Phyllodes tumors are a rare type of tumor that develops in the connective tissues of the breast.
These tumors typically present as a firm, painless mass in the breast, and some may grow quickly. Most phyllodes tumors are benign and are treated with surgical excision alone.
However, a small portion of these tumors can be more aggressive and require additional treatment, including radiation therapy and chemotherapy.
Phyllodes tumors can be removed with mastectomy (removal of the whole breast with the tumor) or lumpectomy (removal of the tumor with a small amount of surrounding breast tissue) depending on the size and type of the tumor and patient preference. Because phyllodes tumors rarely spread to lymph nodes, lymph node evaluation is usually not performed at the time of surgery.
Tests
Mammograms
Mammograms are the fastest, most accurate way of detecting an abnormal growth in your breast. With tomosynthesis, or 3-D mammography, radiology technologists can get breast images from multiple angles, enhancing the accuracy of a reading and reducing the potential need for repeat scans.
Breast Ultrasound and MRI
Your doctor may request a noninvasive imaging exam, such as breast ultrasound or breast MRI, if you have dense breasts and you’re at a higher risk of breast cancer — especially for those with a 20 percent or higher lifetime risk for breast cancer.
Ductoscopy
More than 80 percent of breast cancer growths arise in milk ducts. If your symptoms include a watery, blood-tinged discharge from the nipple, your surgeon will use ductoscopy to find the lesion to sample or remove it. It uses a fiber-optic scope less than a millimeter thick inserted into the milk duct at the nipple to send images to a computer monitor.
Estrogen and Progesterone Receptor Test
This test looks for estrogen and progesterone (hormone) receptors in your cancer tissue. If your breast cancer cells have estrogen and progesterone receptors, the cancer may grow more quickly. The test tells your doctor whether treatment to block estrogen and progesterone will be effective.
Human Epidermal Growth Factor Type 2 (HER2/Neu) Receptor Test
This test measures how many HER2/neu breast cancer genes there are and how much HER2/neu protein is made in a sample of breast tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer may grow or spread more quickly.
Multigene Tests
Because no tumor has a single mutation, genomic profiling allows the pathologist (cellular expert) to identify groups of mutations in your tumor tissue sample. We then can create a tumor profile for you. That profile helps us determine what type of treatment would be the most effective and how long you should have treatment.
Treatments
Lumpectomy
This procedure removes a tumor (lump) and a small amount of normal tissue around it. Sylvester cancer surgeons pioneered the technique for oncoplastic lumpectomy and now teach other surgeons around the country. During a lumpectomy, your surgeon removes the tumor and a small area of surrounding tissue. Your doctor sculpts the remaining breast tissue to give your breast a natural appearance, with touch-ups to the other breast to make them match.
Lumpectomy with Breast Reduction
For women with large breasts, the surgical oncologist and plastic surgeon can do breast-reduction surgery, starting with the cancerous breast to make sure the removed tissue contains the lump and a clean — or safe — margin around the lump. The plastic surgeon reduces the other breast to match.
Partial Mastectomy
This surgery, also called a segmental mastectomy, removes a larger part of the breast than for a lumpectomy.
Skin and Nipple-Sparing Mastectomy
When appropriate and possible, this procedure preserves the skin and nipple to minimize scarring and improve your surgeon's ability to reconstruct your breasts.
Mastectomy
A mastectomy removes the entire breast that's affected by cancer. The surgeon may remove one or more of the lymph nodes under your arm during surgery, or as a separate procedure later, to see if cancer has spread.
If you have a mastectomy, you may choose to have breast reconstruction surgery during at the same time, or you can decide to do it later. Your surgeon may perform an oncoplastic lumpectomy, or your breast cancer surgeon and a plastic surgeon can work together to do reconstructive surgery. New techniques make it possible to create a breast that's close in form and appearance to your natural breast.
Sentinel Lymph Node Biopsy
Doctors use this minor surgery to determine if cancer has spread beyond a primary tumor into your lymphatic system. A sentinel lymph node is the first place cancer cells may move to when they begin to spread. During the biopsy, your doctor injects a special dye (tracer) to locate the nodes and remove them to look for cancer cells. If they're free of cancer, it means it's unlikely that cancer has spread and it's not necessary to remove more lymph nodes.
Sylvester offers a novel treatment that prevents taking more lymph nodes, even if the sentinel node is suspicious. Before surgery, an ultrasound scan of the armpit can highlight which lymph nodes are involved (they will appear enlarged or swollen). When chemotherapy is used before surgery (neoadjuvant chemotherapy), it can convert a previously positive lymph node to negative when biopsied, which means more lymph nodes don't need to be removed.
Venous Lymph Node Transfer and Lymphatic Grafting
If you have lymphedema from a previous surgery, Sylvester’s expert surgeons can prevent or provide relief from the debilitating condition caused when cancerous lymph nodes in the armpit must be removed during surgery, disrupting the normal flow of lymphatic fluid out of the arm. With nowhere to go, the fluid backs up in the tissues of the limb, causing painful swelling. In vascularized lymph node transfer, lymph nodes and their blood supply are transferred into regions where lymph nodes have been dissected to restore normal drainage.
Radiation Therapy
If you have a cancerous phyllodes tumor that hasn’t spread outside your breast, your doctor may include radiation therapy as part of your treatment to destroy remaining cancer cells after the tumor has been removed.
Chemotherapy
Chemotherapy is cancer-fighting medicine that's administered intravenously or by a pill. Chemotherapy also might be recommended before surgery, called neoadjuvant chemotherapy, to help reduce the size of the tumor and improve surgical results. Often, more than one chemotherapy medicines are used at the same time or one after the other to destroy different kinds of cancer cells that come from the same breast cancer.
Follow-Up Care After Phyllodes Treatment
These tumors sometimes can recur in the breast itself; or, if you had a mastectomy, they can develop in the skin and underlying tissues of the breast. Most recurrences happen within a year or two of surgery. Cancerous phyllodes tumors may return more quickly than benign phyllodes tumors.
To ensure any recurring tumors are caught at the earliest stages, your doctor will design a follow-up plan including:
- Clinical breast exam within four to six monthsMammogram, ultrasound, and possibly breast magnetic resonance imaging (MRI) six months after treatment, and on a regular basis.
- Computed tomography (CT) scans of your chest and abdomen for two to five years if your phyllodes tumor was cancerous and you're at increased risk for a recurrence.
Why Choose Sylvester Comprehensive Cancer Center?
Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.
Renowned Braman Family Breast Cancer Institute at Sylvester. We offer treatments customized to your individual needs at one of the nation's best breast cancer diagnosis and care programs.
Breast Imaging Center of Excellence designation by the American College of Radiology. Thanks to imaging excellence, you receive a more precise diagnosis, which then guides a more effective treatment plan.
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