Also called papillary carcinoma, papillary breast cancer is a rare form of breast cancer where the tumor is cyst-like. The cancer starts in the breast’s milk duct, usually under the nipple, causing a bloody nipple discharge. Papillary breast cancer is generally non-invasive in nature and rarely occurs or spreads outside the milk ducts. The cancer cells look like papules or finger-like projections when viewed under the microscope. This probably explains how this breast cancer type got its name.

The cancer tumor is usually small and cyst-like to start with and the lymph nodes (glands) are less likely to be involved, unlike other breast cancer types. Moreover, the tumor could also be benign (non-cancerous). The tumor in other types of breast cancer usually is a solid mass that decays to become a cyst. At times, the cancer cell size could be smaller than normal, and it could therefore be referred to as micropapillary. There is another variant of papillary breast cancer called intracystic papillary carcinoma, which is low-grade and is much easier to treat.

Causes & Symptoms

Like most other forms of breast cancer, papillary carcinoma may not have much symptoms to show. Papillary breast cancer signs can be a change in breast size, a lump or breast skin thickening, alterations to the nipple like an inverted nipple (pulled-in nipple), nipple discharge, breast color changes and itchy breasts. Nipple discharge is not common. Not all nipple discharges mean cancer, by the way.

Occurrence/ Risk Factors

Papillary breast cancer occurs in 1 to 2 percent of all breast cancer patients, and men could occasionally be diagnosed with the condition too. Generally, the cancer occurs most frequently in post-menopausal, older women. The disease is usually diagnosed in ladies falling in the 62-67 years age group. Some of the risk factors are alcohol consumption, giving birth to a child after 35 years of age, not breastfeeding the kid, etc. Generally, the risk factors are not much different from other types of breast cancers. By the way, a risk factor only increases the probabilities of the person getting the cancer but it doesn’t guarantee cancer.

Diagnosis

The diagnosis for papillary carcinoma is similar to other breast cancer types. Ultrasound, mammography (breast X-ray) and fine-needle aspiration (FNA) usually help detect papillary carcinoma. Regular breast screening could generally detect the cancer prior to the symptoms becoming apparent. This is why some ladies could have the cancer but no symptoms to tell.

Treatment

The treatment for papillary carcinoma could be local or systemic in nature. Local therapy is carried out to ensure the cancer doesn’t affect the breast again. The therapy usually entails surgery and could also comprise radiation. Systemic therapy, on the other hand, is more holistic and is performed to make sure the disease doesn’t come back or spread to other body parts. The therapy may involve hormone (endocrine) therapy, targeted therapy, and chemotherapy.

Surgery is typically the approach taken to treat papillary carcinoma. Mastectomy (breast removal through surgery) and lumpectomy (breast-conserving surgery) are common treatments for the disease. The less common treatment or therapies are radiation and hormonal therapies, which should not be mistaken for hormone replacement therapy. If mastectomy is performed, a breast reconstruction would have to be performed – either simultaneously (immediate reconstruction) or later (delayed reconstruction).

The kind of surgery opted for depends on the breast’s affected area, number of areas affected, and tumor size. Also, the doctors would check if the lymph nodes have cancer cells. To ascertain this, the surgeon would likely harvest a lymph node sample. In case the sample does not have any cancerous cells, it means the remaining nodes are clean too. However, if the sample nodes are affected, another surgery or radiotherapy could be recommended to clear the remaining nodes.