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Male breast cancer
|Disease:||Male breast cancer|
Just like women, men also have breast tissue that can undergo cancerous changes. Any man can develop breast cancer despite the fact that women are about 100 times more likely to get breast cancer. Between the ages of 60 and 70, male breast cancer is most common.
The prognosis for breast cancer in men is the same as for breast cancer in women. Male breast cancer used to be diagnosed at a more advanced stage, which may have led people to believe it had a worse prognosis. Important distinctions such as breast size and awareness affect early diagnosis and survival in cases of male breast cancer despite the fact that male breast cancer and breast cancer in women are similar.
The earlier the disease is discovered, the more treatment options and the better chances of recovery. So knowing the signs and symptoms of breast cancer may help save one's life.
A thickening or lump in the breast is the most common sign of breast cancer for both men and women. The lump is often painless. Other symptoms for male breast cancer include:
The group of abnormal cells that grow more rapidly than normal cells is called cancer. Either by growing directly into surrounding structures or after traveling to another part of the body through the lymphatic system or bloodstream, cancer cells have the ability to invade and destroy normal tissues. The microscopic cancer cells form small clusters that continue to grow, becoming harder and more densely packed.
What triggers abnormal cell growth in breast tissue in men is not clear in most cases. Compared with about 5% to 10% of breast cancers in women, about one in six cases of breast cancers in men are inherited. The risk of developing breast cancer is greater when someone has defects in the breast cancer gene 1 or 2 (BRCA 1 or BCRA 2). The risk of developing breast cancer may be increased by inherited genes. To determine one's chance of inheriting an abnormal gene, it's important to know one's family history.
Most genetic mutations related to breast cancer develop during one's lifetime, so they are not all inherited. Radiation exposure, such as receiving chest radiation therapy in childhood, or other factors that are yet not known, may result in these acquired mutations.
It doesn't necessarily mean that a person will develop breast cancer when having one or even several risk factors, because some men with no identifiable risk factors get breast cancer, while others with more than one risk factor never do.
Below are some of the factors that make people more susceptible to breast cancer:
Nearly 20% of male breast cancers are inherited. The risk of developing breast and prostate cancer is greater when having defects in one of several genes, especially BRCA 1 or BRCA2. By making proteins that keep cells from growing abnormally, these genes usually help prevent cancer. However, the genes aren't as effective at protecting a person from cancer if he has a mutation.
About 100 times more than other men's risk, men with a BRCA2 mutation have a 6% lifetime risk of breast cancer. It's more likely that a person will develop breast cancer if he has inherited mutations in the cell-cycle checkpoint kinase 2 (CHEK-2) gene and the p53 tumor suppressor gene.
Because obesity increases the number of fat cells in the body, it may be a risk factor for breast cancer in men. Increasing the amount of estrogen in the body and, therefore, the risk of breast cancer, fat cells convert androgens into estrogen.
A congenital abnormality of the sex chromosomes X and Y may cause breast cancer in men. Normally, a male has only one X and one Y chromosome. In addition to one Y chromosome, two or more X chromosomes are present in Klinefelter's syndrome. The genetic material that determines the sex of a child and related development is contained in the Y chromosome.
Abnormal development of the testicles is caused by the extra X chromosome that occurs in Klinefelter's syndrome. So, men with this syndrome produce lower levels of the male hormone androgen and more female hormone estrogen, which can cause noncancerous breast growth (gynecomastia).
Breast cancer is usually diagnosed in men between the ages of 60 and 70, with an average age range of 65 to 67.
Exposure to estrogen:
The risk of breast cancer is much higher if one takes estrogen-related drugs, such as those used as part of a sex change procedure. In hormone therapy for prostate cancer, estrogen drugs may also be used. Though not enough to outweigh the benefit of treating prostate cancer, the risk of breast cancer may be slightly increased by such drugs.
