Male Breast Cancer Treatment
General Information(Symptoms and Diagnosis)
Stages
Treatment
General Information about Male Breast Cancer
Key Points
- Male breast cancer is a disease in which malignant (cancer)
cells form in the tissues of the breast.
- Radiation exposure, high levels of estrogen, and a family
history of breast cancer can increase a man's risk of breast cancer.
- Male breast cancer is sometimes caused by inherited gene
mutations (changes).
- Men with breast cancer usually have lumps that can be felt.
- Tests that examine the breasts are used to detect (find)
and diagnose breast cancer in men.
- If cancer is found, tests are done to study the cancer
cells.
- Survival for men with breast cancer is similar to survival
for women with breast cancer.
- Certain factors affect prognosis (chance of recovery) and
treatment options.
Male
breast cancer is a disease in which malignant (cancer) cells form in
the tissues of the breast.
Breast cancer may occur in
men. Men at any age may develop breast cancer, but it is usually
detected (found) in men between 60 and 70 years of age. Male breast cancer makes up
less than 1% of all cases of breast cancer.
The following types of
breast cancer are found in men:
- Infiltrating ductal
carcinoma: Cancer
that has spread beyond the cells
lining ducts in the
breast. Most men
with breast cancer have this type of cancer.
- Ductal carcinoma in
situ: Abnormal
cells that are found in the lining of a duct; also called intraductal
carcinoma.
- Inflammatory breast
cancer: A type of cancer in which the breast looks red and
swollen and feels warm.
- Paget disease of
the nipple: A tumor
that has grown from ducts beneath the nipple
onto the surface of the nipple.
Lobular carcinoma in situ
(abnormal cells found in one of the lobes
or sections of the breast), which sometimes occurs in women, has not
been seen in men.
Male breast anatomy:
Anatomy of the male breast showing the nipple, areola, fatty tissue,
and ducts. Nearby lymph nodes, ribs, and muscle are also shown.
Radiation
exposure, high levels of estrogen, and a family history of breast
cancer can increase a man's risk of breast cancer.
Anything that increases
your risk of getting a disease is called a risk
factor. Having a risk factor does not mean that you will
get cancer; not having risk factors doesn't mean that you will not get
cancer. Talk with your doctor if you think you may be at risk. Risk
factors for breast cancer in men may include the following:
- Being exposed to radiation.
- Having a disease linked to high levels of estrogen in the body, such
as cirrhosis (liver disease) or Klinefelter syndrome (a genetic disorder.)
- Having several female relatives who have had breast cancer,
especially relatives who have an alteration
of the BRCA2 gene.
Male
breast cancer is sometimes caused by inherited gene mutations (changes).
The genes in cells carry
the hereditary
information that is received from a person's parents. Hereditary breast
cancer makes up about 5% to 10% of all breast cancer. Some mutated genes related to
breast cancer are more common in certain ethnic groups.
Men who have a mutated gene related to breast cancer have an increased
risk of this disease.
There are tests that can
detect (find) mutated genes. These genetic
tests are sometimes done for members of families with a
high risk of cancer. See the following PDQ
summaries for more information:
- Genetics of Breast and Gynecologic Cancers
- Breast Cancer Prevention
- Breast Cancer Screening
Men
with breast cancer usually have lumps that can be felt.
Lumps and other signs may be caused by male
breast cancer or by other conditions.
Check with your doctor if you notice a change in your breasts.
Tests
that examine the breasts are used to detect (find) and diagnose breast
cancer in men.
The following tests and
procedures may be used:
- Physical
exam and history
: An exam of the body to check general signs of
health, including checking for signs of disease, such as lumps or
anything else that seems unusual. A history of the patient's health
habits and past illnesses and treatments will also be taken.
- Clinical
breast exam (CBE): An exam of the breast by
a doctor or other health professional. The doctor will carefully feel
the breasts and under the arms for lumps or anything else that seems
unusual.
- Ultrasound
exam: A procedure in which high-energy sound waves
(ultrasound) are bounced off internal tissues
or organs and make
echoes. The echoes form a picture of body tissues called a sonogram. The picture can be
printed to be looked at later.
