Unlike most forms of breast cancer, which usually starts in the ducts or glands, phyllodes tumors are rare tumors that start in the connective tissue (called the stroma) of the breast. They comprise less than 1% of all breast cancers.
Duke breast surgical oncologists are experts in diagnosing and treating phyllodes tumors, a rare type of tumor that grows in the breast. As nationally recognized leaders in phyllodes tumor research and treatment, we perform a comprehensive evaluation to accurately diagnose your phyllodes tumor and genetic testing to determine your risk for future malignancies. We work as a team to perform complicated chest wall (thoracic) surgery when phyllodes tumors return or spread to other parts of the body.
What Are Phyllodes Tumors?
Types of Phyllodes Tumors
They are classified into three subtypes: benign, borderline, and malignant, based on findings seen under a microscope. Some of these subtypes can overlap. Our specialists are experts in correctly classifying your phyllodes tumor. This ensures you receive the best treatment recommendation.
Benign Phyllodes Tumor
Most phyllodes tumors are classified as benign (non-cancerous). The firm masses grow slowly in the breast tissue and typically occur in women in their 40s. They are the least likely phyllodes tumor type to return, but if they do, most continue to be benign.
Benign Phyllodes vs Fibroadenoma
Phyllodes tumors may be misdiagnosed as fibroadenomas, which are also firm, benign breast lumps. Fibroadenomas commonly occur in younger women, typically in their teenage years or early 20s. While fibroadenoma and benign phyllodes tumors look similar on an imaging test and even a core needle biopsy, a correct diagnosis can be made after the mass is removed and tested.
Borderline Phyllodes Tumors
Phyllodes tumors are classified as borderline if they have characteristics associated with benign and malignant phyllodes tumors.
Malignant Phyllodes Tumors
Up to 15% of phyllodes tumors are considered malignant and may become metastatic. These tumors grow rapidly and are more likely to return or spread after treatment. Malignant and metastatic phyllodes tumors require more aggressive treatment and should be managed by a team of experts who specialize in phyllodes tumor treatment.
The Duke Cancer Center is a state-of-the-art patient care facility that provides almost all outpatient services in one convenient location.
Diagnosing Phyllodes Tumors
Ultrasound-Guided Core Needle Biopsy
A hollow needle punctures the skin and removes a small amount of tissue for examination under a microscope to aid in diagnosis. A definitive diagnosis may not be made until the mass is surgically removed and examined.
Genetic Testing and Counseling
Because a rare genetic condition can increase your risk of a malignant phyllodes tumor, you may be referred to our genetic counselors for genetic counseling and testing. This helps us determine your risk of future cancers.
Benign Phyllodes Tumor Treatment
Small benign phyllodes tumors may be removed through a minimally invasive surgical procedure called an excisional biopsy. The tumor and a rim or margin of tissue surrounding the tumor are removed to ensure that only healthy tissue remains.
Lumpectomy or Partial Mastectomy
The size of the tumor determines if a lumpectomy is needed. A lumpectomy or partial mastectomy removes a slightly larger portion of the breast than an excisional biopsy and takes a larger margin of healthy tissue around the breast. A lumpectomy aims to preserve the breast shape and contour and create an aesthetically pleasing result.
About 10% of benign phyllodes tumors will return in the breast, usually within the first two years of surgery. The timing of follow-up monitoring, including breast exams and ultrasound imaging, can vary from every six months to every few years, depending on the features of the phyllodes tumor.
Borderline and Malignant Phyllodes Tumor Treatment
Your doctor will consider several factors when determining the right treatment plan for borderline and malignant phyllodes tumors. These factors include:
- Tumor size
- How the tumor was removed during the initial operation
- How much breast tissue was preserved or how much is available around the tumor
- Microscopic findings and other lab results
Treatment options include additional surgery, such as a lumpectomy if an excisional biopsy was initially performed, mastectomy, and/or radiation therapy after surgery. Duke’s extensive experience treating phyllodes tumors has helped to improve outcomes for people with borderline and malignant phyllodes tumors.
Locally Recurrent and Metastatic Phyllodes Treatment
Malignant phyllodes tumors may return to the same, or very near the same location (this is called locally recurrent). They may also become metastatic, meaning they return elsewhere in the body. These complex tumors require more extensive treatment, including complete mastectomy, chest wall resection (removes the tumor, chest wall, and muscle if the tumor has spread to the chest), breast reconstruction, and/or radiation therapy.
Complex Chest Wall Surgery for Chest Wall Recurrence
Phyllodes tumors that return after mastectomy and have spread deep into the chest wall require a coordinated team of surgeons who routinely remove these rare rumors to prevent a future recurrence. Duke is one of the few cancer centers in the country with a team of breast and thoracic surgeons who are expertly equipped and regularly perform complex surgery to remove the tumor, chest wall, and muscle to ensure a wide, tumor-free margin. The highly skilled team also includes specialized plastic surgeons who reconstruct the area immediately following the procedure.
Why Choose Duke
One-Day Coordinated Consultation with Phyllodes Tumor Specialists
If the tumor returns after mastectomy, more extensive surgery may be needed. Your consultation will include a complete range of diagnostic tests. You will meet with members of Duke’s team of phyllodes tumor experts and with a surgical oncologist, medical oncologist, radiation oncologist, and a plastic surgeon when needed. If you have not already undergone genetic testing, you will complete these tests and meet with our genetics counselor, if needed. We gather all the information we require to make an informed decision about your treatment plan that we discuss with you on the day of your appointment.
Nationally Recognized Experts in Phyllodes Tumors
Our phyllodes tumor experts are helping to standardize phyllodes tumor treatment and reporting so that centers across the country will use the same information to diagnose and treat all phyllodes tumors.
Leading Research on Phyllodes Tumor Treatment
We are also leading research to determine the best approach to phyllodes tumor treatments. Our tumor registry collects phyllodes tumor tissue and uses it to better understand the tumor and test new therapies.
Multi-Specialty Approach to Treatment Decision Making
Our team of experts includes specialists in breast surgical oncology and thoracic surgical oncology who routinely perform large chest wall reconstruction surgery for people with malignant phyllode tumors. People come to us for care from around the U.S. because of our unparalleled expertise in complex chest wall surgery and reconstruction. We offer options to people who have been told elsewhere that chest wall reconstruction surgery is not an option.
Our Support Services Follow You Through Your Journey
We offer the full range of services to help minimize the side effects of treatment and give you the support you need to cope with the emotional and psychological effects of treatment. Our services include meetings with registered dieticians, family therapists, self-image services, survivorship support, social workers, and palliative care providers.
Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.