Breast cancer in men is rare, accounting for less than 1% of all breast cancer cases. Although breast cancer in men occurs less frequently than breast cancer in women, the diseases are similar in many ways.
The breast is comprised mainly of fatty tissue. Within this tissue is a network of lobes, which are made up of lobules (tiny, tube-like structures) that contain milk glands. Tiny ducts connect the glands, lobules, and lobes and carry the milk from the lobes to the nipple, located in the middle of the areola (darker area that surrounds the nipple of the breast). Blood and lymph vessels run throughout the breast; blood nourishes the cells, and the lymph system drains bodily waste products.
The main types of breast cancer are the same for men and women. About 90% of all breast cancers occur in the ducts or lobes, with nearly 75% being ductal carcinoma (cancer that begins in the cells lining the milk ducts). Approximately 30% of male breast cancer cases are lobular carcinoma (cancer that begins in the lobules) that is found in both breasts.
A type of breast cancer that has spread outside of the duct and into the surrounding tissue is called invasive or infiltrating ductal carcinoma (IDC). The majority of male breast cancer cases are IDC. If the cancer begins at the end of the ducts, it is called infiltrating lobular carcinoma, a rare type of breast cancer.
Disease that has not spread is called in situ, meaning "in place." The course of in situ disease, as well as its treatment, depends on where in the breast the cancer started. Currently, oncologists recommend that ductal carcinoma in situ (DCIS), which accounts for the majority of in situ breast cancers, be surgically removed to help prevent the cancer from spreading to other parts of the breast or the body. DCIS is uncommon in men.
Inflammatory breast cancer makes up about 1% to 3% of all breast cancers. Paget's disease of the nipple begins in the ducts, but spreads to the skin of the nipple. Paget's disease is more common in men than in women. Other, less common cancers of the breast include medullary, mucinous, tubular, or papillary.
Breast cancer cells may spread through the bloodstream or to the lymph nodes. Regional lymph nodes include those located under the arm (axillary), in the neck (cervical), or just below the collarbone (supraclavicular). The most common sites of distant metastasis (spread) of breast cancer are the skin, distant lymph nodes, bones, lungs, and liver.
Breast cancer in men is detected the same way as breast cancer in women is-through self-examination, clinical examination, or mammography (x-ray of the breast). Changes in the breast may be easier to detect because men have less breast tissue. However, the awareness of breast cancer in men is much lower than it is in women; therefore, men may not perform regular breast self-examinations or ask their doctor about the disease.
Statistics
In 2008, there will be an estimated 1,990 new cases of breast cancer diagnosed in men in the United States. An estimated 450 men will die of breast cancer this year.
Breast cancer in men and women has similar survival rates. For the earliest stages of breast cancer, stages 0 and I, the five-year relative survival rate (the percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) is 98%. Survival rates drop as the stages (see Staging) increase. Men with breast cancer that has spread regionally have an 84% five-year relative survival rate, and men with cancer that has spread to other parts of the body have a 24% five-year survival rate.
Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with breast cancer. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2008.
A risk factor is anything that increases a person's chance of developing a disease, including cancer. There are risk factors that can be controlled, such as smoking, and risk factors that cannot be controlled, such as age and family history. Although risk factors can influence disease, for many risk factors it is not known whether they actually cause the disease directly. Some people with several risk factors never develop the disease, while others with no known risk factors do. Knowing your risk factors and communicating with your doctor can help guide you in making wise lifestyle and health-care choices.
The following factors can raise a man's risk of developing breast cancer:
Family history of breast disease or presence of a genetic mutation. About 20% of male breast cancers occur in men who have a family history of the disease. Men with breast cancer gene 2 (BRCA2) gene mutations may be at increased risk for breast cancer or other types of cancer. Learn more about The Genetics of Breast Cancer.
Age. The average age for men to be diagnosed with breast cancer is 65.
Elevated estrogen levels. The presence of certain diseases, conditions, or treatments can increase estrogen levels.
Klinefelter's syndrome, a genetic condition in which men are born with an extra X chromosome, may increase the risk of male breast cancer because men with Klinefelter's syndrome have higher levels of estrogens and lower levels of androgens (male hormones).
