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Archive for May, 2010

Detailed Guide: Breast Cancer in Men
How Is Breast Cancer in Men Diagnosed?

Signs and symptoms

Men need to know that breast cancer is not limited to only women. Possible signs of breast cancer to watch for include:

A lump or swelling, which is usually (but not always) painless
Skin dimpling or puckering
Nipple retraction (turning inward)
Redness or scaling of the nipple or breast skin
Discharge from the nipple
These changes aren’t always caused by cancer. For example, most breast lumps in men are due to gynecomastia (a harmless enlargement of breast tissue). Still, if you notice any breast changes, you should see your health care professional as soon as possible.

Medical history and physical exam

If there is a chance you may have breast cancer, your doctor will want to get a complete personal and family medical history. This may give some clues about the cause of any symptoms you are having and if you might be at increased risk for breast cancer.

A thorough clinical breast exam will be done to locate any lumps or suspicious areas and to feel their texture, size, and relationship to the skin and muscle tissue. The doctor may also examine the rest of your body to look for any evidence of possible spread, such as enlarged lymph nodes (especially under the arm) or an enlarged liver. Your general physical condition may also be evaluated.

Tests used to evaluate breast disease

If the history and physical exam suggest breast cancer may be possible, several types of tests may be done.

Diagnostic mammography

A diagnostic mammogram is an x-ray exam of the breast that is done when problems are present. In some cases, special images known as cone views with magnification are used to make a small area of abnormal breast tissue easier to evaluate. The results of this test may suggest that a biopsy is needed to tell whether the abnormal area is cancer. Mammography is often more accurate in men than women, since men do not have dense breasts or other common breast changes that might interfere with the test.

Breast ultrasound

Ultrasound, also known as sonography, uses high-frequency sound waves to outline a part of the body. For this test, a small, microphone-like instrument called a transducer is placed on the skin (which is often first lubricated with gel). It emits sound waves and picks up the echoes as they bounce off body tissues. The echoes are converted by a computer into a black and white image on a computer screen. This test is painless and does not expose you to radiation.

Breast ultrasound is sometimes used to evaluate breast abnormalities that are found during mammography or a physical exam. It can be useful to see if a breast lump or mass is a cyst or a tumor. A cyst is a non-cancerous, fluid-filled sac that can feel the same as a tumor on physical exam. A mass that is not a cyst will often need to be biopsied.

Nipple discharge exam

Fluid leaking from the nipple is called nipple discharge. If you have a nipple discharge, you should have it checked by your doctor. If there is blood in this fluid, you might need more tests. One test collects some of the fluid to look at under a microscope to see if any cancer cells are present. This test is often not helpful, since a breast cancer can still be present even when no cancer cells are found in a nipple discharge. Other tests may be more helpful, such as a mammogram or breast ultrasound. If you have a breast mass, a biopsy will likely be needed (even if the nipple discharge does not contain cancer cells or blood).

Biopsy

A biopsy removes a body tissue sample to be looked at under a microscope. A biopsy is the only way to tell if a breast abnormality is cancerous. Unless the doctor is sure the lump is not cancer, this should always be done. There are several types of biopsies. Your doctor will choose the type of biopsy based on your individual situation.

Fine needle aspiration biopsy: Fine needle aspiration (FNA) biopsy is the easiest and quickest biopsy technique. The doctor uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of tissue from a suspicious area. The doctor can guide the needle into the area of the breast abnormality while feeling the lump. A local anesthetic (numbing medicine) may or may not be used. Because such a thin needle is used for the biopsy, the process of getting the anesthetic may actually be more uncomfortable than the biopsy itself.

When the samples of most breast abnormalities are looked at under a microscope, they show if they are benign or cancerous. Sometimes,though, the results of the FNA are not clear, and another type of biopsy is needed.

Core needle biopsy: For a core biopsy, the doctor removes a small cylinder of tissue from a breast abnormality to be looked at under a microscope. The needle used in this technique is larger than that used for FNA. The biopsy is done with local anesthesia in the doctor’s office.

