Introduction
Phyllodes tumor is a lesion limited to mammary tissue; it was described by Muller in 1838. It was first discovered by Muller. It is present in one among 100,000 and its cause is still not known. It mostly occurs in women and mostly in the third and fourth decades. It also occurs in adolescents.
Studies state that it is highly present in whites and, in particular, in East Asians. Treatment of phyllodes tumor is mainly by surgical treatment for which better results are obtained, increasing the quality of life of the individual suffering from phyllodes tumor of the breast. This article explains the factors affecting the prognosis of the surgical management of the tumor and the ways to improve the prognosis.
What Are Phyllodes Tumors?
Phyllodes are rare fibroepithelial tumors present in the breast. They account for nearly one percent of all breast tumors and about three percent of fibroepithelial lesions of the breast. They are commonly seen in women aged 40 but can be present in women of any age as well. The risk of occurrence of phyllodes tumor is increased by the presence of a few genetic conditions, like Li-Fraumeni syndrome (a syndrome leading to an increased risk of cancer development).
What Are the Types of Phyllodes Tumors?
According to the World Health Organization, Phyllodes tumors are broadly divided into three types based on histological (microscopic) features. Histologic features show the degree of stromal cell types, overgrowth, and tumor margins.
Following are the divisions in the phyllodes tumors:
-
Grade I - Benign tumors.
-
Grade II - Borderline tumors.
-
Grade III - Malignant tumors
What Are the Symptoms of Phyllodes Tumor?
It is usually present as a smooth round, firm, motile, well-circumscribed, usually painless mass on examination. They also do not show any mammographic, or pathognomic features, and it becomes difficult to differentiate them from fibroadenomas. Except the lesion is immensely large, identification can be done.
What Are the Treatment Options?
Treatment for all phyllode tumors is not the same. The approach varies depending on the grade of the tumor and the patient's clinical condition. The following are a few treatment approaches used for treating phyllode tumors.
-
Surgical Treatment: Total wide excisions with margins greater than one centimeter are often treatable and decrease the recurrence rate. Huge tumors require complete removal of the breast (mastectomy). There is a higher chance of recurrence associated with breast-conserving surgery than with mastectomy. Mastectomy reduces metastasis (the spread of the tumor to adjacent tissues), which can reduce the local recurrence rate.
-
Radiation Therapy: An adjuvant therapy that uses high-energy X-rays to destroy cancer cells.
-
Chemotherapy: Chemotherapy includes drugs given before and after surgery to increase the benefits of treatment.
-
After Surgery (Adjuvant Chemotherapy):
-
Any leftover cancer cells after the surgery are killed by adjuvant chemotherapy. It also aids in lowering the risk of recurrence of cancer.
-
Before Surgery ( Neoadjuvant Therapy):
-
Huge tumors require extensive surgery, while tumors of lesser size can be removed with minor surgery. Neoadjuvant therapy helps decrease the size of the tumor, thereby decreasing the need for extensive surgery.
-
-
Hormone Therapy: Certain hormones like estrogen and progesterone can help grow cancer cells with hormone receptors. Hormone therapy cannot be used in individuals who do not have hormone receptors.
What Are the Factors Affecting the Prognosis?
Every point, from the occurrence of the disease to the clinical condition evaluation of the individual due to the tumors, diagnosis of the tumor, grading of the tumor, treatment approach, and technical expertise, affects the prognosis of the condition.
Radiological findings:
Diagnosis becomes the major factor in determining the treatment approach and, consecutively, the prognosis of the condition. Mammograms were performed on low-grade phyllode, intermediate-grade, and high-grade tumors. They can be visualized as round or solidly lobulated. They show the presence of sharp, well-defined borders and calcifications that resemble popcorn. All grades of tumors showed the same features without any difference.
Ultrasonography:
On ultrasound, they appear as irregularly homogenous solid masses, and this is a common manifestation in tumors of any level.
Cytological Examination:
A fine needle aspiration is performed, and the diagnosis is made as a phyllode tumor. Excisional biopsy was mostly used to confirm the diagnosis.
-
Once the diagnosis is made, the treatment is planned.
-
Mostly, all the phyllodes are treated using surgical techniques.
-
The surgical technique's approach also determines the disorder's success and prognosis.
-
After the proper surgical technique is identified and performed, the surgical extent of the tumor is also considered.
-
Recurrence is another factor that brings down the prognosis. Recurrence can occur due to surgical margins, nuclear atypia, and several tumors, stromal overgrowth, pleomorphism, and histological grade.
-
All the factors that determine the extent of the disease present and the rate at which the disease can metastasize decide the prognosis of the tumors.
How Can the Prognosis Be Improved?
Proper and early diagnosis of the phyllodes tumors of the breast can help in obtaining an excellent surgical plan and avoiding reoperation. Differentiating between phyllodes tumor and fibroadenoma is essential but difficult to diagnose by any biopsy.
An interprofessional team should manage the phyllode tumors, consisting of an oncologist, a surgical oncologist, a radiologist, a pathologist, and nurses specially trained in oncology. Working together as a team can help achieve the best clinical outcome.
The primary physician should refer the patient with an undiagnosed or suspected mass in the breast to an oncologist. Surgical treatment is either by obliterating the tumor or by obliterating the mammary gland by a procedure called mastectomy. A continuous follow-up should be maintained to detect any recurrence or relapse of the tumors.
Conclusion
The histotype of phyllodes tumors (benign, borderline, and malignant), assessed on certain criteria, was a prognostic factor in patients. Based on the data and observations, it can be concluded that a wide local excision, with an adequate margin of normal breast tissue, is the preferred initial therapy for the phyllode tumor of the breast and shows the best prognosis. Factors affecting the prognosis are described in this article. The recurrence of phyllodes usually occurs very rarely. Non-cancerous tumors can show a good prognosis compared to malignant or cancerous phyllodes that are usually poor in prognosis. The surgical oncologist must be consulted to obtain the perfect treatment plan for a good prognosis.
