This information is about a rare type of tumour called phyllodes tumour. Phyllodes tumours can be non-cancerous (benign) or cancerous (malignant). You may find it useful to read this information alongside our general information about breast cancer.
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you’re having your treatment.
Phyllodes tumours are rare and most are non-cancerous (benign). They get their name from a Greek word that means 'leaf like' because they grow in a leaf like pattern. They are made up of a mixture of cells from connective (fibrous) tissue and the tissue layer (epithelium) that lines the breast.
There are three main types of phyllodes tumour:
Non-cancerous (benign) tumours – these make up about 50–60% of phyllodes tumours.
Borderline tumours – these are not yet malignant (cancerous) but are more likely to turn malignant.
Cancerous (malignant) tumours – these make up about 20–25% of all phyllodes tumours.
Most benign and borderline phyllodes tumours can be completely cured with treatment. The outlook after treatment for people with malignant tumours is usually very good.
Although phyllodes tumours can affect people of any age, they are most often found in pre-menopausal women between the ages of 40 and 50. They usually only affect one breast although occasionally they can occur in both breasts.
It’s uncommon for phyllodes tumours to spread to other parts of the body. Any spread is more likely to occur with a malignant tumour. A tumour that has spread to another part of the body is known as a secondary cancer or metastasis.
Risk factors and causes of phyllodes tumours
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We don’t know the exact cause of phyllodes tumours. They appear to be more common in women who have benign breast lumps called fibroadenomas. However, most women who have fibroadenomas do not develop phyllodes tumours.
Signs and symptoms of phyllodes tumours
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The most common symptom is usually a firm-feeling lump in the breast. The lump may grow quickly, over a few weeks or months. If left untreated, the lump may cause a bulge in the breast and very occasionally the skin over the lump may ulcerate.
How phyllodes tumours are diagnosed
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Phyllodes tumours are diagnosed in the same way as any type of breast cancer. It may be picked up during a routine screening or it may be that you experience symptoms and go to your GP.
You’ll be referred to a breast clinic to see a specialist. The specialist will ask you some questions and examine your breasts and the lymph nodes (glands) in your armpits. They will then explain which tests you need. Women usually have a mammogram and/or an ultrasound scan, which is followed by a core biopsy and/or a fine needle aspiration. These procedures are explained below.
A mammogram (breast x-ray)
You‘ll be asked to take off your top and bra and will be given a gown to wear before the mammogram. The radiographer (who takes the x-ray) positions you so that your breast is against the x-ray machine. Your breast is then flattened and squashed (compressed) with a flat, clear, plastic plate, which keeps the breast still to get a clear picture. This can be uncomfortable and a little painful but doesn’t last long. You’ll have two mammograms of each breast taken from different angles.
This test uses sound waves to build up a picture of the breast. The person doing the scan puts a gel onto your breast and moves a small hand-held device around the area. A picture of the inside of the breast shows up on a screen.
The doctor uses a needle to take a few small pieces of tissue from the lump or abnormal area. First, they will inject some local anaesthetic into the area to numb it. The tissue is sent to the laboratory to test for cancer cells. After a biopsy your breast can be bruised and feel sore for a few days. You can take painkillers until it eases and the bruising should go away within a couple of weeks.
At the laboratory, the tissue is examined under a microscope by a doctor who is an expert in cell types (a pathologist).
Fine needle aspiration (FNA)
This is a quick and simple procedure carried out in the x-ray department. Using a fine needle, your doctor withdraws some cells from the lump or abnormal area into a syringe. The doctor uses x-ray or ultrasound guidance to make sure cells are taken from the right area. The sample is then sent to the laboratory to check for cancer cells.
Treatment for phyllodes tumours
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Surgery is the main treatment for phyllodes tumours. Usually it's all the treatment that's needed.
If the phyllodes tumour is borderline or malignant, surgery is sometimes followed by radiotherapy to the rest of the breast. Chemotherapy treatment is only needed if a malignant tumour spreads outside the breast.
You will usually have an operation to remove the lump as well as a margin of healthy tissue around it. This is called a wide local excision or lumpectomy. After your operation the tissue that has been removed will be examined under the microscope by the pathologist. If there are tumour cells at the edge of the removed tissue, your surgeon will usually recommend that you have another operation to remove more tissue from the area where the tumour was found. This reduces the risk of any tumour cells being left behind and the tumour regrowing.
In some women, the lump may be large in proportion to the rest of the breast and they may be advised to have the whole breast removed (mastectomy). If you need a mastectomy, your surgeon should discuss with you the different options for breast reconstruction (when a new breast shape is formed). Breast reconstruction can be done at the same time as mastectomy or later.
Radiotherapy treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. After surgery, radiotherapy is sometimes given to reduce the chances of a borderline or malignant tumour coming back.
Radiotherapy is usually given as a series of short daily sessions, Monday–Friday, with a rest at weekends. If you need radiotherapy, your doctor will give you more information about your treatment plan.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs are carried in the blood and can reach cancer cells anywhere in the body. Chemotherapy is only likely to be given if the cancer spreads to another part of the body. Because phyllodes tumours don’t tend to spread outside the breast, chemotherapy isn’t often needed.
The chemotherapy drugs that are given to treat malignant phyllodes tumours are the same as those used to treat a type of cancer called soft tissue sarcoma. This is because the cells that are abnormal in phyllodes tumours are the same as the ones that are abnormal in soft tissue sarcomas.
Chemotherapy is usually given into a vein as an injection or a drip (infusion). You will usually have treatment over a period of about 4–6 months. A combination of two or more chemotherapy drugs may be given.
As phyllodes tumours are quite rare, researchers are trying to find out more about how they develop and why some tumours come back. Before any research trial is allowed to take place, an ethics committee must approve it and agree that it’s in the interest of patients.
You may be invited to take part in a clinical trial. Your doctor must discuss the trial with you so that you have a full understanding of what it involves. You may decide not to take part, or withdraw from a trial at any stage. In this situation you’ll receive the best standard treatment available.
After your treatment you’ll have regular check-ups with the hospital team. They will usually ask you about your general health, examine your breasts and arrange for you to have any necessary tests.
Sometimes phyllodes tumours can come back in the same area of breast tissue (known as a local recurrence). This risk is higher with malignant tumours and if it does happen it’s usually within two years of surgery. If there is a recurrence, further surgery is usually advised. This may involve another wide local excision to remove the tumour or a mastectomy, which removes the whole breast. Radiotherapy may also be given after surgery or it may be used instead if surgery isn’t possible.
You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. Our cancer support specialists can give you information about counselling in your area.
This fact sheet has been compiled using information from a number of reliable sources, including:
Raghavan D, et al. Textbook of Uncommon Cancer. 3rd edition. 2006. John Wiley & Sons.
Belkacemi Y, et al. Management of Rare Adult Tumours. 2010. Springer.
National Institute for Health and Clinical Excellence (NICE). Breast cancer (early and locally advanced). February 2009.
Harrison J, et al. Diseases of the Breast. 4th edition. 2010. Lippincott Williams and Wilkins.
UpToDate. Phyllodes tumours of the breast. www.uptodate.com (accessed September 2012).
With thanks to Mr Douglas Macmillan, Oncoplastic Breast Surgeon and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.