2006-02-20 20:03:41

乳癌不是女性的專利, 男性也有可能得乳癌!中山醫學大學附設醫院去年中收治一名五十八歲男性乳癌病患, 由於一般男性對乳癌警覺性不夠, 就醫時大都是中晚期, 這名病患到院檢查時癌細胞已轉移到淋巴腺, 經手術切除後, 目前還在進行化療, 醫師研判十年存活率應有五成。

中山醫學大學附設醫院外科主治醫師姚忠瑾今天表示, 雖然機率不高, 但男性也有可能得乳癌, 臨床上, 大部分看到的男性乳房腫塊都是良性, 根據國外的統計, 男性乳癌的發生率約萬分之一, 約占所有乳癌的百分之一、所有男性癌症的百分之零點二, 相對的, 女性乳癌則占了所有女性癌症的百分之二十六。

姚忠瑾指出, 大部分男性乳癌的病患在發現乳暈下有一腫塊時, 都不會很在意, 有時甚至會認為和勤練體能, 導致胸大肌發達有關, 一直到腫塊愈長愈大才來求診, 像這名男病患在就診前半年就發現乳房有硬塊, 半年後來就診時已是乳癌第三期, 且已轉移到淋巴腺。

姚忠瑾說, 根據二00四年的研究顯示, 男性乳癌的發生率比二十五年前增加了百分之二十五, 女性乳癌則比同時期增加百分之五十二, 研究也發現, 男性乳癌的病患第一次來求診時比女性乳癌病患要來的晚期, 可能是因為男性不被認為會罹患乳癌, 同時也不女性較常進行自我檢查及篩檢。

姚忠瑾強調, 男性乳癌和女性乳癌治療方法和預後差不多, 愈早發現治療的效果愈好, 治療的原則以手術切除為主, 包括整個乳房及腋下淋巴腺廓清, 若有淋巴腺轉移則會建議加上化療;若腫瘤侵犯到胸大肌, 則會建議加上局部放射治療;若病理切片的荷爾蒙受體為陽性, 則會建議使用選擇性雌性激素接受體調節劑或是芳香媒抑制劑治療。

姚忠瑾提醒, 男性乳癌的症狀與女性乳癌差不多, 都會在乳房先出現硬塊, 接著皮膚凹陷、出現分泌物, 由於男性乳暈較小、乳房組織較少, 因此, 癌細胞較容易轉移到其他部位, 他建議, 超過五十歲以上的男性, 如有單側乳房腫塊最好找一般外科專科醫師求診, 早期發現、早期治療的效果是相當好的。
Detailed Guide: Male Breast Cancer
What Is Breast Cancer in Men?

Breast cancer is a malignant tumor that has developed from cells of the breast. The disease occurs primarily in women but occasionally occurs in men.

Many people do not realize that men have breast tissue and that they can develop breast cancer. Until puberty, young boys and girls have a small amount of breast tissue consisting of a few ducts (tubular passages) located under the nipple and areola (area around the nipple). At puberty, a girl's ovaries produce female hormones, causing breast ducts to grow, lobules (milk glands) to form at the ends of ducts, and the amount of stroma (fatty and connective tissue surrounding ducts and lobules) to increase. On the other hand, male hormones produced by the testicles prevent further growth of breast tissue. Men's breast tissue contains ducts, but only a few if any lobules.

Like all cells of the body, a man's breast duct cells can undergo cancerous changes. Because women have many more breast cells than men do and perhaps because their breast cells are constantly exposed to the growth-promoting effects of female hormones, breast cancer is much more common in women.

Many types of breast disorders can affect both men and women. Most breast disorders are benign (not cancerous). Benign breast tumors do not spread outside of the breast and are not life threatening. Other tumors are malignant (cancerous) and may become life threatening. Benign tumors, such as papillomas and fibroadenomas, are common in women but are extremely rare in men.

