Treating breast cancer in men


Many hospitals use multidisciplinary teams (MDTs) to treat breast cancer in men. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.


Members of your MDT may include:


  • a surgeon

  • a clinical oncologist (a specialist in the non-surgical treatment of cancer)

  • a pathologist (a specialist in diseased tissue)

  • a radiologist (a doctor who specialises in analysing the results of imaging tests such as X-rays and ultrasound scans)

  • a dietitian

  • a social worker

  • a psychologist

As well as having a specialist MDT, you may also be assigned a key worker who will usually be a specialist nurse. They will be responsible for co-ordinating your care.


Deciding what treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best 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 that you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.


Your treatment plan


Your recommended treatment plan will depend on how far the cancer has spread. If the cancer has not spread significantly beyond your breast (stage 3 or below), a complete cure may be possible.


Surgery to remove the affected breast is usually recommended followed by radiotherapy, hormone therapy and /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 (stage 4 breast cancer), a complete cure will not be possible. However, hormone therapy and chemotherapy can be used to relieve symptoms, slow down the spread of the cancer and prolong lifespan.


Surgery


Surgery is the first treatment option that is often recommended for breast cancer and usually involves an operation called a modified radical mastectomy. This is where the surgeon removes the entire breast as well as the lymph nodes (glands) in the armpit.


Once surgery has been completed there will be a scar where your nipple used to be and an indentation in your chest where the breast tissue was.


It is possible to have reconstructive surgery after having a modified radical mastectomy. Tissue can be taken from other parts of your body, such as your lower abdomen or buttocks, and be used to recreate the shape of the breast.


An alternative option is to use breast implants that are similar to those that are used in cosmetic surgery. However, they are obviously much smaller. In many cases, reconstructive surgery can be carried out immediately after a mastectomy has been performed.


It is also possible to restore the appearance of a nipple by having a tattoo on your chest. ‘Nipple tattoos’ can be created in around 30 to 40 minutes and have a very realistic appearance.


You should discuss the various options for reconstructive surgery with your MDT.


After surgery


Most men are well enough to leave hospital three to five days after having surgery for breast cancer. After the operation, it is likely that you will feel very tired and it may take several weeks before you are well enough to start carrying out relatively strenuous activities, such as lifting objects or driving.


Your MDT will be able to give you a more precise recommendation.


The wound at the site of the surgery will take about two to three weeks to heal. It is important to keep the wound clean during this time using unscented soap. You should look out 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 that the wound may have become infected.


It is difficult to predict when you will 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 provide you with advice but the final decision will be yours.


It can take several months 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.


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


The Royal College of Surgeons have produced a useful leaflet for people who are recovering after having a mastectomy.


Complications of surgery


Following surgery, you may experience numbness or tingling at the site of the scar and in your upper arm. This is common and is caused by nerve damage that occurs during surgery. The numbness and tingling should pass within a few weeks or months although it can occasionally be permanent.


Another common complication that can occur after a mastectomy is painful swelling in the arms and legs and, occasionally, in other parts of the body, such as the head and chest. This is called lymphoedema and it is caused by the disruption of the lymphatic system (a series of channels and lymph nodes which is normally responsible for removing excess fluid from tissue).


If multiple lymph nodes are surgically removed, as in the case of a modified radical mastectomy, it can disrupt the lymphatic system’s ability to drain fluid which can lead to swelling.


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


Read more about treating lymphoedema.


Radiotherapy


Radiotherapy is a type of treatment that uses 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 course of radiotherapy usually involves five sessions a week over the course of six weeks. The sessions are short and usually only last for 10 to 15 minutes.


Radiotherapy is not usually painful although you will probably experience some side effects. This is because the energy that is released during radiotherapy can also damage healthy cells.


Common side effects of radiotherapy 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 to relieve the symptoms of pain. This is known as palliative radiotherapy. Palliative radiotherapy is usually given in just one or two doses and does not usually cause any side effects


Read more about radiotherapy.


Hormone therapy


About 90% 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 that the cancerous cells require oestrogen to grow. Oestrogen is a type of hormone that is found in low levels in men and in much higher levels in women.


Therefore, the aim of hormone therapy is to block the effects of oestrogen on the breast tissue to prevent the cancer reoccurring after surgery.


