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Is Breast Phyllodes Tumor Benign or Malignant?

Phyllodes tumors (葉狀腫瘤) are rare, unique breast tumors, named after the leaf-like pattern they form under the microscope. They pose a series of diagnostic and therapeutic challenges to healthcare practitioners. The doctor provides a comprehensive approach to diagnosing and managing this unusual tumor, ensuring individualised care for each patient. 

What is a Phyllodes Tumor?   

A Phyllodes tumor is an uncommon fibroepithelial tumor that develops in the breast's connective tissue. These tumors account for less than 1% of all breast tumors and are most commonly found in women aged between 40-50 years. Depending on their growth pattern and other histological characteristics, they can display a wide range of behaviors, from benign (non-cancerous) to borderline and malignant (cancerous). 

 

Benign vs Malignant Phyllodes Tumors 

While most phyllodes tumors are benign, some can be malignant. Benign tumors grow slowly and are less likely to spread, though they can still grow large and cause discomfort. Malignant phyllodes tumors, however, are more aggressive and have a greater chance of spreading (metastasizing) to other body parts. It's crucial to accurately diagnose the type of tumor to devise an appropriate treatment plan. 

Benign Phyllodes Tumors 

Benign phyllodes tumors are non-cancerous growths. These tumors have well-defined borders and relatively uniform cell structure when observed under a microscope. They also have fewer dividing cells compared to malignant phyllodes tumors.  

Although benign, these tumors can still grow large and may become palpable, causing a noticeable lump in the breast. Due to their potential to grow quickly, and the small chance they may become cancerous over time, doctors usually recommend surgical removal.  

The prognosis for benign phyllodes tumors is generally excellent, with a low recurrence rate when the tumors are completely removed with a sufficient margin of healthy tissue. 

 

Malignant Phyllodes Tumors  

Malignant phyllodes tumors are cancerous and grow more rapidly than their benign counterparts. They are characterised by a high number of dividing cells, a lack of well-defined borders, and cells that appear more irregular and variable when viewed under a microscope.  

These tumors can metastasize or spread to other body parts, though this is relatively rare. The most common sites of metastasis are the lungs and bones.  

Treating malignant phyllodes tumors usually involves surgery, often followed by radiation therapy to reduce the risk of recurrence. Unlike most forms of breast cancer, malignant phyllodes tumors are generally not responsive to chemotherapy or hormone therapy. 

Symptoms and Risks of Phyllodes Tumors 

The most common symptom of a phyllodes tumor is a well-defined, smooth, and movable lump in the breast. It's often firm or hard to touch and can grow rapidly, sometimes noticeably increasing in size over weeks or months.  

In general, these tumors are painless, but their rapid growth can sometimes cause a feeling of breast discomfort or pain. Other less common symptoms include breast skin changes, such as dimpling or redness, and nipple discharge. 

 

How to Diagnose Phyllodes Tumors?  

Diagnosing a phyllodes tumor involves a series of steps, including a physical examination, imaging studies such as a mammogram or ultrasound, and a biopsy where a tumor sample is taken for microscopic examination. The definitive diagnosis, however, can only be made after the complete removal and examination of the tumor, as these tumors can closely resemble fibroadenomas, a more common type of benign breast tumor. 

 

Risk Factor   

According to the American Cancer Society, these tumors almost exclusively affect women and only a handful of cases have been reported in males. Phyllodes tumors are relatively rare breast tumors, accounting for less than 1% of all breast tumors. They most often occur in women in their 40s, but women of any age can develop these tumors. Despite extensive research, specific risk factors for developing phyllodes tumors are poorly understood. However, some studies suggest a possible connection with a history of fibroadenomas, another type of benign breast tumor.  

While anyone can develop phyllodes tumors, the risk may be slightly higher in women with a family history of breast cancer or certain genetic mutations linked to breast cancer, like BRCA1 or BRCA2. However, these links are not definitively established. More research is needed to understand the risk factors and causes of phyllodes tumors fully. Regular check-ups and breast screenings can help detect abnormalities early, increasing the chances of successful treatment. 

 

The link between phyllodes tumors and breast cancer, what are the risks?    

Phyllodes tumors are not a form of breast cancer, but they can behave similarly to certain types of cancer. While benign phyllodes tumors do not increase the risk of breast cancer, malignant phyllodes tumors can spread to other areas of the body if not treated promptly. The risk of recurrence or metastasis depends on various factors, including tumor size, the speed of growth, and whether the tumor has been fully removed. 

 

Phyllodes tumor treatment  

Treatment for phyllodes tumors typically involves surgery to remove the tumor. A lumpectomy (removal of the tumor and some surrounding tissue) is often enough for benign and borderline tumors. A mastectomy (removal of the entire breast) may be necessary for malignant phyllodes tumors. Post-surgical treatment might include radiation therapy or chemotherapy, especially for malignant tumors. 

 

Living with Phyllodes Tumor: Lifestyle Tips and Precautions  

Living with a phyllodes tumor requires regular follow-up care, as there's a risk of recurrence, particularly for malignant tumors. A healthy lifestyle can help improve overall well-being and recovery. This includes a balanced diet, regular exercise, limiting alcohol, and avoiding tobacco. Regular self-breast examinations and screenings are crucial for early detection of any changes. 

Phyllodes tumors, while rare, can pose significant challenges due to their potential to become malignant. Early detection and treatment are vital to preventing complications. At OT&P Healthcare, our team provides comprehensive and individualised care to those with a Phyllodes tumor. If you have concerns about breast lumps or any changes in your breast, we're here to provide you with the best care and support, every step of the way. 

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References

  1. American Cancer Society. Phyllodes Tumors of the Breast. 17 Oct 2023 Retrieved from https://www.cancer.org/cancer/types/breast-cancer/non-cancerous-breast-conditions/phyllodes-tumors-of-the-breast.html  
  1. Cleveland Clinic. Phyllodes Tumors. 17 Oct 2023 Retrieved from https://my.clevelandclinic.org/health/diseases/24226-phyllodes-tumors  
  1. Breastcancer.org. Cancerous Phyllodes Tumors of the Breast. 17 Oct 2023 Retrieved from https://www.breastcancer.org/types/cancerous-phyllodes-tumors  
  1. Medscape. Phyllodes Tumor (Cystosarcoma Phyllodes). 17 Oct 2023 Retrieved from https://emedicine.medscape.com/article/188728-overview?form=fpf  

Topics: Women's Health, General Practice / Family Medicine

OT&P Healthcare

OT&P Healthcare

OT&P Healthcare is a Premium Private Healthcare Practice in Hong Kong. Our priority is to help individuals to enhance and optimise their health by providing easy access to a wide range of excellent practitioners and information, supported by management systems and technology that ensure quality of service and value. Our Mission is to provide pre-eminent private healthcare in Hong Kong. We aim to be the best in class fully integrated healthcare service, providing a circle of care for all our patients' needs.

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