Latest news with #Paget
BBC News
20-04-2025
- Health
- BBC News
Woman one of first at Walsall hospital to have mastectomy while awake
A woman has become one of a hospital's first patients to have breast surgery while still being Wilkes, 62, underwent a mastectomy after being diagnosed with a rare condition associated with breast cancer, called Paget's disease of the causes eczema-like changes to the skin of the nipple and the areola. It is usually a sign of breast cancer in the tissue behind the at Walsall Manor Hospital successfully performed a mastectomy on Ms Wilkes under a regional anaesthetic, which "blocks" an area of the body, and conscious sedation - meaning she received medicine but was still conscious for the procedure. She was discharged the same Wilkes said: "I found a lump in December last year and made an appointment with the doctor. They did a biopsy and MRI scan to confirm I have Paget's disease and needed a mastectomy."I have COPD [chronic obstructive pulmonary disease] and other health conditions so I was very nervous about surgery and my lungs not being able to cope if I was put to sleep."The staff were absolutely fantastic and reassured me all the way. They held my hand and spoke me through everything. I don't remember a thing from the surgery or being in any pain."I was so grateful I could go home that evening and didn't need a night in the hospital." Matt Green, consultant breast surgeon and clinical director for general surgery at the NHS trust, said it was the second operation of its kind performed at the Walsall said: "It is used for patients who are not deemed appropriate for general anaesthetic due to other medical problems that would make them very high risk for the anaesthetic."He said in Ms Wilkes's case if surgery had not been carried out "her pre-cancerous changes would have progressed to her developing breast cancer, which could then spread and become untreatable". Follow BBC Birmingham on BBC Sounds, Facebook, X and Instagram.
Los Angeles Times
11-03-2025
- Health
- Los Angeles Times
Paget's Disease: Diagnosis, Management, and Insights into the Breast (PDB)
Paget's disease of the breast is a rare kind of breast cancer that mostly affects the skin around the nipple. It happens in only a small number of breast cancer cases because it's linked to certain gene changes and other types of breast tumors. Doctors notice it more in women who have stopped having periods (postmenopausal women). Things like what you eat, where you live, and how often you get check-ups can change your chances of having this disease. Paget's disease of the breast is found more often in countries like the United States and those in Western Europe, compared to places in Asia. This could be because people in those countries have more access to doctors, tests, and information about breast health. Even though this disease is not very common, it's important to pay attention to it because it can be connected to other serious breast tumors. Catching and treating it early helps people have better results and stay healthier in the long run. Table of Contents: Paget's disease of the breast is a rare breast cancer that affects the skin of the nipple and sometimes the areola. It is characterized by a rash or eczema like appearance on the nipple and areola which can be accompanied by itching, redness and discharge. It is often associated with an underlying breast cancer which can be invasive or non-invasive (ductal carcinoma in situ, DCIS). Paget's disease of the breast is named after Sir James Paget, a 19th century British doctor who first described the condition. The pathogenesis of PDB is explained by two theories: The first theory is the epidermotropic theory which suggests that Paget cells come from an underlying ductal carcinoma in situ (DCIS) or invasive breast carcinoma. These cells retain their malignant properties and contribute to the histopathological findings of Paget's disease. These cancer cells are thought to migrate from an underlying carcinoma through the lactiferous ducts to the nipple epidermis. The second theory is the in situ transformation theory which suggests that Paget cells arise as a primary intraepidermal malignancy independent of any underlying breast carcinoma. This theory is supported by cases where no underlying breast tumor is found. Epidermotropic Theory: This is the most widely accepted theory which suggests that malignant ductal cells migrate from an underlying carcinoma through the lactiferous ducts to the epidermis of the nipple. These cells retain their malignant properties and contribute to the histopathological findings of Paget's disease. This theory is supported by the frequent finding of underlying DCIS or invasive carcinoma in patients with PDB. In some cases this underlying carcinoma can be an invasive breast cancer which affects the prognosis and treatment. In Situ Transformation Theory: This is an alternative theory which suggests that malignant cells arise de novo within the epidermis of the nipple possibly due to local field effects or genetic mutations. Although this theory is less accepted, it highlights the complexity of the disease. Further research is needed to understand the molecular mechanisms. Characteristic features are