Phyllodes Tumor- Symptoms, Causes, Complications, And Treatment

The name of the tumor Phyllodes comes from the Greek word “leaflike.” which represents the shape of the tumor which is identical to a leaf-like pattern.

A phyllodes tumor is one of the rarest tumors found. This type of tumor is mostly found in connective tissues of the breast known as the stroma. which also comprises ligaments and tissues of the duct, blood vessels, and lymph vessels surrounding the breast.

Tumors like this are often reviewed as borderline tumors. Reason, studies have shown that 90% of the diagnoses are benign! Phyllodes tumors do not outgrow the breast, Although in any case, it is cancerous, it has the tendency to spread at a very fast pace.

Also, there is a 25% chance of noncancerous Phyllodes developing into malignant, so it is better to seek medical advice immediately!

Malignant tumors are also known as sarcoma, and can only be treated by a surgery as they inherently recur in nature. However, its occurrence in phyllodes tumors has been linked to its margin status.

Patients who are diagnosed with a positive margin, have a much higher risk of metastases as compared to a negative margin, which has a slightly lower risk of metastasizing. In most cases, Malignant tumors are considered to be at the highest risk with metastases.

Furthermore, the tumor has no barrier for age! Phyllodes tumors can happen in any stage of life, but the disease has been shown frequently in the age group of 30-55.

Like its existence, The invention of the phyllodes tumor was quite complicated. It was first described as a giant type of fibroadenoma in early 1774.

Later in 1838, Johannes Muller used the term “cystosarcoma phyllodes” to describe the lesions limited to mammary tissue and its surroundings. As the study reached further it was seen that the tumor is rarely found in adolescents and the elderly. Until then the diagnosis was not able to describe the disease as cancerous or tumorous.

Later in 1943, it was discovered as a potential biological tumor by Cooper and Ackerman. They discover the cancerous and noncancerous types of the tumor and give an in-depth study of the same.

The refined and more detailed version of this research was discovered by Rosen in 1981 which later on became the globally accepted study and adapted by the World Health Organization and the term “phyllodes tumor” which is till now used to describe the disease.

Today’s advanced research and technology medical professionals are trying to cure the illness. Although the disease is not life-threatening until taken care of in time.

Phyllodes tumors tend to grow at a fast pace. Within a period of a few weeks or months, it can grow up to the size of 2-3 cm or larger, depending upon the nature of the tumor. The size of the tumor can also grow upto 10cm or in rare cases it goes upto 30-40 cm size of a lump.

It is recommended to seek immediate medical attention for effective treatment.

For most cases the root cause of the illness is unidentified, but several factors may associate the growth of tumor in the breast, which includes

• Injury in or around breast tissues.
• Breastfeeding.
• Pregnancy.
• Heightened estrogen levels, a female hormone responsible to regulate the functionality of the reproductive system and physical characteristics of the female body.
• Smooth textured lump.
• Redness and slight temperature rise in mammary gland.
• Critical cases include breast pain and open sore, blue skin, and dilated veins.

It is rare to see, but sprouting of phyllodes tumors can also be caused by an inherited genetic malady known as Li-Fraumeni syndrome. While detecting the tumor, doctors usually confuse it with less unique breast cancer known as fibroadenoma.

The key variation in both of the diseases is fibroadenoma is just hard lumps made by connective tissue clusters, on the other hand, phyllodes tumors are cancerous and grow faster and later in life.

Phyllodes tumors cannot be cured with medications, one has to go under surgery to remove the lumps, even if it is benign. In case of late diagnoses, it can develop a cancerous stage or turn into malignant, in that case, a more rigorous course of treatment will be advised.

Treatment of phyllodes tumor cannot be cured by one specialist only. It needs four doctors to cure cancerous Phyllodes tumors completely. Their respective fields and roles are:

1. Clinical oncologist:

   This field of doctorate specifically deals with radiotherapy for treating cancer. In the case of phyllodes tumor treatment, a clinical oncologist will use chemotherapy, radiotherapy, and cancer drugs to remove any signs and symptoms of cancer after the operation.

2. Pathologist:

   Doctors of this field are considered physicians who examine body tissues and fluids. Before surgery, a pathologist will examine the tissue sample collected during biopsy to examine any cancer treatment and diagnose post-surgery tumor lumps to examine any probability of relapse.

3. Radiologists:

   Doctors of this field are specialized in the diagnosis of cancer and tumors through medical imaging techniques like x-rays, ultrasound, and scans to diagnose and treat disease.

4. Surgeon:

   A general surgeon is specialized in the removal of internal cancer and tumors through surgery and operations. They are the ones who will collectively examine all the tests and conduct your surgery for cancer lump removal.