- MRI
(magnetic resonance imaging): A procedure that uses a
magnet, radio waves,
and a computer to make a series of detailed pictures of areas inside
the body. This procedure is also called nuclear magnetic resonance
imaging (NMRI).
- Blood
chemistry studies : A procedure in which a
blood sample is checked to measure the amounts of certain substances
released into the blood by organs and tissues in the body. An unusual
(higher or lower than normal) amount of a substance can be a sign of
disease.
- Biopsy
: The removal of cells or tissues so they can be
viewed under a microscope
by a pathologist to
check for signs of cancer. The following are different types of
biopsies:
- Fine-needle
aspiration (FNA) biopsy : The removal of tissue or fluid using a thin needle.
- Core
biopsy : The removal of tissue using a
wide needle.
- Excisional
biopsy : The removal of an entire lump of
tissue.
If
cancer is found, tests are done to study the cancer cells.
Decisions about the best
treatment are based on the results of these tests. The tests give
information about:
- How quickly the cancer may grow.
- How likely it is that the cancer will spread through the
body.
- How well certain treatments might work.
- How likely the cancer is to recur
(come back).
Tests include the
following:
- Estrogen
and progesterone receptor test
: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue.
If cancer is found in the breast, tissue from the tumor is checked in the
laboratory to find out whether estrogen and progesterone could affect
the way cancer grows. The test results show whether hormone therapy may stop the
cancer from growing.
- HER2
test: A test to measure the amount of HER2 in cancer
tissue. HER2 is a growth factor
protein that
sends growth signals to cells. When cancer forms, the cells may make
too much of the protein, causing more cancer cells to grow. If cancer
is found in the breast, tissue from the tumor is checked in the
laboratory to find out if there is too much HER2 in the cells. The test
results show whether monoclonal
antibody therapy
may stop the cancer from growing.
Survival
for men with breast cancer is similar to survival for women with breast
cancer.
Survival for men with breast
cancer is similar to that for women with breast cancer when their stage at diagnosis is the same.
Breast cancer in men, however, is often diagnosed at a later stage.
Cancer found at a later stage may be less likely to be cured.
Certain
factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment
options depend on the following:
- The stage of the cancer (whether it is in the breast only
or has spread to other places in the body).
- The type of breast cancer.
- Estrogen-receptor and progesterone-receptor levels in the
tumor tissue.
- Whether the cancer is also found in the other breast.
- The patient's age and general health.
Stages of Male Breast Cancer
Key Points
- After breast cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the breast or to other
parts of the body.
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the
body.
- The following stages are used for male breast cancer:
- Stage 0 (carcinoma in situ)
- Stage I
- Stage II
- Stage IIIA
- Stage IIIB
- Stage IIIC
- Stage IV
After
breast cancer has been diagnosed, tests are done to find out if cancer
cells have spread within the breast or to other parts of the body.
After breast cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the
breast or to other
parts of the body. This process is called staging.
The information gathered from the staging process determines the stage of the disease. It is
important to know the stage in order to plan treatment. Breast cancer
in men is staged the same as it is in women. The spread of cancer from
the breast to lymph nodes
and other parts of the body appears to be similar in men and women.
The following tests and
procedures may be used in the staging process:
- Sentinel
lymph node biopsy : The removal of the sentinel lymph node during surgery. The sentinel lymph
node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph
node the cancer is likely to spread to from the tumor. A radioactive substance and/or
blue dye is injected
near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes.
The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for
cancer cells. If cancer cells are not found, it may not be necessary to
remove more lymph nodes.
- Chest
x-ray : An x-ray
of the organs and
bones inside the chest. An x-ray is a type of energy beam that can go
through the body and onto film, making a picture of areas inside the
body.
- CT
scan (CAT scan): A procedure that makes a
series of detailed pictures of areas inside the body, taken from
different angles. The pictures are made by a computer linked to an
x-ray machine. A dye
may be injected into a vein
or swallowed to help the organs or tissues show up more clearly. This
procedure is also called computed tomography, computerized tomography,
or computerized axial tomography.
- Bone
scan : A procedure to check if there are
rapidly dividing cells, such as cancer cells, in the bone. A very small
amount of radioactive material is injected into a vein and travels
through the bloodstream. The radioactive material collects in the bones
and is detected by a scanner.
