MBC Educational Series

Feeling the Burn: Neuropathy in Cancer Patients and the Overlooked Burden in Male Breast Cancer

Written by: Lennard M. Goetze, Ed.D  |  Phil Hoekstra, Ph.D

This article is an original work prepared for publication exclusively for the Male Breast Cancer Global Alliance. No copyrighted sources were reproduced or paraphrased. All content is intended for educational purposes.

Neuropathy is one of the most common and distressing complications faced by people undergoing cancer treatment—and one of the least adequately addressed in routine survivorship care. Characterized by numbness, tingling, burning pain, electric-shock sensations, temperature sensitivity, and loss of balance, neuropathy can profoundly disrupt mobility, sleep, work, and quality of life. While chemotherapy-induced peripheral neuropathy (CIPN) is widely recognized in oncology, the experience of neuropathy in male breast cancer (MBC) patients remains underrepresented in clinical discourse, research priorities, and survivorship resources.

Men diagnosed with breast cancer often enter care pathways designed primarily around female patients. As a result, side effects such as neuropathy may be under-screened, under-discussed, and under-treated in male survivors—despite the same exposure to neurotoxic chemotherapies, radiation, and adjunctive therapies. Advocacy groups in male breast cancer care have increasingly called attention to this gap, noting that lingering neuropathy becomes a silent burden that outlasts remission and shapes long-term recovery.

 

Why Does Neuropathy Happen in Cancer Care?

Neuropathy in cancer patients arises from multiple converging mechanisms:

1) Chemotherapy Neurotoxicity
Certain chemotherapeutic agents—such as taxanes, platinum compounds, and vinca alkaloids—directly damage peripheral nerves. These drugs interfere with axonal transport, mitochondrial function, and myelin integrity, leading to sensory loss and neuropathic pain that often begins in the toes and fingertips before ascending proximally. Because nerves regenerate slowly, symptoms may persist long after treatment ends.

2) Radiation-Induced Nerve Injury
Radiation can cause fibrosis and microvascular compromise around nerve bundles. While breast cancer radiation targets the chest wall and axillary region, downstream effects on autonomic regulation and microcirculation can alter distal nerve health, contributing to sensory disturbances and cold intolerance in the extremities.

3) Microcirculatory Injury
Cancer therapies can damage small blood vessels that nourish nerves. Reduced perfusion deprives peripheral nerves of oxygen and nutrients, compounding neurotoxicity. The feet—being the most distal tissues—often reveal these deficits first.

4) Inflammation and Immune Dysregulation
Targeted therapies and immunotherapies can trigger inflammatory cascades that affect small fibers and autonomic nerves. In susceptible individuals, this results in burning pain, hypersensitivity, and temperature dysregulation.

5) Compounding Risk Factors
Pre-existing diabetes, vitamin deficiencies, thyroid dysfunction, alcohol exposure, and occupational neurotoxin exposure can amplify neuropathic vulnerability—factors that may be overlooked in male breast cancer care pathways.

Why Male Breast Cancer Patients Are at Particular Risk

Male breast cancer patients frequently report feeling “out of place” in oncology settings, which can discourage proactive reporting of side effects. Neuropathy may be normalized as “expected discomfort” rather than recognized as a treatable condition. Additionally, men may delay reporting sensory changes until functional impairment—falls, gait instability, or sleep disruption—becomes unavoidable. This delay narrows the window for early intervention.

Furthermore, MBC survivors may lack access to gender-specific survivorship education and peer support where neuropathy management strategies are shared. The result is an unmet clinical demand: to screen, detect, identify, and treat neuropathy earlier and more systematically in men with breast cancer.

Screening and Detection: Moving Beyond Symptom Checklists

Traditional neuropathy screening relies heavily on patient-reported symptoms and bedside exams. While essential, these approaches can miss early physiologic changes. Modern survivorship care benefits from combining subjective reporting with functional and imaging-based tools:

·        Quantitative sensory testing to track vibration and thermal thresholds

·        Nerve conduction studies to evaluate large-fiber involvement

·        Thermal imaging to visualize microcirculatory and autonomic changes associated with neuropathic stress patterns in the feet and hands

·        Gait and balance assessments to identify functional risk

Thermal imaging, in particular, offers a non-invasive way to detect asymmetric temperature patterns and distal perfusion changes that often accompany neuropathic dysfunction. While not a standalone diagnostic, it complements neurologic testing by revealing functional changes that may precede overt nerve conduction abnormalities.