Hormone therapy can also be used in cases of advanced breast cancer in order to slow down the spread of the cancer.


Tamoxifen


Tamoxifen is a medication that is widely used during hormone therapy for breast cancer.


It prevents oestrogen from entering the breast tissue cells which helps prevent breast cancer reoccurring. Tamoxifen is available in tablet or liquid form.


It is unclear what the ideal length of a course of tamoxifen should be. Studies in women with breast cancer suggest that a five year course of treatment is the most effective in preventing the return of cancer and extending survival rates. However, it is not known whether this also applies to men.


Tamoxifen can cause unpleasant side effects, so you will need to balance the potential advantages of taking the medication with the possible disadvantages. You should discuss the pros and cons of long-term treatment with tamoxifen with your MDT.


Side effects of tamoxifen include:


  • reduced interest in sex (low libido)

  • inability to obtain or maintain an erection (erectile dysfunction)

  • headache

  • feeling sick – taking your medication with food may help to alleviate this side effect

  • changes in mood, such as feeling irritable or depressed

You should inform your MDT if you experience side effects that become particularly troublesome because alternative medications are available.


Aromatase inhibitors


Aromatase inhibitors are a type of medication that are an alternative hormone treatment to tamoxifen. They may be used if tamoxifen proves to be unsuccessful or if 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 are taken daily for two to five years. As with tamoxifen, there is very little available evidence (compared with female breast cancer) regarding what the most effective length of dosage is.


Side effects of aromatase inhibitors include:


  • joint pain

  • lack of energy

  • hot flushes

  • skin rashes

  • feeling sick

  • being sick

  • thinning of the hair

The side effects are usually mild to moderate. It is also unlikely that you will experience all of the side effects that are listed above.


Chemotherapy


Chemotherapy is used to treat cases of breast cancer where the cancerous cells are not oestrogen receptor positive (ER+), which meaning that hormone therapy would be mostly ineffective. Chemotherapy is usually given after surgery to help prevent the cancer returning or it is used to treat the symptoms of incurable cancer.


Chemotherapy for breast cancer usually 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) or chemotherapy injections (intravenous chemotherapy) or a combination of both.


The side effects of chemotherapy include:


  • feeling sick

  • being sick

  • diarrhoea

  • loss of appetite

  • mouth ulcers

  • tiredness

  • skin rashes

  • infertility

  • hair loss

However, the side effects should resolve once your treatment has finished. Following treatment, your hair should take between three to six months to grow back.


Chemotherapy can also weaken your immune system, making you more vulnerable to infection.


It is therefore important to report any symptoms of a potential infection to your MDT such as:


  • a high temperature of 38C (100.4F) or above

  • flu-like symptoms, such chills or joint pain

  • a general sense of feeling unwell

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


If you are 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 because 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 that are 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.


Read more about chemotherapy.


Biological therapy


As with oestrogen receptor positive (ER+) types of cancer, some cases of breast cancer can be stimulated by a type of protein called human epidermal growth factor receptor 2 (HER2).


Biological therapy uses medication to block the effects of HER2 on breast tissue.


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 and you are able to have biological therapy, you will probably be prescribed a medicine called trastuzumab. Trastuzumab, also known by the brand name Herceptin, is usually used after radiotherapy and/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 that are designed to respond to the HER2 protein.


Trastuzumab is given intravenously (directly in to a vein) through a drip. You will receive the treatment in hospital. Each treatment session takes up to one hour and the number of sessions that you need to have will depend on whether your breast cancer is in its early or more advanced stages. On average, for early breast cancer you will need to have a session once every three weeks, and for cancer that is more advanced you will need to have weekly sessions.


Trastuzumab can cause side effects, including heart problems. This means that it is 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 will need to have regular tests on your heart to ensure that it is not causing any problems.


Other side effects of trastuzumab may include:


  • an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever

  • diarrhoea

  • tiredness

  • aches and pains

Read more about trastuzumab.

Glossary


Mastectomy: A mastectomy is an operation to remove a breast, and most of the skin covering it. It is usually done to treat or prevent breast cancer.
Radiotherapy: Radiation therapy uses x-rays to treat disease, especially cancer.
Lymph nodes: Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. Part of the immune system.
Liver: The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Tissue: Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
Chemotherapy: Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.
Biopsy: A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Brain: The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Lungs: Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.




Treating breast cancer in men

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