large, pale, vacuolated Paget cells in the epidermis often with HER2 overexpression. The strong association with DCIS or invasive carcinoma emphasizes the need for full evaluation. [2] Recent studies have looked at molecular pathways including HER2 signaling and immune evasion mechanisms as potential targets for treatment. For example HER2 targeted therapy like trastuzumab has shown promise in improving outcomes. Paget's disease of the breast is a rare condition and accounts for about 1-4% of all breast cancer. The exact cause of Paget's disease is not known but it is associated with underlying breast cancer. The risk factors for Paget's disease are similar to breast cancer: Knowing these risk factors is important for early detection and prevention. Regular screenings and genetic counseling can help identify those at higher risk and can be managed proactively. [4] PDB usually presents with changes in the nipple-areola complex: Unilateral symptoms are common but bilateral symptoms are rare and should prompt consideration of other diagnoses. Symptom progression varies; early cases may present with subtle scaling and advanced cases may have ulceration and nipple destruction. Recognizing these stages is important for timely interventions. Case studies show that early detection of these subtle signs can improve prognosis. Diagnosis of PDB is a combination of clinical evaluation, imaging and histopathological assessment. If an underlying cancer is suspected, a sentinel lymph node biopsy may be done to assess the spread of cancer to the axillary lymph nodes. [5] A comparison of imaging modalities shows that MRI is more sensitive than mammography and ultrasound especially in younger patients or those with dense breasts. However, the cost and false positive results should be considered. Advanced techniques like diffusion-weighted imaging (DWI) and contrast-enhanced mammography are emerging as promising tools to improve diagnostic accuracy. Immunohistochemistry: HER2 is overexpressed in 80-100% of cases, ER and PR status varies depending on the underlying cancer. Advances in molecular diagnostics including next-generation sequencing is helping us understand the genetic basis of PDB. For example, TP53 and PIK3CA mutations have been linked to disease progression and potential targets for therapy. Treatment of PDB depends on the extent of disease and presence of underlying cancer. Treatment options are surgery, radiation and systemic therapy. Radiation Therapy: Reduces local recurrence, especially after BCS. Whole breast radiation therapy is usually recommended after BCS to make sure any remaining cancer cells are killed and reduce the risk of recurrence. Oncoplastic surgery has improved the cosmetic outcome for BCS patients. Nipple-sparing mastectomy is also becoming popular, balancing oncological safety and aesthetic preservation. 3D imaging and intraoperative margin assessment has further improved surgical precision. Emerging therapies like antibody-drug conjugates (e.g. trastuzumab deruxtecan) and immune checkpoint inhibitors are being studied in clinical trials and may add to the treatment options for PDB. Combination therapy targeting both HER2 and PD-1/PD-L1 are showing promising results in early phase trials and may be the future of personalized medicine. Prognosis of Paget's disease of the breast depends on the underlying cancer and stage of the disease. If the underlying cancer is non-invasive (DCIS), prognosis is good, 5 year survival is over 90%. If the underlying cancer is invasive, prognosis is poor, 5 year survival is 50-60%. Prognosis is poorer if the cancer has spread to the nodes or other parts of the body. Early detection and comprehensive treatment is key to better outcomes. Advances in imaging and targeted therapy has improved the management of Paget's disease and hope for better survival and quality of life. In peripartum women presenting with nipple-areola complex changes, PDB should be included in the differential diagnosis. PDB is often associated with tumors in the same breast tissue so it is important to evaluate the same breast for any underlying tumors. Diagnostic delays are common because PDB looks like benign conditions. Multidisciplinary management is important to balance maternal and fetal well being while ensuring prompt treatment [2]. Case reports have shown the challenges of managing PDB during pregnancy and the importance of individualized care plan. Imaging modalities like ultrasound which is non-ionizing radiation is preferred during pregnancy. Modern Treatment TrendsBreast conserving approach is the trend now with improvements in imaging, surgery and adjuvant therapy. Personalized treatment plan based on tumor biology and patient preference has resulted to better functional and cosmetic outcome. AI is also being integrated in imaging and pathology to aid in earlier detection and more accurate diagnosis of PDB. Patient education and awareness is key in the diagnosis and treatment of Paget's disease of the breast. Women should be aware of the signs and symptoms of Paget's disease, a rash or eczema like appearance on the nipple and areola, itching, redness and discharge. Women should also be aware of their risk for breast cancer and take steps to