Male Breast Cancer

The kinds of breast cancer in men are similar to that in women, which may include:

• Invasive ductal carcinoma: Cancer cells start in the ducts and grow into the other parts of the breast tissue. The invasive cancer cells can spread and metastasize.
• Invasive lobular carcinoma: Cancer cells begin in the lobules and spread to the breast tissue near the lobules.
• Ductal carcinoma in situ (DCIS): The presence of abnormal cells inside the breast milk duct is known as DCIS. It is the initial stage of breast cancer. DCIS is noninvasive, which means it hasn't spread outside the milk duct and is unlikely to become invasive.
• Special types of invasive breast cancers: There are a few special types of breast cancer, but they are less common and may or may not have a good prognosis compared with infiltrating ductal carcinoma. These include:
  • Adenocystic carcinoma
  • Low-grade adenosquamous cell carcinoma
  • Medullary carcinoma
  • Mucinous carcinoma
  • Papillary carcinoma
  • Tubular carcinoma
  • Micropapillary carcinoma
  • Mixed carcinoma
  • Metaplastic carcinoma

The most common symptoms of breast cancer in men include:

• A lump or painless mass or thickening in the breast region or underarm
• Any changes in the size or shape of the breast
• A dimple in the breast's skin, which appears like an orange's skin
• Inverted nipples (pointed inward)
• A scaly red and swollen area on the breast, nipple, or areola region (a dark skin region around the nipple)
• Any fluid discharge from the nipple, especially blood discharge

The following are the risk factors for breast cancer in men:

• As age increases, there is an increased risk of breast cancer
• Genetic mutation in BRCA1 and BRCA2 genes may increase the risk of breast cancer
• Family history
• Men who had radiation therapy for their chest are at a high risk of breast cancer.
• Any history of hormone replacement therapy or drugs containing estrogen used to treat prostate cancer may increase the risk of breast cancer in men.
• A rare genetic condition called Klinefelter syndrome, where the individual has one extra X chromosome. It results in excess production of estrogen and low production of androgens (hormones that help develop male sexual features).
• Cirrhosis of the liver leads to decreased androgen production, which may increase the risk of breast cancer in men.

The cancer care team uses a staging system as a standard way to describe the extent of cancer's spread. The staging of breast cancer in men is similar to that in women. The American Joint Committee on Cancer TNM staging system is the most standard staging system used to determine breast cancer in men.

TNM stands for the following:

• T: Indicates the size of the tumor
• N: Indicates the spread of the cancer cells to the nearby lymph nodes
• M: Indicates that cancer has spread to distant organs

T categories for breast cancer

• TX: Primary tumor cannot be assessed
• T0: There is no evidence of a tumor
• Tis: Carcinoma in situ
• T1: The size of the tumor is 2 cm or less than 2 cm
• T2: The size of the tumor is more than 2 cm but not more than 5 cm
• T3: The size of the tumor is more than 5 cm
• T4: The tumor grows into the chest wall or the adjacent tissues.

N categories for breast cancer

In the N category, N followed by a number indicates cancer has spread to nearby lymph nodes or the number of lymph nodes involved. Lymph node staging is based on how the lymph nodes look under a microscope.

If the cancer cells spread to an area of 0.2 mm and not more than 2 mm, it is called micrometastasis. On the other hand, if the cancer cells spread to areas larger than 2 mm, it is called macrometastasis or metastasis.

N categories for breast cancer include the following:

• NX: Nearby lymph nodes are not assessed.
• N0: Cancer cannot spread to nearby lymph nodes.
• N0(i+): The area of cancer spread is less than 200 cells or less than 0.2 mm. The i+ indicates the isolated tumor cells seen in routine stain technique or a special immunohistochemistry test.
• N0(mol+): Cancer cells are not seen in the lymph nodes but are detected using RT-PCR, a molecular test used to find even a small number of cancer cells.
• N1: Cancer cells have spread to one to three lymph nodes.
• N1(mi): Micrometastasis is seen in the lymph nodes in the underarm. The area of spread of cancer cells is less than 0.2 mm but not more than 2 mm.
• N1a: Cancer cells have spread to one to three lymph nodes in the underarm, with at least one area of cancer spreading more than 2 mm.
• N1b: Cancer has spread to internal mammary lymph nodes on the same side of the cancer and can be found only in the sentinel biopsy.
• N1c: Both N1a and N1b apply.
• N2: Cancer cells have spread to four to nine lymph nodes under the arm, and cancer has enlarged the internal mammary lymph nodes.
• N2a: Cancer cells have spread to four to nine lymph nodes under the arm, and at least one area of cancer spread is larger than 2 mm.
• N2b: Cancer has spread to one or more internal mammary lymph nodes causing them to enlarge.
• N3: Any of the following.
• N3a: Cancer cells have spread to 10 or more auxiliary lymph nodes with at least one area of cancer spread more than 2 mm.
• N3b: Cancer cells have spread at least one auxiliary lymph node with enlarged internal mammary lymph nodes.
• N3c: Cancer has spread to above the collar bone at least one area of cancer is spread more than 2mm.

M categories for breast cancer

• M0: Cancer cells have not spread to distant organs.
• M0(i+): Few cancer cells have spread to blood and bone marrow, and some have spread to lymph nodes away from the underarm, collarbone, and internal mammary lymph nodes.
• M1: Cancer has spread to distant organs.

The following are the ways to diagnose breast cancer in men:

• Physical examination: An examination of health-related and disease-related symptoms, looking for lumps or other abnormalities.
• Clinical examination: Your healthcare provider may examine your breast and underarms and check for any unusual lumps or changes.
• Mammogram: It is the best screening option to detect breast cancers. Mammograms are X-rays of the breast that are used for the early detection of cancer. In addition, mammograms can lower the risk of death caused by breast cancer. With breast cancer cases on the rise, mammograms must be performed regularly.
• Ultrasound: Sonography is a diagnostic method, where sound waves produce the image structures inside your body. The doctor uses this method to get clear images of the internal tissues.
• MRI: Breast MRIs use magnetic and radio waves to take pictures of the breast.
• Blood chemistry studies: A blood sample is taken to measure the number of certain substances released into the body, and any unusual amounts may be an indication of a disease.
• Biopsy: Involves the removal of tissues or cells, which are then viewed under a microscope for any signs of malignancy.

Standard treatment options for breast cancer in men include:

• Surgery: Surgical removal of the cancer-afflicted breast and the lymph nodes in the underarm.
• Chemotherapy: A cancer treatment that uses powerful medications to kill fast-growing cancer cells and stop them from growing. The chemotherapy drugs can be administered orally or intravenously.
• Radiotherapy: Uses powerful rays to kill cancer cells. Radiotherapy is done after the surgery.
• Hormone therapy: One of the cancer treatments that removes or blocks the hormones and stops the growth of cancer cells.
• Targeted therapy: Targets only the cancer cells and does not affect other healthy cells in the body.