Male Breast Cancer, Sarcomas Of Breast, Pregnancy And Breast Cancer

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.