Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too.

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1 Male Breast Cancer Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too. Many people do not know that men can get breast cancer. It is usually found in men between 60 and 70 years of age. Male breast cancer makes up less than 1% of all cases of breast cancer. This reference summary will help you understand male breast cancer. It talks about the diagnosis and treatment options of this type of cancer. Breast Anatomy The breast is made up of: Lobules, or lobes, which are sections of the breast. Ducts, or channels leading from the lobules. A nipple and areola. Fatty tissue. Connective tissue. Blood vessels. Lymph vessels. Before puberty, young boys and girls have a small amount of breast tissue. This tissue has a few ducts under the nipple and areola. The areola is the area around the nipple. Lobes Ducts Nipple Fatty Tissue During puberty, a girl's ovaries make female hormones that cause breast ducts to grow. Lobules form at the ends of ducts. The amount of fatty tissue increases. In boys, hormones made by the testicles keep breast tissue from growing too much. Men's breast tissue has ducts and very few, if any, lobes. Last reviewed: 03/26/2013 1

2 Male Breast Cancer The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing without control. This causes an abnormal growth. The growth is also called a tumor. If the tumor does not invade nearby tissues and body parts, it is called a benign tumor. It is also called a non-cancerous growth. They often are not life threatening. If the tumor invades and destroys nearby cells, it is called cancer. It is also called a malignant tumor. Cancer cells may also spread to different parts of the body through blood vessels and lymph channels. Lymph is a nearly clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes. Cancer that moves from one tissue to other body parts is known as metastatic cancer. For example, a breast tumor may grow through the chest wall. It can grow to nearby tissues over time. Cancers in the body are given names. The names depend on where the cancer started. Cancer that begins in the breasts will always be called breast cancer, even if it has spread to another place such as the liver, bones, or brain. There are several different types of cancer that can affect the breast. The most common type of breast cancer in men is infiltrating ductal carcinoma. This cancer breaks through the wall of the duct and grows through the fatty tissue of the breast. Ductal carcinoma in situ is another type of breast cancer. It involves cancer cells that are found in the lining of a duct. It is also called intraductal carcinoma. Inflammatory breast cancer is a rare type of breast cancer. It causes the breast to look red and swollen and to feel warm. Infiltrating Ductal Carcinoma Another type of breast cancer that can affect men is Paget disease of the nipple. A tumor grows from ducts beneath the nipple onto the surface of the nipple. 2

3 Risk Factors It is usually impossible to know the cause of cancer in an individual. But we do know what causes cancer in general. Doctors also know factors that can increase the chances of getting cancer. These are known as risk factors. Being exposed to radiation can raise a man's risk of getting breast cancer. A man also has a higher risk of breast cancer if he has high levels of estrogen. Certain diseases can cause high levels of this hormone in men. Some examples include cirrhosis and Klinefelter syndrome. Cirrhosis is a liver disease. It causes the liver cells to be replaced by scar tissue. Klinefelter syndrome is a genetic disorder in men. It is caused by having an extra X chromosome in most of their cells. It can cause larger than normal breasts and small testicles. It can also cause a lack of facial and body hair. Another risk factor is if a man has multiple female relatives who have had breast cancer. This is especially true if they have a change to the BRCA2 gene. This gene normally helps control cell growth. Not everybody who has risk factors for breast cancer gets it. Some people who have no risk factors still develop breast cancer. Signs and Symptoms Early cancer of the breast usually has no symptoms. Later, as the cancer grows, it may cause a lump that can be felt in the breast or the underarm area. Other symptoms include: A change in the size or shape of the breast. Dimpling or pulling in of the skin of the breast. Discharge from the nipple. Red, warm, tender breast skin that has the texture of an orange peel. Retracted or inverted nipple. These symptoms may not be caused by breast cancer. Make sure to see a doctor to find out what is causing your symptoms if you notice a change in your breasts. 3

