A guide to diagnosis and treatment
A phyllodes tumour is a smooth, hard lump of tissue that can appear anywhere in the breast.. Once formed a phyllodes tumour may grow quite large, quite quickly.
Malignant and borderline malignant phyllodes tumours are rare types of breast cancer. They may be difficult to diagnose because they can be confused with other breast problems such as a fibroadenoma. Once a diagnosis has been confirmed the treatment is usually tailored to the individual.
Although they can affect people at any age, phyllodes tumours are most common in women between 40 and 50 who haven’t yet been through the menopause.
Phyllodes tumours are grouped into three classes:
- benign (not cancer)
- borderline malignant
The information on this webpage is about malignant and borderline malignant phyllodes tumours. There is more information about benign phyllodes tumours in the Breast awareness section of our website.
A malignant phyllodes tumour usually becomes noticeable as a lump in the breast. Your GP is likely to refer you to a breast clinic where you’ll undergo a range of tests to help make a diagnosis. They include a clinical examination, mammogram, ultrasound scan, fine needle aspiration and/or needle core biopsy. These investigations are known as triple assessment.
You may also have a magnetic resonance imaging (MRI) scan. This uses magnetism and radio waves to produce a series of cross sectional images of the inside of the body.
Sometimes a triple assessment won’t be able to confirm that you have a phyllodes tumour, so you’ll need an operation that removes the lump to find out what it is.
Phyllodes tumours are always treated with surgery. You will be offered breast-conserving surgery or a mastectomy, with or without breast reconstruction.
Breast-conserving surgery, usually referred to as wide local excision or lumpectomy, is the removal of the cancer with a margin (border) of normal breast tissue around it. A mastectomy is the removal of all the breast tissue including the nipple.
You may be given a choice between these two types of surgery. If a wide local excision is possible, then it is important that a clear margin of tissue is taken from around the cancer. If a clear margin of tissue is not seen when the area removed is examined under the microscope, then a second operation might be needed.
Unlike other types of breast cancer, malignant and borderline malignant phyllodes tumours rarely spread to the lymph nodes under the arm (axilla) so these will not be routinely taken out during surgery. However, your surgeon will look at your individual case and recommend the best surgery for you.
Adjuvant (additional) treatment
If you have a borderline malignant phyllodes tumour you will not need any additional treatments after surgery.
If you have a malignant phyllodes tumour, you won’t usually need any other treatment such as radiotherapy and chemotherapy. However, your surgeon may want you to see an oncologist (a doctor who specialises in the treatment of cancer) to look at your individual case. Hormone therapies are not used to treat malignant phyllodes tumours.
Can it come back or spread?
In most cases, a malignant or borderline malignant phyllodes tumour is successfully treated the first time by surgery. But sometimes the tumour can come back. If this happens, more surgery will usually be offered. Additional treatments may be given although this may depend on whether the phyllodes tumour was borderline malignant or a malignant phyllodes tumour. A malignant phyllodes tumour can spread through the bloodstream to other parts of the body, known as secondary breast cancer, although in the vast majority of cases this does not happen. If your malignant phyllodes tumour spreads your surgeon will send you to an oncologist, who will assess your case and recommend the best treatment for you.
Your follow-up care after treatment for a malignant or borderline malignant phyllodes tumour will vary. Your individual situation and hospital will both play a part. Your specialist team will tell you how often to go for follow-up appointments.
If you have any concerns in between follow-up appointments or develop any new symptoms, you can contact your GP (local doctor), specialist or breast care nurse. They will arrange for you to be seen earlier if needed.
For more information about being diagnosed with a borderline malignant or malignant phyllodes tumour, please see our factsheet Phyllodes tumours: malignant and borderline malignant.
Last reviewed March 2012; next planned review 2013