In addition to the treatments already discussed, patients may also consider not undergoing (parts of) treatment. Undergoing medical treatment must always be a consideration of effect and side effect. The specific advantages and disadvantages of the patient’s situation must be discussed together with the patient’s doctor.
Radiation, also called radiotherapy, is a local treatment of the chest and/or armpit using radiation. This radiation comes from outside and goes through the skin. Radiation can be given at different times, namely: instead of or after an axillary lymph node removal, after a breast mastectomy or breast-conserving surgery, in the event of the return of the disease or with metastases.
Chemotherapy is a treatment with drugs (cytostatics) which kill cancer cells or inhibit their cell division. Chemotherapy is given in the form of a treatment course: a period which requires medication, then a period which requires no medication. Chemotherapy can be given at different times, namely: before or after surgery, if there are metastases or in the palliative phase.
Targeted therapy is treatment with drugs which specifically target cancer cells. This treatment is only possible if there is a HER2 positive tumour. Examples of targeted medicines are: trastuzumab, pertuzumab and lapatinib.
Anti-hormonal therapy is a treatment with drugs which inhibit the production of certain hormones or reduce their influence. This treatment is only possible if there is a hormone-sensitive tumour. However, this is the case with 90% of men. Anti-hormonal therapy can be given at different times, namely: before or after surgery, if there are metastases or in the palliative phase.
Sentinel lymph node procedure
The sentinel node is the lymph node which first collects the lymph fluid from the tumour. A sentinel node procedure is an investigation to see if there are cancer cells in the sentinel gland. If the latter is the case, additional treatment will generally be advised. Additional treatment may consist of radiation and/or in some cases a second operation to remove all lymph nodes from the armpit (axillary lymph node dissection).
For the possible side effects of radiotherapy, see the column “radiotherapy”.
Surgery can be a breast mastectomy (complete removal of the nipple and underlying tissue) or breast-conserving surgery (only the tumour and surrounding tissue are removed, but the nipple is spared). Breast conserving surgery is usually not possible because men only have a small amount of breast tissue under the nipple.
There is a possibility of breast reconstruction after a mastectomy. This reconstruction can consist of various parts; creating a new nipple of the skin around the existing scar, creating an areola by means of medical tattooing and filling up any dents caused by the breast mastectomy using one’s own fatty tissue (lipofilling).