A core biopsy uses a larger needle to sample breast changes felt by the doctor or pinpointed by ultrasound or a mammogram. (When mammograms taken from different angles are used to pinpoint the biopsy site, this is known as a stereotactic core needle biopsy.) In some centers, the biopsy can be guided by an MRI scan.

Because it removes larger pieces of tissue, a core needle biopsy is more likely than an FNA to provide a clear diagnosis, although it may still miss some cancers.

Surgical (open) biopsy: Sometimes, surgery is needed to remove all or part of the lump for microscopic examination. Usually this is an excisional biopsy, where the surgeon removes the entire mass or abnormal area, as well as a surrounding margin of normal-appearing breast tissue. If the mass is very large, an incisional biopsy, where only part of the mass is removed, may be done instead. In rare cases, this type of biopsy can be done in the doctor’s office, but it is more commonly done in the hospital’s outpatient department under a local anesthesia (you are awake, but the area around the breast is numb). You may also be given medicine to make you drowsy.

This type of biopsy is more complicated than an FNA biopsy or a core needle biopsy, but it is more likely to give an accurate diagnosis and, in some cases, may be the only surgery that is needed if the cancer is not invasive. It typically needs several stitches and may leave a scar.

Lymph node dissection and sentinel lymph node biopsy: These procedures are done specifically to look for cancer in the lymph nodes. They are described in more detail in the section, “How is breast cancer treated?”

Lab tests of breast cancer biopsy samples

Once breast tissue samples have been obtained from a biopsy, they are looked at in the lab to determine whether breast cancer is present and if so, what type it is. Other lab tests can help determine how quickly a cancer is likely to grow and (to some extent) what treatments are likely to be effective.

If a benign condition is diagnosed, no further treatment is needed. If the diagnosis is cancer, there should be time for you to learn about the disease and to discuss treatment options with your cancer care team, friends, and family. It is usually not necessary to rush into treatment. You may want to get a second opinion before deciding on what treatment is best for you.

The tissue removed during the biopsy (or during surgery) is first looked at under a microscope to see if cancer is present. The biopsy is also used to determine the cancer’s type. Most breast cancers in men are invasive ductal carcinomas.

Grading

A pathologist (a doctor who specializes in diagnosing disease in tissue samples) also assigns a histologic grade to the cancer, which is based on how closely the cancer in the biopsy sample looks like normal breast tissue. The grade helps predict the patient’s prognosis (outlook). In general, a lower grade number indicates a slower-growing cancer that is less likely to spread, while a higher number indicates a faster-growing cancer that is more likely to spread.

The grade is based on the arrangement of the cells in relation to each other, as well as features of individual cells.

Grade 1 (well differentiated) cancers have relatively normal-looking cells that do not appear to be growing rapidly and are arranged in small tubules.
Grade 2 (moderately differentiated) cancers have features between grades 1 and 3.
Grade 3 (poorly differentiated) cancers are formed by cells that appear very abnormal, grow rapidly, and rarely form tubules.
This system of grading is used for invasive cancers but not for in situ cancers.

Estrogen receptor (ER) and progesterone receptor (PR) status

Receptors are cell proteins that can attach to certain substances, such as hormones, that circulate in the blood. Normal breast cells and some breast cancer cells have receptors that attach to estrogen and progesterone. These 2 hormones often fuel the growth of breast cancer cells.

An important step in evaluating a breast cancer is to test a portion of the cancer removed during the biopsy (or surgery) for the presence of estrogen and progesterone receptors. Cancer cells may contain neither, one, or both of these receptors. Breast cancers that contain estrogen receptors are often referred to as ER-positive cancers, while those containing progesterone receptors are called PR-positive cancers.

About 9 out of 10 male breast cancers are ER-positive, PR-positive, or are positive for both types of receptor. These cancers tend to have a better prognosis than cancers without these receptors and are much more likely to respond to hormonal therapy (see the section, “How is breast cancer in men treated?”).

HER2/neu status

In a small number of breast cancers in men, the cells have too much of a growth-promoting protein called HER2/neu (often just shortened to HER2). The HER2/neu gene instructs cells to make this protein. Tumors with increased levels of HER2/neu are referred to as HER2-positive.

