Cystic Swellings of Breast
Classification:
1.Inflammatory :Acute bacterial mastitis with abscess
2.Neoplastic:
a.Benign:Cystosarcoma phylloides
b.Malignant: Intracystic carcinoma of the breast
3.Non-neoplastic cyst:
a.Fibroadenosis.
b.Simple cysts of the breast
4.Retention cyst of the breast: Galactocoele
5.Other rare causes of cysts of the breast:
a.Tuberculous mastitis with cold abscess of breast.
b. Lymphatic cyst of the breast (congenital).
c. Hydatid cyst of the breast.
d. Haematoma of the breast.
BREAST ABSCESS
Entry of organisms --> Stage of cellulitis -->Stage of abscess
This is the pathogenesis of breast abscess..and remember that,benign tumor is less fatal than malignant tumor because benign tumor do not metastasis while malignant will metastasis to different location..Metastasis means spread of the cancer cell from one part to another..For example ,the origin of cancer will be at breast tissue but since its a malignant type,it can spread to liver,kidney,bone,lungs n etc..
ACUTE BACTERIAL MASTITIS (Breast abscess--pyogenic mastitis)
Aetiopathogenesis
l. Most commonly encountered during lactational mastitis.
Precipitating factors are:
-crack /fissure in the nipple.
-Retracted nipple. Hense, cleaning of the breast is a problem
-oral cavity infection in the child.
2. It can be due to an infection of a haematoma.
-In both conditions the common organism is Staphylococus aureus which enters through the nipple, proliferates intraductally and produces clotting of the milk. Within the clot the organisms multiply
which results in a cellulitic stage or the breast (mastitis) and in untreated cases,it may give rise to a breast abscess. Initially only one lobule and duct get affected. later other lobules,giving rise to an intramammary abscess.
Clinical features:
1.Severe pain in the breast due to spreading inflammatory exudate.
2.Breast is swollen, tense, tender, warm to touch. These are the signs of cellulitic stage.
3.Once breast abscess develops,there is high grade fever with chills and rigor and soft,cystic fluctuant swelling can be felt in the breast.In untreated cases,abscess may rupture through the skin resulting in necrosis of the skin of the breast,ulceration ,discharge.
4.In deep seated abscess, it is difficult to elicit fluctuation and often fluctuation is a late sign.Hence,if throbbing pain,fever with chills and rigors are present, immediate drainage is mandatory.If not, significant amount of breast tissue will be destroyed.
Antibioma
-It means antibiotic induced. 'oma'= Tumour (swelling)
-it occurs in the breast .When there is an abscess, if antibiotic are given without draining the abscess,the abscess cavity may become fibrous and it results in firm to hard lump in the breast.It gives rise to vagus ill-health of the patient.
-Treatment. Excision of antibioma.
-Treatment. Excision of antibioma.
Carcinoma of the Breast:
Aetiological factors that causing breast cancer:
1.Genetic factors
Only 5–10% of breast cancers are thought to be linked to an inherited breast cancer gene. Our genes store the biological information we inherit from our parents. The genes most commonly linked to an increased risk of breast cancer in families are BRCA1 and BRCA2. Other genes have been identified, but they only slightly increase the risk. If you have one relative who was diagnosed with breast cancer at an older age, it’s not likely that the cancer is due to an inherited breast cancer gene.
A genetic mutation that increases the risk of breast cancer is only likely to be present in a family if:
-there are three close relatives on the same side of the family who developed breast cancer at any age
-there are two close relatives on the same side of the family who developed breast cancer under the age of 60
-there is one close relative who developed breast cancer under the age of 40
-there is a close male relative with breast cancer
-there is a close relative with breast cancer in both breasts
-there is a close relative with breast cancer and another relative on the same side of the family with ovarian cancer.
-Close relatives, sometimes called your first degree relatives, are parents, children, sisters and brothers.
2.Alcohol
Drinking more than two units of alcohol a day over many years can damage your liver. This increases your breast cancer risk because the liver helps to control oestrogen levels.
3.Your weight
After the menopause, body fat is the main source of oestrogen. So if you’re overweight, the level of oestrogen in your body may be high, increasing your breast cancer risk.
4.Smoking
Smoking heavily over many years, especially if you started smoking at a young age, increases your risk.
5.Age
The risk of breast cancer increases with age. It’s rare in women under 35, and 8 out of 10 breast cancers (80%) occur in women aged 50 or over.Breast cancer can also occurs to men.
6.History of Breast Cancer
Women who’ve had breast cancer or other breast conditions in the past may be at a higher risk of developing breast cancer. This includes women who have previously had:
-breast cancer, including ductal carcinoma in situ (DCIS)
-lobular carcinoma in situ (LCIS)
-an over-production of slightly abnormal cells called atypical ductal hyperplasia
-radiotherapy to the chest to treat Hodgkin lymphoma at a young age
-dense breast tissue (when the breast is mostly made up of glandular and connective tissue with very little fatty tissue).
