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Doc: Leaflike tumor in breast is rare occurrence

Keith Roach
To Your Health

Dear Dr. Roach: I was diagnosed with having a borderline phyllodes tumor in my right breast. The general surgeon also referred to this type of tumor as a “cystosarcoma.” My understanding is that this type of tumor occurs in only 1 percent of all breast tumors. The tumor was removed (it was 6.9 cm), and it was determined that the stromal cells had moderate to severe atypia. No wide excision was performed, as the surgeon was reluctant to do it based on the tumor being attached to the nipple.

Can you explain what procedure (if any) should be done now? The surgeon is saying that a three-month waiting period prior to any additional procedures is acceptable. I am confused, as everything I’ve read about this type of tumor differs.

C.B.S.F.

Dear C.B.S.F.: Phyllodes tumors are a rare type of breast cancer. They used to be called “cystosarcoma phyllodes,” although they are not true sarcomas (cancers derived from connective tissue) and might not have cysts; the term has since been abandoned. The word “phyllodes” means “leaflike,” based on the pathologic appearance. Phyllodes tumors are grouped as “benign,” “borderline” or “malignant,” also based on their pathologic characteristics (such as the atypia you mention) and mitotic figures, an estimate of tumor growth. As with other tumors, even a “benign” tumor by pathology can recur, so expert follow-up is mandatory. However, the prognosis for benign and borderline phyllodes tumors is very good (more than 90 percent survival at five years).

Because these tumors are so rare, there is no agreement on optimal treatment. Surgical treatment is the usual first treatment, and wide excision (removing a large amount of normal tissue around the tumor to be sure of getting all the abnormal cells) reduces its recurrence rate. Radiation is a reasonable treatment for borderline tumors if wide excision is impossible. Waiting after surgery before radiation is appropriate; this allows wound healing. Chemotherapy is rarely used, and hormone therapy is not effective.

Your surgeon knows more about you than I do, but I would expect that he or she would recommend consultation with a radiation oncologist.

Dear Dr. Roach: Is there any evidence that an athletic heart developed by prolonged exercise either adds to or reduces life expectancy?

P.A.O.

Dear P.A.O.: People who exercise more have a significantly longer life expectancy than those who do not, and there is a rough correlation between the amount of exercise done and how much benefit is received.

The optimum amount of exercise also remains controversial, but several studies have suggested that it is much more than most of us get — about the equivalent of 8-10 miles daily. However, there’s much more benefit in going from very little exercise (walking almost none) to a light or moderate amount (perhaps 2-4 miles a day) than going from moderate to prolonged. There is some evidence that there may be no benefit or even harm from extreme levels of exercise, compared with moderate exercise, at least in middle-aged men.

Exercise intensity is important for performance, so a person who runs 8 miles a day is likely to be faster than a person who walks the same distance. However, in terms of life expectancy, it does not matter as much whether you run, jog or walk. Some of the benefits are due to the beneficial effects of regular exercise on the heart, but there are many other benefits, including reduction of cancer risk.

Email questions to ToYourGoodHealth@med.cornell.edu.