Treatment of Male Breast Cancer
Breast cancer in men is treated the same as it is in women. In most cases no one right treatment exists. Instead, you’ll want to find the approach that’s best for you. To do that, you’ll need to consider many different factors, including the stage of your cancer and your age.
Before making any decisions, learn as much as you can about the many treatment options. Talk extensively with your health care team. Consider a second opinion. Don’t be afraid to ask questions. In addition, look for breast cancer books, Web sites, and information from organizations such as the American Cancer Society and the Susan G. Komen Breast Cancer Foundation. Talking to others who have faced the same decision also may help. This may be the most important decision you ever make.
Treatments exist for every type and stage of breast cancer. Some men may need only surgery. Others will need surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy.
Surgery
Breast-sparing procedures are often an option for women but are not typically feasible for men. This is because a man’s breast doesn’t contain much tissue underneath the nipple, so removing the cancer usually means removing most of the tissue. Breast cancer operations include the following:
- Simple mastectomy. During a simple mastectomy, your surgeon removes all of your breast tissue — the lobules, ducts, fatty tissue, and a strip of skin with the nipple and areola. Depending on the results of the operation and follow-up tests, you may also need treatment with radiation to the chest wall, chemotherapy or hormone therapy.
- Modified radical mastectomy. Most men with breast cancer require a modified radical mastectomy. In this procedure, a surgeon removes your entire breast and some underarm (axillary) lymph nodes, but leaves your chest muscles intact. If the cancer has spread into the chest wall, your doctor may need to do a radical mastectomy that removes the chest wall muscles. Serious arm swelling (lymphedema) is more likely to occur in modified radical mastectomy than in simple mastectomy with sentinel node biopsy. Your lymph nodes will be tested to see if the cancer has spread. Depending on those results, you may need further treatment.
- Sentinel lymph node biopsy. Breast cancer first spreads to the lymph nodes under the arm. That’s why you need to have these nodes examined. If your surgeon doesn’t plan to do this, be sure you understand the reason. Until recently surgeons would remove as many lymph nodes as possible. But this greatly increased the risk of numbness, recurrent infections and serious swelling of the arm. That’s why a procedure has been developed that focuses on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to develop cancer. If a sentinel node is removed, examined and found to be healthy, the chance of finding cancer in any of the remaining nodes is very small, and no other nodes need to be removed. This spares the need for a more extensive operation and greatly decreases the risk of complications. It’s important that the procedure be performed by a team experienced with it.
Radiation therapy
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. It’s administered by a radiation oncologist at a radiation center. It may be used to shrink the tumor before surgery or to eliminate any remaining cancer cells in the breast, chest muscles or armpit after surgery.
Most men who undergo radiation therapy for breast cancer receive external beam radiation. In this procedure you receive radiation on the cancerous area from a machine outside your body. Radiation is usually started three to four weeks after surgery, to allow some time for your body to heal. You’ll typically receive treatment five days a week for five or six consecutive weeks. The treatments are painless and are similar to getting an X-ray. Each takes a few minutes. The effects are cumulative, however, and you may become quite tired toward the end of the series. Your breast may be pink, puffy and somewhat tender, as if it had been sunburned.
Chemotherapy
Chemotherapy uses drugs to destroy cancer cells. Your doctor may recommend chemotherapy after surgery to kill any cancer cells that may have spread outside your breast. Treatment often involves receiving two or more drugs in different combinations. These may be administered intravenously, in pill form or both. You may have treatments every two or three weeks for three to six months.
For many people, chemotherapy can feel like another illness. The side effects may include hair loss, nausea, vomiting and fatigue. These effects occur because chemotherapy affects healthy cells — especially fast-growing cells in your digestive tract, hair and bone marrow — as well as cancerous ones. Not everyone has side effects, however, and there are now better ways to control some of them.
New drugs can help prevent or reduce nausea. Relaxation techniques, including guided imagery, meditation and deep breathing, also may help. In addition, exercise has been shown to be effective in reducing fatigue caused by chemotherapy.
One side effect for which no treatment exists is “chemobrain,” the common term for cognitive changes that occur during and after cancer treatment. It is uncertain how common or how severe chemobrain is and who is more likely to develop it. Women undergoing adjuvant chemotherapy for breast cancer were the first to call attention to this problem. Since then, researchers have found that chemotherapy can affect your cognitive abilities in a number of ways, including:
- Word finding. You might find yourself reaching for the right word during conversation.
- Memory. You might experience short-term memory lapses, such as not remembering where you put your keys or what you were supposed to buy at the store. Memory changes may continue for a long time.
- Multitasking. Many jobs require you to manage multiple tasks during the day. Multitasking is important at work and at home — for example, talking with your kids and making dinner at the same time. Chemotherapy may affect how well you’re able to perform multiple tasks at once.
- Learning. It might take longer to learn new things. For example, you might find you need to read paragraphs over a few times before you really grasp the content.
- Processing speed. It might take you longer to do tasks that were once quickly done and easy for you.
In rare cases, certain chemotherapy medications may lead to cancer of the white blood cells (acute myeloid leukemia) — usually within one to two years after treatment ends.
Hormone therapy
Estrogen receptor positive cancer means that estrogen might encourage the growth of breast cancer cells in your body. Estrogen is present in men, though in smaller amounts than in women. But more than 75 percent of breast cancers in men have estrogen receptors. Normally estrogen binds to certain sites in your breast and in other parts of your body. But during this treatment, a hormonal medication binds to these sites instead and prevents estrogen from reaching them. This may help destroy cancer cells that have spread or reduce the chances that your cancer will recur.
The primary medication used to reduce the effect of estrogen in your body is tamoxifen (Nolvadex). This synthetic hormone belongs to a class of drugs known as selective estrogen receptor modulators (SERMs). It’s used as a treatment for men with hormone-sensitive metastatic breast cancer and as an adjuvant therapy for men with early-stage estrogen receptor positive breast cancer. You take tamoxifen daily, in pill form.
The male hormones — androgens — also play a role in the growth of breast cancer in men, although the role is unclear. Limiting androgens through the use of certain drugs does appear to effectively reduce the spread of the cancer. These drugs include:
- Luteinizing hormone-releasing hormone analogs. These drugs cause the testicles to reduce their androgen production.
- Antiandrogen drugs. Antiandrogens block the effect of male hormones on breast cancer cells.
Side effects of hormonal therapies may include hot flashes, decreased sexual desire, loss of erection, weight gain and mood swings.
A new group of hormonal therapy medications called aromatase inhibitors (anastrazole, exemestane and letrozole) are used to treat hormone-sensitive breast cancer in postmenopausal women. At this time, no data exist as to the usefulness of these medications in the treatment of male breast cancer.
Biological therapy
Sometimes called biological response modifier or immunotherapy, this treatment tries to stimulate your body’s immune system to fight cancer. Using substances produced by the body or similar substances made in a laboratory, biological therapy seeks to enhance your body’s natural defenses against specific diseases. Many of these therapies are experimental and available only in clinical trials.
One medication, trastuzumab (Herceptin), is a monoclonal antibody — a substance produced in a laboratory by mixing cells — that’s available for treating certain cases of breast cancer. Herceptin is effective against tumors that produce excess amounts of the HER-2 protein. Side effects of Herceptin, though uncommon, may include heart problems, fever, chills, nausea and vomiting, weakness, diarrhea, and headache. If used in combination with a certain type of chemotherapy called anthracyclines, for example doxorubicin (Adriamycin) or epirubicin (Ellence), Herceptin is more likely to cause heart problems.
