By Dr Ananya Mandal, MD
Patients with symptoms of male breast cancer need to be thoroughly evaluated for presence of breast cancer especially if they are over 60 and have the known risk factors.
Diagnosis of breast cancer in men involves assessing the patient’s history, examination of the breast, mammogram and so forth.
Assessing the patient’s history
History of breast cancer in the family, exposure to chemicals, heat, radiation or female hormones and history or presence of liver disease is assessed in the patient.
Examination of the breast
Examination of the breast to assess the size, shape, location, mobility and possible spread to lymph nodes of the tumor.
This is a type of X ray that can help determine whether there are any changes in breast tissue which may be cancerous. It is routinely performed in females for screening for breast cancer and is painless and does not require hospital stay.
The mammogram gives a picture of the breast tissues and any abnormality of the tissues or tumors may show up as white spots that need further evaluation.
This method uses high frequency sound waves to produce an image of the tissues of the breast. The specialist places a probe or sensor over the breasts and the pattern of the sound that hits the tumour and reflects back is captured on the monitor attached to the sensor. The image will highlight any lumps or abnormalities in the breasts.
This is usually diagnostic and prescribed if there is a suspicion of breast cancer. If lumps or abnormalities are felt on examination or on mammogram or ultrasound a biopsy is advised. It involves taking a sample of suspected tumor tissue and examining it in a laboratory for the presence of cancerous cells.
A biopsy may be performed using a thin long needle that is inserted into the lump and a tiny amount of tissue sample is withdrawn and examined under the microscope. This is called FNA or fine needle aspiration.
For men with suspected breast cancer a core biopsy is recommended. This type of biopsy can usually indicate whether the cancer has started to spread from the breast into the surrounding area. This is called invasive breast cancer. The procedure involves numbing the area of the biopsy and inserting a hollow needle into it for withdrawing a sample of tissues.
Incisional biopsy involves removal of a larger part of the tumor after opening up the skin over the lump. This is a more invasive procedure.
The affected lymph node in the armpit may also be removed and examined to check for possible spread of the cancer. This is called sentinel lymph node biopsy.
Magnetic resonance imaging of the breast
Magnetic resonance imaging (MRI) of the breast uses radio waves and strong magnets instead of x-rays. A contrast MRI uses a special dye called gadolinium that is injected into a vein before or during the scan to show details better.
Nipple discharge examination
The fluid leaking from the nipple may be examined under the microscope for presence of cancer cells. This not an effective test since breast cancer may be present despite a clean nipple discharge.
Checking for estrogen receptors
Checking for special proteins, known as estrogen receptors, on the surface of the cancerous cells. These receptors are found in around 90% of cases and this receptor positivity makes treatment with a hormonal drug Tamoxifen possible. Those negative for estrogen receptor cannot be prescribed tamoxifen for treatment of breast cancer.
Checking for spread to other organs
Checking for spread to other organs and bones include a CT scan of liver, lungs and brain, X rays of long bones and chest, abdominal ultrasound examination and bone scans.
Staging the cancer
Once diagnosis is made the cancer needs to be staged. This helps in determining appropriate treatment regimen as well as predicts the outcome of therapy. Staging for breast cancer may be outlined as:
Stage 0 – This forms 10% of male breast cancers and is known as ductal carcinoma in situ
Stage 1 – The tumor is less than 2cm in diameter and has not spread to lymph nodes in the armpit
Stage 2 – The tumor is between 2 and 5cm in diameter and/or there are signs that the cancer has spread to the lymph nodes near the armpit.
Stage 3 – The tumor is larger than 5cm and has affected the skin and muscle. Near-by lymph nodes are also affected but nodes beyond the breast and armpits are not affected.
Stage 4 – The cancer has spread to other parts of the body like lungs, liver, bones or brain. This is known as secondary, or metastatic, cancer.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)