Liver disease, such as cirrhosis, can disrupt hormone levels and cause low levels of androgens and higher levels of estrogens. Estrogen-related drugs may be given in low levels for the treatment of prostate cancer and may slightly increase the risk of breast cancer.
Radiation. High doses of radiation may increase the risk of breast cancer. An increased risk of breast cancer has been observed in long-term survivors of atomic bombs, people with lymphoma treated with radiation therapy to the chest, people undergoing large numbers of x-rays for tuberculosis or non-malignant conditions of the spine, and children treated with radiation for ringworm.
Lifestyle factors. As with other types of cancer, studies continue to show that various habits may contribute to the development of breast cancer.
Obesity. According to a recent study, being obese or even overweight increases the risk of breast cancer.
Lack of exercise. Exercise lowers hormone levels and boosts the immune system; lack of exercise contributes to obesity.
Alcohol use. Drinking more than one alcoholic drink per day may raise the risk of breast cancer.
Currently, there is no proven method for preventing male breast cancer. A person's best chance of surviving breast cancer is early detection through regular self-examinations, clinical breast examinations, and mammography. Therefore, all men should be familiar with the feel of their breast tissue normally, so they can bring any lump or change to their doctor's attention. During an annual physical examination, the health-care professional will perform a clinical examination of the breast. Mammograms are not routinely offered to men and may be difficult to perform because of the small amount of breast tissue. For men with a strong family history of breast cancer or the presence of a genetic mutation that increases their risk of developing the disease, routine mammography may be recommended.
Men with breast cancer may experience the following symptoms. Sometimes, men with breast cancer do not show any of these symptoms. Or, these symptoms may be similar to symptoms of other medical conditions. If you are concerned about a symptom on this list, please talk with your doctor.
A lump or swelling in the breast tissue. Because men generally have small amounts of breast tissue, it is easier to feel small lumps.
Any new irregularity (redness, scaliness, puckering) on the skin or nipple, or a discharge from the nipple
Doctors use many tests to diagnose cancer and determine if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of symptoms
Previous test results
The following tests may be used to diagnose breast cancer in men:
Clinical breast examination. During this procedure, the doctor will systematically feel for lumps in the breast tissue and under the arm.
Diagnostic mammography. If a lump or suspicious area is found, the doctor will order a diagnostic mammogram. A diagnostic mammogram is similar to a screening mammography, except more views (pictures) of the breast are taken.
Ultrasound. Ultrasound uses high-frequency sound waves to create an image of the breast tissue. An ultrasound may distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is not cancer.
Nipple discharge examination. Fluid from the nipple can be examined under a microscope to look for cancer cells.
Biopsy
A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluates cells, tissues, and organs to diagnose disease).
Image guided percutaneous core biopsy is used when a distinct lump can't be felt. During this procedure, a hollow needle is guided to the area of concern with the help of mammography or ultrasound. If a cancer is only found by magnetic resonance imaging (MRI), then the needle biopsy may be guided by that technique. A small metal clip may be put into the breast to mark the site of biopsy, in case the sample tissue proves cancerous and additional surgery is required. An advantage of this technique is that a patient may only need one operation for treatment or staging.
Stereotactic core biopsy is a type of image guided biopsy that uses x-rays to find the area of tissue to be removed.
Vacuum-assisted biopsy uses a thicker, hollow needle to remove multiple, larger cores of tissue with a single insertion of the vacuum-assisted probe. This technique also uses image guidance.
Surgical biopsy removes the largest amount of tissue. This biopsy may be incisional (removal of part of the lump) or excisional (removal of the entire lump).
If cancer is diagnosed, a second operation is often needed to obtain a clear margin (area around the tumor where there are no cancer cells) and/or remove lymph nodes.
Doctors may also test the tissue obtained during a biopsy to help guide treatment decisions. The tests include:
Estrogen receptor (ER) and progesterone receptor (PR) tests. These tests help determine both the prognosis (chance of recovery) and predict whether the cells respond to hormone therapy. Generally, ER or PR positive (+) tumors will respond to hormone therapy. A person's ER/PR status helps guide treatment decisions. About 75% of male breast cancers have estrogen or progesterone receptors.