- PET
scan (positron emission tomography scan): A
procedure to find malignant
tumor cells in
the body. A small amount of radioactive glucose
(sugar) is injected into a vein. The PET scanner rotates around the
body and makes a picture of where glucose is being used in the body.
Malignant tumor cells show up brighter in the picture because they are
more active and take up more glucose than normal cells do.
There
are three ways that cancer spreads in the body.
Cancer can spread
through tissue, the
lymph system, and
the blood:
- Tissue. The cancer spreads from where it began by growing
into nearby areas.
- Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through the lymph vessels to other parts
of the body.
- Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood vessels to other parts
of the body.
Cancer
may spread from where it began to other parts of the body.
When cancer spreads
to another part of the body, it is called metastasis.
Cancer cells break
away from where they began (the primary
tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system,
travels through the lymph vessels, and forms a tumor (metastatic tumor) in another
part of the body.
- Blood. The cancer gets into the blood, travels through the
blood vessels, and forms a tumor (metastatic tumor) in another part of
the body.
The metastatic tumor is
the same type of cancer as the primary tumor. For example, if breast
cancer spreads to the bone, the cancer cells in the bone are actually
breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The
following stages are used for male breast cancer:
This section describes
the stages of breast cancer.
The breast cancer stage is based on the results of testing that is done
on the tumor and lymph nodes removed during surgery and other tests.
Stage
0 (carcinoma in situ)
There are 3 types of breast carcinoma in situ:
- Ductal carcinoma in
situ (DCIS) is a noninvasive
condition in
which abnormal cells are found in the
lining of a breast duct. The abnormal cells
have not spread outside the duct to other tissues
in the breast. In some cases, DCIS may become invasive cancer and spread
to other tissues. At this time, there is no way to know which lesions could become
invasive.
- Paget disease of
the nipple is a condition in which abnormal cells are
found in the nipple
only.
- Lobular carcinoma
in situ (LCIS) is a condition
in which abnormal cells are found in the lobules of the breast. This condition has
not been seen in men.
Pea, peanut, walnut, and
lime show tumor sizes.
Stage
I
In stage I, cancer has formed. Stage I
is divided into stages IA and IB.
- In stage IA,
the tumor is 2 centimeters or smaller.
Cancer has not spread outside the breast.
- In stage IB,
small clusters of breast cancer
cells (larger
than 0.2 millimeter
but not larger than 2 millimeters) are found in the lymph nodes and either:
- no tumor
is found in the breast;
or
- the tumor is 2 centimeters
or smaller.
Stage
II
Stage II is divided into
stages IIA and IIB.
- In stage IIA
- no tumor
is found in the breast
or the tumor is 2 centimeters
or smaller. Cancer
(larger than 2 millimeters)
is found in 1 to 3 axillary
lymph nodes or in the lymph
nodes near the breastbone
(found during a sentinel lymph
node biopsy); or
- the tumor is larger than 2 centimeters but not larger
than 5 centimeters. Cancer has not spread to the lymph nodes.
- In stage IIB,
the tumor is:
- larger than 2 centimeters
but not larger than 5 centimeters. Small clusters of breast cancer cells (larger than 0.2 millimeter but not larger
than 2 millimeters) are found in the lymph
nodes; or
- larger than 2 centimeters but not larger than 5
centimeters. Cancer has spread to 1 to 3 axillary
lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy);
or
- larger than 5 centimeters. Cancer has not spread to the
lymph nodes.
Stage
IIIA
In stage IIIA:
- no tumor
is found in the breast
or the tumor may be any size. Cancer
is found in 4 to 9 axillary
lymph nodes or in the lymph
nodes near the breastbone
(found during imaging tests
or a physical exam);
or
- the tumor is larger than 5 centimeters.
Small clusters of breast cancer
cells (larger
than 0.2 millimeter
but not larger than 2 millimeters) are found in the lymph nodes; or
- the tumor is larger than 5 centimeters. Cancer has spread
to 1 to 3 axillary lymph nodes or to the lymph nodes near the
breastbone (found during a sentinel
lymph node biopsy).
Stage
IIIB
In stage IIIB, the tumor may be any size and cancer has spread to the chest wall and/or to the
skin of the breast
and caused swelling or an ulcer.