Standard Solutions for Managing Cancer-Related Neuropathy

There is no single cure for CIPN, but a multimodal management strategy can significantly reduce suffering:

Pharmacologic Options

·        Neuropathic pain agents (e.g., duloxetine)

·        Topical analgesics for focal pain

·        Careful medication review to avoid neurotoxic overlaps

Rehabilitation and Physical Therapy

·        Balance training and proprioceptive exercises

·        Gait stabilization and fall-prevention programs

·        Strength training to reduce compensatory injury

Lifestyle and Supportive Interventions

·        Foot protection and proper footwear to prevent unnoticed injury

·        Nutritional assessment (B vitamins, metabolic support)

·        Sleep and pain hygiene strategies

Adjunctive Non-Invasive Modalities

·        Neuromodulation techniques

·        Image-guided monitoring of extremity health to track response to interventions

·        Education on daily foot checks to catch early skin or sensory changes

Neuropathy and Dermatomal Mapping

Peripheral neuropathy and radiculopathy often produce burning, tingling, or electric pain in specific distributions. Thermography can visualize these patterns along dermatomes—the “wiring diagram” of the skin mapped to spinal nerve roots. Dr. Hoekstra describes how thermal gradients trace neuropathic pathways, helping localize nerve impingement in the spine or peripheral nerves in the limbs. When combined with autonomic challenge testing, clinicians can differentiate acute inflammatory phases (often warmer) from chronic ischemic or denervated phases (often cooler).

 

This capability is especially valuable in pain management and personal injury contexts, where objective documentation of nerve-related dysfunction supports diagnosis, treatment planning, and medico-legal clarity.

The Case for Proactive Neuropathy Care in MBC Survivorship

For male breast cancer survivors, neuropathy is not merely a side effect—it is a quality-of-life determinant. Persistent numbness or burning pain undermines confidence in walking, returning to work, and re-engaging in daily life. When neuropathy is under-identified, survivors feel unseen; when it is proactively addressed, recovery becomes tangible.

Elevating neuropathy screening within male breast cancer survivorship reframes care from survival alone to functional restoration. By integrating early detection tools, imaging-informed surveillance, and multidisciplinary treatment pathways, clinicians can move from reactive pain management to proactive nerve protection. In doing so, the cancer community honors a simple truth voiced by patients themselves: relief from neuropathy is not optional—it is essential to healing.

 

 

Part 2 —

A Diagnostic Perspective on Neuropathy in Cancer Care

By: Robert L. Bard, MD, DABR, FAIUM, FASLMS

From a diagnostic imaging perspective, neuropathy in cancer patients is not a mysterious side effect—it is a predictable consequence of how modern oncology therapies interact with nerve biology, microcirculation, and tissue metabolism. Peripheral nerves are uniquely vulnerable structures. They rely on uninterrupted blood supply, intact mitochondrial function, and stable axonal transport to maintain sensory and motor signaling over long distances. Cancer treatments disrupt each of these systems in different ways, which explains why neuropathy often emerges first in the feet and hands.

Chemotherapeutic agents are designed to target rapidly dividing cells, but many also interfere with microtubule dynamics and mitochondrial integrity within neurons. This impairs axonal transport—the cellular “highway” that delivers nutrients and signaling molecules along nerve fibers. When transport fails, distal segments of long nerves become metabolically deprived, producing the classic stocking-and-glove distribution of numbness, burning pain, and temperature sensitivity. In parallel, treatment-related injury to the small vessels that nourish nerves reduces oxygen delivery, compounding neural stress in the most distal tissues.

Radiation therapy introduces a different pathway to neuropathy. By inducing endothelial injury and fibrotic change within irradiated fields and adjacent neurovascular bundles, radiation alters vascular regulation and autonomic signaling. Even when radiation is localized to the chest wall or axilla in breast cancer care, downstream effects on autonomic tone can influence distal circulation and nerve health. Over time, this dysregulation manifests as altered temperature control, color changes, edema, and sensory disturbances in the extremities.