HER-2/neu tests: This is a protein that is overexpressed (too much of it) in about 25% of breast cancers. The HER-2 status helps determine whether a drug called trastuzumab (Herceptin) might be useful for treating breast cancer. Read more in the ASCO Patient Guide: HER-2 Testing in Breast Cancer.
The amount of DNA the breast cancer cells contain and the percentage of cells that are in a growth phase of the cell cycle. This information can help predict how fast the breast tumor will grow. Generally, the higher the ploidy (amount of DNA) and the more cells in the S (growth) phase, the faster the tumor will grow or the more likely it is to recur (come back after treatment).
Staging is a way of describing a cancer, such as where it is located, where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis. There are different stage descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size of the tumor. Some stages are divided into smaller groups that help describe a patient's condition in more detail.
TX: The primary tumor cannot be evaluated.
T0: There is no evidence of cancer in the breast.
Tis: Refers to carcinoma (cancer) in situ. In this case, the cancer is confined within the natural boundaries of the breast tissue and has not spread into the surrounding tissue of the breast. There are three types of breast carcinoma in situ:
Tis (DCIS): Ductal carcinoma in situ (DCIS) is a precursor of early breast cancer and means that only a few cancer cells have been found in breast ducts and have not spread past the layer of tissue where they began. It can later develop into an invasive type of breast cancer.
Tis (LCIS): Lobular carcinoma in situ (LCIS) describes abnormal cells found in the lobules or glands of the breast. LCIS increases the risk of developing invasive breast cancer (cancer that spreads into surrounding tissues).
Tis (Paget's): Paget’s disease of the nipple is a rare form of early breast cancer. This designation is used if there is Paget’s disease but no tumor present.
T1: A tumor in the breast is 2 centimeters (cm) or smaller in size at its widest dimension.
T1 mic: Microinvasion, or micrometastases, means a few cancer cells have spread to surrounding tissue, but none are larger than 0.1 cm.
T1a: The tumor is larger than 0.1 cm, but smaller than 0.5 cm.
T1b: The tumor is larger than 0.5 cm, but smaller than 1 cm.
T1c: The tumor is larger than 1 cm, but smaller than or equal to 2 cm.
T2: The tumor is larger than 2 cm, but smaller than or equal to 5 cm.
T3: The tumor is larger than 5 cm.
T4: The tumor has spread to the chest wall or to the skin or is diagnosed as inflammatory breast cancer.
T4a: The tumor has spread into the chest wall.
T4b: There is edema (swelling), pitting (as in peau d'orange), or ulceration (a sore, painful area where the breast skin/tissue is breaking down) of the breast skin or surrounding skin nodules of the same breast.
T4c: There are signs of both T4a and T4b.
T4d: Refers to inflammatory carcinoma. This is an aggressive type of breast cancer that causes the breast to look red and swollen and feel warm.
Node. The "N" in the TNM staging abbreviation means node. Lymph nodes are tiny, bean-shaped organs located throughout the body that normally help fight infection and cancer as part of the body's immune system. There are lymph nodes very near to the breast that are under the arm, above the collarbone, and under the breastbone. There are also distant lymph nodes (lymph nodes found in other parts of the body).
NX: The lymph nodes cannot be assessed.
N0: No cancer was found in the lymph nodes.
N1: The cancer has spread to one to three of the axillary lymph nodes (under the arm).
N2: The cancer has spread to four to nine lymph nodes under the arm and the nodes are stuck to each other or other structures. Or, the cancer has spread only to the internal mammary lymph nodes (lymph nodes to the right or left of the sternum [breast bone] on the inside of the chest).
N2a: The cancer has spread to four to nine lymph nodes under the arm, and these nodes are stuck to each other or other structures.
N2b: The cancer has spread only to the lymph nodes in the breast, not the lymph nodes under the arm.
N3: The cancer has spread to 10 or more nodes under the breastbone.
N3a: The cancer has spread to 10 or more infraclavicular lymph nodes (under the collarbone).
N3b: The cancer has spread to lymph nodes behind the breast and under the arms.
N3c: The cancer has spread to the supraclavicular lymph nodes (above the collarbone).
If there is cancer in the lymph nodes, it helps doctors to know how many lymph nodes are involved. When the pathologist looks at the tissue samples from the biopsy, he or she will determine the number of lymph nodes that contain cancer.
