Male breast cancer

sarcomas of breast
pregnancy and breast
cancer
 Male breast cancer

• Rare
• Age 60-70 years.
• Etiology: genetic, testicular or liver disease,
gynecomastia, radiation etc.
 Diagnosis & staging
same as in women
 surgery
Modified radical mastectomy/ radical
mastectomy.
Breast conservation is not considered.
Incision should encompass the tumour and the
nipple.
Do not hesitate in placing unconventional
incisions or using flaps.
Keep the incision below the anterior axillary fold.
 Radiation therapy
• Indications are same as in female breast
cancer.
• T2 disease is under controversy but there is no
proven benefit.
 Hormonal treatment
• Almost 90% of male breast cancers are either
esterogen or progesteron receptor positive!
• Sequential.
• Anti esterogens.
• Orchidectomy/ LHRH analogoues.
• Aromitase inhibitors?
 chemotherapy
• The drugs and combinations are the same.
 Primary Sarcomas of breast
• Liposarcoma, angiosarcoma, leiomyosarcoma
etc.
• These behave in the same manner as
sarcomas in other parts of the body.
• Treated with chemotherapy in the same
manner.
• Hematogenous spread to lungs.
 Malignant phyllodes

• Benign.
• Borderline.

• Malignant phyllodes based on degree of

stromal cellular atypia, mitotic activity, stromal
overgrowth and infilterative vs circumscribed
margins.
 Malignant phyllodes

• This is treated with wide margins.

• Radiation is added after a recurrence.
• Chemotherapy is given on similar lines as
sarcoma and generally advised in metastatic
setting.
 Metaplastic carcinoma
• When ductal type of invasive carcinoma shows
appearance other than epithelial and glandular.
• Two types:
• Spindle cell variant or sarcomatoid variant.
• The sarcomatoid variant has acquired the
immunophenotype e.g. vimentin positive.
• Surgery here includes axillary dissection.
• Systemic treatment is platinum based.
 Pregnancy & breast cancer
• when malignancy is diagnosed while one is
preg. or within one year after delivery.
• Guinee et al studied 407 patients and found
that the relative risk of dying decreased by 15%
each year upto four years from pregnancy,
when it becomes almost at par. Similar results
from MSKCC, Denmark etc.
• There are reports where survival have been
found comparable in node neg group.
• 0.2 to 3.8% of all primary breast malignancies
are diagnosed during pregnancy. This is on the
rise.
• There is two fold higher chance of nodal
disease at the time of diagnosis and 2.5 fold
more chance of distant metastasis.
• This is due to more aggressive growth due to
biologic effects of preg or due to delay in
diagnosis due to preg. or both is not known.
 Staging work up
• Effects on organogenesis (4cGy).
• Risk of childhood malignancy (1cGy).
• X-ray chest with abdominal shielding.
• Ultrasound abdomen.
• Bone scan with indweling catheter (s. alkaline
phosphatase).
• MRI without contrast should be safe.
• Sentinal node sampling.
 Local treatment
• Safety of surgical procedure and anaesthesia is
well established.
• Selection of anesthetic agents is advisable.
• There are few reports on IUGR.
 Local treatment

• Radiation therapy must be avoided.

• There are case reports on safely delivered
radiation therapy and the fetus. But, based on
the knowledge from radiation exposures,
acceptable doses and the exposure methods it
cannot be recommended.

• Is BCS out?
 Systemic treatment
• No hormonal treatment during pregnancy.
• Maximum damage is caused during first
trimester sp with antifolates and
antimetabolites.
• Most of the drugs e.g. adriamycin,
cyclophosphamide, 5fu, taxanes can be safely
given in second and third trimester.
• However sor a safe outcome good coordination
is required with the obs team.
 What to recommend
• Terminate pregnancy in first trimester and
focus on breast cancer treatment.
• Radiation and hormonal treatment not to be
given during preg.
• Chemotherapy and surgery to be carried out
with extra care and caution.
• Breast conservation to be safely and judiciously
offered to the patients.
• It should be an informed decision by the
patient.
 Pregnancy after breast cancer
• No issues.
• Generally wait for two years, and counsel
patients depending on stage.
NCI consensus statement
THANKS

for your valuable time.