reduce their risk, get regular mammograms and do breast self exam. Educational campaigns and resources can help women to seek medical attention if they notice any changes in their breast tissue. Early intervention can make a big difference in prognosis and treatment outcome. Multidisciplinary approach is important in the diagnosis and treatment of Paget's disease of the breast. A team of healthcare professionals including breast surgeon, medical oncologist, radiation oncologist and pathologist should work together to develop a treatment plan that is individualized to the patient. Treatment may include surgery, radiation therapy, chemotherapy and hormone therapy depending on the underlying cancer and stage of the disease. Team work among specialists ensures comprehensive care of all aspects of the disease. This team based approach not only improves clinical outcome but also the overall well being of the patient and provide holistic treatment experience. Paget's disease of the breast is a rare but significant malignancy that requires high index of suspicion for early diagnosis. Mammary Paget disease which involves the nipple-areola complex requires thorough understanding of its clinical presentation and underlying pathology. Advances in imaging, histopathology and systemic therapy has improved diagnostic accuracy and treatment outcome. Breast conserving surgery when possible is a trend towards less invasive management which is patient centered. Future research should focus on the molecular mechanism of PDB and identification of new therapeutic targets to further improve outcome. Development of AI driven diagnostic tool and precision therapy will be the game changer in PDB management in the coming years. [1] Hudson-Phillips, S., Cox, K., Patel, P., & Al Sarakbi, W. (2023). Paget's disease of the breast: diagnosis and management. British journal of hospital medicine (London, England : 2005), 84(1), 1–8. [2] Gilmore, R., Prasath, V., & Habibi, M. (2020). Paget Disease of the Breast in Pregnancy and Lactation. Advances in experimental medicine and biology, 1252, 133–136. [3] Karakas C. (2011). Paget's disease of the breast. Journal of carcinogenesis, 10, 31. [4] Dalton, J. C., & Plichta, J. K. (2024). Paget's disease of the breast: Insights from imaging to guide surgical management. American journal of surgery, 231, 16–17. [5] Sakorafas, G. H., Blanchard, K., Sarr, M. G., & Farley, D. R. (2001). Paget's disease of the breast. Cancer treatment reviews, 27(1), 9–18.
Yahoo
28-01-2025
- Entertainment
- Yahoo
10 PHS students earn All-State honors
Jan. 28—Ten Ector County ISD musicians have achieved the coveted All-State Musician designation and are heading to the Texas Music Educators Association convention Feb. 12-15 in San Antonio. All 10 students are seniors. Nine are from Permian High School and one attends STEM Academy, but is in choir at PHS. Of the 10, eight are choir, one is in PHS Band and one in PHS Orchestra. Executive Director of Fine Arts Aaron Hawley said in an email that this is the first time they have had an All-State Musician from STEM. Director of Choirs Laurie Wash said 14,000 students across the state begin the All-State process, but only a few make it. "It's extraordinary that these kids have accomplished this," Wash said. She added that the students have a passion for music, detail and they're excited about pushing themselves. "They don't shrink from difficulty and (we're) very proud of them; very proud of them," Wash said. Aiden Armendariz, a string bass player in the orchestra, made All-State for the second time this year. Orchestra Director Todd Berridge said 350 students made All-State statewide. Berridge said he first saw Armendariz as a sixth-grader at Wilson & Young Middle School and knew he was going to do "good things." "He barely missed it in his sophomore year. ... The competition is so fierce," Berridge said. He added that orchestra students go up against he rest of the state from the first audition. Band and choir are narrowed down from area competition, but for strings "it's state from the very first thing." "To make it from the orchestra point of view, not to diminish what our brethren do in the other part, is a much more difficult process, because it's the same thing — 20,000 kids enter the process and it's whittled down," Berridge said. At the TMEA convention, he's looking forward to watching the students in action because they are already on a professional level. "They're normal kids, but when they get out there, they've already learned how to rehearse and how to prepare on a professional level. It's amazing," Berridge said. Jenesis Paget, 17, who is in Kantorei and Black Magic, made All-State for the third year. "It really is a privilege. I worked really hard for this accomplishment. It really is just an amazing experience going into All-State for the third time, being able to experience it this year with my friends. We have eight All-Staters this year (in choir)," Paget said. The one thing Paget did differently this year was attend Texas Christian University choir camp which was extremely helpful. She was awarded a $2,400 TMEA scholarship for a year and hopes to attend TCU to become a music educator. This being her last year of high school, making