How Serious Is a Phyllodes Tumor?

Phyllodes tumors are types of breast tumors that arise in the breast's connective called the stroma. Phyllodes tumors are commonly seen in women in their 40s but can be found in any age group. These tumors are mostly seen in women more than in men, and most are noncancerous (benign).

Phyllodes tumors are classified into three categories:

1. Benign: More than half of the phyllodes tumors are benign and do not spread to other organs.
2. Borderline: These tumors have mixed features of both benign and malignant tumors.
3. Malignant: Cancerous tumors that account for one in four phyllodes tumors. These tumors grow very fast and spread to other body parts, and they are most likely to come back after the treatment.

The exact cause of phyllodes tumors is unknown, but experts believe the following factors increase the risk and growth of phyllodes tumors in women:

• Women with a rare genetic disorder called Li-Fraumeni syndrome
• Injury
• Breastfeeding
• Pregnancy
• Increased levels of a female hormone called estrogen

The first sign of phyllodes tumors is a lump in the breast.

• The lump may be firm and painless, but a few may be painful.
• They may grow quickly, and the bulge may be visible under the skin.
• The skin over the lump may be warm and red.
• There may also be skin ulceration over the lump. 

Very few people may have symptoms such as bloody nipple discharge, nipple ulceration, and nipple inversion.

A benign phyllodes tumor does not affect the risk of breast cancer. Malignant phyllodes tumors may carry a high risk of recurrence after surgery, but they do not affect your risk of getting other types of breast cancer.

The phyllodes tumors are mostly benign tumors, but they may require surgical treatment. Sometimes, these tumors may be malignant and require aggressive treatments.

Surgical methods

• Wide excision surgery: The phyllodes tumor is removed along with some healthy tissue in this surgery. This prevents the risk of recurrence of the tumor.
• Lumpectomy: In this procedure, the tumor is removed along with 1 cm of healthy tissue surrounding the lump, and then the tissue is examined under a microscope to check if all the tumor cells are removed. If the pathologist suspects any tumor cells that may be left in the breast, surgery has to be done to remove the wider portion of the breast tissue.
• Mastectomy: This is done when the tumors are malignant or if there are very large benign lumps. A part or whole breast is removed in this procedure. Breast reconstruction can be done later or at the same time.

Nonsurgical procedures

• Radiation therapy and chemotherapy: This may be done in case of malignant tumors. They may be combined with surgery or done alone.
• Follow-up treatment: Get regular checkups or mammograms as scheduled by your doctor.

It can be tricky to diagnose a phyllodes tumor as it may mimic other breast tumors. For example, it can mostly be confused with benign fibroadenomas. Fibroadenomas are the most common breast tumors. But there are a few differences between phyllodes tumors and fibroadenomas.

• Phyllodes tumors grow very fast in just a few weeks and months, whereas fibroadenomas tend to grow slowly.
• Another difference is that phyllodes tumors are mostly seen in the 40s, whereas fibroadenomas are seen in younger people in the age group of 20 to 30 years.

The diagnostic methods include:

• Mammogram: X-rays of the breast that are used for the early detection of abnormalities. The phyllodes tumor lumps or growth are clearly defined and round in shape. Some tiny flecks of calcium may also be noticed inside the lump.
• Ultrasound: A diagnostic method also called sonography, where sound waves are used to produce images of structures inside your body.
• MRI: This may help provide detailed pictures of the tumor.
• Needle biopsy: The doctor takes a small tissue sample from the lump using a needle and checks it under a microscope for signs of malignancy.
• Excisional biopsy or lump removal: Most doctors may do this test to confirm whether the tumor is benign, malignant, or borderline. In this method, the whole lump is removed for the diagnosis.