Metastasis. The "M" in the TNM system describes if the cancer has metastasized to other parts of the body.
MX: Distant spread cannot be assessed.
M0: The disease has not metastasized.
M1: There is metastasis to another part of the body.
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications.
Stage 0: Ductal carcinoma in situ is cancer that has not spread past the ducts or lobules of the breast (the natural boundaries). It is also called noninvasive cancer.
Stage I: The tumor is small and has not spread to the lymph nodes (T1, N0, M0).
Stage IIa: Any one of these conditions:
The tumor is smaller than 2 cm, and has spread to the axillary lymph nodes under the arm (T1, T1 mic, N1, M0).
The tumor is between 2 cm and 5 cm, but has not spread to the axillary lymph nodes (T2, N0, M0).
There is no evidence of a tumor in the breast, but there is cancer in the axillary lymph nodes (T0, N1, M0).
Stage IIb: Any one of these conditions:
The tumor is between 2 cm and 5 cm, and has spread to the axillary lymph nodes (T2, N1, M0).
The tumor is larger than 5 cm, but has not spread to the axillary lymph nodes (T3, N0, M0).
Stage IIIa: Any of these conditions:
The tumor is smaller than 5 cm, and has spread to the axillary lymph nodes that are attached to each other or to other structures (T0, T1, T1 mic, T2, N2, M0).
The tumor is larger than 5 cm, and has spread to the axillary lymph nodes, which may or may not be attached to each other or to other structures (T3, N1 or N2, M0).
Stage IIIb: The tumor has spread to the chest wall or caused swelling or ulceration of the breast or is diagnosed as inflammatory breast cancer. It may or may not have spread to the lymph nodes under the arm, but has not spread to other parts of the body (T4, N0, N1, N2, M0).
Stage IIIc: A tumor of any size that has not spread to distant parts of the body, but has spread to the lymph nodes above the collarbone, under the collarbone, or both the nodes inside the breast and under the arm (any T, N3, M0).
Stage IV: The tumor can be any size and has spread to distant sites in the body, usually the bones, lungs, liver, or brain (any T, any N, M1).
Recurrent breast cancer
Breast cancer is called recurrent if the cancer has come back after it was first diagnosed and treated. It may come back in the breast (called a local recurrence), in the chest wall, or in another part of the body (called a distant metastasis), including distant organs (such as the lungs or liver), bones, or other lymph nodes.
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
The treatment of male breast cancer depends on the stage, grade, size, and location of the tumor, whether the cancer has spread, and the man's overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. Male breast cancer may be treated with surgery, chemotherapy, hormonal therapy, and radiation treatment.
Surgery
If the tumor is small, a biopsy may be all that is needed to remove the tumor completely. However, if more surgery is required, a mastectomy may be necessary. A simple (total) mastectomy involves removing the entire breast, but not the lymph nodes under the arm or underlying chest muscles. A modified radical mastectomy removes the breast tissue and lymph nodes, and a radical mastectomy removes the breast tissue, lymph nodes, and chest wall muscles under the breast.
Because men do not have much breast tissue, lumpectomies, which remove only the tumor, are generally not an option.
The most significant side effect of surgery is lymphedema (arm swelling) (link to side effects section), which can occur when lymph nodes are removed or damaged during surgery. Because the lymph nodes are part of the channels that drain the lymphatic fluid from the arm, damage to the area may hold back the flow of lymphatic fluid and cause it to back up in the arm. The use of sentinel node biopsy, which finds the first lymph node to which the breast tissue drains and monitors it for the presence of cancer cells, has been shown to reduce the incidence of lymphedema.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. It can be given orally or by injection. Generally, chemotherapy does not require a hospital stay, and men are usually treated in an outpatient setting.
Chemotherapy is often given in combinations because studies have shown they are more effective when given together. The most common combinations include:
Cyclophosphamide (Cytoxan or Neosar), methotrexate (Amethopterin), and fluorouracil (5-FU, Efudex) (CMF)
Cyclophosphamide, doxorubicin (Adriamycin), and 5-FU (CAF)
Doxorubicin (Adriamycin) and cyclophosphamide (AC)
Cyclophosphamide, doxorubicin (Adriamycin) in combination with paclitaxel (Taxol) or docetaxel (Taxotere)
Other medications that may be prescribed include paclitaxel, docetaxel, vinorelbine (Navelbine), gemcitabine (Gemzar) and capecitabine (Xeloda). Trastuzumab (Herceptin) is also useful in treating breast cancer.
