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Treatments and drugs
By Mayo Clinic staffBreast cancer in men is generally treated the same as it is in women. In most cases no one right treatment exists. Instead, you'll want to find the approach that's best for you. To do that, you'll need to consider many different factors, including the stage of your cancer and your age.
Before making any decisions, learn as much as you can about the many treatment options. Talk extensively with your health care team. Consider a second opinion. Don't be afraid to ask questions. In addition, look for breast cancer books, Web sites, and information from organizations such as the American Cancer Society and Susan G. Komen for the Cure. Talking to others who have faced the same decision also may help. This may be the most important decision you ever make.
Treatments exist for every type and stage of breast cancer. Some men may need only surgery. Others will need surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy.
Surgery
Breast-sparing procedures are often an option for women, but are not typically feasible for men. This is because a man's breast doesn't contain much tissue, so removing the cancer usually means removing all of the breast. Breast cancer operations include the following:
- Simple mastectomy. During a simple mastectomy, your surgeon removes all of your breast tissue — the lobules, ducts, fatty tissue, and a strip of skin with the nipple and areola. Depending on the results of the operation and follow-up tests, you may also need treatment with radiation to the chest wall, chemotherapy or hormone therapy.
- Modified radical mastectomy. Most men with breast cancer require a modified radical mastectomy. In this procedure, a surgeon removes your entire breast and some underarm (axillary) lymph nodes, but leaves your chest muscles intact. If the cancer has spread into the chest wall, your doctor may need to do a radical mastectomy that removes the chest wall muscles. Serious arm swelling (lymphedema) is more likely to occur in modified radical mastectomy than in simple mastectomy with sentinel node biopsy. Your lymph nodes will be tested to see if the cancer has spread. Depending on those results, you may need further treatment.
- Sentinel lymph node biopsy. Breast cancer first spreads to the lymph nodes under the arm. That's why you need to have these nodes examined. If your surgeon doesn't plan to do this, be sure you understand the reason. Until recently surgeons would remove as many lymph nodes as possible. But this greatly increased the risk of numbness, recurrent infections and serious swelling of the arm. That's why a procedure has been developed that focuses on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to develop cancer. If a sentinel node is removed, examined and found to be healthy, the chance of finding cancer in any of the remaining nodes is very small, and no other nodes need to be removed. This spares the need for a more extensive operation and decreases the risk of complications. It's important that the procedure be performed by an experienced team.
Radiation therapy
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. It's administered by a radiation oncologist at a radiation center. It may be used to shrink the tumor before surgery or to eliminate any remaining cancer cells in the breast, chest muscles or armpit after surgery.
Most men who undergo radiation therapy for breast cancer receive external beam radiation. In this procedure you receive radiation directed at the cancerous area from a machine outside your body. Radiation is usually started three to four weeks after surgery, to allow some time for your body to heal.
If your doctor recommends chemotherapy, the radiation will be delayed until all of the chemotherapy treatments are completed. You'll typically receive treatment five days a week for about six consecutive weeks. The treatments are painless, and each treatment takes just a few minutes. The effects are cumulative, however, and you may become quite tired toward the end of the series. Your breast may be pink, puffy and somewhat tender, as if it had been sunburned.
Chemotherapy
Chemotherapy uses drugs to destroy cancer cells. Your doctor may recommend chemotherapy after surgery to kill any cancer cells that may have spread outside your breast. Treatment often involves receiving two or more drugs in different combinations. These may be administered intravenously, in pill form or both. You may have treatments every two or three weeks for three to six months.
For many people, chemotherapy can feel like another illness. The side effects may include hair loss, nausea, vomiting and fatigue. These effects occur because chemotherapy affects healthy cells — especially fast-growing cells in your digestive tract, hair and bone marrow — as well as cancerous ones. Not everyone has side effects, however, and there are now better ways to control some of them.
New drugs can help prevent or reduce nausea. Relaxation techniques, including guided imagery, meditation and deep breathing, also may help. In addition, exercise has been shown to be effective in reducing fatigue caused by chemotherapy.
One side effect of chemotherapy that has only recently been described is called "chemobrain." This refers to the difficulties some patients have with thinking or concentrating while receiving chemotherapy or after. It's uncertain how commonly this occurs, or if this is even due to the chemotherapy. Many people who receive chemotherapy don't experience this side effect. Those who do may have difficulty with word finding, memory, multitasking and learning new things. Studies suggest it may effect between 20 percent and 30 percent of people undergoing chemotherapy. There's no way to predict who will experience this mild cognitive impairment, and it's not clear whether the treatment or the cancer is the actual cause of chemobrain.
In 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. Some chemotherapy medications have the potential to damage the heart.
Hormone therapy
Estrogen receptor positive cancer means that estrogen might encourage the growth of breast cancer cells in your body. Estrogen is present in men, though in smaller amounts than in women. But 90 percent of breast cancers in men have estrogen receptors. Normally estrogen binds to certain cells in your breast and in other parts of your body. Hormone-blocking agents such as tamoxifen block this binding of estrogen to those receptors. This may help destroy cancer cells that have spread or reduce the chances that your cancer will recur.
The primary medication used to reduce the effect of estrogen in your body is tamoxifen (Nolvadex). This synthetic hormone belongs to a class of drugs known as selective estrogen receptor modulators (SERMs). It's used as a treatment for men with hormone-sensitive metastatic breast cancer and as an adjuvant therapy for men with early-stage estrogen receptor positive breast cancer. You take tamoxifen daily, in pill form, for five years.
The male hormones — androgens — also play a role in the growth of breast cancer in men, although the role is unclear. Limiting androgens through the use of certain drugs does appear to effectively reduce the spread of the cancer. These drugs include:
- Luteinizing hormone-releasing hormone analogues. These drugs cause the testicles to reduce their androgen production.
- Anti-androgen drugs. Anti-androgens block the effect of male hormones on breast cancer cells.
Side effects of hormonal therapies may include hot flashes, decreased sexual desire, loss of erection, weight gain and mood swings.
A new group of hormonal therapy medications called aromatase inhibitors (anastrozole, exemestane and letrozole) are used to treat hormone-sensitive breast cancer in postmenopausal women. At this time, no data exist as to the usefulness of these medications in the treatment of male breast cancer.
Herceptin therapy
One new medication, trastuzumab (Herceptin), is a monoclonal antibody that attacks and blocks the activity of a certain protein made by some breast cancers. Only about one-third of breast cancers make too much of this protein called HER-2-neu. This protein stimulates the cancer cells to grow. Trastuzumab binds onto this protein and blocks its effect and kills the cancer cells. This treatment only works in those breast cancers that make too much HER-2-neu. Side effects of trastuzumab are uncommon, but may include heart problems, fever, chills, nausea and vomiting, weakness, diarrhea and headache.
Biological therapy
Sometimes called biological response modifier or immunotherapy, this treatment tries to stimulate your body's immune system to fight cancer. Using substances produced by the body or similar substances made in a laboratory, biological therapy seeks to enhance your body's natural defenses against specific diseases. Many of these therapies are experimental and available only in clinical trials.
