Male breast cancer

Treating breast cancer in men

Treatment for breast cancer in men largely depends on how far the cancer has spread.

Most hospitals use multidisciplinary teams (MDTs) to treat men with breast cancer. These are teams of specialistswho work together to make decisions about the best way to proceed with your treatment.

Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the ideal 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 you'd like to ask the specialist . For example, you could ask aboutthe advantages and disadvantages of particular treatments.

Your treatment plan

Your recommended treatment plan depends on how far the cancer has spread. If the cancer hasn't spread significantly beyond your breast, a complete cure may be possible.

In these cases, surgery to remove the affected breast is usually recommended. This is often followed by Radiotherapy , hormone therapy, or chemotherapy to help prevent the cancer returning.

If the cancer has spread beyond your breast into other parts of your body, such as your lungs, a complete cure won't be possible. However, hormone therapy and chemotherapy can be used to relieve symptoms and slow down the spread of the cancer.

More information about these treatments can be found below.

Surgery

An operation called a mastectomy is usually recommended as the first treatment for breast cancer.

A mastectomy involves removing the entire breast,sometimes with the nipple and lymph nodes (glands) in the armpit. A procedure known as asentinel lymph node biopsy may also be performed.

In some cases, part of the muscle under the breast may also be removed if there's a risk the cancer has spread to this area.

Once surgery has been completed, there will be a straight scar across your chest where your nipple used to be and possibly an indentation around the area where the breast tissue used to be.

After surgery

Most men are well enough to leave hospital one to three days after surgery.

After the operation, it's likely you'll feel very tired and it may take a few weeks before you're well enough to start carrying out relatively strenuous activities, such as lifting objects or driving. Your specialist nurse will be able to offer more specific advice about this.

The wound takes about two to three weeks to heal. It's important to keep the wound clean during this time.

You should look for any signs that the wound may have become infected, such as redness and swelling around the wound or a discharge of pus. Inform your MDT as soon as possible if you suspect an infection.

It's difficult to predict when you'll feel able to return to work. Some people choose to remain off work until other treatments, such as radiotherapy, have been completed.

Others prefer to return to work in between treatments. Your MDT will be able to advise you, but the final decision will be yours.

It can take several weeks to fully recover from the effects of a mastectomy. A structured exercise programme, where the intensity and amount of time spent exercising is gradually increased, will probably be recommended.

Yourtreatment teamwill be able to provide you with more advice or refer you to a physiotherapist (a specialist with training in rehabilitation using exercise).

The Royal College of Surgeons of Englandhas produced a useful leaflet for people who are recovering after having a mastectomy (PDF, 363kb) .

Complications of surgery

Aftersurgery, you may experience numbness or tingling at the site of the scar and in your upper arm. This is common, and iscaused by nerve damage during surgery.

The numbness and tingling should pass within a few weeks or months, although it can occasionally be permanent.

Anotherpossible complication is painful swelling in the arms. This is called lymphoedema , which is caused by the disruption of the lymphatic system (a series of channels and lymph nodes normally responsible for removing excess fluid from tissue).

If many lymph nodes are surgically removed, it can disrupt the lymphatic system's ability to drain fluid, which can lead to swelling.

There's no cure for lymphoedema, but it's possible to control the symptoms using a combination of different techniques, such as massage and compression garments.

See treating lymphoedema for more information.

Radiotherapy

Radiotherapy is a type of treatment involving a machine that releases high-energy waves to destroy cancerous cells. It can be given a few weeks after surgery to prevent the cancerous cells returning.

A typical course of radiotherapy involves two to five sessions a week over the course of three to six weeks. The sessions are short and usually only last for 10 to 15 minutes.

Radiotherapy isn't usually painful, although you'll probably experience some side effects. This is because the energy released during radiotherapy can also damage healthy cells.

Common side effects of radiotherapy can include:

extreme tiredness (fatigue)
feeling sick (nausea)
sore, red and irritated skin on the breast similar in appearance to sunburn

The side effects of radiotherapy should pass after your course of treatment has finished, although some men experience prolonged fatigue for several months.

Radiotherapy can also be used in cases of advanced breast cancer to slow down the spread of the cancer and relieve the symptoms of pain. This is known as palliative radiotherapy.

Palliative radiotherapy is usually given in just one or two doses and doesn't usually cause any side effects.

Hormone therapy

Up to90% of cases of breast cancers in men are oestrogen receptor positive, or ER+. "E" is used because the American spelling of oestrogen is "estrogen".

This means the cancerous cells require oestrogen to grow. Oestrogen is a type of hormone found in low levels in men and much higher levels in women.

The aim of hormone therapy is to block the effects of oestrogen on the breast tissue to prevent the cancer recurring after surgery. It can also be used in cases of advanced breast cancer to slow down the spread of the cancer.

