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Breast Cancer (Expert Forum)
Phyllodes Tumor
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Phyllodes Tumor
by SuzanneM., Dec 06, 2002 12:00AM
My sister was recently diagnosed with a benign phyllodes tumor, and I just have a few questions. (1) Is this considered a form of breast cancer even though it is benign? (2) From what I have read, even a benign tumor can return, sometimes as a malignancy. How is this possible if it is benign and has been removed? (3) Also, I've read that it can spread through the blood. The information out there tends to put benign and malignant patients together; so, I'm wondering does this possibility exist for patients with benign tumors or just those with malignant tumors? Since this tumor is somewhat rare, it has been hard to find consistent information, not only on the tumor itself, but specifically on the prognosis for benign patients. Any help you can give is very much appreciated. Thanks~Suzanne
Doctor's Answer
by CCF-RN,MSN-rf, Dec 06, 2002 12:00AM
Dear Suzanne M. Phyllodes tumors are not staged in the same manner as breast cancer. The following information regarding phyllodes tumor is directly from the textbook “Cancer: Principles and Practice of Oncology” 6th edition, edited by DeVita,V., Hellman,S., and Rosenberg, S. I hope it is of some help to you. Beyond this, in terms of your individual case, you would need to discuss any additional interpretations with your physician.
“The term phyllodes tumor includes a group of lesions of varying malignant potential ranging from completely benign (non-cancerous) to fully malignant sarcomas.
Phyllodes tumors are classified as benign, borderline, or malignant based on the nature of the tumor margins (pushing or infiltrative) and presence of cellular atypia, mitotic activity, and overgrowth in the stroma. There is disagreement about which of these criteria is most important, although most experts favor stromal overgrowth. The percentage of phyllodes tumors classified as malignant ranges from 23% to 50%. Axillary metastases are reported in less than 5% of cases, but are a poor prognostic sign when present. Metastases more commonly follow the pattern seen with sarcomas (with lung as the most common site) and histologically resemble sarcomas. Approximately 20% of phyllodes tumors recur locally if excised with no margin or a margin of a few millimeters of normal breast tissue, regardless of whether they are benign or malignant. A wide excision with a 2cm margin of normal breast tissue is appropriate therapy for benign and borderline phyllodes tumors unless they are so large that this is not cosmetically feasible. In the past, many authors have advocated mastectomy for the management of malignant phyllodes tumors. Since phyllodes tumors are not multicentric, there is no clear-cut biologic rationale for mastectomy, and series have reported the successful treatment of malignant phyllodes tumors with wide excision. The use of systemic therapy for malignant phyllodes tumors is based on guidelines for treating sarcomas.”
Benign phyllodes tumors are treated with surgery only.
“The term phyllodes tumor includes a group of lesions of varying malignant potential ranging from completely benign (non-cancerous) to fully malignant sarcomas.
Phyllodes tumors are classified as benign, borderline, or malignant based on the nature of the tumor margins (pushing or infiltrative) and presence of cellular atypia, mitotic activity, and overgrowth in the stroma. There is disagreement about which of these criteria is most important, although most experts favor stromal overgrowth. The percentage of phyllodes tumors classified as malignant ranges from 23% to 50%. Axillary metastases are reported in less than 5% of cases, but are a poor prognostic sign when present. Metastases more commonly follow the pattern seen with sarcomas (with lung as the most common site) and histologically resemble sarcomas. Approximately 20% of phyllodes tumors recur locally if excised with no margin or a margin of a few millimeters of normal breast tissue, regardless of whether they are benign or malignant. A wide excision with a 2cm margin of normal breast tissue is appropriate therapy for benign and borderline phyllodes tumors unless they are so large that this is not cosmetically feasible. In the past, many authors have advocated mastectomy for the management of malignant phyllodes tumors. Since phyllodes tumors are not multicentric, there is no clear-cut biologic rationale for mastectomy, and series have reported the successful treatment of malignant phyllodes tumors with wide excision. The use of systemic therapy for malignant phyllodes tumors is based on guidelines for treating sarcomas.”
Benign phyllodes tumors are treated with surgery only.