Side effects of chemotherapy vary depending on which drugs the person receives. These include poor appetite, nausea, vomiting, diarrhea, mouth sores, hair loss, and a lack of energy. People undergoing chemotherapy are also more likely to get infections and bruise and bleed easily, because chemotherapy decreases production of white blood cells, red blood cells, and platelets. These side effects often go away between treatments and after the treatments have stopped. The doctor can suggest ways to relieve these side effects.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to multiple drug databases.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Radiation therapy is given regularly for a number of weeks after surgery to eliminate remaining cancer cells near the tumor site or elsewhere within the breast.
The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation treatment is given using implants, it is called brachytherapy or internal radiation therapy.
Radiation therapy can cause side effects, including fatigue, swelling, and skin changes. A small amount of the lung can be affected by the radiation. The risk of pneumonitis, or a radiation-related pneumonia, is rare.
Hormonal therapy
Because more than 75% of breast cancers in men have estrogen receptors, hormonal therapy is often an option. Anti-estrogen agents, such as tamoxifen (Nolvadex), are often effective in shrinking breast tumors. Other hormonal therapies include:
Megesterol (Megace). Megesterol is a progesterone-like drug used to treat a progesterone receptor-positive tumor.
Aromatase inhibitors. Aromatase inhibitors block the production of estrogen. These agents are effective in treating breast cancer in women, but there is not much information on their use in male breast cancer.
Anti-androgen therapy. Male breast cancers often have receptors for male hormones. By lowering the production of androgens in the man's body, oncologists have been able to shrink a tumor that has metastasized.
Side effects of hormonal therapy can include hot flashes, decreased sexual desire or ability, and mood swings.
Cancer and cancer treatment can cause a variety of side effects; some are easily controlled and others require specialized care. Below are some of the side effects that are more common to male breast cancer and its treatments. For more detailed information on managing these and other side effects of cancer and cancer treatment, visit the Cancer.Net Managing Side Effects section.
Anemia. Anemia is common in people with cancer, especially those receiving chemotherapy. Anemia is an abnormally low level of red blood cells (RBCs). RBCs contain hemoglobin (an iron protein) that carries oxygen to all parts of the body. If the level of RBCs is too low, parts of the body do not get enough oxygen and cannot work properly. Most people with anemia feel tired or weak. The fatigue (tiredness) associated with anemia can seriously affect quality of life and make it more difficult for patients to cope with cancer and treatment side effects.
Appetite loss. Appetite changes are common with cancer and cancer treatment, including chemotherapy. Individuals with a poor appetite or appetite loss may eat less than usual, not feel hungry at all, or feel satiated (full) after eating only a small amount. Ongoing appetite loss can lead to weight loss, malnutrition, and loss of muscle mass and strength. The combination of weight loss and loss of muscle mass, also called wasting, is referred to as cachexia.
Fatigue. Fatigue is extreme exhaustion or tiredness, and is the most common problem that people with cancer experience. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much. Fatigue can seriously affect family and other daily activities, can make patients avoid or skip cancer treatments, and may even affect the will to live.
Fluid in the abdomen (ascites). Ascites is the buildup of fluid in the abdomen, in the area around the organs known as the peritoneal cavity. Ten percent of all ascites is caused by cancer and is called malignant ascites. Most cancer-related ascites appears in patients with cancers of the ovary, endometrium (lining of the uterus), breast, colon, gastrointestinal (GI) system, or pancreas. These cancers can cause fluid to build up in the body. People with ascites may experience weight gain, abdominal swelling, a sense of fullness or bloating, a sense of heaviness, indigestion, nausea and/or vomiting, changes to the navel, hemorrhoids (a condition that causes painful swelling near the anus), or ankle swelling.