Imaging provides a unique window into these processes because neuropathy is not solely a neural problem—it is a neurovascular and metabolic disorder with structural and functional signatures. High-resolution ultrasound can visualize peripheral nerves, revealing enlargement, altered echotexture, and perineural edema associated with inflammatory or compressive neuropathies. Doppler ultrasound adds physiologic context by assessing regional blood flow, highlighting areas of microcirculatory compromise that parallel sensory symptoms. When nerve irritation coexists with ischemic stress, imaging helps distinguish primary neural pathology from secondary vascular contributors—an important distinction for targeted intervention.

Functional imaging modalities further extend diagnostic insight. Thermal imaging, for example, visualizes patterns of cutaneous temperature regulation that reflect autonomic control of microcirculation. In neuropathic states, asymmetry, distal cooling, or focal hotspots often parallel patient-reported burning or numbness. While not a standalone diagnostic tool, thermal imaging complements neurologic testing by revealing functional dysregulation that may precede structural nerve changes detectable by conduction studies. This functional perspective is particularly valuable in early survivorship, when symptoms are evolving and intervention windows are still open.

Imaging also supports longitudinal care. Neuropathy in cancer patients is dynamic: symptoms may worsen during therapy, plateau, or slowly recover afterward. Serial imaging—tracking nerve morphology, regional perfusion, and functional temperature patterns—provides objective markers of change over time. These markers inform clinical decisions about dose modification, rehabilitation strategies, protective footwear, and referral timing to neurology or pain management. In male breast cancer survivorship, where neuropathy may be underreported, objective imaging evidence helps validate patient experience and accelerates appropriate care pathways.

From a broader diagnostic standpoint, neuropathy rarely exists in isolation. Imaging frequently reveals concurrent contributors such as spinal degenerative changes, entrapment neuropathies, or vascular insufficiency that magnify treatment-related nerve injury. By integrating peripheral nerve imaging with regional vascular assessment, clinicians can address layered pathology rather than treating neuropathy as a single-cause phenomenon. This integrative approach aligns with precision survivorship—tailoring interventions to the dominant drivers of nerve dysfunction in each patient.

Ultimately, the value of imaging in cancer-related neuropathy lies in its ability to translate subjective symptoms into objective, trackable physiology. When patients say their feet burn, go numb, or feel “disconnected,” imaging provides clinicians with a map of where neurovascular stress is occurring and how it changes with time and therapy. This diagnostic clarity reframes neuropathy from an inevitable side effect to a monitorable condition—one that can be detected earlier, managed more precisely, and mitigated before it becomes a permanent barrier to recovery and quality of life.

 

References

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2.     Cavaletti, G., & Marmiroli, P. (2010). Chemotherapy-induced peripheral neurotoxicity. Nature Reviews Neurology, 6(12), 657–666. https://doi.org/10.1038/nrneurol.2010.160

3.     Hershman, D. L., et al. (2014). Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO clinical practice guideline. Journal of Clinical Oncology, 32(18), 1941–1967. https://doi.org/10.1200/JCO.2013.54.0914

4.     National Cancer Institute. (2024). Peripheral neuropathy (PDQ®)–Health professional version. https://www.cancer.gov/about-cancer/treatment/side-effects/nerve-problems/peripheral-neuropathy-pdq

5.     Staff, N. P., Grisold, A., Grisold, W., & Windebank, A. J. (2017). Chemotherapy-induced peripheral neuropathy: A current review. Annals of Neurology, 81(6), 772–781. https://doi.org/10.1002/ana.24951

6.     Giordano, S. H. (2018). Breast cancer in men. New England Journal of Medicine, 378(24), 2311–2320. https://doi.org/10.1056/NEJMra1707939

7.     Loprinzi, C. L., et al. (2020). Management of cancer treatment–related peripheral neuropathy. Journal of Clinical Oncology, 38(28), 3325–3348. https://doi.org/10.1200/JCO.20.01399

8.     Mols, F., Beijers, T., Vreugdenhil, G., & van de Poll-Franse, L. (2014). Chemotherapy-induced peripheral neuropathy and its association with quality of life among cancer survivors. Supportive Care in Cancer, 22(8), 2261–2269. https://doi.org/10.1007/s00520-014-2208-4