What are the other Names for this Condition? (Also known as/Synonyms)

• EPC of Breast
• Mammary Encapsulated Papillary Carcinoma
• Mammary EPC

What is Encapsulated Papillary Carcinoma of Breast? (Definition/Background Information)

• Breast cancer is the most common type of cancer diagnosed in women. It is a type of cancer in which certain cells in the breast become abnormal, grow uncontrollably, and form a malignant mass (tumor). There are various types of breast cancers
• Encapsulated Papillary Carcinoma (EPC) of Breast is a rare subtype of breast cancer. It is diagnosed under the microscope by a pathologist on examination of the tumor cells. The condition is generally noted in post-menopausal (older) women. If invasion is not noted, then EPC is considered an in situ carcinoma
• The cause of formation of Encapsulated Papillary Carcinoma of Breast is not well-established. Certain chromosomal and genetic alterations have been documented. The condition causes a painless lump in the breast. The condition may be associated with nipple discharge. EPC may be diagnosed via a breast biopsy
• The treatment of Encapsulated Papillary Carcinoma of Breast usually involves a complete removal of the tumor i.e., total surgical resection. Depending on the stage of the malignancy and the healthcare provider’s evaluation, radiotherapy and/or chemotherapy may be advocated
• The prognosis of Mammary Encapsulated Papillary Carcinoma depends on many factors, but in particular, the stage of the tumor. Since there is a risk for recurrence and metastasis (spread of tumor to local and regional areas), close clinical monitoring is necessary with periodic follow-ups

Who gets Encapsulated Papillary Carcinoma of Breast? (Age and Sex Distribution)

• Encapsulated Papillary Carcinoma of Breast is an uncommon breast cancer type that is seen in women following menopause, usually in the 60-70 years’ age group
• All racial and ethnic groups are affected, and no specific predilection is seen

What are the Risk Factors for Encapsulated Papillary Carcinoma of Breast? (Predisposing Factors)

The risk factors for Encapsulated Papillary Carcinoma of Breast are not well established since the condition is rare. In general, the risk factors for developing breast cancer may include:

• Women have a much greater chance of developing breast cancer than men
• Age: The risk increases for women over the age of 55 years
• Personal history: Having cancer in one breast, puts a woman at risk for having cancer in the other breast as well
• Family history: Women with a mother, sister, or daughter diagnosed with breast cancer have a higher risk for developing the condition
• Inherited gene mutations: Mutations in certain genes (BRCA1 or BRCA2) can lead to a much higher risk
• Radiation therapy: Receiving radiation therapy to the chest or breast area can also increase the risk. It is noted that the risk for developing breast cancer later in life is the greatest for radiation therapy administered during puberty
• Obesity: Being overweight or obese elevates the risk after menopause
• Alcohol use: Consuming alcohol more than one drink per day; the more the alcohol consumed, the greater is the risk
• Menstrual cycle: Women who got their period before the age of 12 years, and those who reached menopause after age 55 have an increased risk
• Postmenopausal hormone therapy: Women taking hormone replacement therapy medications containing both estrogen and progesterone for menopause have a higher risk of developing breast cancer
• Reproductive history: Having the first child after the age of 35, or never having children
• Physical inactivity: A lack of physical exercise (leading a sedentary life) can increase the risk
• Breastfeeding: Not breastfeeding one's child can increase the risk for developing the condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Encapsulated Papillary Carcinoma of Breast? (Etiology)

The exact cause of development of Encapsulated Papillary Carcinoma of Breast is currently not well understood. The cause is believed to be similar to the formation of invasive breast carcinomas.

• Some tumors show specific genetic alterations namely, chromosomal material loss on 16q and gains on 16p and 1q
• Some tumors are also known to present PIKC3A gene mutations

What are the Signs and Symptoms of Encapsulated Papillary Carcinoma of Breast?

The signs and symptoms of Encapsulated Papillary Carcinoma of Breast may include:

• The presence of a usually well-circumscribed tumor mass
• The tumor is frequently localized to the central and sub-areolar regions of the breast
• Nipple discharge may be noted
• Large-sized tumors may present significant signs and symptoms
• The condition can be bilateral affecting both the breasts

How is Encapsulated Papillary Carcinoma of Breast Diagnosed?

Encapsulated Papillary Carcinoma (EPC) of Breast may be diagnosed in the following manner:

• Complete physical examination with comprehensive medical and family history evaluation
• Breast exam to check for any lumps or unusual signs in the breasts
• Blood tests including complete blood count (CBC) test
• Mammogram: A mammogram uses X-rays to provide images of the breast
• Galactography: A mammography using a contrast solution, mostly used to analyze the reason behind a nipple discharge
• Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast
• Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast
• Positron emission tomography (PET) scan to help determine, if the cancer has spread to other organ systems
• Breast biopsy:
  • A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
  • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
  • Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis

Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:

• Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue. The FNA biopsy is not a helpful tool in diagnosing EPC of Breast
• Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast
• Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis

Even though certain molecular mutations have been detected in the tumor, the mutations that have been characterized are not helpful in establishing a diagnosis.

The differential diagnosis to exclude conditions with similar presentations include:

• Benign hyperplastic papillary apocrine lesions of breast
• Invasive papillary carcinoma of breast
• Papillary ductal carcinoma in situ of breast
• Papilloma with superimposed ductal carcinoma in situ of breast
• Solid papillary carcinoma of breast

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Encapsulated Papillary Carcinoma of Breast?

