Papillary Carcinoma of the Breast

Papillary carcinoma of the breast, also known as intraductal papillary carcinoma, is a rare type of breast cancer that accounts for only 0.5% of all new cases of invasive breast cancers.

Under a microscope, papillary carcinoma looks similar to fingerlike projections called papules. Many papillary tumors are not cancerous; these are called papillomas. Papillary tumors that are cancerous (malignant) include both in situ cells, meaning they haven’t spread outside the duct, and invasive cells, which have begun to spread.

Although concerning, papillary carcinoma of the breast is less likely to spread to the lymph nodes, is more responsive to treatment, and may offer a better prognosis than other types of invasive ductal cancers. 

This article will cover the symptoms, causes, diagnosis, and treatment options for papillary carcinoma of the breast.

Types of Papillary Breast Cancer

There are several variations of papillary breast cancer.

Benign (Noncancerous) Papillary Lesions

• Intraductal papilloma (solitary): A single tumor that grows in the milk ducts near the nipple
• Intraductal papillomatosis: Tumors that grow in the milk ducts near the nipple

Atypical Papillary Lesions

• Intraductal papilloma with atypical hyperplasia: Abnormal growth of cells
• Papilloma with ductal carcinoma in situ (DCIS), a precancerous condition

Malignant Papillary Lesions

Noninvasive:

• Papillary DCIS: Begins in the milk duct of the breast, but hasn't spread outside the duct
• Encapsulated papillary carcinoma: A rare tumor that is contained in one area
• Solid papillary carcinoma: A rare form with solid nodules, mainly affecting older women

Invasive:

• Invasive papillary carcinoma: A very rare form of ductal carcinoma
• Invasive micropapillary carcinoma: A variant of breast carcinoma with a high chance for regional lymph node involvement
  

Symptoms

Often, papillary carcinomas don't cause any symptoms and are not caught with breast self-examination.

When they do cause symptoms, you may experience the following:

• A lump large enough to feel with the fingers
• Nipple changes like the nipple turning inward
• Breast tenderness
• Discharge

Causes

Papillary carcinomas are most often diagnosed in women who have already gone through menopause. Interestingly, diagnoses of papillary carcinoma in men appear to be more common than other types of male breast cancer.

Anyone can develop papillary carcinoma of the breast; researchers do not really know what causes it to develop.

Diagnosis

Papillary carcinoma is usually found during a routine mammogram (breast imaging), appearing as a well-defined mass behind or just next to the areola.

Imaging tests alone are not enough to make a diagnosis of papillary breast carcinoma, so mammograms, ultrasound, and/or breast magnetic resonance imaging (MRI) are done in conjunction with tissue biopsy.

A tissue biopsy for papillary breast carcinoma involves taking a sample of the tumor and examining it under a microscope. The cancer cells' fingerlike appearance is what distinguishes them from cells that would be characteristic of other types of breast cancer.

Papillary carcinoma is often found with DCIS, which is a type of early-stage breast cancer confined to a milk duct.

Misdiagnosis

Papillary carcinoma is sometimes misdiagnosed as intraductal papilloma or papillomatosis. 

Intraductal papilloma is a noncancerous condition in which a tiny, wartlike growth in breast tissue punctures a duct. Intraductal papillomas grow inside the breast's milk ducts and may cause benign nipple discharge.

Papillomatosis is a kind of hyperplasia, another noncancerous condition that may occur in the ducts and cause cells to grow larger and faster than normal.

Having one or more intraductal papillomas, or papillomatosis, slightly increases your risk of developing breast cancer.

Treatment

Most cases of papillary carcinoma are low-grade, slow-growing cancers. Many do not spread very far beyond their original site. That said, treatment is important. Options depend on various features of the cancer, including:

• Size of the tumor (papillary breast tumors are often small)
• Tumor grade
• Hormone receptor status
• HER2 (human epidermal growth factor receptor 2) status

Surgery

Surgical options include lumpectomy, removal of the noninvasive cancer along with a margin of surrounding tissue, or mastectomy, removal of all breast tissue (including the nipple and the areola).

Drug Therapies

Chemotherapy destroys cells and may be offered depending on tumor grade, hormone receptor and HER2 status, and if lymph nodes are affected.

Hormone therapy drugs, on the other hand, can block the effect of estrogen on cancer cells. Papillary breast cancer cells will be tested to determine if estrogen binds to them. If it does, hormone therapy can be helpful.

Targeted therapies also block the growth and spread of cancer cells. The most widely used target therapy is Herceptin (trastuzumab). Herceptin has been found to be very effective for treating HER2-positive breast cancers. It is not helpful for HER2-negative cancers, however.

Finally, bisphosphonates—bone-building drugs found to help reduce the risk of cancer recurrence in postmenopausal women—can also be helpful in preventing cancer cells from spreading. 

Summary

Papillary carcinoma of the breast is a rare type of breast cancer that accounts for only 0.5% of all new cases of invasive breast cancers. It mostly affects women who have already gone through menopause. There may be no symptoms and you may not find a lump during a self-examination. This cancer is slow-growing and is not likely to spread to the lymph nodes.

A Word From Verywell

Cancer support groups are a great resource for finding people who have first-hand experience with a breast cancer diagnosis. Just be prepared that you may not meet someone else who has papillary carcinoma of the breast, given how rare it is. Connecting with others who also are coping with a breast cancer diagnosis and going through treatment, however, can be invaluable.

When it comes to discussing the specifics of your condition, however, your best resource remains your healthcare team.