HER2-positive breast cancers have too many copies of the HER2/neu gene (known as gene amplification). This results in greater than normal amounts of the HER2/neu protein on the cancer cells. These cancers tend to grow and spread more aggressively than other breast cancers.

All newly diagnosed breast cancers should be tested for HER2/neu because HER2-positive cancers are much more likely to benefit from treatment with drugs that target the HER2/neu protein, such as trastuzumab (Herceptin®) and lapatinib (Tykerb®). See the section, “How is breast cancer in men treated?” for more information on these drugs.

Testing of the biopsy or surgery sample is usually done in 1 of 2 ways:

Immunohistochemistry (IHC): In this test, special antibodies that identify the HER2/neu protein are applied to the sample, which cause it to change color if abnormally high levels are present. The test results are reported as 0, 1+, 2+, or 3+.
Fluorescent in situ hybridization (FISH): This test uses fluorescent pieces of DNA that specifically stick to copies of the HER2/neu gene in cells, which can then be counted under a special microscope.
Many breast cancer specialists think the FISH test gives more accurate results than IHC, but it is more expensive and takes longer to get the results. Often the IHC test is used first. If the results are 1+ (or 0), the cancer is considered HER2-negative. People with HER2-negative tumors are not treated with drugs that target HER2 (like trastuzumab). If the test comes back 3+, the cancer is HER2-positive. Patients with HER2-positive tumors may be treated with drugs like trastuzumab. When the result is 2+, the HER2 status of the tumor is not clear. This often leads to having the tumor tested with FISH. Newer test methods are now becoming available as well (see the section, “What’s new in breast cancer research and treatment?”).

Tests of ploidy and cell proliferation rate

The ploidy of cancer cells refers to the amount of DNA they contain. If there’s a normal amount of DNA in the cells, they are said to be diploid. If the amount is abnormal, then the cells are described as aneuploid. Although these tests may help determine prognosis, they rarely change the course of treatment and are considered optional. They are not usually recommended as part of a routine breast cancer work-up. Different methods can be used to measure ploidy:

Flow cytometry uses lasers and computers to measure the amount of DNA in cancer cells suspended in liquid as they flow past the laser beam.
Image cytometry uses computers to analyze digital images of the cells from a microscope slide.
Flow cytometry can also measure the S-phase fraction, which is the percentage of cells in a sample that are replicating (copying) their DNA. DNA replication means that the cell is getting ready to divide into 2 new cells. The rate of cancer cell division can also be estimated by a Ki-67 test, which identifies cells in the S-phase, as well as cells getting ready to replicate DNA, cells that have just completed DNA replication, and cells in the process of dividing. A high S-phase fraction or Ki-67 labeling index means that the cancer cells are dividing more rapidly, which indicates a more aggressive cancer.

Tests of gene patterns

Researchers have found that looking at the patterns of a number of specific genes at the same time (sometimes referred to as gene expression profiling) can help predict whether or not an early stage breast cancer is likely to come back after initial treatment. This can help when deciding whether additional (adjuvant) treatment such as chemotherapy might be helpful after surgery. Two such tests (Oncotype DX® and MammaPrint®), which look at different sets of genes, are now available.

Although some doctors are using these tests (along with other information) to help make decisions about offering chemotherapy, others are waiting for more research to prove they are helpful. Large clinical trials of these tests are now under way. These tests have been studied mainly in breast cancers in women, and it’s not yet clear if they would be as useful in breast cancers in men. Still, men may want to discuss whether or not these tests might be appropriate with their doctors.

Last Medical Review: 01/14/2010
Last Revised: 01/14/2010

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Maria thank you, an excellent point and yes men also can get breast cancer.

It is rare, but it does happen and will be just as devastating. So to all you adoreable guys out there, make sure when you are in the shower and checking your ‘bits and pieces’ you also check for any lumps in the breast area. Keep safe because we love you.

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Some women are unaware there are different types of breast cancer. We think a yearly check -up and a mammogram ,looking for lumps, will keep us safe.

But no ,there is another type of cancer, Inflammatory Breast Cancer and it is a killer.