Also, cancer may have spread to :
- up to 9 axillary
lymph nodes; or
- the lymph nodes
near the breastbone.
Cancer that has spread
to the skin of the breast may also be inflammatory
breast cancer. See the section on Inflammatory Male Breast
Cancer for more information.
Stage
IIIC
In stage IIIC, no tumor is found in the breast or the tumor may be
any size. Cancer may have spread to the skin of the breast and caused
swelling or an ulcer
and/or has spread to the chest
wall. Also, cancer has spread to:
- 10 or more axillary
lymph nodes; or
- lymph nodes
above or below the collarbone;
or
- axillary lymph nodes and lymph nodes near the breastbone.
Cancer that has spread
to the skin of the breast may also be inflammatory
breast cancer. See the section on Inflammatory Male Breast
Cancer for more information.
For treatment, stage
IIIC breast cancer is divided into operable
and inoperable
stage IIIC.
Stage
IV
In stage IV, cancer has spread to other organs of the body, most
often the bones, lungs,
liver, or brain.
Inflammatory Male Breast Cancer
In inflammatory breast cancer, cancer has spread to the
skin of the breast
and the breast looks red and swollen and feels warm. The redness and
warmth occur because the cancer cells
block the lymph vessels
in the skin. The skin of the breast may also show the dimpled
appearance called peau d'orange
(like the skin of an orange). There may not be any lumps in the breast
that can be felt. Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.
Recurrent Male Breast Cancer
Recurrent breast cancer is cancer that has recurred
(come back) after it has been treated. The cancer may come back in the breast, in the chest wall, or in other
parts of the body.
Treatment Option Overview
Key Points
- There are different types of treatment for men with breast
cancer.
- Five types of standard treatment are used to treat men with
breast cancer:
- Surgery
- Chemotherapy
- Hormone therapy
- Radiation therapy
- Targeted therapy
There
are different types of treatment for men with breast cancer.
Different types of
treatment are available for men with breast
cancer. Some treatments are standard
(the currently used treatment), and some are being tested in clinical trials. A treatment
clinical trial is a research
study meant to help improve current treatments or obtain
information on new treatments for patients with cancer. When clinical trials
show that a new treatment is better than the standard treatment, the
new treatment may become the standard treatment.
For some patients,
taking part in a clinical trial may be the best treatment choice. Many
of today's standard treatments for cancer are based on earlier clinical
trials. Patients who take part in a clinical trial may receive the
standard treatment or be among the first to receive a new treatment.
Patients who take part
in clinical trials also help improve the way cancer will be treated in
the future. Even when clinical trials do not lead to effective new
treatments, they often answer important questions and help move
research forward.
Some clinical trials
only include patients who have not yet received treatment. Other trials
test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring (coming back) or
reduce the side effects
of cancer treatment.
Clinical trials are
taking place in many parts of the country. Information about clinical
trials is available from the NCI website. Choosing the most appropriate
cancer treatment is a decision that ideally involves the patient,
family, and health care team.
Five
types of standard treatment are used to treat men with breast cancer:
Surgery
Surgery for men with breast
cancer is usually a modified
radical mastectomy (removal of the breast, many of the lymph nodes under the arm,
the lining over the chest muscles, and sometimes part of the chest wall muscles).
Modified radical
mastectomy. The dotted line shows where the entire breast and some
lymph nodes are removed. Part of the chest wall muscle may also be
removed.
Breast-conserving surgery,
an operation to remove the cancer but not the breast itself, is also
used for some men with breast cancer. A lumpectomy
is done to remove the tumor
(lump) and a small amount of normal tissue
around it. Radiation therapy
is given after surgery to kill any cancer cells
that are left.
Breast-conserving surgery.
Dotted lines show the area containing the tumor that is removed and
some of the lymph nodes that may be removed.
Chemotherapy
Chemotherapy is a cancer
treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by
stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs
enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When
chemotherapy is placed directly into the cerebrospinal
fluid, an organ,
or a body cavity
such as the abdomen,
the drugs mainly affect cancer cells in those areas (regional chemotherapy). The
way the chemotherapy is given depends on the type and stage of the cancer being
treated.
See Drugs Approved for
Breast Cancer for more information.