All-State is bittersweet. "But I know that next year I'll be able to go to TMEA as a college student and get to see things that I've never seen before. One day I want to work for TMEA. That's what I want to do," Paget said. Paget and other students noted that PHS choir is a big family. "There's just so much love that we spread and knowing that we're all working for the same thing to make Ms. Wash proud and get good scores; it's really good," she added. Armendariz, an 18-year-old senior, said he feels blessed to make All-State this year. "After making it last year, I felt like I had a better chance making it this year, because I feel like I've had my foot better in the game. Now I'm more familiar with the waters, but for sure, I feel like the Lord really just blessed me, (and) helped me (make) it again this year," he added. He said he made more of an effort to prepare this year by starting to learn the audition music the day it came out, which was usually May 1. Armendariz learned the etudes right away and spent his whole summer practicing those. "Then in August the orchestral excerpts came out, and so I learned those as soon as I could. After I learned them, all it took was me just perfecting them, rather than just practicing them and learning them last minute," Armendariz said. That was a key element to his success that he learned sophomore year. "I auditioned my sophomore year as well, but I didn't make it that year because I did not prepare at all. I didn't even know what I was getting myself into, either. I even learned one of the audition musics the week before, because I just wasn't prepared. But after that year, I finally learned and prepared a lot for that," Armendariz said. He added that the PHS Orchestra, like the choir, is one big group of friends and family. "One of my favorite things, too, is Mr. Berridge. He really gives us really cool music to do, especially this year, we're doing a really cool piece with our symphony, and we're doing it with the choir as well, so it's going to be so much fun. He's really given us a lot of professional repertoire that I've been so lucky to play at such a young age," Armendariz said. He plans to attend University of Texas San Antonio, but he'll also be planting a church. "All my music accomplishments were possible because of the Lord. That's really it," Armendariz said. Caidence Searcy, a 17-year-old in Kantorei and VOCA (the varsity girls choir), is marking her third year as an All-Stater. She said repeated practicing raised her level of performance. She noted that she came close to making it her freshman year. Like Paget, she also went to TCU choir camp this summer which helped her. However, she said she probably didn't practice as much as in the past. She added that it means a lot that she's finishing out her high school career with something that means a lot to her. "It wasn't just doing state, it was the entire process and then practicing to wait for the process the next year. It defined a lot of what I did these past few years," Searcy said. She plans to attend Odessa College for two years while she keeps working and saving money. Then she hopes to go to University of North Texas and "get the highest degree I can" and direct a college choir. Haley Hart, a senior at STEM Academy, has been part of PHS choirs for three years as a member of Kantorei and a small group called Black Velvet, a new women's ensemble. This is her first year to make All-State. "It's crazy. It was unbelievable. It's such a big accomplishment. I was just really proud of everything that I had done," Hart said. She added that the achievement was a "sweet thing for my last year." Hart plans to attend Tarleton State University, major in music education and hopefully become an elementary music teacher. She added that she is looking forward to the TMEA convention. "I'm so excited to get to perform with the top of the top, the most amazing singers in Texas," she said. "I'm excited to hear the orchestra and just be able to visit the booths and everything. I'm very excited for that." Juggling her choir commitment and commuting from STEM Academy was a challenge the first year. "I had to ride a bus because I didn't have my license ... They dropped me off at the field house, and I had to walk all the way through and it was such a culture shock, because I've been at STEM since second grade. Walking through these halls was crazy for the first time, but I got my license, and now I drive back and forth, back and forth. It's not as hard as I thought, but it's definitely a struggle some days," Hart said. She didn't think about giving up because what she's gained has been "so valuable." "I wouldn't trade that," Hart said. A total of 10 students make an All-State Ensemble: — Aiden Armendariz (12), String Bass — PHS Orchestra (2nd Year) — Diego Campos (12), Bb Clarinet — PHS Band — Haley Hart (12), Alto 1 — PHS Choir (STEM Academy Student) — Jacob Lechtenberg (12), Bass 2 — PHS Choir — Madelyn Linville (12), Soprano 1 — PHS Choir — Jenesis Paget (12), Alto 2 — PHS Choir (3rd Year) — Sienna Pina (12), Soprano 2 — PHS Choir — Valeria Rodriguez (12), Alto 1 — PHS Choir — Bobby Schenkel (12), Tenor 2 — PHS Choir — Caidence Searcy (12), Alto 1 — PHS Choir (3rd Year)
