Male Breast Cancer (cont.)
How is male breast cancer treated?
Like breast cancer in women, treatment depends upon the
stage of the cancer and the overall physical condition of the patient. Treatments are the same as
for breast cancer in women.
Most men diagnosed with breast cancer are initially
treated by surgery. A modified radical mastectomy (removal of the breast, lining over the chest
muscles, and portions of the axillary lymph nodes) is the most common surgical
treatment of male breast cancer. Sometimes portions of the muscles of the chest
wall are also removed.
After surgery, adjuvant therapies are often prescribed.
These are recommended especially if the cancer has spread to the lymph nodes
(node-positive cancer). Adjuvant therapies include chemotherapy, radiation
therapy, targeted therapy, and hormone therapy.
In cases of metastatic cancer, chemotherapy, hormone therapy, or a combination
of both, are generally recommended.
Chemotherapy refers to the
administration of toxic drugs that stop the growth of cancer cells. Chemotherapy
may be given as pills, as an injection, or via an intravenous infusion,
depending upon the types of drugs chosen. Combinations of different drugs are
usually given, and treatment is administered in cycles with a recovery period
following each treatment. Some of the most common chemotherapeutic agents for
treating breast cancer are cyclophosphamide,
methotrexate,
fluorouracil, and
doxorubicin (Adriamycin). In most cases, chemotherapy is administered on an
outpatient basis. Chemotherapy may be associated with unpleasant side effects
including hair loss, nausea and vomiting, and diarrhea.
Radiation therapy uses
high-energy radiation to kill tumor cells. Radiation therapy may be delivered
either externally (using a machine to send radiation toward the tumor) or
internally (radioactive
substances placed in needles or catheters and inserted into the body).
Hormonal therapy prevents
hormones from stimulating growth of cancer cells and is useful when the cancer
cells have binding sites (receptors) for hormones. Male breast cancers usually
have estrogen receptors and are most commonly treated with the drug tamoxifen, which blocks the action of estrogen on the
cancer cells. Side effects of tamoxifen treatment can include hot flashes,
weight gain, mood changes, and impotence.
While estrogen is the most common target of hormonal therapy, studies have
also shown that treatments directed against the actions of male hormones
(anti-androgens) can also reduce the size of male breast cancer metastases. The
reasons why anti-androgens are effective in widespread disease are not fully
understood. Orchiectomy (removal of the testes) was formerly performed to lower
androgen levels, but newer nonsurgical methods are currently favored. Drugs
known as luteinizing hormone-releasing hormone (LHRH) analogs affect the
pituitary gland and result in lowered production of male hormones by the testes.
Targeted therapy involves agents that are designed to specifically target one of the cancer-specific changes in cells. An example of targeted therapy is trastuzumab (Herceptin), a monoclonal antibody that blocks the activity the protein known as HER-2-neu that is made by some breast cancers. This treatment is only used in breast cancers whose cells express the HER-2-neu protein and is given intravenously. Trastuzumab has been shown to be effective in women with breast cancer but has not been extensively tested in men with breast cancer. Similarly, Lapatinib (Tykerb) is a drug taken in pill form that also targets the HER2/neu protein. It is used in combination with other agents to treat HER2-positive breast cancer that is no longer responsive to trastuzumab.
If a cancer that has been surgically removed regrows at
the original site, this is referred to as local recurrence. Locally recurrent
cancers are usually
treated by surgery along with chemotherapy, or radiation therapy combined with
chemotherapy.
Next: What is the outcome (prognosis) of male breast
cancer? »
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