Symptons may look like a rash or an insect bite. If you have either go to your doctor and have it checked. Don’t wait.

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Cancer victim Jane Tomlinson was denied a new drug which could have extended her life because her NHS trust would not pay the £6,700 cost, her widower said.

The charity fundraiser was angry at suffering from a “postcode lottery” but refused to go public even though she was close to death, said Mike Tomlinson.
The mother of three had raised £1.75million, including “hundreds of thousands” for facilities run by the trust which refused to help her.
She preferred to “die early” rather than use her celebrity to get special treatment, said Mr Tomlinson.
“Jane has been fundamentally let down by an unjust system,” he said in an emotional press conference held on his late wife’s instructions.
“This is the National Health Service – potential life expectancy should not depend on where the person resides.”
Mrs Tomlinson did get the drug lapatinib from another hospital but her condition had seriously deteriorated during the three-month delay.
She died last month of breast cancer, aged 43, but her family believes she could still be alive if it had been given to her promptly.
Her condition had improved dramatically when she started taking lapatinib – only available for patients with advanced breast cancer – with a second drug in April.
For a while, the disease was “under control” but she deteriorated again after 12 weeks of a research trial and died in early September.
Her widower received a personal apology from Dr Phil Ayres, deputy medical director of the Leeds Teaching Hospitals NHS Trust. He admitted more could have been done to find the money.
Mr Tomlinson said his wife was ‘very unwell’ after her final gruelling charity event in the US last year.
She had chemotherapy in her home city of Leeds but in January her oncologist said she needed lapatinib.
Taken in pill form, it can hold tumours at bay but is not yet licensed by the NHS.
It was available from GlaxoSmithKline as part of the trial. The drug was free but “additional costs” were £6,700 per patient.
The manufacturer also refused to supply Mrs Tomlinson on a “compassionate” individual basis. Eventually the City Hospital in Nottingham agreed to treat her.
“It caused a lot of distress,” said Mr Tomlinson.
“The delay seriously affected her health. It is felt by the family this shortened her life.”
He said the couple wanted to highlight the problems caused by a postcode lottery for patients.
He urged Gordon Brown – who paid tribute to Mrs Tomlinson when she died – to introduce a “consistent” policy in which all patients suitable for unlicensed trial drugs had access to the same treatment.
Such drugs should be available in an approved trial if licensed by another nation, said Mr Tomlinson.
“Jane wanted the issue to be drawn to the wider attention of the public,” he said.
“She was extremely cross there were inconsistencies.”
Lapatinib was approved in the US in March. A trial of 324 women given it with the drug Xeloda showed it delayed advanced breast cancer by eight months compared to four months for Xeloda alone.

Jane died Monday 3rd September 2007, she was just 43 years of age. Her last days spent in St.Gemmas Hospice in Leeds.

She left behind husband Mike and three children, Suzanne,Rebecca and Steven.

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Think Positive

If you are visiting this site because you, or someone close to you, has cancer I have only two pieces of advice. Firstly get as well informed as you can. Secondly, live a life of positive energy, even when things just seem to get worse.

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Emilio my HERO

Emilio, you have done so much for Stephan and I. You and you alone know the hard times. I and I alone know how much you helped us and gave back dignity when all hope was lost.

Through sickness and in ‘wealth’ like a good spouse you were ALWAYS there.

We have to now watch you suffer, life is so cruel and unkind. You have children , grandchildren and good friends who love you.

Emilio I want you to know that YOU are my HERO. Thank you my dearest friend . I love you. xx

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So many victims, so many lives. I do not know Mandy, or the friends she has lost. I only know her words echo my own.

Dear Cancer:

You suck.

I want you to know how much I hate you. I know that this won’t exactly get you on board at the get-go, but I’ve got some things to say to you, and you’re going to listen.

Cancer, I’m young, but already I can name dozens of people whom I know who have fought you courageously. You make me fire-spitting angry at your arbitrary choices of victims, and your impossibility of prevention. This Summer, I looked you in the face for the first time, and I saw the depths of evil in your eyes. There is no good that comes from you, and I watched as you ate my friend alive.