The complications of Encapsulated Papillary Carcinoma of Breast may include:

• Emotional distress due to the presence of breast cancer
• Metastasis of the tumor to the local sites (usually to the axillary lymph nodes) 
• Recurrences following surgery; incompletely excised tumors may recur
• Side effects of chemotherapy, which may include nausea, vomiting, hair loss, decreased appetite, mouth sores, fatigue, low blood cell counts, and a higher chance of developing infections
• Side effects of radiation therapy that may include sunburn-like rashes, where radiation was targeted, red or dry skin, heaviness of the breasts, and general fatigue
• Lymphedema (swelling of an arm) may occur after surgery or radiation therapy, due to restriction of flow of lymph fluid resulting in a build-up of lymph. It may form weeks to years after treatment that involves radiation therapy to the axillary lymph nodes

How is Encapsulated Papillary Carcinoma of Breast Treated?

Treatment options available for individuals with Encapsulated Papillary Carcinoma of Breast are dependent upon the following:

• Type of cancer
• The staging of the cancer: If a breast cancer is diagnosed, staging helps determine whether it has spread, and what treatment options are best-suited for the patient
• Whether the cancer cells are sensitive to certain particular hormones, and
• One’s personal preferences

Surgery: Surgery is generally the most common form of treatment for breast cancer. Various types of surgery to remove the malignant tumor include:

• Lumpectomy: Breast-sparing surgery (least invasive breast cancer surgery) in which the tumor, as well as a small portion of the surrounding tissue is removed
• Mastectomy: Surgery to remove all of the breast tissue; it may be simple (removal of the breast, nipple, areola, sentinel lymph nodes) or radical mastectomy (removal of the breast, nipple, areola, all axillary lymph nodes, and underlying muscle of the chest wall)
• Sentinel node biopsy: Procedure done to examine the “sentinel lymph node,” or lymph node(s) closest to the tumor, as this is the most likely location, where cancer cells may have spread to. This lymph node is removed and tested for cancerous cells
• Axillary node dissection: This procedure is performed to remove some axillary lymph nodes in the underarm area, to allow dissection and examination. This helps in establishing whether the cancer has spread to more than one lymph node

Other treatment options may include chemotherapy and radiation therapy.

• Radiotherapy can be used as primary therapy in situations where the tumor cannot be removed completely, or when the tumor reappears after surgery
• Radiotherapy can also be used as additional therapy after surgery, if there is a possibility of tumor recurrence after surgery, or if there are inadequate margins (possibility of tumor left behind) following surgery. In some cases, due to location of tumor, a complete surgical removal of the tumor is difficult
• Chemotherapy can be used for treating the tumor in the following conditions:
  • When the tumors cannot be removed completely (due to incomplete surgical resection)
  • Tumors that recur after surgery 
  • Tumors that have spread to distant parts of the body 

How can Encapsulated Papillary Carcinoma of Breast be Prevented?

Currently, no specific preventive measures are available for Encapsulated Papillary Carcinoma of Breast. In general, it is important to be aware of the following:

• Learning to do regular ‘breast self-exams’ in order to help identify any unusual lumps or signs in the breast
• Maintain a healthy body weight and exercise regularly
• Implement and follow a well-balanced diet; a high intake of fiber via fresh fruits and vegetables helps in a healthy lifestyle
• Avoid or completely stop smoking
• If taking alcohol, only drink in moderation; limit to one or (maximum) two drinks a day
• Limit combination hormone therapy used to treat symptoms of menopause. It is advised that individuals be aware of the potential benefits and risks of such hormonal medications
• Cancer screenings can help detect any breast cancer during the early stages

What is the Prognosis of Encapsulated Papillary Carcinoma of Breast? (Outcomes/Resolutions)

Encapsulated Papillary Carcinoma (EPC) of Breast is a very uncommon type of breast cancer.

• If there is no definitive invasion noted, then the prognosis is usually good. In such cases, a surgical excision of the tumor is adequate treatment. The recurrence rates are typically low
• In some tumors, invasion can be detected that may rarely result in lymph node metastasis. When there is metastasis, then the prognosis will depend on the stage of the tumor
• The prognosis of breast cancer, in general, depends upon a set of several factors that include: 
  • The grade of the breast tumor
  • The size of the breast tumor: Individuals with small-sized tumors fare better than those with large-sized tumors
  • Stage of breast cancer: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
  • Cell growth rate
  • Overall health of the individual: Individuals with overall excellent health have better prognosis compared with those with poor health
  • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
  • Individuals with bulky disease of the breast cancer have a poorer prognosis
  • Involvement of the lymph node, which can adversely affect the prognosis
  • Involvement of vital organs may complicate the condition
  • The surgical resectability of the tumor (meaning if the tumor can be removed completely)
  • Whether the tumor is occurring for the first time or is a recurrent tumor. Recurring tumors have worse prognosis compared to tumors that do not recur 
  • Response to treatment of breast cancer: Tumors that respond to treatment have better prognosis compared to tumors that do not respond to treatment
  • Progression of the condition makes the outcome worse
• An early diagnosis and prompt treatment of the tumor generally yields better outcomes than a late diagnosis and delayed treatment
• The combination chemotherapy drugs used, may have some severe side effects (like cardio-toxicity). These chiefly impacts the elderly adults, or those who are already affected by other medical conditions. Tolerance to the chemotherapy sessions is a positive influencing factor

Additional and Relevant Useful Information for Encapsulated Papillary Carcinoma of Breast:

The following DoveMed website links are useful resources for additional information:

https://www.dovemed.com/healthy-living/womens-health/

https://www.dovemed.com/diseases-conditions/cancer/