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How does the doctor know I have breast cancer?

For men, breast cancer is most often found because you have a lump or other change in your breast.

The doctor will ask about your symptoms and do a physical exam, including a breast exam to look for changes in the nipples or the skin. The doctor will also check the lymph nodes under your arm and above your collarbone. Sometimes breast cancer can spread there.

Tests to find breast cancer

If signs and symptoms suggest you might have breast cancer, more tests will be done. Here are some of the tests you may need:

Mammogram: Mammograms are x-rays that are mostly used to find breast cancer early in women. But for men, a mammogram may be done to look more closely at the breast problem you have.

Breast ultrasound: For this test, a small wand is moved around on your skin. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture on a computer screen. Ultrasound can help the doctor see whether a lump is a fluid-filled cyst (pronounced “sist”) or a tumor that could be cancer.

Breast biopsy

In a biopsy, the doctor takes out part or all of an abnormal area to check it for cancer cells. A biopsy is the only way to tell for sure if you have breast cancer.

There are many types of biopsies, including:

• Core needle biopsy (CNB, the most common type)
• Fine needle aspiration (FNA)
• Surgical biopsy

Ask your doctor what kind you will need and what to expect.

Lab tests of biopsy samples: If cancer is found on a breast biopsy, other tests will be done on the samples to learn more about it. Lab tests can show:

• The type of breast cancer, based on the type of breast cells it started from
• The grade of the cancer, based on how abnormal the cells look
• The hormone receptor (ER and PR) status, based on whether the cancer cells have receptors for the hormones estrogen or progesterone
• The HER2 status, based on whether the cancer cells make too much of the HER2 protein
• Whether the cancer cells have certain other gene or protein changes.

This information can help your doctors determine the best treatment options for you.

Staging breast cancer

If you have breast cancer, the doctor will want to find out how far it has spread. This is called staging. Your doctor will want to find out the stage of your cancer to help decide what treatments might be best for you.

Tests to look for breast cancer spread

You might have one or more of these tests to help determine the stage of your cancer.

Lymph node biopsy: Removing one or more lymph nodes to check them for cancer cells. This can be done in different ways:

• Needle biopsy (usually an FNA)
• Sentinel lymph node biopsy (SLNB)
• Axillary lymph node dissection (ALND)

Imaging tests: These tests take pictures of the inside of your body to look for cancer spread. Which tests you need depends on your situation:

• Chest x-ray
• CT scan
• MRI
• Ultrasound
• PET scan
• Bone scan

Stages of breast cancer

The stage describes how far the cancer has spread within the breast and whether it has reached nearby lymph nodes or other parts of the body. In general, a lower stage number means the cancer has spread less. For example:

• Stage 0: Also known as carcinoma in situ (such as DCIS). The cancer is still only in the layer of cells where it started.
• Stage 1: Usually a smaller tumor only in the breast (or only small amounts of cancer in nearby lymph nodes).
• Stage 2: May be a larger tumor, and may have spread to a few nearby lymph nodes.
• Stage 3: May be an even larger tumor, or more lymph nodes are affected, or the cancer has grown into nearby areas.
• Stage 4: Cancer has spread to distant organs like the lungs, liver, bones, or brain.

Other factors can also affect the stage, such as the cancer’s hormone receptor status, HER2 status, and grade. This makes breast cancer staging complex. Ask your doctor about your stage and what it means.

What kind of treatment will I need?

There are many ways to treat breast cancer. Doctors often use more than one type of treatment. The treatment plan that’s best for you will depend on:

• The type and stage of your breast cancer
• The results of lab tests on biopsy samples
• The chance that a type of treatment will cure the cancer or help in some way
• Your age and overall health
• Your feelings about treatment and the side effects that might come with it

Surgery for breast cancer

Surgery is a common treatment for breast cancer. Most men with breast cancer have a mastectomy, which removes all of the breast tissue on the side that has cancer. Some men might be able to have a lumpectomy, which only takes out the lump and a little bit around it, but this is much less common because most men don’t have much breast tissue.

Surgery might also be needed to take out lymph nodes in the underarm area that might have cancer.

