Breast Cancer - Moose and Doc

A breast cancer explanations website

 

By Dr. Halls

Papillary Breast Cancer

Papillary breast cancer is a very uncommon form of infiltrating ductal breast cancer.

The word ‘papillary’ literally means ‘nipple-like’.  So, the characteristics of this cancer are a well-defined margin with many small projections. 

These projections or ‘fronds‘  look like little fingers or nipples, or like the bumpy surface of taste-buds on the tongue.

We have a newer page, with up-to-date references on types of breast cancer Here.

This carcinoma commonly presents as either a palpable lesion or a nodule on a mammogram.  Sometimes, it presents as a complex cyst with solid elements, of about 2 to 3 cm in diameter, containing a brownish mixture of neoplastic tissue and blood clots.

Dr. Halls Dr. Halls
Actually, I’ve never heard of a papillary breast cancer being as big as 3 centimeters.


 
 

About half of all cases occur beneath the nipple. This results in bloody nipple discharge.

Sometimes papillary breast cancer is called ‘intracystic‘ papillary carcinoma.  This simply means that the tumor is found ‘inside’ a cyst, or a dilated duct segment, and is therefore somewhat more fluid and ‘cyst-like’ than a solid mass.

Dr. Halls Dr. Halls
Bloody discharge, doesn’t mean cancer however.


 
 

papillary breast cancer
Dr. Halls Dr. Halls
Inside that very dilated duct, see all the slender fingers of papillary cancer cells.


 
 

There is a heterogeneous collection of breast cancers that have cyst-like presentations.

In carcinomas, such as papillary breast cancer, the tumor presents more or less as a cyst.

However,  in other types of breast cancer, the abnormality may present as a mass that ‘decays’ into a cyst. 

This latter ‘ductal carcinoma with cystic degeneration’ tends to be associated with a more serious, aggressive breast cancer.

Statistical prevalence of Papillary Breast Cancer

Papillary breast cancer is very rare and only diagnosed in 1% to 2% of all patients.

Occasionally the disease is found in men as well. Papillary carcinoma most frequently occurs in older, post-menopausal women. 

In terms of the grade and aggressiveness, papillary breast cancer commonly presents as a moderate or ‘grade 2‘ tumor.

Invasive papillary carcinoma usually occurs following the development of papillary ductal carcinoma in situ (DCIS).

If the cancer is just beginning to affect the ducts it might be called ‘infiltrating’ papillary carcinoma.  However, invasive papillary breast cancer refers to when the abnormality is clearly in the ducts and moving beyond.

Mammography and ultrasound can usually identify papillary carcinoma, but a fine-needle aspiration biopsy may not be sufficient to distinguish between in situ, infiltrating, and invasive forms.

This is due to the fluid nature of the carcinoma and because the invasion tends to occur at the edge of the tumor.  Because of this, surgical excision of the mass is often necessary.

Prognosis and Treatments

Papillary carcinoma is a slow-growing form of breast cancer, and specialists report a 10-year survival rate of between 85% to 100%.

Furthermore, studies show a 10-year ‘disease-free‘ rate of just under 75%.

Non-invasive papillary carcinoma has a similar prognosis, which is excellent, by the way, to most other ductal carcinomas.

Interestingly, the invasive presentation of papillary carcinoma has a better prognosis than other invasive ductal carcinomas.

Negative axillary lymph node involvement significantly improves 5-year survival rate.

Tumor size and cancer grade also play a role, but there is no statistically significant difference in this regard between papillary and other ductal breast carcinomas.

The outlook for papillary breast cancer is also more positive for younger women (under 50).

Segmental Mastectomy is the most common treatment for Papillary Breast Cancer

As for treatment and follow-up options, segmental mastectomy is the most frequent course of action. Less commonly, patients undertake hormonal and radiation therapies.

Let’s go over a few Q&A’s:

What are the Symptoms?

Like other breast cancers, this type of cancer may also not have any symptoms.

A routine mammogram may detect the development.

For those who do experience symptoms, they may include:-

  • A mass or lump
  • Nipple discharge
  • Itchy breast
  • Change in breast color
  • Flaking skin
  • Breast thickening
  • Redness.

What are the risk factors for papillary breast carcinoma?

Gender – although papillary breast cancer occasionally occurs in men, the disease is a lot more common in women.  

Age – This cancer usually occurs in women between the ages of 62 and 67.   

Race – darker-skin women are more likely to get papillary breast cancer than white women.

Menopause – this type of breast cancer is more common among postmenopausal women.

What is the difference between papillary breast cancer and other types of breast cancer?

The difference is in the arrangement of the cancer cells.  The cells are arranged in finger-like projections or papules.

Under a microscope, the cells appear fern-like. Sometimes, the cancer cells are very small in size, in which case the cancer is micropapillary.

Treatment Options

Treatment options are:-

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Hormonal therapy
  • Therapy that targets the HER2 protein.

Further Reading

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References

About Steven Halls

Dr Halls has 25 years experience as a radiologist. He worked for 13 years at Cross Cancer Institute in Edmonton, a world-class cancer treatment facility. He has had high-volume experience with cancer, interventional procedures, clinical trials and his own phase 1 and 2 research in MRI and breast cancer staging.