One has a greater chance of also developing the disease if he has a close relative, such as a mother or a sister, with breast cancer. Though about one in five men with breast cancer have a relative who's had it too, but it doesn't mean it is hereditary just because one has a family history of breast cancer.
Excessive use of alcohol:
The risk of breast cancer is greater if one drinks heavy amounts of alcohol.
The body's androgen activity may be reduced and its estrogen activity increased if one has liver disease, such as cirrhosis. The risk of gynecomastia and breast cancer can be increased by this.
A person is more likely to develop breast cancer later in life in case he has received radiation therapy to his chest as a child or young adult.
Generally, breast cancer in men is treated the same as it is in women. The patient should find the approach that's best for him because in most cases, there is no one right treatment. In addition to the stage of one's cancer and his age, he'll need to consider many different factors to find the best approach for him.
One should learn as much as he can about the many treatment options before making any decisions, talk extensively with the health care team, consider a second opinion, look for breast cancer books, Web sites, and information from organizations, and talk to others who have faced the same decision. This may be the most important decision one ever makes.
There are specific treatments for every type and stage of breast cancer. Some men may need surgery and an additional (adjuvant) therapy such as hormone therapy, chemotherapy or radiation. Others may need only surgery.
Because a man's breast doesn’t contain much tissue – thus removing the cancer usually means removing the entire breast - breast-sparing procedures are often an option for women, but are not typically feasible for men. The following are some of the available breast cancer operations for men:
Sentinel lymph node biopsy:
The lymph nodes under the arm is where breast cancer first spreads. Because of this, a person needs to have these nodes examined. One should understand the reason if the surgeon doesn't plan to do this. Until recently, surgeons used to remove as many lymph nodes as possible. However, removing the lymph nodes increases a person’s risk of serious swelling of the arm, recurrent infections and numbness. Because of this, a procedure has been developed that focuses on finding the sentinel nodes, which are the first nodes to develop cancer because they are the first ones to receive drainage from breast tumors. The chances of finding cancer in any of the nodes will be very small in case a sentinel node is removed, examined and found to be healthy. Only an experienced team should perform this procedure.
Modified radical mastectomy:
A modified radical mastectomy is required by most men with breast cancer. The entire breast and some underarm (axillary) lymph nodes is removed in this procedure, however, the chest muscles are left intact. The doctor may need to do a radical mastectomy that removes the chest wall muscles if the cancer has spread into the chest wall. In modified radical mastectomy, serious arm swelling (lymphedema) is more likely to occur than in simple mastectomy with sentinel node biopsy. To see if the cancer has spread, the lymph nodes will be tested. The patient may need further treatment depending on those results.
The surgeon removes all of the breast tissue in this procedure, including the lobules, ducts, fatty tissue, and a strip of skin with the nipple and areola. One may also need treatment with hormone therapy, chemotherapy or radiation to the chest wall, depending on the results of the operation and follow-up tests.
The monoclonal antibody that attacks and blocks the activity of a certain protein called HER-2-neu made by some breast cancers is a medication called trastuzumab. However, only about one-third of breast cancers make too much of HER-2-neu that stimulates the cancer cells to grow. Trastuzumab binds onto this protein and blocks its effect and kills the cancer cells. Only in the breast cancers that make too much HER-2-neu do this treatment work. Headache, diarrhea, weakness, nausea and vomiting, chills, fever and heart problems may be included in the uncommon side effects of trastuzumab.
This treatment tries to stimulate the body's immune system to fight cancer and it's sometimes called biological response modifier or immunotherapy. Biological therapy seeks to enhance the body's natural defenses against specific diseases using substances produced by the body or similar substances made in a laboratory. Many of these therapies are experimental and available only in clinical trials.
Medications are used in chemotherapy in order to destroy cancer cells. To kill any cancer cells that may have spread outside the breast, the doctor may recommend chemotherapy after surgery, in which case the patient will Receive two or more drugs in different combinations that could be administered in intravenously, in pill form, or both. Every two or three weeks for three to six months, the patient may have treatments.