Side effects of surgery

Any type of surgery can have risks and side effects, such as pain, bleeding, or infection. Surgery to the breast or underarm can also lead to changes in how the breast looks or swelling in the arm (lymphedema). Be sure to ask your doctor what you can expect. If you have problems, let your doctors know. They should be able to help you with any problems that come up.

Radiation treatments

Radiation uses high-energy rays (like x-rays) to kill cancer cells. This treatment may be used:

• After surgery, to kill any cancer cells that may be left in the breast or underarm area
• To treat cancer that has spread, such as to the bones or brain

Radiation is aimed at the cancer from a machine outside the body. Most often, it’s given over several treatments. Each treatment is a lot like getting an x-ray, but the radiation is stronger.

Side effects of radiation treatments

Side effects depend on where the radiation is aimed. The most common side effects of radiation are:

• Skin changes or swelling where the radiation is given
• Feeling very tired (fatigue)

Most side effects get better after treatment ends. Some might last longer. If your doctor suggests radiation treatment, ask about what to expect.

Chemotherapy

Chemotherapy (chemo) is the use of drugs to kill cancer cells. The drugs may be given into a vein or taken as pills. These drugs go into the blood and spread through the body. Chemo might be used:

• Before surgery to shrink the tumor and make it easier to remove
• After surgery to try to kill any remaining cancer cells
• For cancer that has spread

Chemo is given in cycles or rounds that often last a few weeks. In each round, treatment is followed by a break to give your body time to recover. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.

Side effects of chemo

Chemo might make you feel very tired, sick to your stomach, and cause your hair to fall out. Some chemo drugs might cause other problems, like low blood cell counts, heart damage, or numbness or tingling in your hands and feet. Ask your cancer care team what you can expect.

There are ways to treat most chemo side effects. If you have side effects, be sure to talk to your cancer care team so they can help.

Hormone treatment

Many breast cancers grow in response to the hormones estrogen and progesterone. These are usually thought of as female hormones, but men make small amounts, too.

Drugs that block the effect of estrogen or cut down estrogen levels, such as tamoxifen, can be used to treat some breast cancers. Most often hormone treatment is given for at least 5 years, starting before or after surgery, to help lower the chances the cancer will come back. It can also be used to treat more advanced breast cancers.

Side effects of hormone drugs

There are many hormone drugs, and side effects depend on which one you’re taking. Ask your doctor about what to expect.

Targeted drugs

Targeted drugs attack parts of cancer cells that make them different from normal cells. This is different from chemo. Most often, your cancer cells will need to be tested to see if a targeted drug might be helpful for you.

Side effects of targeted drugs

The side effects of targeted drugs depend on which drug is used. Ask your doctor about what you can expect.

Immunotherapy

Immunotherapy medicines boost your own immune system to help it see and destroy cancer cells in your body. It might be helpful for more advanced breast cancers that have certain features.

Side effects of immunotherapy drugs

The side effects of these drugs tend to be mild for most people. But some people might have a reaction (like an allergic reaction) while getting one of these drugs. While it’s not common, sometimes the immune system might attack other, normal parts of the body, which can cause serious side effects. Ask your doctor about what to expect.

Clinical trials

Clinical trials are research studies that may give you a chance to try newer treatments not yet available to everyone. They are also how doctors learn better ways to treat cancer. Ask your doctor about clinical trials you may qualify for. It’s up to you whether to take part, and you can always stop at any time.

What about other treatments that I hear about?

You may hear about ways to relieve symptoms or treat your cancer such as herbs, diets, acupuncture, massage, or many others. Some may help with symptoms, but many aren’t proven to work and could even be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

What will happen after treatment?

You’ll be glad when treatment is over. But it can be hard not to worry about cancer coming back. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. Your doctors will ask about symptoms, do physical exams, and may order tests to see if the cancer has come back.

At first, your visits may be every 3 to 6 months. Then, the longer you’re cancer-free, the less often the visits are needed. After 5 years, they may be done once a year.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.

You can’t change the fact that you have cancer. What you can change is how you live the rest of your life – making healthy choices and feeling as well as you can.