Surgery: Surgery remains the initial and primary treatment for breast cancer in men. After biopsy has established a diagnosis of breast cancer, stage I and II patients may be treated with modified radical mastectomy, which involves mastectomy and a sampling of axillary nodes, if positive, then an axillary node dissection is performed.
Radiation Therapy: Another very common procedure is radiation therapy (radiotherapy), this treatment option uses high energy x-rays to kill cancer cells and shrink tumors. Radiotherapy is also used for spread prevention (adjuvant) after mastectomy in patients with advanced tumors or where there are a large number of axillary nodes involved.
Even in the early stages of the male breast cancer disease, cancer cells can metastasize. These cells usually do not cause symptoms, and more importantly often do not show up on x-rays, and cannot be felt during a physical examination. If left untreated, however, these cells can later establish new tumors elsewhere in the body. Systemic treatment of patients who have no evidence of cancer spread but are at risk for developing it is called adjuvant therapy. The goal of adjuvant therapy is to kill undetected cancer cells that have moved from the breast using radiation and chemotherapy especially for locally advanced cancers or cancers that have spread to one or more lymph nodes.
Hormonal Therapy: The presence or absence of ERs and PRs– intracellular receptors is very important in understanding the biological behavior of breast cancer in men and potential responsiveness to hormonal therapy. About 76% of male breast cancers are ER-positive (sensitive) and 83% are PR-positive. Just like in women, male breast cancers that do not have these receptors, that is they are ER/PR negative are generally considered more aggressive and less responsive to hormonal therapy.
There are different types of hormonal agents that can be used in the treatment of male breast cancer.
Tamoxifen: This is one of the most widely used drugs for hormonal therapy; it is a member of a class of medications known as selective estrogen receptor modulators. In the breast, tamoxifen is an estrogen inhibitor and this is why it is the treatment of choice for most men with hormone receptor (HR)–sensitive breast cancer. In adjuvant (preventive) treatment, 20 mg of tamoxifen is taken orally for about five years (based on your doctor’s recommendation).
Common side effects of Tamoxifen include fatigue, hot flashes, and impotence.
While tamoxifen is the gold standard when applying hormonal treatment, other types of hormones may also be used. These include:
Aromatase inhibitors like anastrozole, exemestane, letrozole that block the conversion of testosterone to estrogen. The effectiveness of these type of hormone therapy for breast cancer in men is still being studied. Side effects include bone related conditions like osteoporosis, and bone fractures
Luteinizing hormone-releasing hormone (LHRH) agonists such as leuprolide and goserelineffectively reduce the spread of cancer by acting on the pituitary gland and causing the testes to decrease their production of androgens (androgens are thought to have a role in some male breast cancer). LHRH agonists are usually administered by injection. Another approach is to combine Aromatase inhibitors with LHRH agonists for breast cancer in men, this is currently being studied via clinical trials.
Megestrol is used rarely and only after other agents have been tried for the treatment of breast cancer in men because we are still not sure exactly how it works.
Side effects include blood clots and weight gain from increased appetite.
Biological Therapy: In addition to hormone therapies, male breast cancers are also screened for the expression of the HER2 (human epidermal growth factor receptor 2) gene. According to the American Association for Cancer Research these genes occur normally in cells for cell growth regulation, however in a small fraction of breast cancers, instead of having two gene copies of the HER2 gene there are multiple copies. In these cases, tumors grow faster, are more aggressive and are less sensitive to both chemotherapy and hormone therapy. In men, recent studies show a lower percentage of breast cancers having an overexpression of the HER2 gene. Typical treatment is usually Trasuzumab (Herceptin) or Lapatinib (typically in combination with capecitabine
Bengala et al , describe side effects of Trasuzumab as cardiotoxicity (decreased ejection fraction and heart failure), fever, chills, nausea and vomiting, weakness, diarrhea, and headache.
common side effects of Lapatinib are diarrhea, dizziness, rash, and hand–foot syndrome (which may lead to numbness, tingling, redness, swelling, and discomfort in the hands and feet). Clinical trials are currently investigating the usage of both of these agents for male breast cancer.