Tamoxifen

Tamoxifen isone of the hormone-blockingmedications widely used for breast cancer. It's available in tablet or liquid form, and prevents oestrogen entering the breast tissue cells.

The ideal length of treatment with tamoxifen is unclear. Studies in women with breast cancer suggest a five-year course of treatment is the most effective for preventing the return of cancer and extending survival rates. However, it's unclear if this also applies to men.

Tamoxifen can also cause unpleasant side effects, which will be taken into consideration when yourtreatment teamis deciding which treatments to recommend. You can discuss the pros and cons of long-term treatment with tamoxifen with your doctors.

Side effects of tamoxifen caninclude:

reduced interest in sex (loss oflibido)
inability to obtain or maintain an erection (erectile dysfunction)
headache
feeling sicktaking your medication with food may help reduce this side effect
changes in mood, such as feeling irritable or depressed

You should inform yourteam if you experience side effects that become particularly troublesome, as alternative medications are available.

Aromatase inhibitors

Aromatase inhibitors are an alternativetype of hormone medication. They may be used if tamoxifen proves unsuccessful or the side effects of tamoxifen are particularly troublesome. Aromatase inhibitors can also be used to slow the spread of advanced breast cancer.

In men, oestrogen is created when a protein called aromatase converts another hormone called androgens. Aromatase inhibitors block the effects of aromatase, which in turn lowers the amount of oestrogen in the body.

Aromatase inhibitors are usually given in tablet form and taken daily for two to five years. As with tamoxifen, there's little available evidence about the most effective length of dosage in men, compared with female breast cancer.

Side effects of aromatase inhibitors can include:

joint pain
lack of energy
hot flushes
skin rashes
feeling sick
being sick
thinning of the hair

However, it's unlikely you'll experience any or all of these side effects.

Chemotherapy

Chemotherapy is used to treat cases of breast cancer where hormone therapy would be largely ineffective because the cancerous cells are not oestrogen receptor positive (ER+).

It's usually given after surgery to help prevent the cancer returning, or it's used to treat the symptoms of incurable cancer.

Chemotherapy for breast cancer involves taking a combination of cancer-killing medications. Treatment is usually given every two to three weeks over the course of six months.

You may be given chemotherapy tablets (oral chemotherapy), chemotherapy injections (intravenous chemotherapy), or a combination of both.

The side effects of chemotherapy can include:

feeling sick
being sick
diarrhoea
loss of appetite
mouth ulcers
tiredness
skin rashes
infertility
hair loss

The side effects should resolve once your treatment has finished.Your hair should grow back about three to six monthsafter treatment.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. It's important totell your MDT aboutany symptoms of a potential infection, such as:

a high temperature of 38C (100.4F) or above
flu-like symptoms, such as chills or joint pain
a general sense of feeling unwell

You should also avoid close contact with people known to have an infection.

If you're sexually active, you should use a condom for 48 hours after receiving a dose of chemotherapy medication. This is because the medication used in chemotherapy could pass into your semen and cause irritation in the tissue of your partner's genitals.

You should avoid having children while receiving chemotherapy as many of the medications can damage your sperm and increase your chances of having a baby with a birth defect. Again, using a reliable method of contraception, such as a condom, is recommended

Depending on the medications used, it may be several months after your course of chemotherapy has ended before you can safely have children. Your MDT will be able to give you a more detailed recommendation.

Biological therapy

Biological therapy uses medication to block the effects of a protein called human epidermal growth factor receptor 2 (HER2) in cases where HER2 is contributing to breast cancer.

Biological therapies are sometimes referred to as targeted therapies because they are designed to target biological processes that cancers rely on to grow and reproduce.

If you have high levels of the HER2 protein andare able to have biological therapy, you'll probably be prescribed a medicine called trastuzumab.Also known by the brand name Herceptin, itis usually used after radiotherapy or chemotherapy to prevent cancerous cells returning.

Trastuzumab

Trastuzumab is a type of biological therapy known as a monoclonal antibody. Antibodies occur naturally in the body and are created by the immune system to destroy harmful cells, such as viruses and bacteria. The trastuzumab antibody targets and destroys cancer cells designed to respond to the HER2 protein.

Trastuzumab is given through a drip, directly into a vein (intravenously). You'll receive the treatment in hospital. Each treatment session takes up to one hour, and the number of sessions you need depends on whether your breast cancer is in its early or more advanced stages.

On average, for early breast cancer you'll need to have a session once every three weeks, and for more advanced cancer you'll need to have weekly sessions.

Trastuzumab can cause side effects, including heart problems. This means it's not suitable if you have a heart problem, such as angina , uncontrolled high blood pressure (hypertension), or heart valve disease.

If you need to take trastuzumab, you'll need to have regular tests on your heart to ensure it's not causing any problems.

Other side effects of trastuzumabcan include: