Treatment overview for breast cancer in men
Treatment for breast cancer in men can include surgery, radiotherapy, chemotherapy, hormonal therapy and targeted therapy with Herceptin. Treatments used for men are similar to those used for breast cancer in women.
Your doctor will advise you on the best plan of treatment, taking into account a number of factors. These include:
your general health
the type of cancer
the stage and grade of the cancer
whether it is ER positive and/or HER2 positive, or triple-negative.
Early and locally advanced breast cancer
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For most men the main treatment for early breast cancer is surgery to remove it. Sometimes only the lump and some surrounding tissue will need to be removed. But as men generally have only a small amount of breast tissue, an operation to remove breast cancer usually involves taking away all of the breast tissue and the nipple in the affected side.
Many men will also have other types of treatments to reduce the risk of the cancer coming back. Occasionally some men who have larger cancers may have chemotherapy or hormonal therapy before surgery to shrink the tumour. This is known as neo-adjuvant therapy.
After the breast tissue has been removed, you will usually have radiotherapy to the chest wall. This is to get rid of any cancer cells that may have been left behind after surgery. Some men may have radiotherapy to the lymph nodes in the armpit or the lower part of the neck.
If the cancer is large, has spread to the lymph nodes or is high-grade, you may be given chemotherapy after your operation. This is called adjuvant chemotherapy. Men who have triple-negative breast cancer are also usually treated with chemotherapy. If the cancer is ER positive, you’ll be given hormonal treatment for a number of years. If you have HER2 positive breast cancer, you may have treatment with Herceptin.
Secondary breast cancer
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If the cancer has spread beyond the breast and lymph nodes in the armpit to elsewhere in the body, this is called secondary breast cancer. The most common places that breast cancer cells may spread to are the bone, liver, lungs or brain. Secondary breast cancer can also spread to other lymph nodes, such as those in the lower part of the neck.
Although secondary breast cancer can spread to any of these areas, it most commonly affects just one or two parts of the body.
Treatment for secondary breast cancer depends on several factors, so can be different for each person. The most appropriate treatment depends on where the breast cancer has spread to. A man with secondary breast cancer affecting the bones will have different symptoms and may need different treatment from a man with secondary breast cancer in the liver.
It isn’t usually possible to cure breast cancer that has spread elsewhere in the body, but treatment may be able to control it for a long time. Treatment may also be used to reduce symptoms and improve quality of life.
The main treatments for cancer that has spread are hormonal therapy and chemotherapy, although surgery and radiotherapy may be helpful in some situations. The choice of treatment depends on where the cancer has spread to in the body, whether the cancer has oestrogen receptors (is ER positive) and which treatments, if any, have already been given.
Hormonal therapy is the most commonly used treatment for ER positive breast cancer that has spread. Hormonal therapy can be taken as tablets, as injections or as a combination of both. It’s usually taken for as long as it is effective. It is often used to treat secondary breast cancer in the bone.
Chemotherapy may be used if it’s known the cancer won’t respond to hormonal therapy (for example, if you have ER negative breast cancer). It may also be used to treat secondary cancer that is growing quickly or has spread to the liver or lungs. Herceptin may be given with chemotherapy in men who have HER2 positive breast cancer.
Radiotherapy may be used to shrink a tumour that is causing pain, especially in the bone. This is known as palliative radiotherapy.
Before you have any treatment, your cancer specialist and breast care nurse will talk it over with you and answer your questions.
How treatment is planned
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In most hospitals a team of specialists will talk to you about the treatment they feel is best for your situation.
This multidisciplinary team (MDT) will include:
a surgeon who specialises in breast surgery
an oncologist (cancer specialist) who specialises in chemotherapy, radiotherapy, hormonal therapy and biological therapy
a specialist breast care nurse who gives information
a research nurse involved in clinical trials
a radiologist who analyses x-rays and scans
a pathologist who advises on the type and extent
of the cancer
a physiotherapist who shows you exercises after surgery.
It may also include other healthcare professionals, such as a plastic surgeon, psychologist, social worker or counsellor.
The MDT will take a number of factors into account when advising you on the best course of action, including your general health, the type and size of the cancer and whether it has begun to spread.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
You can also call our cancer support specialists to talk through any worries or questions you have about treatment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you.
Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.
Our video explains the benefits and disadvantages of getting a second opinion.