes in the skin of your nipple such as flakiness, crustiness, oozing or hardening
• Itching and redness in your nipple or breast
• Discharge from your nipple that might be yellow or red
• Nipple becomes dented in or flattened
• A lump or thick skin in your breast

Paget's disease carcinoma needs personalized treatment

Treatment for Paget's disease carcinoma begins with surgery to remove any cancer in your breast. In a lumpectomy, your surgeon will remove your nipple and areola, as well as surrounding breast tissue. If you have other tumors in your breast, you may need a mastectomy to remove your entire breast.

After you are done with cancer treatment, you can have surgery to reconstruct your breast, nipple and areola. You can also get the nipple and areola tattooed onto your breast if necessary.

If only part of your breast is removed, you will need to have radiation therapy following surgery. Radiation therapy uses high-powered beams and particles to burn away cancer cells. Because radiation therapy is precisely targeted, healthy cells are left unharmed. Some women who have mastectomy will also need radiation therapy, especially if cancer has spread to lymph nodes.

If cancer has possibly spread to other areas of your body, you will get chemotherapy treatment to destroy any cancer cells no matter where they are. Chemotherapy uses medicines you take as a pill or through an IV to kill cancer cells.

Sometimes Paget's disease carcinoma uses natural hormones like estrogen or progesterone to grow. Early in your treatment, your doctor will test your specific type of cancer to find out if it uses these hormones. If it does, you can help stop cancer from coming back by having hormone therapy. During hormone therapy, you take a pill each day for five to ten years that stops your body from making hormones or stops your breast cells from absorbing hormones. Hormone therapy is very helpful at keeping you cancer-free.

All breast cancers start the same way — as the cells in your breast grow and divide naturally, something goes wrong. Your cells make a bad copy of your DNA that causes new cells to grow out of control into tumors.

However, not all breast cancers are exactly the same. They start in different types of cells. Some breast cancers use hormones like estrogen or progesterone to grow faster. Others have a HER2 gene that makes them more aggressive.

When breast cancer doesn't have a HER2 gene and doesn't use hormones to grow, it is called triple negative breast cancer. These cancers can be harder to treat because they don't respond to targeted therapies.

However, that doesn't mean that triple negative breast cancers can't be treated and put into remission. As cancer research leads to more advanced treatments, women with all types of breast cancer are seeing better results from cancer treatment.

Know the signs of triple negative breast cancer

Triple negative breast cancers have similar symptoms to other breast cancers. You may notice changes in your breast, such as:

• A lump
• Redness, warmth or scaliness in the skin of your breast
• Discharge from your nipple
• Nipple that looks dented
• Part of your breast tissue feels thicker

Though younger women and black women are more likely to have triple-negative breast cancer, all women should talk to their doctor about any changes in their breasts.

Triple negative breast cancer responds to triple-threat treatment

If you are diagnosed with breast cancer, your doctor will perform tests to figure out exactly what type of breast cancer you have. Knowing the type of breast cancer helps you get the best treatment for your specific condition. In general, you will undergo three types of treatment for triple-negative breast cancer: surgery, chemotherapy and radiation therapy.

Surgery is often the first step in treating cancer for many patients. Women with triple negative breast cancers typically have their whole breast removed (mastectomy). In some cases, women may have chemotherapy before surgery to shrink cancer tumors so your doctors only have to remove part of the breast (lumpectomy).

You may also get chemotherapy, starting a few weeks after surgery to ensure all cancer cells are eliminated. Chemotherapy uses drugs to kill cancer cells anywhere in the body and is effective for treating triple negative breast cancer.

Sometimes you may also need radiation therapy, which uses high-powered X-rays beams or particles to destroy any cancer cells left in or around your breast after surgery. Women who have a lumpectomy will need radiation therapy following surgery. Sometimes women who get a mastectomy also need radiation treatments, especially if cancer has spread into lymph nodes.

At Main Line Health, we create personalized treatment plans for each patient with breast cancer, taking into account the type and stage of breast cancer as well as your overall health and lifestyle.

Tubular carcinoma grows slowly, rarely spreads

Breast cancer happens when cells divide and grow like normal, but make a mistake when copying DNA into new cells. The new cells then grow out of control into cancerous tumors.

Breast cancer is normally named after what type of cell it starts in. For instance, invasive ductal carcinoma starts in the milk duct cells of the breast. However, breast cancer types can get even more specific. Tubular carcinoma is a type of invasive ductal carcinoma where all the cancer cells look tube-shaped under a microscope.

Tubular carcinoma is rare and usually not aggressive. Typically the tumors are small and don't grow very fast. The cancer also rarely leaves your breast. Tubular carcinoma responds well to treatment and often has a good outlook, meaning you are more likely to get become and stay cancer-free.

Tubular carcinoma treatment has few side effects

Like other breast cancers, tubular carcinoma is usually treated first by surgery. Your surgeon will carefully remove just the cancerous area of your breast (lumpectomy) or the entire breast (mastectomy). Most patients with tubular carcinoma only need a lumpectomy for treatment.

If you have had a lumpectomy, you will likely have radiation therapy a few weeks after surgery once you have healed. Radiation therapy uses high-powered beams of energy to destroy cancer cells that might be left after surgery.

Many patients with tubular carcinoma don't require chemotherapy since the cancer rarely spreads to other parts of the body. If cancer has spread, chemotherapy can kill cancer cells no matter where they are in your body using specialized medicines.

Because tubular carcinoma uses estrogen to grow, taking hormone therapy after cancer treatment can help keep cancer away. During hormone therapy, you take a pill every day for five to ten years. The pill stops your breast tissues from absorbing estrogen or stops your body from making estrogen entirely. Hormone therapies can be effective at keeping tubular carcinoma from coming back.