Phyllodes Tumor: Causes, Symptoms, Treatment, Diagnosis

Phyllodes tumors are a rare kind of breast tumor that grows in the connective tissue of the breast. According to the American Cancer Society, most of the phyllodes tumors are not cancerous and do not spread outside the breast.⁽¹⁾ Some of the phyllodes tumors are called borderline tumors as they are between benign and cancerous.

A person can get these Phyllodes tumors at any age but they are known to be common in females above 40 years of age. Those with a rare inherited genetic condition called Li-Fraumeni syndrome are more likely to get phyllodes tumors.⁽²⁾

The exact cause of phyllodes tumor is unknown. It is believed that hormone imbalance can play a role along with the other factors, which include:⁽³⁾

• Pregnancy
• Trauma
• Increased estrogen activity
• Lactation

How these factors lead to tumor growth is yet unknown. It is thought that a protein called endothelin-1 stimulates breast fibroblast growth, which secretes protein and creates a structural framework in the connective tissue.

Phyllodes tumors grow very quickly and the first symptom is the appearance of a lump under the skin of the breast. These lumps are mostly seen forming at the upper outer portion of the breast making the veins distended and swollen. This makes the breast appear blue in color.

The size of the tumor can range from 1-45 cm and in many cases, the entire breast is affected.⁽³⁾

Phyllodes tumor is not painful but some people may notice a discharge from the nipple, nipple inversion and ulceration, or bloody sores.

Phyllodes tumors look similar to other lumps in the breast known as fibroadenoma making them hard to diagnose. First, a person may feel a lump on self-examination of the breast. In such cases, a doctor should be consulted as these tumors grow quickly. A doctor may recommend further testing to confirm the diagnosis.

First, a clinical breast examination is done by the doctor in which they also check for the shape and size of the breast. Then the following test is recommended:

• A mammogram is done which uses an x-ray to take pictures of the breast.
• Ultrasound uses sound waves for breast pictures.
• MRI scan used powerful magnets and radio waves for cross-sectional pictures of the breast.
• A biopsy is done by removing a piece from the tumor through a hollow needle and sometimes whole tumor is also removed.

To be sure whether the tumor is a phyllodes tumor or fibroadenoma, the whole tumor needs to be removed.

Even if benign, phyllodes tumor can grow and cause pain and other problems. This is why a doctor recommends surgery to remove it. In this case, the lump and some of the healthy tissue from the surrounding are removed.

There are a few surgeries that are used in the treatment of phyllodes tumors.

Lumpectomy: In this the surgeon removes the tumor along with at least 1 cm of the tissue around. This prevents the tumor from coming back.

Partial Mastectomy: In the case of a large tumor the entire part of the breast with it is removed.

Total Mastectomy: In this procedure, the whole of the breast is removed and the person can go ahead with breast reconstruction surgery at the same time. In case of cancerous tumors the doctor may recommend the following:

Radiation Therapy: In this high energy waves are used to kill cancer. It can be used after surgery to treat cancerous phyllodes tumor that has not spread outside the breast.

Chemotherapy: In this therapy, chemicals are used to kill cancer cells throughout the body. It is an option when cancer has spread to other parts of the body.

Whether cancerous or not, phyllodes tumor can recur. A cancerous one may recur faster than the non-cancerous one. The recurrence usually happens in between 1-2 years of surgery.⁽¹⁾ A doctor keeps a close watch after removing the initial tumor and follow-up with regular breast exams, mammograms, ultrasound, and MRIs.

Phyllodes tumors are mostly non-cancerous but may sometimes recur. It is very important for a person to keep track of the tumor return. One should be regular with self-breast examination and follow-up with the doctor.