Treatment of Cancer of the breast, male

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Treatment options depend on how advanced the cancer is when it is diagnosed. The team at the hospital will offer support, give information, and discuss which treatments are likely to be most effective.

Surgery
Men cannot usually have a lumpectomy (where only the lump is removed) because there is so little tissue in the breast, and the cancer is usually near the nipple. Generally a mastectomy (operation to remove the whole breast) is performed. Usually nearby lymph nodes (for example, under the arm) are also removed in case the cancer has spread.

Radiotherapy
After surgery, patients will be offered radiotherapy to the breast area to destroy any cancer cells that may remain and ensure that the cancer does not return. However, sometimes cancer cells can separate off from the cancer in the breast and travel to other parts of the body via the blood or lymphatic system. These areas may be too small to be seen on scans. For this reason, doctors often suggest that patients should also have some sort of extra treatment. The idea behind this treatment is to prevent or delay the chances of the cancer coming back. This treatment is called adjuvant therapy and may include hormone therapy, chemotherapy or both.

Chemotherapy
Some men will be offered chemotherapy after surgery and radiotherapy. This is given to treat any active cancer cells that may be left behind anywhere in the body. The decision on whether to use chemotherapy will depend on the size of the cancer, its appearance under the microscope and the presence of spread to lymph nodes under the arm. Patients will need to discuss the risk of the cancer coming back together with the advantages and disadvantages of chemotherapy. Chemotherapy drugs are the same as those given to women.

Hormone therapy
Most breast cancer needs female hormones to grow. Men have a little oestrogen in their blood, although some men with breast cancer seem to have a higher than average amount. Drugs can be used to reduce the amount of oestrogen: tamoxifen prevents oestrogen entering the cells, and aromatase inhibitors such as letrazole block the formation of oestrogen.

Deciding which treatment is best
Many men with advanced breast cancer would respond to any of several treatments. However, some men respond better to some treatments than others. A specialist will look at many factors before recommending any treatment. These include:

Where the cancer has spread. If the cancer has come back to the breast or if it has spread to the bone or parts of the brain, surgery may be an option. If the cancer has spread to the lymph nodes, bones or skin then hormone treatment is often tried. Chemotherapy may be used if the cancer is growing very quickly or if the hormone therapy stops working. If the cancer has spread to the liver or lungs, then chemotherapy is often tried first. Radiotherapy works well if the cancer has spread to the bones, parts of the brain, eyes, lymph nodes or locally near the original cancer.
Whether or not the cancer cells have special proteins on their surfaces called hormone receptors. Cancers where the majority of cells have these receptors are more likely to respond well to hormone therapy. This test can be performed on cancer cells removed through a biopsy.
How rapidly the cancer is growing.
What treatment was used for the cancer when it was first diagnosed.
Whether or not the cancer cells have special proteins, known as HER2 receptors, on their surfaces. If this is the case, a new treatment called herceptin may be useful.

Doctors will discuss how much each man can expect to be helped by treatment and what might happen if he had no extra treatment. They can then balance the benefits against the chance of side effects and come to a decision about whether they have the extra treatment or not.