Fluid in the arms or legs (lymphedema). Lymphedema is the abnormal buildup of fluid in the lymphatic system, the series of channels and nodes (small sacs that hold fluid) that carries lymph through the body and helps fight infection and disease. Lymph is a clear liquid that carries protein and cells that fight infection. When cancers metastasize, cells first go to the lymph nodes and then are carried to other parts of the body. Lymphedema can develop immediately after cancer surgery or radiation therapy, or it can develop months or years later. About 15% of women who have radical mastectomies (removal of the breast, underarm lymph nodes, and lining of the chest muscles) develop lymphedema. The most common causes of lymphedema include surgery to remove the lymph nodes, especially for breast cancer, prostate cancer, or melanoma; radiation therapy to the lymph nodes; metastatic cancer (cancer that has spread from its primary location); bacterial or fungal infection; injury to the lymph nodes; and other diseases involving the lymph system.
Fluid around the lungs (malignant pleural effusion). A pleural effusion is a condition characterized by extra fluid building up in the pleural space, the space between the edge of the lungs and the chest wall. A malignant pleural effusion is caused by cancer that grows in the pleural space. About half of patients with cancer develop a pleural effusion. More than 75% of patients with a malignant pleural effusion have lymphoma or cancers of the breast, lung, or ovary. The symptoms of a pleural effusion include dyspnea (shortness of breath), dry cough, pain, feeling of chest heaviness, inability to exercise, and malaise (feeling unwell).
Hair loss (alopecia). A potential side effect of radiation therapy and chemotherapy is hair loss. Radiation therapy and chemotherapy cause hair loss by damaging the hair follicles responsible for hair growth. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. The hair may fall out entirely, gradually, or in sections. In some cases, the hair will simply thin-sometimes unnoticeably-and may become duller and dryer. Losing one's hair can be a psychologically and emotionally challenging experience and can affect a patient's self-image and quality of life. However, the hair loss is usually temporary, and the hair often grows back.
Hormone deprivation symptoms in men. Many men who experience a halt in their hormone levels because of prostate cancer treatment (particularly those treatments that stop the production of testosterone, such as removal of the testicles or androgen ablation [hormone treatment]) experience symptoms, such as hot flashes, osteoporosis (loss of bone mass that makes bones break and fracture easily), decreased libido (desire for sex), erectile dysfunction (problems with erections), fatigue, and depression or irritability, that are caused by the body's lack of testosterone. These symptoms may occur in men without prostate cancer also, as part of the aging process. In men without prostate cancer, treatments to raise testosterone levels can help relieve these symptoms. Since testosterone helps prostate cancer grow, this is not an option for men with prostate cancer.
Hypercalcemia. Hypercalcemia is an unusually high level of calcium in the blood. Hypercalcemia can be life threatening and is the most common metabolic disorder associated with cancer, occurring in 10% to 20% of patients with cancer. While most of the calcium in the body is stored in the bones, about 1% of the body's calcium circulates in the bloodstream. Calcium is important for many bodily functions, including bone formation, muscle contractions, and nerve and brain function. Patients with hypercalcemia may experience loss of appetite, nausea and/or vomiting; constipation and abdominal pain; increased thirst and frequent urination; fatigue, weakness, and muscle pain; changes in mental status, including confusion, disorientation, and difficulty thinking; and headaches. Severe hypercalcemia can be associated with kidney stones, irregular heartbeat or heart attack, and eventually loss of consciousness and coma.
Infection. An infection occurs when harmful bacteria, viruses, or fungi (such as yeast) invade the body and the immune system is not able to destroy them quickly enough. Patients with cancer are more likely to develop infections because both cancer and cancer treatments (particularly chemotherapy and radiation therapy to the bones or extensive areas of the body) can weaken the immune system. Symptoms of infection include fever (temperature of 100.5°F or higher); chills or sweating; sore throat or sores in the mouth; abdominal pain; pain or burning when urinating or frequent urination; diarrhea or sores around the anus; cough or breathlessness; redness, swelling, or pain, particularly around a cut or wound; and unusual vaginal discharge or itching.
Mouth sores (mucositis). Mucositis is an inflammation of the inside of the mouth and throat, leading to painful ulcers and mouth sores. It occurs in up to 40% of patients receiving chemotherapy. Mucositis can be caused by a chemotherapeutic drug directly, the reduced immunity brought on by chemotherapy, or radiation treatment to the head and neck area.
