Breast cancer is one of the most common cancers affecting females or people assigned female at birth, with a wide range of types and characteristics. While many breast tumors arise in the ducts or glands, a small fraction originates in the breast’s connective tissue, forming less common types such as phyllodes tumors.
What is a Phyllodes Tumor?
Phyllodes tumors are rare fibroepithelial neoplasms, accounting for only 0.3% to 1% of all breast tumors. The World Health Organization classifies phyllodes tumors into three types: benign, borderline, and malignant. This classification depends on features like cell structure, how dense the tissue is, how fast cells are dividing, and if the edges look well-defined.
Benign phyllodes tumors make up the majority and have the lowest risk of spreading or recurring. Borderline tumors show some concerning features but are not fully cancerous. Malignant phyllodes tumors, which are cancerous, grow quickly and have the highest chance of spreading or returning after treatment.
These tumors begin in the breast’s connective tissue rather than in ducts or glands, which is where most breast cancers start. Because phyllodes tumors can look similar to another common breast condition called fibroadenoma, a thorough examination of the tissue under a microscope is needed for diagnosis.
Types of Phyllodes Tumors
This tumor is categorized into three distinct types based on its behavior and growth patterns.
Benign Phyllodes Tumors
They are non-cancerous and account for the majority of cases. These tumors typically grow slowly and have a low risk of spreading or returning after treatment. They are often easier to treat due to their low recurrence potential.
Borderline Phyllodes Tumors
They fall between benign and malignant categories. While they show some signs of abnormal growth, they do not fully exhibit the characteristics of cancer. Borderline tumors have a moderate chance of growing or returning after treatment, so they require close monitoring.
Malignant Phyllodes Tumors
They are cancerous and make up about 25% of all phyllodes cases. These tumors tend to grow quickly, often presenting as a fast-growing breast lump, and have a higher risk of spreading to other parts of the body or recurring after treatment. Due to their aggressive nature, malignant types often need more intensive management.
Phyllodes Tumor Symptoms
It usually feels like a hard, smooth lump in the breast. It’s typically well-defined and often grows quickly, sometimes reaching over 3 cm within a few weeks. As it enlarges, it can stretch the skin, making it appear shiny, translucent, or even sore. Interestingly, these tumors tend to appear more often in the left breast than in the right.
If the tumor is malignant, additional symptoms might develop, including:
- Fatigue
- Shortness of breath
- Bone pain
These symptoms could suggest that cancer has spread to the bones or lungs. If you notice any unusual breast changes, it’s important to consult a healthcare provider for a full evaluation of symptoms.
Causes of Phyllodes Tumor
These are rare, accounting for less than 1% of all breast tumors. They primarily occur in the breast tissue of people assigned female at birth (AFAB), though rare cases have also been found in people assigned male at birth (AMAB), often linked to gynecomastia, which suggests a possible hormonal link.
These tumors can develop at any age but are most common in middle-aged individuals. People with Li-Fraumeni syndrome, a genetic disorder associated with a higher cancer risk, appear more susceptible to this tumor. Some studies also mention a few family cases, such as those involving both a mother and daughter.
While the genetic risk factors for phyllodes tumor breast growth remain mostly unknown, researchers believe hormonal and growth factors may play a role. For instance, growth factors from the breast’s epithelium and higher levels of estrogen during pregnancy and lactation may encourage tumor growth. Endothelin-1, a substance that stimulates breast fibroblast growth, could also contribute. However, the precise role of these factors is not completely understood.
Diagnosis of Phyllodes Tumor
They are often first detected as firm, painless lumps in the breast, though they may cause discomfort in some cases. These tumors tend to grow quickly, sometimes stretching the skin over the affected area. To begin the diagnostic process, healthcare providers may use imaging tests, such as mammograms or ultrasounds, to differentiate the tumor from other breast lumps. However, these imaging tests alone cannot confirm a phyllodes tumor, as they can resemble fibroadenomas.
To accurately diagnose this tumor, a core needle biopsy is typically performed. During this procedure, a hollow needle, often guided by ultrasound, removes a sample of the tumor tissue for lab analysis. If the results are inconclusive, or if the tumor appears suspicious, an excisional biopsy might be recommended. This involves removing the entire tumor, which allows for a more thorough examination. The biopsy results can reveal whether the tumor is benign, borderline, or malignant. If the tumor is found to be malignant, additional tests may be necessary to check for any spread to other parts of the body.
Phyllodes Tumor Treatment
Treatment usually involves surgery to remove the tumor completely. Even if a tumor is benign, healthcare providers recommend removing it to prevent future growth, discomfort, or the chance of it becoming malignant.
For a benign tumor, an excisional biopsy may be sufficient if it removes the entire growth. However, if the tumor is borderline or malignant, a wider margin of healthy tissue around the tumor must be removed to reduce recurrence risk.
If the tumor is malignant, radiation therapy may be recommended after surgery, especially if there’s any uncertainty about the tumor’s complete removal. This approach reduces the chance of local recurrence.
Follow-up care after surgery is essential, as this tumor can sometimes come back. Regular breast exams and imaging tests help ensure any recurrence is detected early.
The Importance of Clinical Trials for Breast Cancer
Breast cancer clinical trials are essential for advancing treatments and improving outcomes for those affected by both primary and secondary breast cancer. These trials help researchers discover new therapies, refine existing ones, and explore innovative options for patients at all stages of the disease. Through clinical trials, patients gain access to cutting-edge treatments that may offer more effective options with fewer side effects.
For individuals with secondary breast cancer, clinical trials are especially valuable. They provide an opportunity to explore treatments that target specific aspects of metastatic disease, potentially offering better management and an improved quality of life. By participating in these trials, patients not only access potential breakthroughs but also contribute to valuable research that could benefit future generations facing breast cancer.
Conclusion:
In conclusion, understanding and treating phyllodes tumors requires specialized care and vigilant follow-up to manage the risk of recurrence. Surgical removal remains the primary treatment, with additional interventions like radiation therapy if the tumor is malignant. Furthermore, for those affected by rare tumors like phyllodes or more common forms of breast cancer, participation in paid research studies in Nebraska can offer access to potential treatments and innovative care approaches. By joining these clinical trials, patients contribute to advancing medical knowledge. Additionally, they gain potential benefits from potential therapies that could improve their treatment outcomes and quality of life.
