Not long ago, a piece of news that "a woman's breasts have recurring symptoms of eczema is breast cancer " became a hot search on Weibo. According to reports, a 38-year-old woman in Xi'an went to the hospital for consultation and claimed that her left nipple often experienced itching a year ago, accompanied by inflammation, flushing and other problems. However, the treatment according to the breast eczema method did not work. Great turnaround. After detailed examination, the woman was finally diagnosed with " breast eczema-like carcinoma ".
Symptoms are similar to eczema, and are easily misdiagnosed
Breast eczema-like cancer is also known as "Breast Paget's disease (Page's disease)". It is a rare malignant lesion that occurs in the nipple-areola area. Typical symptoms are: Eczema-like changes such as nipple epithelial desquamation, erosion, ulceration, itching, and scabbing.
Its clinical manifestations are similar to eczema-like inflammation. Therefore, some patients mistakenly think it is eczema and repeatedly visit the dermatology department. As a result, they do not receive timely diagnosis and delay treatment.
Of course, the incidence of Pagets disease is relatively low, accounting for only 2% to 3% of female breast cancer. Therefore, if female friends experience nipple itching, rash, peeling and other symptoms, do not panic. This is not necessarily eczema-like cancer ; but if these symptoms recur and persist for a long time, you should go to a breast specialist or dermatology department as soon as possible. .
So, how to differentiate between common eczema and pagets disease?
Under normal circumstances, common eczema can be seen in all ages, and occurs in both men and women. The course of the disease is relatively acute, and eczema-like skin lesions can be distributed throughout the body. The skin has various manifestations, including erythema, papules, and scratches, and is relatively clean. ; The nipple is basically normal, the skin is slightly red and swollen, the pain is mild, and the touch is similar to normal breast tissue; it can improve quickly after formal treatment by a dermatology department.
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Pagets disease is more common in middle-aged and elderly women; the course of the disease is long, and the lesions are mainly centered on the nipple and around the areola; the skin mostly shows eczema-like changes such as desquamation, erosion, ulceration, itching, and scabbing. , the nipple may be damaged, there may be repeated scabbing and bloody oozing, obvious erosion, and strong pain.
The onset is slow, and early diagnosis and early treatment has a good prognosis
Clinically, simple pagets disease is rare, and most are combined with deep breast lesions. According to relevant reports, about 50% of patients with Pagets disease are complicated by deep invasive breast cancer, 36% are complicated by deep intraductal cancer of the breast, and only 14% are Pagets disease that simply involves the nipple and areola. Therefore, once pagets disease is suspected, in addition to a scraping examination of suspicious lesions in the nipple and areola area, breast color ultrasound, mammography , and breast MRI should also be completed to check whether there are combined intra-breast lesions to avoid missing the possibility. Although
Pagets disease is a malignant tumor, its degree of malignancy is low and its onset is slow. As long as the cancerous part is discovered and removed in time, its cure rate is still quite high.
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Be alert to the danger signals sent by the breasts
In addition to eczema-like skin lesions, female friends should also be alert to these danger signals sent by the breasts:
Lumps In the early stage of breast cancer, breast cancer is a lump without obvious pain, and the size of the lump is variable. Irregular in shape and hard in texture.
Pain Early breast cancer generally does not cause obvious pain. A few patients will experience intermittent pain and vague pain, or mild discomfort in one breast, which may also cause shoulder pain and discomfort.
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Abnormal discharge The nipples of early breast cancer patients will overflow milky white and light yellow liquid, and some patients’ discharge will appear watery or blood-like in color.
Breast skin changes There is a certain correlation between skin changes and the depth and degree of invasion of the lump. The lump may be darker, orange peel-like, or even edema-like or eczema-like. It is also possible that the skin will not show obvious changes.
Nipple changes Under normal circumstances, the breasts on both sides are symmetrically distributed, but if there are tumors around the nipples, the nipples will change in height.
In order to facilitate the timely detection of breast abnormalities, female friends can often perform self-examination in daily life. The method is " look, touch and squeeze ":
Take off your shirt, face the mirror, hang your hands naturally, and Compare side by side to observe whether there are abnormalities in breast shape, size, skin, and whether nipples are sunken or eroded. Take a standing or supine position, place your left hand behind your head, put your right fingers together and use your right fingertips to move along the direction from the 12 o'clock position. Move the examination gradually in the clockwise direction, then palpate the armpit to check for lumps. The same goes for the right breast, with the direction of examination being counterclockwise; gently squeeze the nipple and pay attention to whether there is any discharge from the nipple.
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Author | Yu Feng, attending physician at the Breast Cancer Center of Chongqing University Cancer Hospital
Source | "Family Medicine" magazine, Issue 13, July 2022
Editor | Zhang Yue
Second review | Zhou You
final review｜Liu Huiying and Zhang Ruxian