Lymphatic vessels are important structures in the breast. They are like veins, except that they carry lymph instead of blood. Lymph is a clear fluid that contains tissue fluid and waste products and immune system cells (cells that are important in fighting infections). Lymph nodes are small bean-shaped collections of immune system cells that are found along lymphatic vessels. Cancer cells can enter lymphatic vessels and spread to lymph nodes.

Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary lymph nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal mammary nodes) and either above or below the collarbone (supra- or infraclavicular nodes).

When breast cancer cells reach the axillary (underarm) lymph nodes, they may continue to grow, often causing the lymph nodes in that area to swell. If breast cancer cells have spread to the underarm lymph nodes, they are more likely to have spread to other organs of the body as well. This is why it is important to find out if breast cancer has spread to your axillary lymph nodes when you are choosing a treatment.

Benign Breast Conditions

Gynecomastia is the most common male breast disorder. It is not a tumor but rather an increase in the amount of a man's breast tissue. Usually, men have too little breast tissue to be felt or noticed. A man with gynecomastia has a button-like or disk-like growth under his nipple and areola, which can be felt and sometimes seen. Gynecomastia, common among teenage boys, is due to changes in hormone balance during adolescence. The same condition is also common in older men and is also due to changes in their hormone balance.

Rarely, gynecomastia occurs because tumors or diseases of certain endocrine (hormone-producing) glands cause a man's body to produce more estrogen (the main female hormone). Although men's glands normally produce some estrogen, it is not enough to cause breast growth. Diseases of the liver, which is an important organ in male and female hormone metabolism, can change a man's hormone balance and lead to gynecomastia. Obesity may be another cause of elevated estrogens in men.

Many commonly prescribed medicines can sometimes cause gynecomastia, too. These include some drugs used to treat ulcers and heartburn, high blood pressure, and heart failure. Men with gynecomastia should ask their doctors about whether any medicines they are taking might be causing this condition.

Klinefelter syndrome, a rare genetic condition, can lead to gynecomastia and increase a man's risk of developing breast cancer. This condition is discussed further in the section on risk factors for male breast cancer.

Types of Breast Cancer

Adenocarcinoma: Nearly all breast cancers start in the ducts or lobules of the breast. Because this is glandular tissue, they are called adenocarcinomas, a term applied to cancers of glandular tissue anywhere in the body. The 2 main types of breast adenocarcinomas are ductal carcinomas and lobular carcinomas.

Ductal carcinoma in situ (DCIS): DCIS is an uncommon type of breast adenocarcinoma in men (about 10%). Cancer cells fill the ducts but do not invade through the walls of the ducts into the fatty tissue of the breast or spread outside the breast. It is almost always curable.

In situ is the term used for the early stage of cancer, when it is confined to the immediate area where it began. Specifically in breast cancer, in situ means that the cancer remains confined to ducts (ductal carcinoma in situ) or lobules (lobular carcinoma in situ). It has not invaded surrounding fatty tissues in the breast nor spread to other organs in the body.

Infiltrating (or invasive) ductal carcinoma (IDC): Starting in a duct of the breast, this type of adenocarcinoma breaks through the wall of the duct and invades the fatty tissue of the breast. At this point, it can metastasize (or spread) to other parts of the body. IDC (alone or mixed with other types of invasive or in situ breast cancer) accounts for 80% to 90% of male breast cancers.

Other Breast Cancers

Lobular breast cancers in men are very rare, accounting for only 2% of adenocarcinomas. This is because men do not usually have lobular tissue, the milk-producing glands.

Paget disease of the nipple: This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple. It may also spread to the areola (the dark circle around the nipple). The skin of the nipple usually appears crusted, scaly, and red, with areas of itching, oozing, burning, or bleeding. Using the fingertips, a lump may be detected within the breast. If no lump can be felt, the prognosis (outlook for survival) is generally good. Paget disease may be associated with in situ carcinoma or with infiltrating breast carcinoma. It accounts for about 1% of female breast cancers and a higher percentage of male breast cancers. Because the male breast is much smaller than the female breast, all male breast cancers start relatively close to the nipple, so spread to the nipple is more likely.

Revised: 02/09/2006