An Overview of 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 finger-like projections called papules. Many papillary tumors are not cancerous; these are called papillomas. When papillary tumors are malignant, it is because they include both in situ cells, which haven’t spread outside the duct, and invasive cells that have begun to spread.

microscope
Alexander Traksel / Getty Images

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.

Invasive cancers begin growing into the milk ducts of the breast and move to invade fibrous or fatty issue outside the duct. 

Types of Papillary Breast Cancer

There are several variations of papillary breast cancer.

Benign (not harmful) 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 DCIS: Papilloma with ductal carcinoma in situ, a precancerous condition

Malignant papillary lesions

Noninvasive:

  • Papillary ductal carcinoma in situ: 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' finger-like appearance is what distinguishes them from cells that would be characteristic of other types of breast cancer.

Papillary carcinoma is often found with ductal carcinoma in situ (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, wart-like 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:

Surgery

Surgical options include lumpectomy, removal of the non-invasive 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 coping with breast cancer diagnosis and going through treatment can be invaluable. When it comes to discussing the specifics of your condition, however, your best resource remains your healthcare team.

Frequently Asked Questions

  • Is papillary breast cancer hereditary?

    Family history does a play a role and knowing your family history is important. If you have a first-degree relative who has this cancer type, you may be at higher risk.

  • Does papillary breast cancer always originate in the ducts of breasts?

    Yes, like many types of breast cancer, this type starts in the milk ducts of the breast.

  • Is papillary breast cancer fast-growing?

    This type of cancer is typically slow-growing and does not grow far from its original spot.

  • What is the prognosis for papillary breast cancer?

    Because this cancer is not likely to spread to the lymph nodes, it has a better outcome than some other invasive breast cancers.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
Learn about our editorial process