The term papillary breast cancer can refer to a number of different types of breast cancer. These include:
- invasive papillary breast cancer
- invasive micropapillary breast cancer
- intracystic/encapsulated/encysted papillary cancer
- papillary ductal carcinoma in situ
These are often seen mixed with other types of breast cancer.
The treatment and outlook for papillary breast cancer will depend on the type of papillary breast cancer as well as its features.
Papillary breast cancer is not the same as the benign (not cancer) condition intraductal papilloma.
The symptoms of papillary breast cancer can include:
- a change in the size of the breast
- a lump
- thickening of the skin of the breast
- changes to the nipple such as nipple discharge and the nipple being pulled in (inverted)
Routine breast screening can often pick up cancer before there are any symptoms. This means some women will be diagnosed with papillary breast cancer after attending breast screening without having any of the symptoms listed above.
Papillary breast cancer is diagnosed in the same way as other breast cancers.
A range of tests will be done to make the diagnosis. They include:
- a mammogram (breast x-ray)
- ultrasound scan
- core biopsy or fine needle aspiration
Treatment will depend on the type of papillary breast cancer you have.
Breast surgery is usually the first treatment for all types of papillary breast cancer. This may be:
- breast-conserving surgery, also known as wide local excision or lumpectomy – the cancer is removed along with a margin (border) of normal breast tissue around it
- mastectomy – all the breast tissue including the nipple area is removed
The type of surgery recommended depends on:
- where the cancer is in the breast
- the size of the cancer relative to the size of your breast
- whether more than one area in the breast is affected
Your breast surgeon will discuss this with you.
If you have breast-conserving surgery, it’s important that a clear margin (border) of tissue is taken from around the cancer.
If a clear margin of tissue is not seen when the area removed is looked at under the microscope, sometimes a second operation is needed.
If you are going to have a mastectomy, you’ll usually be given the option of having a breast reconstruction either at the same time as the mastectomy (immediate reconstruction) or at a later date (delayed reconstruction).
Surgery to the lymph nodes
If you have an invasive type of papillary breast cancer, your specialist team will want to check if any of the lymph nodes (glands) under the arm contain cancer cells. This, along with other information about your breast cancer, helps them decide whether you will benefit from any additional treatment after surgery. To do this, your surgeon is likely to recommend an operation to remove either some of the lymph nodes (a lymph node sample or biopsy) or all of them (a lymph node clearance).
Sentinel lymph node biopsy is widely used if tests before surgery show no evidence of the lymph nodes containing cancer cells. It identifies whether the sentinel lymph node – the first lymph node that the cancer cells are most likely to spread to – is clear of cancer cells. There may be more than one sentinel lymph node. If clear, this usually means the other nodes are clear too, so no more will need to be removed. Sentinel lymph node biopsy is usually carried out at the same time as your cancer surgery but may be done before your surgery.
If the results of the sentinel lymph node biopsy show that the first node or nodes are affected, more surgery or radiotherapy to the remaining lymph nodes may be recommended.
Sentinel lymph node biopsy is not suitable if tests before your operation show that your lymph nodes contain cancer cells. In this case it’s likely that your surgeon will recommend a lymph node clearance.
Find out more information about surgery to the lymph nodes.
If you have intracystic/encapsulated/encysted papillary breast cancer or papillary carcinoma in situ, you’re less likely to have surgery to the lymph nodes because these types rarely spread to the lymph nodes.
Adjuvant (additional) treatments
After surgery, depending on the type of papillary breast cancer you have, you may need further treatment. This is called adjuvant (additional) therapy and can include:
- hormone (endocrine) therapy
- targeted (biological) therapy
The aim of these treatments is to reduce the risk of breast cancer returning in the same breast or developing in the other breast, or spreading somewhere else in the body.
If you have breast-conserving surgery, you will usually be offered radiotherapy to the breast to reduce the risk of the cancer coming back in the same breast. Sometimes you may be offered radiotherapy to the lymph nodes under your arm.
In some circumstances, radiotherapy to the chest wall may be recommended after a mastectomy, for example if some lymph nodes under the arm are affected.
Radiotherapy is likely to be recommended if you have an invasive type of papillary breast cancer.
Hormone (endocrine) therapy
The hormone oestrogen can stimulate some breast cancers to grow. A number of hormone therapies work in different ways to block the effect of oestrogen on cancer cells.
Hormone therapy will only be prescribed if your breast cancer has receptors within the cell that bind to the hormone oestrogen, known as oestrogen receptor positive or ER+ breast cancer.
Invasive breast cancers are tested for oestrogen receptors using tissue from a biopsy or after surgery. When oestrogen binds to these receptors, it can stimulate the cancer to grow.
If your cancer is oestrogen receptor positive, your specialist will discuss with you which hormone therapy they think is most appropriate.
If oestrogen receptors are not found it is known as oestrogen receptor negative or ER-.
Tests may also be done for progesterone (another hormone) receptors.
The benefits of hormone therapy are less clear for people whose breast cancer is only progesterone receptor positive (PR+ and ER-). Very few breast cancers fall into this category. However, if this is the case for you your specialist will discuss with you whether hormone therapy is appropriate.
If your cancer is hormone receptor negative, then hormone therapy will not be of any benefit.
Chemotherapy destroys cancer cells using anti-cancer drugs.
Chemotherapy may be recommended for some people who have an invasive type of papillary breast cancer. This will depend on various features of the cancer, such as its size, its grade (how quickly the cells are dividing and how different they are to normal breast cells), the hormone receptor and HER2 status and whether the lymph nodes are affected.
Targeted (biological) therapies
Targeted therapies are a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer grow.
The most widely used targeted therapy is trastuzumab (Herceptin). Only people whose invasive breast cancer has high levels of HER2 (called HER2 positive) will benefit from having trastuzumab. HER2 is a protein that helps cancer cells grow.
There are various tests to measure HER2 levels which are done on breast tissue removed during a biopsy or surgery. If your cancer is found to be HER2 negative, then trastuzumab will not be of benefit to you.
Bisphosphonates are a group of drugs that can reduce the risk of invasive breast cancer spreading in post-menopausal women. They can be used regardless of whether the menopause happened naturally or due to breast cancer treatment.
Bisphosphonates can also slow down or prevent bone damage. They’re often given to people who have, or are at risk of, osteoporosis (when bones lose their strength and become more likely to break).
Bisphosphonates can be given as a tablet or into a vein (intravenously).
Your specialist team can tell you if bisphosphonates would be suitable for you.
Being diagnosed with breast cancer can make you feel lonely and isolated.
Many people find it helps to talk to someone who has been through the same experience as them. Breast Cancer Now’s Someone Like Me service can put you in touch with someone who has had a diagnosis of breast cancer, so you can talk through your worries and share experiences over the phone or by email. You can also visit our confidential online Forum and join one of the ongoing discussions.
If you would like any further information and support about breast cancer or just want to talk things through, you can speak to one of our experts by calling our free Helpline on 0808 800 6000.