The aim of treatment for breast cancer is to remove the cancer from the breast and armpit area and to destroy any cancer cells that may have spread to other parts of the body but cannot be detected. Treatment will usually include surgery and may include radiotherapy, chemotherapy or targeted therapies.
Who is involved in your treatment?
Your treatment for cancer will require you to meet a number of doctors and other health professionals from different fields of medicine. They may include some of the following:
- a surgeon, who does breast surgery
- a medical oncologist, is a doctor who specialises in chemotherapy and hormonal therapy, as well as management of pain and other symptoms
- a radiation oncologist, is a doctor who specialises in radiotherapy management
- a radiation therapist, who is trained to deliver the radiotherapy prescribed by the radiation oncologist
- a breast care nurse, who specialises in caring for people after a breast cancer diagnosis and can provide information and support during treatment and recovery
- an oncology nurse, who specialises in administering chemotherapy and assists with radiotherapy
- a general practitioner
- a palliative care consultant, palliative care nurse and palliative care volunteers who specialise in providing support and symptom relief
- a counsellor, psychologist or psychiatrist, who specialises in providing support. They are also trained in treating anxiety and depression, and helping cope with pain
- a social worker, who specialises in providing support and helping organise practical and financial assistance
- a familial cancer specialist, who can advise about genetic testing and cancer risk for your relatives. (If you have a strong family history)
- a dietitian, who specialises in providing information about diet
- an occupational therapist, who specialises in providing practical assistance
- a physiotherapist, who specialises in pain management and providing exercise programs
- a pastoral care/religious representative, who offers emotional and spiritual support (most hospitals have a Chaplaincy service).
Many patients find the large range of specialists to whom they may be referred confusing. Ask the members of your treatment team about their role in your care. You can also ensure that there is open communication between the members of your treatment team by asking them to send your medical information to relevant clinicians in your treatment team, including your general practitioner. At different times in the treatment of the cancer, different treatment team members may be the main co-ordinator of your care. This person may be your general practitioner, surgeon or oncologist or another member of your treatment team. This role will change over time, so it is important to ask, if you are unsure, about who to contact regarding any concerns.
Below are some questions that you might find useful to ask your treatment team in order to establish the role of each member involved in your care:
- Who shall I call if I have a problem?
- Who should I contact out of regular hours if needed?
- Who will regularly review my health and any symptoms I have, such as pain?
- How often will I need to have follow-up?
- Does information about test results and treatment go to all treatment team members?
- Do my treatment team members regularly meet or discuss my progress via telephone calls or letters?
- Who can organise financial and practical support, should I need them?
- Who can advise me on practical issues related to sick leave etc?
Feeling comfortable with your treatment team
It is important that you feel comfortable with your treatment team and that you are getting the information and support you need. It may take some time to establish a good relationship with your treatment team members, and for them to understand your needs. It is important to let your treatment team know of any particular concerns and priorities.
Obtaining a second opinion
You have the right to get a second opinion at any time. Having a second opinion can help clear up any questions, can help you decide which doctor you prefer to manage your treatment, and help you decide which course of treatment to follow.
The most common surgery for men with breast cancer is mastectomy. This involves removal of the whole breast, including the nipple and areola (the darker area of skin around the nipple). Sometimes part of the muscle under the breast is also removed. One or more of the lymph nodes under the arm will usually also be removed and examined. This helps the doctors find out whether the cancer has spread outside the breast and helps in determining treatment options.
Your hospital stay may vary from 1 to 5 days. How long you stay in hospital will depend on the type of surgery and your progress-each man is different in how long he takes to recover from a mastectomy.
You can expect the following after a mastectomy:
- you may have some pain, discomfort, or numbness in your chest and armpit while the wound is healing
- you will have a scar across the affected side of your chest; the appearance of the scar will improve with healing over time
- if lymph nodes have been removed, you will usually have one or more drains (plastic tubes) from the chest and/or underarm to remove blood and lymph fluid that collects during the healing process; these are usually removed a few days after surgery
- you may have some stiffness in your shoulder; it is important to talk with your doctor or breast care nurse about ways to reduce this; physiotherapy can be helpful.
If you are worried about any aspects of treatment or side effects talk to your doctor.
Figure 1 - Male mastectomy
Illustration reproduced with permission from Men with Breast Cancer, Breast Cancer Care 2005
Radiotherapy is sometimes recommended after mastectomy. The main aim of radiotherapy is to destroy any breast cancer cells that may be left in the breast tissue on your chest (after mastectomy). Talk to your doctor about whether radiotherapy may benefit you.
Radiotherapy uses X-rays (controlled doses of radiation) to destroy cancer cells. Radiotherapy is a ‘localised’ treatment, which means it treats only the area of your body it is aimed at. Occasionally radiotherapy is also used to treat the lymph nodes in the armpit and/or lower neck.
Side effects of radiotherapy
Receiving radiotherapy is painless. However, you may find that you have some discomfort or pain afterwards. Some of the most common side effects during or after radiotherapy include:
- the skin on and around the treated area can become red and dry, much like sunburn
- skin starting to look darker than usual
- feeling more tired than usual.
These side effects will improve with time. Discuss how to best manage these side effects with your radiotherapy team.
