male breast cancer - treatment and diagnosis

Male breast cancer is a rare malignant tumor, accounting for 0.2% to 1.5% of all male cancers and about 1% of breast cancer. 

In theory, the occurrence of breast cancer is due to the appearance of malignant tumor tissue in breast cells. Men also have breast tissue, so they can also cause breast cancer. 

Just because of the difference in physiological structure, women are much more likely to develop breast cancer than men.


Etiology



1. Familial

In domestic and foreign reports on male breast cancer, there is a considerable proportion of cases in the family, or there is a family history of female breast cancer, or there are cases of other tumors in the family. 

It suggests that the occurrence of male breast cancer has a certain familial nature.


2. Endogenous

Compared with female breast cancer, the increase in estrogen has no physiological activity in male breasts and lacks excessive stimulation of ovarian hormones. 

However, most patients have male breast development, endocrine abnormalities, and liver function damage.


3. Sex chromosome abnormalities

Also, studies have shown that some patients have small testicles, fibrosis of the seminiferous tubules, and glass-like changes. 

Increased pituitary gonadotropins and sex chromosome abnormalities in the urine are called Klinefelter syndrome. 

In this case, the incidence of breast cancer is 20 times higher than normal men.


4. Other

Breast cancer can also be induced by exposure to radioactive materials, local breast damage, and the use of estrogen in clinical treatment.



Clinical manifestations



1. Painless mass

The lump is generally located under the areola, which is exactly where the male breast tissue is concentrated.


2. Chest skin changes

Male breast cancer patients have adhesions on the chest skin or pectoral muscles.


3. Abnormal nipples

20% of male breast cancer patients have nipple inversion, crusting, and retraction.


4. Nipple discharge

Nipple discharge is more likely to occur in male breast cancer patients, without being paid attention to.


5. Lymph nodes

Many newly diagnosed male breast cancer patients can detect the presence of axillary lymph nodes.



An Examination



1. Needle aspiration cytology

Puncture the cells at the breast mass for pathological examination, and severe hyperplasia and suspicious cancer cells can be seen.


2. ER determination

Most ER receptors in male breast cancer are positive.

3. Molybdenum target X-ray inspection

It can be seen that the inverted nipple is funnel-shaped, the areola area is shaded by burr-like masses, and the dense area may have radial blood vessels, or sediment-like calcification points.



Diagnosis

The diagnosis can be confirmed according to the cause, clinical manifestations, and laboratory tests.



Treatment



1. Surgical treatment


  • For patients who have not invaded the pectoral muscles, modified radical surgery is applied.


  • For patients who invade the pectoral muscles, the main operation method is the radical operation or enlarged radical operation. Because tumors located in the areola area are likely to metastasize to the internal mammary area and axillary lymph nodes; therefore, if there is no radiotherapy equipment and there are contraindications to radiotherapy, enlarged radical surgery has a greater indication. If you have the above equipment, you can consider radical surgery, additional radiotherapy after surgery, but carefully choose a modified radical mastectomy for breast cancer; it is not advisable to choose a surgery less than a simple mastectomy.



2. Radiation therapy

Male breast cancer because of its breast characteristics and a rich lymphatic network under the nipple and areola, and the smaller masses occur lymph node metastasis in the internal breast area or underarms.

Therefore, it is necessary to perform radiotherapy for the internal breast area, axilla, supraclavicular and chest wall after surgery. 

Radiotherapy can be divided into postoperative radiotherapy; preoperative radiotherapy; radiotherapy for tumor recurrence.


3. Chemotherapy

Male breast cancer should be supplemented with chemotherapy before surgery, and according to the lymph node metastasis positive and ER-negative patients plus postoperative chemotherapy, it is expected to improve the survival rate. 

According to the theory of cytology, postoperative chemotherapy should be started early, generally not more than 1 month after surgery, and when conditions permit, adhere to chemotherapy within 1 year after surgery.


4. Endocrine therapy

Mainly used for male patients with advanced or relapsed breast cancer.



Prognosis


Male breast cancer patients have the characteristics of high age, long course of the disease, and poor prognosis. 

But if found early and treated in time, the prognosis of treatment tends to be the same as that of women.

The factors that affect the prognosis of male breast cancer are mainly the pathological type, stage, treatment method, and whether there is lymph node metastasis at the time of treatment. 

Most reports believe that compared with the overall 5-year survival rate after treatment, male 5-year and 10-year survival rates are slightly lower than those of women.


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