Phyllodes tumour

Phyllodes tumours are rare breast tumours. They don’t usually spread to other parts of the body. There are three types of Phyllodes tumour:

  • 50 to 60% are benign (non-cancerous)
  • 20 to 25% are malignant (cancerous)
  • borderline tumours that are more abnormal than benign tumours, but not quite malignant.

We don’t know what causes Phyllodes tumours. They are more common in women who have benign breast lumps called fibroadenomas and in pre-menopausal women between 40 and 50. 

The main symptom is a lump in the breast. It may appear over a few weeks or months. If it isn’t treated the lump can cause a bulge in the breast.

Tests to diagnose the condition include; a mammogram, biopsy, fine needle aspiration or an ultrasound scan.

Benign and borderline tumours can usually be cured with surgery.

You may have a wide local excision to remove the lump and some surrounding healthy tissue. If the lump is large in proportion to the breast, you may be advised to have the whole breast removed (mastectomy).

Malignant tumours may be treated with radiotherapy after surgery or chemotherapy if the cancer has spread outside the breast.

What are Phyllodes tumours?

You may find it useful to read this information with our general information about breast cancer.

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:

  • Benign (non-cancerous) tumours make up about 50 to 60% of all phyllodes tumours.
  • Malignant (cancerous) tumours make up about 20 to 25% of all phyllodes tumours.
  • Borderline tumours are more abnormal than benign tumours, but not quite malignant.

Most benign and borderline phyllodes tumours can be completely cured with treatment.

For people with a malignant tumour, the outlook after treatment is usually very good.

Although phyllodes tumours can affect people of any age, they are more common in pre-menopausal women between the ages of 40 and 50. They usually only affect one breast, although occasionally they can affect both breasts.

It is uncommon for phyllodes tumours to spread to other parts of the body. If they do spread, this 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

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

The most common symptom is usually a firm, painless 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 break and become sore (ulcerate).


How phyllodes tumours are diagnosed

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.

Mammogram (breast x-ray)

A mammogram is a low-dose x-ray of the breast tissue. You‘ll be asked to remove the clothes from the top of your body, including your bra. The radiographer will then position you so that each breast is placed in turn on the x-ray machine and gently but firmly compressed (flattened) with a clear, plastic plate.

The breast tissue needs to be compressed to keep the breast still and to get the clearest picture with the lowest amount of radiation possible. Most women find this uncomfortable, and for some women it is painful for a short time while the breast is being compressed. You will need to stay still for less than a minute while the x-ray is taken. Usually two mammograms are taken of each breast from different angles. The appointment takes about 30 minutes.

Ultrasound scan

This test uses sound waves to produce a picture of the breast tissue. The person doing the scan puts a gel on to your breast and moves a small hand-held device around the area. The sound waves are converted into a picture using a computer. The test is painless and takes 5–10 minutes.

Core biopsy

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 and examined under a microscope by a doctor who is an expert in cell types (a pathologist).

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. 

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

Surgery is the main treatment for phyllodes tumours. Usually it's the only treatment that is needed.

If the phyllodes tumour is 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.

Hormonal therapy, which is often used to treat breast cancer, is not effective for phyllodes tumours.


Surgery for phyllodes tumours

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 for phyllodes tumours

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 malignant tumour coming back.

Radiotherapy is usually given as a series of short, daily sessions, Monday to Friday, with a rest at weekends. If you need radiotherapy, your doctor will give you more information about your treatment plan.

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Chemotherapy for phyllodes tumours

Chemotherapy is the use of anti-cancer drugs (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.

If you do need chemotherapy, it will usually be 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.

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Research - clinical trials for phyllodes tumours

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 to withdraw from a trial, at any stage. In this situation you’ll receive the best standard treatment available.


Follow-up after treatment for phyllodes tumours

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. If this does happen, it is 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.


Your feelings

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 when 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.