Hormone
therapy
Hormone therapy is a cancer
treatment that removes hormones
or blocks their action and stops cancer cells from growing. Hormones
are substances made by glands
in the body and circulated in the bloodstream. Some hormones can cause
certain cancers to grow. If tests show that the cancer cells have
places where hormones can attach (receptors),
drugs, surgery, or radiation therapy is used to reduce the production
of hormones or block them from working.
See Drugs Approved for
Breast Cancer for more information.
Radiation
therapy
Radiation therapy is a
cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. There are two types of
radiation therapy:
- External radiation
therapy uses a machine outside the body to send radiation
toward the cancer.
- Internal radiation
therapy uses a radioactive
substance sealed in needles, seeds,
wires, or catheters
that are placed directly into or near the cancer.
The way the radiation
therapy is given depends on the type and stage of the cancer being
treated. External radiation therapy is used to treat male breast
cancer.
Targeted
therapy
Targeted therapy is a type
of treatment that uses drugs or other substances to identify and attack
specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of
targeted therapy used to treat men with breast cancer.
Monoclonal antibody
therapy uses antibodies
made in the laboratory from a single type of immune system cell. These
antibodies can identify substances on cancer cells or normal substances
that may help cancer cells grow. The antibodies attach to the
substances and kill the cancer cells, block their growth, or keep them
from spreading. Monoclonal antibodies are given by infusion. They may be used
alone or to carry drugs, toxins,
or radioactive material directly to cancer cells. Monoclonal antibodies
are also used with chemotherapy as adjuvant
therapy (treatment given after surgery to lower the risk
that the cancer will come back).
Trastuzumab is a
monoclonal antibody that blocks the effects of the
growth factor protein HER2
Treatment Options for Male Breast Cancer
Breast cancer in men is
treated the same as breast cancer in women. (See the PDQ summary on Breast Cancer
Treatment for more information.)
Initial Surgery
Treatment for men diagnosed with breast cancer is usually modified radical mastectomy.
Breast-conserving surgery
with lumpectomy may
be used for some men.
Adjuvant Therapy
Therapy given after an
operation when cancer
cells can no longer
be seen is called adjuvant
therapy. Even if the doctor removes all the cancer that
can be seen at the time of the operation, the patient may be given radiation therapy, chemotherapy, hormone therapy, and/or targeted therapy after surgery, to try to kill any
cancer cells that may be left.
- Node-negative:
For men whose cancer is node-negative (cancer has not spread to the lymph nodes), adjuvant
therapy should be considered on the same basis as for a woman with breast cancer because there
is no evidence that response
to therapy is different for men and women.
- Node-positive:
For men whose cancer is node-positive (cancer has spread to the lymph
nodes), adjuvant therapy may include the following:
- Chemotherapy plus tamoxifen
(to block the effect of estrogen).
- Other hormone therapy.
- Targeted therapy with a monoclonal
antibody (trastuzumab).
These treatments appear
to increase survival
in men as they do in women. The patient's response
to hormone therapy depends on whether there are hormone receptors (proteins) in the tumor. Most breast cancers
in men have these receptors. Hormone therapy is usually recommended for
male breast cancer
patients, but it can have many side
effects, including hot
flashes and impotence
(the inability to have an erection
adequate for sexual intercourse).
Distant Metastases
Treatment for men with distant metastases (cancer that has spread to
other parts of the body) may be hormone
therapy, chemotherapy,
or both. Hormone therapy may include the following:
- Orchiectomy
(the removal of the testicles
to decrease the amount of hormone
made).
- Luteinizing
hormone-releasing hormone agonist with or without total androgen blockade (to
decrease the the amount of sex hormones made).
- Tamoxifen
for cancer that is estrogen-receptor
positive.
- Progestin
(a female hormone made in a laboratory).
- Aromatase inhibitors
(to decrease the amount of estrogen
made).
Hormone therapies may be
used in sequence (one after the other). Standard
chemotherapy regimens
may be used if hormone therapy does not work. Men usually respond to therapy in the
same way as women who have breast
cancer.
Treatment Options for Locally Recurrent Male Breast Cancer
For men with locally recurrent disease (cancer that has come back in
a limited area after treatment), treatment is usually either:
- Surgery
combined with chemotherapy;
or
- Radiation therapy
combined with chemotherapy.
-NIH