4 Diagnosis If you have the symptoms of breast cancer, your doctor will try to find out if breast cancer is the cause of your symptoms. There may be another cause. Your doctor will ask you about your family medical history. You will also be asked about your symptoms. A physical exam will be done. This includes a clinical breast exam. During this exam, a doctor carefully feels the breast and under the arms. He or she will be checking for lumps or other changes. An ultrasound may be done to look at breast tissues and to find any lumps. An ultrasound uses sound waves to create pictures of the inside of the body. An MRI can also create pictures of the inside of the body. An MRI uses strong magnets to create more detailed pictures. An injection of dye may be given to make abnormal areas easier to see. Blood tests may check to see if hormone levels are lower than normal. This can indicate disease in the body. A biopsy is needed to make the diagnosis. A biopsy is the removal of tissue or fluid to look for cancer cells. It is the only way to tell for sure if cancer is present. A pathologist is a doctor that is skilled in diagnosing diseases. He or she will check the tissue or fluid removed from your breast for cancer cells. Staging If you have breast cancer, your doctor will determine the stage of the cancer. Staging is an attempt to find out if the cancer has spread and, if so, to which parts of the body. Stages are usually described using the numbers 0-4. A lower number is an earlier stage of cancer. Staging is helpful in deciding the best course of treatment. When staging breast cancer, doctors want to find out: How large the tumor is. Whether the cancer invades nearby tissues. Whether the cancer has spread and, if so, to which parts of the body. 4

5 If breast cancer has spread to nearby lymph nodes, it can spread to other areas of the body. Breast cancer can spread to the bones, lungs, liver, and brain. A sentinel lymph node biopsy can help stage breast cancer. The sentinel lymph node is the first lymph node the cancer is likely to have spread to. Before surgery, a dye is injected near the tumor. The first lymph node to get the dye is the sentinel lymph node. It is removed and tested. A chest x-ray may be done to see if cancer has spread to the organs and bones in the chest. Other imaging tests may also be done, such as a CT scan. An x-ray uses a type of high-energy radiation to make a picture of the inside of the body. It can go through the body and onto film. A CT scan is an x-ray machine linked to a computer. A CT scan takes a series of detailed pictures of your organs. You may be given contrast material by mouth or injection to make abnormal areas easier to see. Chest X-Ray A bone scan can show if the cancer has spread to the bones. For this test, you are injected with a small amount of a safe radioactive substance. It travels through the bloodstream and collects in the bones. A machine scans and makes pictures of the bones. A PET scan shows if cancer has spread to other parts of the body. You are first injected with a small, safe amount of radioactive sugar. The scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter because they use sugar faster. Treatment and Supportive Care The type of treatment used depends on the: Size and location of the tumor. Stage of the disease. General health of the patient. Treatment for breast cancer may involve: Surgery. Chemotherapy. Hormone therapy. Radiation therapy. 5

6 Some combination of these treatments is often used. Surgery usually involves removing the breast and some of the tissue around it. Many of the lymph nodes under the arm may also be removed. This is to make sure all of the cancer is taken out. Sometimes only the tumor and a small amount of the tissue around it are removed. A few lymph nodes may also be taken out. If this is the case, other treatments may be used to kill any remaining cancer cells. Chemotherapy is the use of drugs to kill cancer cells. It is usually given in the blood stream through an IV or taken by mouth. Hormone therapy is a cancer treatment that removes hormones or blocks their action. This stops cancer cells from growing. Tests can show if cancer cells have places where hormones attach. If they do, hormone therapy may be used. Radiation therapy uses high-energy rays to kill cancer cells. It also stops them from growing and spreading. The radiation that treats the cells comes from a machine. It aims the rays at a specific area of the body. There are also other types of radiation. One of these uses radioactive liquids to treat certain areas. The liquid is put in needles, seeds, wires, or catheters. It is then placed in or near the cancer. This is known as internal radiation. There may be clinical trials for men with breast cancer. Clinical trials test new medical approaches and treatments. Breast cancer and its treatments can lead to other health problems. It is important to have supportive care before, during, and after cancer treatment. Supportive care is treatment to: Control symptoms. Relieve the side effects of surgery. Help you cope with your emotions. In some cases, chemotherapy can lead to hair loss. This is often temporary. Wigs are available. Choosing one that matches your hair and hairstyle ahead of time is a good idea. 6

7 There are also groups of people who have gone through similar experiences. These groups can provide support. Joining a support group is often a positive step toward recovery. You often meet people who can understand your feelings. Supportive care also deals with the pain associated with cancer and its treatments. Your health care provider or a pain control specialist can suggest ways to reduce pain. Summary Breast cancer in men is rare, but it can happen. Men make up one percent of all cases of breast cancer. Finding the cancer early makes treatment easier in most cases. It also raises survival rates. A clinical breast exam is very important if you have a family history of breast cancer. This includes both men and women in your family. Regular self-checks can help you identify changes in your breasts. The outlook for men with breast cancer is now better than it has ever been. Research has led to advances to provide better care for men with breast cancer and help them live longer. 7

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