Phyllodes tumors are not easy to detect. They are quite identical to fibroadenomas and often mistaken as harmless breast lumps. A general examination will be conducted by your doctor to diagnose the lump size and shape.

To conclude the illness, your doctor will prescribe you series of test like:

1. Mammogram:

   Imaging techniques to examine breast internal situation through X-ray imaging.

2. Ultrasound:

   Is also a type of imaging technique, but more refined. The mechanism uses sound waves to create multiple images of your internal organs.

3. MRI:

   In critical cases where the images of X-ray and ultrasound don't help with clear conclusions, MRI is suggested. It uses powerful magnetic and radio waves to draw images of the breast in a cross-sectional manner.

4. Biopsy:

   It comprises the removal of a piece of the breast affected by the tumor. With the help of a hollow needle, your doctor will take a sample of the tumor through a slight cut and send the sample to a Pathologist for a detailed examination of the tissue cells.

There is no medication invented till now to treat cancer without its complete removal. In both cases of phyllodes tumor, the lump can be painful and discomforting to an individual. So, it is preferable to remove the tumor through surgery.

Since the cancerous phyllodes tend to multiply at a fast pace, it is important to remove some healthy tissues of the breast attached to the lump.

Surgery is mandatory to cure phyllodes tumor, but depending upon the size of the lump, the methodology of the surgery can be distinctive in three different ways:

1. Lumpectomy:

   This method is used for small-sized tumors or cancer lumps. The surgeon will remove the tumor with surrounding healthy skin tissues at least 1 centimeter or 0.4 inches.

2. Partial Mastectomy:

   If the tumor is large and covers almost the entire breast, the surgeon will go for partial mastectomy. In this process, an entire part of the breast will be removed and sent to the lab for testing.

3. Total Mastectomy:

   The method of surgery is used mostly In critical conditions where cancer or the tumor has spread to the entire breast. The surgeon will operate and remove the whole breast.

If the patient desires, they can have breast reconstruction surgery immediately after mastectomy.

Phyllodes tumor is a recurring disease and needs second surgery in a period of one to two years. In comparison to benign one cancerous phyllodes has a faster relapse period.

It is important to have regular checkups and follow-up on the treatment procedure. Routine examinations and imaging tests are recommended every four to six months, to detect any sign of growth.

In case of cancerous phyllodes, therapies and treatment are prescribed to kill any residue of cancer cells in the breast tissues:

• Radiation:

  Using high-energy waves, the radiologists will give radiation in the affected area to kill any leftover cancer cells. This method is often conducted post-surgery to treat cancerous phyllodes and prevent cancer from spreading outside of the breast region.

• Chemotherapy:

  Using strong chemicals, chemotherapy is quite effective in destroying cancer cells throughout. This treatment is usually prescribed in case cancerous tumors appear in other parts of the body.

15% of phyllodes tumors tend to be recurring. Also, metastases to the axillary lymph nodes are observed to be lower than 5% in phyllodes tumor patients.

Keep a regular check on your treatment, and diagnosis status along with some healthy lifestyle might reduce the chances of recurrent phyllodes tumors.

Phyllodes tumor has a rare but possible chance to occur during pregnancy. Scientists are not sure if the tumor has to do something with hormone imbalance. It can grow during pregnancy regardless of having any connection to the pregnancy.

Although, post-pregnancy and lactation can be a subsequent reason for phyllodes tumor to develop, as during lactation and pregnancy the levels of estrogen in the body rise, which is known as a potential reason for developing Phyllodes tumor.

Also, any injury or development of a lump during and after pregnancy should not be ignored, seek medical help immediately if one is related to the symptoms of Phyllodes tumor.

According to the world health organization, phyllodes tumor is divided into three category:

1. Benign (Noncancerous):

   As mentioned earlier, 90% of the cases with phyllodes tumor are benign. They can be easily cured with surgery and have a successful survival rate of approximately 70-90%. It is curable and does not tend to recur.

2. Borderline:

   The term used to describe a stage of phyllodes tumor in which the tumor has a 50-50 chance of developing into phyllodes cancer. The survival rate, in this case, is similar to the benign stage. Yet it has a similar probability of creating cancer cells in the breast.

3. Malignant:

   Is known as the cancerous stage of the disease. In which phyllodes tumors are hard to cure, as even after surgery there is a 20-40% chance that it might occur within five years. In this case, the survival rate is slightly lower than in the noncancerous stages.

   The doctor's advice is to monitor the post-treatment for up to 5 years for any recurrence of cancer cells in the breast or other parts of the body.