Cancer treatment team
Many Primary Care Trusts (PCTs) operate multi-disciplinary teams (MDTs) for the treatment of male breast cancer.
A MDT is made up of a number of different healthcare specialists including:
- surgeon,
- a clinical oncologist (a specialist in the non-surgical treatment of cancer using techniques such as hormone therapy and chemotherapy),
- a pathologist (a specialist in diseased tissue),
- a radiologist (a specialist in radiotherapy),
- a social worker,
- a psychologist, and
- a specialist cancer nurse, who will usually act as the first point of contact between you and the rest of the team.
If you have male breast cancer, you may see several, or all, of the above healthcare professionals as part of your treatment.
Deciding what treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that you would like to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.
Staging
Health professionals use a staging system to describe how far male breast cancer has advanced. These stages are outlined below.
- Stage 1 - the cancerous tumour is less than 2cm (3/4 inch) across, and there are no signs that the cancer has spread to the lymph nodes near the armpit.
- Stage 2 - the cancerous tumour is 2-5cm (3/4 to 2 inches) across, and/or there are signs that the cancer has spread to the lymph nodes near the armpit.
- Stage 3 - the cancerous tumour is larger than 5cm (2 inches) across, and has started to move into surrounding tissues, such as muscle and skin and near-by lymph nodes are also affected. However, there is no sign that the cancer has spread beyond the breast and armpit.
- Stage 4 - there are signs that the cancer has spread to other parts of the body, such as the lungs or bones. This is known as secondary, or metastatic, cancer.
In cases of stage 1, 2, and 3 male breast cancer, a cure may be possible. In cases of stage 4 male breast cancer, a cure is unlikely although it may be possible to control the symptoms and slow the spread of the cancer.
Surgery
Surgery is usually the first treatment option for male breast cancer, and usually involves an operation called a modified radical mastectomy. This involves the surgeon removing the entire breast as well as the lymph nodes in the armpit.
It is possible to have reconstructive surgery after a modified radical mastectomy. Tissue can be taken from other parts of your body, such as your lower abdomen, or buttocks, and used to recreate the shape of the breast.
An alternative option is to use breast implants, which are similar to the breast implants that are used in cosmetic surgery. However, they are obviously a lot smaller.
If the appearance of your nipple has been altered, a quick and effective way to restore its normal appearance is to use a tattoo. Nipple tattoos can be created in 30-40 minutes and have a very realistic appearance.
Radiotherapy
Radiotherapy is a treatment that uses a machine which releases high energy waves to destroy cancerous cells. Radiotherapy can be given a few weeks after surgery in order to prevent the return of cancerous cells, or it can be used to control your symptoms when a cure for the cancer is not possible.
Radiotherapy is usually given five times a week over the course of six weeks. The sessions are short and usually only last for a few minutes.
Radiotherapy is not usually painful although you will probably experience some side effects. This is because the energy that is released during radiotherapy can also damage healthy cells.
Common side effects of radiotherapy include:
- fatigue,
- nausea, and
- the skin of the breast becomes sore, red, and irritated (with an appearance that is similar to sunburn).
The side effects of radiotherapy should pass once your treatment course has finished, although some men experience prolonged fatigue for several months.
Hormone therapy
Hormone therapy can be used in cases of male breast cancer where there are oestrogen receptors on the walls of the cancerous cells. This means that the cells can use oestrogen to help them grow and reproduce. Therefore, the aim of hormone therapy is to block the effects of oestrogen.
Tamoxifen
Hormone therapy can be given after surgery to prevent the return of the cancer, or it can be used to slow the spread of incurable cases of male breast cancer.
Tamoxifen is a widely used medication in hormone therapy. It works by blocking the oestrogen receptors so that oestrogen is unable to enter into cancerous cells.
Tamoxifen in available in pill form and most men who are prescribed it are recommended to take one pill a day for five years.
Side effects of tamoxifen include:
- a decrease in sex drive (libido),
- weight gain,
- hot flushes,
- mood alterations, such as irritability, or euphoria (an intense feeling of happiness),
- depression, and
- insomnia.
Aromatase inhibitors
An alternative hormone treatment to tamoxifen is a class of medication that are known as aromatase inhibitors. Aromatase inhibitors may be used if tamoxifen proves to be unsuccessful, or if you find that the side effects of tamoxifen particularly troublesome.
Men’s bodies create oestrogen by converting another hormone called androgens. This conversion is carried out by a protein called aromatase. As their name suggests, aromatase inhibitors block the effects of the aromatase protein which, in turn, lowers the amount of oestrogen in the body.
Aromatase inhibitors are usually given in pill form, and are taken daily for between 2-5 years. As male breast cancer is a rare condition, there is very little available evidence (compared with female breast cancer) regarding what the most effective length of dosage is.
Side effects of aromatase inhibitors include:
- joint pain,
- lack of energy,
- hot flushes,
- skin rashes,
- nausea,
- vomiting, and
- thinning of the hair.
The side effects are usually mild to moderate. It is also unlikely that you will experience all of the side effects that are listed above.
Chemotherapy
Chemotherapy is used to treat cases of male breast cancer where the cancerous cells do not have oestrogen receptors, meaning that hormone therapy would be mostly ineffective. Chemotherapy is usually given after surgery in order to prevent the cancer returning, or it is used to treat the symptoms of incurable cancer.
Chemotherapy for male breast cancer usually involves taking a combination of cancer-killing medications. Treatment is usually given every 2-3 weeks, over the course of six months.
You may be given chemotherapy tablets (oral chemotherapy), or chemotherapy injections (intravenous chemotherapy), or a combination of both.
The side effects of chemotherapy include:
- nausea,
- vomiting,
- diarrhoea,
- loss of appetite,
- mouth ulcers,
- tiredness,
- skin rashes,
- infertility, and
- hair loss.
However, the side effects should resolve once your treatment has finished. Following treatment, your hair should take between 3-6 months to grow back.