When I met Fred, he was walking with Death as his shadow. He wore his glasses askew on his slender face, since your tumorous figure pushed on his ear. Fred was a good man. A kind man. A funny man. A brave man. He was a man of faith, despite all odds. He was a newscaster, and you got him right where it hurt the most: his face. You swallowed up his eye, and then you went for his brain. We watched as the chemotherapy designed to save his life weakened him so much that the rest of his body shut down.

You are clever, indeed, Cancer. In the end, you couldn’t be blamed for his death. You shoved responsibility off on his failing liver and you shrank into subtlety in your dark corner. When I saw Fred for the last time, you had taken all of his weight away, and stripped him down to his bones. His youthful handsomeness had given way to your vengeance and he looked like a man 30 years older than his age. His mouth was agape. His heart had stopped. Your tumor had shrank. We cursed your name, and blessed the Lord who took him away from this suffering you caused and gave him new life. We anointed his head with oil, and his cup overflowed with our tears and the water that will never run dry. We bade farewell to his broken body, and burned your remains along with his.

Monday, I went with a friend to hear the news that you had returned in his pancreas. This is not surprising – when you want to make a point and do it quickly, you know right where to put yourself. He beat you once. A few months ago, he was free of you. A walking miracle.

You are clever, indeed, Cancer.

You returned just as his strength was rising, his appetite increasing, his independence mounting. He drove himself to church on Sundays and Wednesdays. He ate with friends, and visited with neighbors. His caretakers exhaled. Then, you came back. You bullied his liver into some kind of melt-down, and the rising ammonia levels caused him confusion and forgetfulness. You sucked away his appetite as you took the place of empty space in his abdomen. His navel protrudes. His body is withering. You hide, undetected, in his pancreas, knowing that he’s too weak for a CAT scan, too vulnerable for a biopsy, too fragile for chemotherapy, unable to have radiation. His head bows in fatigue and hopelessness. You applaud yourself for taking one of the strong ones – one whom you had allowed to believe had defeated you for good.

He seeks only palliative care today. His only medications are those that bring him comfort. He will go to Hospice care soon, and we will wait and watch and comfort him as he screams at God for letting this happen to him.

But I know it’s not God. It’s you, Cancer.

As we waited at the cancer specialist yesterday, other patients milled around. Your victims. Breast cancer. Lung cancer. A melanoma or two, just for kicks. Then in walked a young mother and her daughter, not even two years old yet. Which one of them is it, Cancer? Which one are you trying to steal? Who’s heart will you break forever, and why the hell do you think you can do this to them?

To us?

I’m tired of it. I’ve watched friends fight you and win, but lose all of their weight and hair and appetite and spirit in the process. They’ve regained all of those things, but they are forever marred by the scars you’ve put upon their bodies and souls. You make their family mistrustful. “Sure – it’s gone now… but when will it come back?” You make their friends awkward, embarrassed and unequipped to stare you in the eye. Where there was once life, now you and Death stand lurking in the shadows.

What gives you the right?

I need you to know that I’m aware of your power. I know that any of my family members – husband, children, parents – could fall victim to you. I can’t stop it. I can’t predict it. I can’t do anything but wait and see, and in the meantime, I’ll get the call from someone saying that you’ve stopped there for a visit. I’m ready for that call, Cancer. Because I know something you don’t know.

You may bring Death, but Death has already died. Where you sow darkness, light will shine. You do not have the final answer on these bodies or spirits. No matter how fast or rampant or sneakily you come, you do not define the lives that were led by your victims. You are merely a disease. A horrible, evil disease. But you do not have claim on these people, who are loved and nursed by others. Life has claimed them long before you have. So, you can pretend to show mercy, but you do not know what mercy is. You can pretend to be valiant, but there is nothing valiant in your character. Try as you might to destroy life, you will fail, because our spirits were claimed by One who brought light and life eternal. You are the Valley of the Shadow of Death, but we will fear no evil, for God is with us.

Thanks be to God.

Sincerely,

Mandy
In honor and memory of Fred, Bob, Louise, Linda, Dot, Susan, Karen, Linda, Darrell…

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