By Dr Ananya Mandal, MD
Male breast cancer in most cases is diagnosed in advanced stages or beyond stages 2 and 3. Treatment is based on the stage of the cancer and the grade of the tumor. High grade tumors are more aggressive and spread more rapidly than low grade tumors that grow more slowly.
Who treats male breast cancer?
Male breast cancer management team includes:
a clinical oncologist (a specialist in the non-surgical treatment of cancer)
pathologist (a specialist in diseased tissue)
radiologist (a doctor who specialises in analysing the results of imaging tests)
a nutrition consultant
a social worker
Treatment of male breast cancer can be broken down into surgery, radiotherapy, chemotherapy and so forth.
Surgery for male breast cancer
The primary modality of a localized cancer treatment is surgical removal of the lump.
A wide local excision is undertaken and this is called mastectomy. This more common in men since there is less breast tissue and the nipple is usually removed.
Surgery may also include removal of a single lymph node from the armpit called sentinel lymph node biopsy or removal of all the affected lymph nodes from the armpit.
After surgery the skin over the breast is replaced using a grafted skin from other sites such as the abdomen or thighs. Some patients may require or desire a nipple reconstruction surgery as well.
Earlier a wider mastectomy called the radical mastectomy was performed. These days it has been replaced by less invasive procedures such as modified radical or simple mastectomy.
Types of surgery
Simple or total mastectomy means that the surgeon removes the entire breast, including the nipple, but does not remove underarm lymph nodes (axillary lymph nodes) or muscle tissue from beneath the breast.
Modified radical mastectomy – Here the surgeon removes the entire breast and lymph nodes under the arm as well.
Radical mastectomy is performed if the tumor is large and growing into the chest muscles. Here the entire breast, axillary lymph nodes, and the chest wall muscles under the breast are removed.
Breast-conserving surgery, such as a lumpectomy (removal of only the breast lump and a surrounding margin of normal tissue), is a treatment option for women with breast cancer who opt for it. It is not used as often in men, mainly because the male breast has only a small amount of tissue beneath the nipple
Radiotherapy for male breast cancer
After the surgical removal patients may be advised radiation therapy. This aims at killing the residual cancer cells. Radiation may be given as external beams or may be given by placing a radioactive device within the skin called brachytherapy. Regional lymph nodes may also be treated with radiotherapy.
Common side effects of radiotherapy include extreme tiredness, nausea and sore, red, and irritated skin on the breast.
Chemotherapy for male breast cancer
Chemotherapy is given using anticancer drugs. These include drugs like Cyclophophamide, Doxorubicin, Methotrexate, 5 flurouracil, Paclitaxel, Docetaxel etc.
The side effects of chemotherapy include nausea, vomiting, diarrhea, loss of appetite, mouth sores, fatigue, skin rashes, hair loss and infertility.
Chemotherapy can also weaken the immune system making the patient vulnerable to infections and decrease blood counts making the person anemic and giving rise to bleeding tendencies due to decrease number of platelets in blood.
Hormonal therapy for male breast cancer
Hormone therapy includes drugs like Tamoxifen. This is commonly used in estrogen receptor positive female and male breast cancer patients. Tamoxifen and Toremifene help to block the effects of hormones on breast tissue that are known to stimulate the growth of cancerous cells may be used to prevent the cancer recurrence.
Fulvestrant also acts on the estrogen receptor, but instead of blocking it, this drug eliminates it. In women, this drug is often effective even if the breast cancer is no longer responding to tamoxifen. It has not been studied in men with breast cancer.
Monoclonal antibodies or biological therapy
These are targeted therapies used in breast cancer in females and are being tried in male breast cancer patients as well. It includes drugs like Trastuzumab. This is used in patients who are positive for a particular protein called HER2.
These include Anastrozole, Letrozolea and exemastane. They block the production of small amounts of estrogen by the adrenal glands. They have been found to be very effective in treating breast cancer in women, but they have not been well studied in men.
This is appropriate in more advanced cases where symptom relief and prevention of cancer progression is the primary aim. Hormonal therapy and chemotherapy may be used. Radiation therapy may also be used alone or in conjunction with other modalities of therapy.
Other therapies for male breast cancer
Other therapies include:
gonadal ablation in metastatic male breast cancer
surgical removal of testes or orchiectomy
surgical removal of adrenal glands or adrenalectomy
removal of the pituitary gland or its tumors or hypophysectomy etc.
Outlook for male breast cancer
Since most breast cancers in males are detected late, their outcome is usually poorer than in women. 5-year survival depends on the stage of the disease (75-100% for stage I disease and 30-60% for stage III disease). There is also an addition increased risk of cancer in the other breast.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)