Nausea and vomiting. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.
Skin problems. The skin is an organ system that contains many nerves. Because of this, skin problems can be very painful. Because the skin is on the outside of the body and visible to others, many patients find skin problems especially difficult to cope with. Because the skin protects the inside of the body from infection, skin problems can often lead to other serious problems. As with other side effects, prevention or early treatment is best. In other cases, treatment and wound care can often improve pain and quality of life. Skin problems can have many different causes, including chemotherapy leaking out of the intravenous (IV) tube, which can cause pain or burning; peeling or burned skin caused by radiation therapy; pressure ulcers (bed sores) caused by constant pressure on one area of the body; and pruritus (itching) in patients with cancer, most often caused by leukemia, lymphoma, myeloma, or other cancers.
Weight gain. Although it is more common to lose weight during cancer treatment, some patients with cancer gain weight. Slight increases in weight during cancer treatment are generally not problematic. However, significant weight gain may affect a patient's health and the ability to tolerate treatments. Chemotherapy, steroid medications, and hormone therapies can cause weight gain.
After treatment for breast cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery. The recommendations for breast cancer follow-up care usually include regular physical examinations and mammograms. Specific information can be found in the ASCO Patient Guide: Follow-up Care for Breast Cancer.
Breast cancer can recur in the breast or other areas of the body. The symptoms of a cancer recurrence include a new lump in the breast, under the arm, or along the chest wall; bone pain or fractures; headaches or seizures; chronic coughing or trouble breathing; extreme fatigue; and/or feeling ill. Talk with your doctor if you experience these or other symptoms. For some people, the possibility of recurrence becomes overwhelming. Learn more about Coping With Fear of Recurrence.
After surgery (mastectomy or lumpectomy) to treat breast cancer, the breast may be scarred and may have a different shape or size than before surgery. If lymph nodes were removed as part of the surgery, lymphedema (swelling of the arm) may occur. Read the Cancer.Net Feature: After Treatment for Breast Cancer: Preventing Lymphedema.
Some patients experience breathlessness, a dry cough, and/or chest pain two to three months after finishing radiation treatment because the radiation can cause swelling and fibrosis (hardening or thickening) of the lungs. These symptoms are usually temporary. Talk with your doctor if you develop any new symptoms after radiation treatment or if the side effects are not going away.
Men recovering from breast cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight and diet and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help you rebuild your strength and energy level. Your doctor can help you create a safe exercise plan based upon your needs, physical abilities, and fitness level. Read the Cancer.Net Feature: Healthy Living After Cancer.
Genetic testing is becoming available to offer information for people with strong family histories of cancer. For male breast cancer, even if there is no family history of breast cancer, it is a good idea to talk with a genetic counselor.
Many people also benefit from survivor support groups or counseling.
Late effects of treatment for breast cancer include secondary leukemia, which currently affects 1% of people with breast cancer. There has also been some data suggesting that osteoporosis (loss of bone mass that makes bones break easily) is emerging as a side effect of treatment.
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
What is the exact type of cancer that I have?
Has it spread from its original location?
What is the stage of my cancer, and what does the stage indicate for treatment options?
What type of side effects from treatment can I expect?
What are the chances that the cancer will recur?
What is my prognosis?
How can I keep myself as healthy as possible during treatment?
Is there a clinical trial available? Is there a benefit to me to participate in a clinical trial?
Research involving more advanced diagnostic procedures and treatment for male breast cancer is ongoing. The following advancements may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor.
There are tests that help predict how aggressive a breast cancer may be. For example, tests that measure the changes in p53 tumor suppressor gene, epidermal growth factor receptor, and microvessel density (the number of small blood vessels that supply oxygen and nutrition to the cancer) are being studied.
A clinical trial may be the recommended course of action if the breast cancer is advanced; your oncologist will help choose a clinical trial.
Doctors and scientists are always looking for better ways to treat men with breast cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments, such as new chemotherapy, before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that this is the only way to make progress in treating male breast cancer, such as finding new drugs. Even if they do not benefit directly from the clinical trial, their participation may benefit men who develop breast cancer in the future.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands the standard treatments, and how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
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