Radiotherapy can cause your skin to become more sensitive during treatment. The following tips will help you look after your skin during your course of radiotherapy:
- where possible keep your skin dry and clean
- after washing gently pat the skin dry
- do not use aftershave or lotions without first checking with your doctor, nurse or radiation therapist
- do not use deodorants, or sunscreen in or around the area that is treated
- wear loose-fitting cotton clothing over the treatment area.
“Radiotherapy wasn’t too much of a problem. We were all down there at the clinic, all got cancer, all going in for treatment and a few of us there started to make everyone laugh. It was good.”
Chemotherapy involves using drugs to kill cancer cells. The aim of chemotherapy is to destroy any cancer cells that may have spread outside the breast and armpit but can not be detected. Different types of chemotherapy drugs may be used to treat breast cancer. The side effects will depend on which drugs and drug combinations are used. Chemotherapy can be used on its own or in combination with surgery or radiotherapy. Chemotherapy is given by mouth using tablets or by injection-most commonly into a vein in the arm through the use of an intravenous drip. Treatment is in cycles, usually lasting for several weeks or months. You have treatment then a period of rest before the next treatment, and then the cycle is repeated.
Side effects of chemotherapy
In addition to destroying cancer cells, chemotherapy can also damage some normal cells, especially those which normally divide more rapidly and have a high turnover. Cells with a high turnover are those lining the mouth, stomach and bowel, as well as cells in skin, hair and bone marrow. If these normal cells are damaged from chemotherapy, you might experience side-effects such as nausea, mouth ulcers, skin problems, weight gain or loss, tiredness or hair loss. Exercising, even during treatment, may help you to feel less tired. Gentle exercise, like walking, is ideal, but some men find that more strenuous exercise is helpful too.
Side effects will vary depending on the drugs used and individual variation. Modern treatments mean that these symptoms are often not severe, and if they do occur they can be medically treated. Unlike cancer cells, normal cells can repair themselves and recover from the effects of chemotherapy. If you do experience side effects, even if you do not think they are serious, it is important to discuss them with your doctor so that the best possible treatment can be given
“It’s been two years since I finished chemo treatment and there are still foods that I ate when I was having chemo that I can’t stand the smell of now.”
Hormonal and targeted therapies
Hormonal and targeted therapies (such as trastuzumab) may be used in addition to surgery and radiotherapy for treating breast cancer in men. Many breast cancers need hormones called oestrogens to grow. Hormonal therapies work by decreasing the amount of oestrogen in the body or by stopping the cancer cells from getting oestrogen. Hormonal therapies include anti-estrogens (tamoxifen) and aromatase inhibitors.
Side effects of hormonal therapy
The most common side effects of hormonal therapy for men include:
- hot flushes (sudden feeling of being overheated, accompanied by sweating and redness in the chest, neck and face)
- decrease in libido/sexual interest.
Blood clots are a rare side effect of hormonal therapy. Talk to your doctors if you have had blood clots before, and ask how to help prevent blood clots. Contact your doctor immediately (or hospital emergency department if your doctor is not available) if you have chest pain, or if you notice any pain, warmth, swelling or tenderness in an arm or leg.
Different drugs affect individual men in different ways. Some men will have more side effects than others while some may not have any side effects at all. Most side effects can be managed. If you experience any new symptoms it is important to talk to your doctor.
“I’m currently on tamoxifen, no one could tell me if there would be any side effects in men. As yet I’ve only experienced hot flushes, which makes life interesting”
Questions to ask your doctor
Below is a list of questions that could help you decide about the treatment of your breast cancer. You may want the answers to some of the questions straight away, while some may become important later on. Some may not matter to you at all. You can either ask these questions directly, or use them as a guide to put together your own questions.
- What treatment would you recommend and why?
- How long will I be in hospital?
- What are the side effects of treatment?
- How much will my treatment cost? Where can I go for financial assistance?
- Will I need to travel for treatment?
- When can I return to work?
- Can I still drive after treatment?
- Can I still play sport after treatment?
- Who can I speak to about sexual concerns?
- Are there any clinical trials suitable for me?
- Will my children be at higher risk of breast cancer?
- Where can my partner and I go for support?
After treatment, men do not need to have regular imaging, however regular follow-up with your doctor or surgeon is recommended.
For every person, the follow-up management plan will be worked out according to the type of cancer, the treatment you have had and any other medical problems you might have. If you find a breast lump, breast change, or other symptoms, do not wait until the regular appointment - see your GP or specialist as soon as possible.
Lymphoedema is a swelling in an area of the body due to blockage of the lymphatic vessels. It can be very mild or quite severe. Lymphoedema can develop months, or even years, after treatment. Some men develop lymphoedema after surgery to remove lymph nodes and/or radiotherapy to the armpit.
It can develop in the arm (on the same side as the treated armpit), breast, or remaining breast tissue. Symptoms include swelling, tightness in the skin or pain in the arm or chest. These symptoms are not to be confused with angina which is caused by constricted blood flow through the blood vessels of the heart. Symptoms of angina usually include chest pain, pain down the left side of the body, chest tightness or pressure, or shortness of breath. Tell your doctors promptly about any symptoms that develop after treatment.
If lymphoedema develops, your surgeon can advise you on what can be done to reduce the swelling and avoid infection and may suggest a referral to a physiotherapist or occupational therapist.