Breast cancer in men

Breast cancer is approximately 1.24% of tumors in men (0.2 per 100 000) and occurs in the ratio 1 :100 among malignant tumors of the body. Ill mainly aged 55-65 years, but there are reports of patients aged 6 years and 91 years.
To date there is no unity in views about the background of changes tissue occurs cancer breast cancer in men. The value of pre-existing gynecomastia in the Genesis of cancer, i.e. rudimentary formations pseudomolitor structure with many underdeveloped channels and ducts, surrounded by fibrous tissue, has been shaken by subsequent studies showed that the so-called gynecomastia is, obviously, hyperplasia of any tissue of the breast. In favor of this assumption proved morphological data: the preservation of a General plan of the structure of male breast cancer, the similarity with the physiological hyperplasia, which is observed in newborn female and adolescent girls in puberty, the lack of clear boundaries between the unchanged part of the breast and hearth "gynecomastia" in men. According to the employee of the Institute of Oncology E. L. Neishtadt (1978), 42 of 147 patients (28,5%) with a focal forms "gynecomastia" in varying degrees, were identified elements intracanalicular proliferation of epithelial either true papillary patterns, similar formations in women.
If you combine clinical and morphological data, we can conclude that there are two types of fibroadenomatosis in men who often described as gynecomastia. The first form is diffuse, characterized by single or double-sided breast growth, with a lobed and fine seals. In this form the glandular epithelium in tubes does not show the tendency to proliferation. The second form - focal - differs single dense site, most often located in the nipple. Here are the proliferation of epithelial in the lumen of ferrous cavities, papillary patterns. This form is reminiscent of papillary cancer in women.
In the pathogenesis of breast cancer in men, many have noted the role of heredity, repetitive injuries (boxers), metabolic disorders. Note the frequency of this form of malignant tumor in men, for a long time took estrogenic drugs (adenoma, cancer prostate gland), and chronic hepatopathies and violation of the process of inactivation of hormones, such as liver cirrhosis. This, in particular, explain the frequency of bilateral changes in the breast. Synchronous cancer was observed in 2% of patients, and more than half of them over 1 year to 20 years before the discovery of malignant tumors there were pockets of seals in the breast.
Tumors are usually located in around the area, relatively quickly invade the skin associated with the surrounding tissues. Metastasis to lymph nodes occurs more often than women, therefore, the increase and compaction of axillary nodes may be the first signs of the disease. When wounded and advanced forms of tumor clinical diagnosis is made easier (x-ray examination little informative because of the small size of the body), but with small tumors is complicated, because they may be among fibrotsementnoy glandular tissue. Any seal or multiple seals appeared in the zone of breast cancer in men, are subject to removal, and it is reasonable to dissect the entire fabric of cancer (by type total biopsy). Often have to resort to such bilateral transactions. A number of patients required differential diagnosis of TB, actinomycosis, tertiary syphilis, benign tumors, atheromas, lipomas.
Remember, however, that in all cases definitively clarify the diagnosis is possible only on the basis of histological studies.
Therapeutic measures differ little from those of the women, however, preoperative radiation therapy is used in almost all patients that are associated with tumor invasion of axillary nodes and frequency of ulcer forms of cancer. Modified and savings operations are not shown. The standard is mastectomy on Halstead that does not save from local recurrence, the percentage of which in men is much higher than in women.
When metastatic forms more widely than in women, make operations on endocrine organs: orchidectomy, adrenal and gipofizektomii. According to the National cancer Institute, USA (Meyskens, 1976), of 70 patients with distant metastases that were exposed orchidectomy, 47 (67%) showed marked analgesic and anti-tumor effect (up to regression of metastatic lesions), which continued to 58 months. In the absence of a positive response to hormone therapy term of life of the patients did not exceed 38 months. However, the mechanism of action of hormones is understudied and indications for use ablative surgery of endocrine organs are not clearly formulated. In General, the prognosis for cancer breast cancer in men is much worse than women, although at a relatively early diagnosis, especially in the case of cancer on the background of focal proliferation, 25% of patients live long (10 years or more) without recurrence and distant metastasis.