Chemotherapy can feel like another illness for many people. Fatigue, vomiting, nausea and hair loss may be some of its side effects. These occur because chemotherapy affects healthy cells, especially fast-growing cells in the digestive tract, hair and bone marrow, as well as cancerous ones. There are now better ways to control some of them, in addition to the fact that not everyone has side effects.
Nausea can be reduced or prevented by new drugs. Deep breathing, meditation and guided imagery are included in relaxation techniques that may help. And in reducing fatigue caused by chemotherapy, exercise has been shown to be effective.
"Chemobrain" is one side effect of chemotherapy that has only recently been described; it refers to the difficulties some patients have with thinking or concentrating while or after receiving chemotherapy. How commonly this occurs or if this is even due to the chemotherapy is still not known. This side effect is not experienced by many people who receive chemotherapy. However, those who do may have difficulty learning new things, multitasking, memory and word finding. Some studies have suggested that this side effect may affect between 20% and 30% of people who are undergoing chemotherapy. Whether the treatment or the cancer is the actual cause of chemobrain is not clear, and there's no way to predict who will experience this mild cognitive impairment.
Some chemotherapy medications have the potential to damage the heart and in some rare cases, certain chemotherapy medications may lead to cancer of the white blood cells (acute myeloid leukemia), usually within one to two years after treatment ends.
Estrogen receptor positive cancer means that estrogen might encourage the growth of breast cancer cells in the body. Estrogen is present in men in smaller amounts than in women. However, 90% of breast cancers in men have estrogen receptors. Estrogen normally binds to certain cells in the breast and in other parts of the body. Tamoxifen and other hormone-blocking agents block this binding of estrogen to those receptors. This may reduce the chance that the cancer will recur or may help destroy cancer cells that have spread.
Tamoxifen is the primary medication used to reduce the effect of estrogen in the body. This synthetic hormone belongs to a class of drugs known as selective estrogen receptor modulators (SERMs). It's used as an adjuvant therapy for men with early-stage estrogen receptor positive breast cancer and as a treatment for men with hormone-sensitive metastatic breast cancer. For five years, the patient takes tamoxifen daily in pill form.
Although the role is unclear, the male hormone androgen also plays a role in the growth of breast cancer in men. Through the use of certain drugs, limiting androgens appears to effectively reduce the spread of the cancer. These drugs include:
Mood swings, weight gain, loss of erection, decreased sexual desire and hot flashes may be included in the side effects of hormonal therapies.
To treat hormone-sensitive breast cancer in postmenopausal women, a new group of hormonal therapy medications called aromatase inhibitors are used. In the treatment of male breast cancer, no data exist as to the usefulness of these medications at this time.
To kill cancer cells and shrink tumors, radiation therapy uses high-energy X-rays, which is administered by a radiation oncologist at a radiation center. To eliminate any remaining cells in the armpit, chest muscles or breast after surgery, or to shrink the tumor before surgery, radiation therapy may be used.
External beam radiation is received by most men who undergo radiation therapy for breast cancer. Radiation is directed at the cancerous area from a machine outside the patient's body in this procedure. To allow some time for the patient's body to heal, radiation is usually started three to four weeks after surgery.
The radiation will be delayed until all of the chemotherapy treatments are completed in case the doctor recommends chemotherapy. Radiation therapy is typically received five days a week for about six consecutive weeks. Each treatment takes just a few minutes, and the treatments are painless. However, the patient may become quite tired toward the end of the series as the effects are cumulative. And as if the breast had been sunburned, it may be somewhat tender, puffy and pink.
Dr. Talal Sabouni
Dr. Hani Najjar
Dr. Faisal Dibsi
Yaser Habrawi , F.R.C.S.Ed
Samir Moussa M.D.
Dr. Tahsin Martini
Dr. Samer Al-Jneidy
Dr . Dirar Abboud