By Dr. Kathleen Ruddy
Papillary neoplasms in the breast are abnormalities in the breast tissue that concern doctors because of their unpredictability. They may be detected with mammography or because they cause unpleasant nipple discharge. Even if the neoplasms appear harmless when they are discovered, they can develop into cancer with time. Surgical removal is commonly recommended by oncologists. Knowing about the neoplasm can help patients understand their doctor’s suggestions and cooperate with them to choose the best treatment.
A Neoplasm
A neoplasm is an abnormal mass of tissue that results from abnormal cell growth. The cell growth is not proportional to the surrounding cells and continues even after the stimuli that caused it ceases. Some neoplasms form a lump, but not all of them. The ones who form a lump are also called tumors.
Potentially malignant neoplasms do not yet act as cancer, but will transform into cancer if they are given enough time. Malignant neoplasms are commonly known as cancer; they destroy the surrounding tissue, can form metastases and can be lethal.
Benign Papillary Tumor
The name “papillary” comes from the finger-like projections, or papules, seen when the tumor is examined under the microscope. Most papillary tumors are benign and these are called papillomas. When a papillary tumor is discovered, a doctor will usually perform a biopsy to see whether the tumor is benign or malignant. The problem with this is that such biopsy, where only a little part of the tumor is taken out, is often not reliable. It could happen that only the benign part of the tumor was taken out, and the malignant part was missed.
Even if the biopsy showed that the tumor is benign, doctors will often recommend surgical excision to make sure the tumor doesn’t further develop.
Malignant Papillary Tumor
Malignant papillary tumors are a form of breast cancer. They are a subtype of the invasive ductal cancer, meaning that they are likely to invade other tissues around them. Like other types of ductal cancers, papillary breast cancer or papillary carcinoma begins in the milk ducts of the breast. Often this type of cancer starts with the ductal carcinoma in situ (DCIS) where the cancer cells are confined to the ducts. After the DCIS has developed, it often transforms into the invasive papillary cancer which spreads to other tissues.
The Symptoms of Papillary Carcinoma
A routine mammography might detect an abnormality in the breast, which is later identified as the papillary carcinoma. Besides the mammogram, other clues can help recognize this particular breast cancer. One symptom is a mass or a lump that forms in the breast and can be felt with the hand during breast examination. The mass is small in size, usually measuring 2 to 3 cm. Another symptom is bloody nipple discharge if the tumor is positioned beneath the nipple, which is the case in 50 percent of papillary carcinomas.
Surgical Removal of Papillary Tumors
To determine if the surgery is necessary doctors will do a needle biopsy to examine a part of the tumor to see if it is malignant or potentially cancerous. Even if the biopsy showed that the tumor is benign, doctors will often recommend surgical excision to make sure the tumor doesn’t further develop. In some cases, breast conservation surgery or lumpectomy will be done to remove only the part of the breast which contained the tumor. Mastectomy is most commonly administered treatment with papillary carcinoma. It results in full removal of the breast, but it makes the recurrence of the cancer much less likely.
Accompanying Treatments
Sometimes other treatments besides the surgery are necessary. Doctors will adjust the treatment to the features of the tumor and the stage of the cancer. If the papillary tumor is invasive, it is often treated the same as the invasive ductal carcinoma. Radiation therapy after the surgery makes sure that no cancer cells are left in the breast and in the lymph nodes. Chemotherapy is also often recommended, as well as the therapy that targets the HER2 protein. The hormonal therapy is sometimes performed. Different therapies might be combined to achieve the best result.
Although often benign, papillary neoplasms can often be an indicator of cancer and turn into one if left alone long enough. Doctors will perform a biopsy to determine whether the tumor is malignant. Women should pay attention to any nipple discharge, especially bloody because it is a symptom of papillary carcinoma. In case of papillary carcinoma, surgery is required to remove the cancerous tissue. Even when the tumor is not cancerous, some doctors prefer to surgically remove the abnormal breast tissue to make sure the cancer doesn’t form. With prompt action, dangerous neoplasms can be efficiently removed, and the breasts conserved.
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