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A phyllodes tumour is a fast-growing, usually painless breast lump of gland and connective tissue that forms leaf-like fronds. Most are benign, some borderline and a few malignant, behaving like a sarcoma and spreading through the blood. Treatment is surgery with a rim of normal tissue; radiotherapy is considered for higher grades, and chemotherapy has little proven role.
Phyllodes tumours are fibroepithelial tumours in which the stroma, not the epithelium, is the neoplastic component; the epithelium is stretched into the leaf-like clefts that give the name. The World Health Organization grades them benign, borderline or malignant on stromal cellularity, nuclear atypia, mitotic count, stromal overgrowth and the character of the border, and most are benign. They present as a smooth, mobile, often large lump that has grown quickly over months, in women a decade older than those with fibroadenoma. Imaging cannot reliably separate the two, and a core biopsy often returns only a fibroepithelial lesion, so any rapidly growing or large fibroepithelial lesion is excised for diagnosis. Benign phyllodes tumours and fibroadenomas share MED12 mutations, and TERT promoter mutations accumulate in borderline and malignant tumours.
Surgery is the treatment for every grade. Wide local excision with clear margins is the aim, and mastectomy is reserved for tumours too large for the breast; the traditional demand for a 1 cm margin has softened, and guidelines now accept any negative margin for benign tumours while recommending re-excision for positive margins in borderline and malignant disease. Lymph node metastases are rare, so sentinel node biopsy and axillary dissection are not performed. Adjuvant radiotherapy has no randomised evidence: a single-arm phase 2 study of 46 borderline and malignant tumours treated with margin-negative breast-conserving surgery and radiotherapy reported no local recurrences, and guidelines list radiotherapy as a consideration after breast conservation for these grades. Adjuvant chemotherapy has no proven benefit and hormone receptors, though often present in the epithelium, do not guide treatment.
Benign tumours are cured by excision and recur locally in a minority, often at a higher grade than the original. Malignant tumours recur locally more often and a substantial minority metastasise, most often to the lungs and bone within the first few years, at which point they are treated like soft-tissue sarcomas with doxorubicin-based chemotherapy, and survival after recurrence is short. Follow-up with examination and imaging for the first few years catches most recurrences. The rarity of the disease means margin width, the role of radiotherapy and the value of molecular grading rest on retrospective series and registries rather than trials.
Under one percent of breast tumours, typically in women in their forties, a decade later than fibroadenoma; most are benign, and only the malignant minority behave as sarcomas and spread.
Most cancers start in the ducts and drain first to the axillary nodes, which is why the armpit is checked and a sentinel node is sampled.
Same organ: Triple-negative breast cancer (TNBC), Breast cancer (all types), HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Male breast cancer, Ductal carcinoma in situ (DCIS), High-risk early HR-positive breast cancer, HR-positive metastatic breast cancer after CDK4/6 inhibitors, HER2-low and HER2-ultralow metastatic breast cancer, Early HER2-positive breast cancer, HER2-positive breast cancer with brain metastases, Early triple-negative breast cancer, Metastatic triple-negative breast cancer, Basal-like 1 triple-negative breast cancer (BL1), Basal-like 2 triple-negative breast cancer (BL2), Mesenchymal triple-negative breast cancer (M), Mesenchymal stem-like triple-negative breast cancer (MSL), Luminal androgen receptor triple-negative breast cancer (LAR), Immunomodulatory triple-negative breast cancer (IM), Metaplastic breast carcinoma, Carcinoma with medullary pattern (medullary breast cancer), Adenoid cystic carcinoma of the breast, Apocrine carcinoma of the breast, Secretory carcinoma of the breast, BRCA-associated triple-negative breast cancer, Inflammatory breast cancer, Paget disease of the nipple, Invasive lobular carcinoma of the breast, Invasive breast carcinoma of no special type (invasive ductal carcinoma), Tubular carcinoma of the breast, Mucinous carcinoma of the breast, Papillary carcinomas of the breast (encapsulated, solid and invasive papillary), Invasive cribriform carcinoma of the breast, Invasive micropapillary carcinoma of the breast, Neuroendocrine neoplasms of the breast, Lobular carcinoma in situ (LCIS)
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Also on OnCo: Symptoms and red flags · Early detection roadmap.
Ultrasound and mammography, core needle biopsy, and excision of any rapidly growing or large fibroepithelial lesion because biopsy cannot reliably separate phyllodes tumour from fibroadenoma.
Complete excision with clear margins; observation if margins are close after a benign diagnosis.
Wide excision aiming for clear margins or mastectomy for large tumours, no axillary staging, and adjuvant radiotherapy considered after breast conservation.
Treated as a soft-tissue sarcoma with doxorubicin-based chemotherapy; no proven benefit from adjuvant chemotherapy.
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The three-tier grading on a phyllodes pathology report and the margin recommendations for each grade follow this review and the WHO classification it informed.
Adjuvant radiotherapy is considered after breast conservation for borderline and malignant phyllodes tumours; it does not address the risk of distant spread.
Query for this cancer: (TITLE:"Phyllodes tumour of the breast" OR ABSTRACT:"Phyllodes tumour of the breast" OR TITLE:"Cystosarcoma phyllodes historical" OR ABSTRACT:"Cystosarcoma phyllodes historical" OR TITLE:"Fibroepithelial tumour of the breast" OR ABSTRACT:"Fibroepithelial tumour of the breast" OR TITLE:"Malignant phyllodes tumour" OR ABSTRACT:"Malignant phyllodes tumour") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Phyllodes tumour of the breast, not a curated reading list.
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
Reduce by 50% for bilirubin 20-50 µmol/L and 75% for 50-85 µmol/L.
Alkylating chemotherapy can damage a blood stem cell in a way that shows up years later as myelodysplastic syndrome or acute myeloid leukaemia. It is uncommon, it depends on the total dose, and the risk falls away after about ten years. Knowing the cumulative dose you were given is the single most useful thing on your treatment summary.
Heart damage from cancer treatment: anthracyclines weaken the heart muscle permanently in a dose-related way, trastuzumab does so reversibly, and some kinase inhibitors raise blood pressure or disturb rhythm. Heart function (LVEF) is monitored by ultrasound during treatment.
Hodgkin lymphoma is usually cured, and the problems that follow arrive twenty and thirty years later: heart disease, an underactive thyroid, and second cancers, especially breast cancer in women irradiated to the chest when young. Most of them can be watched for.
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