7.Hormonal factors
Exposure to the hormones oestrogen and progesterone for long, uninterrupted periods can affect your breast cancer risk. Factors that increase this risk include:
-taking combined hormone replacement therapy (HRT) containing oestrogen and progesterone over several years (if you’re over 50)
-not having children or having them later in life
-not having breastfed or breastfeeding for less than a year
-starting your periods early (under 12) or having a late menopause (after 50)
-taking the contraceptive pill (but the risk reduces if you stop taking it).
Ways To Examine Your Breasts :
.jpg)
* Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
* Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. A firm ridge in the lower curve of each breast is normal. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot
* Lie down and place your right arm behind your head. The exam is done while lying down, and not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and it is as thin as possible, making it much easier to feel all the breast tissue. In such a state any abnormality will be noticed easily.
.
* Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone.(sternum or breastbone). Be sure to check the entire area. Breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
* There is some evidence to suggest that the up and down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast without missing any breast tissue.
* Repeat the exam on your left breast, using the finger pads of the right hand.
* While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
* Examine each underarm and armpits while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm fully straight up tightens the tissue in this area and makes it difficult to examine.
-and one more thing..Do those examination after your menses..If possible not a week before your date.You might confuse with the tenderness and swelling which is actually due to hormonal changes..
Let me explain the differences between the tests.
-Sometime,one of the early signs of breast cancer are certain types of microcalcifications. Microcalcifications are tiny deposits of calcium...and remember,swelling or sensation of lump in breast tissue doesn't mean that it's cancer.It might be due to infection,inflammation,cyst ,or any other cause other than cancer.In worst case even it is cancer,it might be benign ..So don't worry much.. .
Breast ultrasound is good at distinguishing between a fluid-filled cyst and a solid mass. Ultrasound cannot image the entire breast at once, so it's used for a diagnostic spot check of areas that a screening mammogram has already revealed.These can be seen fairly well on mammograms, but cannot be seen at all with ultrasound. If the only sign of breast cancer are these microcalcifications, an ultrasound will not see it.
Also, a mammogram provides a good image of the entire breast, where as an ultrasound of the breast is highly directed. It mean, ultrasound is very good if the patient can feel a lump.
Mammography is superior for less dense breasts (usual after the menopause) and is almost invariably performed. A combination of ultrasound and mammography can detect more invasive tumours.
Ultrasound is very effective (especially in younger women). It is particularly useful when breast tissue is dense. In young patients it can be diagnostically more useful than mammography.
MRI tends to be used in difficult cases such as dense breast tissue (especially in young women), cases of familial breast cancer associated with BRCA mutations, silicone gel implants, positive axillary lymph node status with occult primary tumour in the breast or where multiple tumour foci are suspected. A positive result on MRI alone should not result in operation.
Honestly ,you cannot possibly self-diagnose a breast cancer. Even doctors, including oncologist, can't confirm until the appropriate tests have been done.So if you suspect that you might have it,then without delay,go to the nearest hospital.
by Lakdhes ..
1.Genetic factors
Only 5–10% of breast cancers are thought to be linked to an inherited breast cancer gene. Our genes store the biological information we inherit from our parents. The genes most commonly linked to an increased risk of breast cancer in families are BRCA1 and BRCA2. Other genes have been identified, but they only slightly increase the risk. If you have one relative who was diagnosed with breast cancer at an older age, it’s not likely that the cancer is due to an inherited breast cancer gene.
A genetic mutation that increases the risk of breast cancer is only likely to be present in a family if:
-there are three close relatives on the same side of the family who developed breast cancer at any age
-there are two close relatives on the same side of the family who developed breast cancer under the age of 60
-there is one close relative who developed breast cancer under the age of 40
-there is a close male relative with breast cancer
-there is a close relative with breast cancer in both breasts
-there is a close relative with breast cancer and another relative on the same side of the family with ovarian cancer.
-Close relatives, sometimes called your first degree relatives, are parents, children, sisters and brothers.
2.Alcohol
Drinking more than two units of alcohol a day over many years can damage your liver. This increases your breast cancer risk because the liver helps to control oestrogen levels.
3.Your weight
After the menopause, body fat is the main source of oestrogen. So if you’re overweight, the level of oestrogen in your body may be high, increasing your breast cancer risk.
4.Smoking
Smoking heavily over many years, especially if you started smoking at a young age, increases your risk.
5.Age
The risk of breast cancer increases with age. It’s rare in women under 35, and 8 out of 10 breast cancers (80%) occur in women aged 50 or over.Breast cancer can also occurs to men.
6.History of Breast Cancer
Women who’ve had breast cancer or other breast conditions in the past may be at a higher risk of developing breast cancer. This includes women who have previously had:
-breast cancer, including ductal carcinoma in situ (DCIS)
-lobular carcinoma in situ (LCIS)
-an over-production of slightly abnormal cells called atypical ductal hyperplasia
-radiotherapy to the chest to treat Hodgkin lymphoma at a young age
-dense breast tissue (when the breast is mostly made up of glandular and connective tissue with very little fatty tissue).
7.Hormonal factors
Exposure to the hormones oestrogen and progesterone for long, uninterrupted periods can affect your breast cancer risk. Factors that increase this risk include:
-taking combined hormone replacement therapy (HRT) containing oestrogen and progesterone over several years (if you’re over 50)
-not having children or having them later in life
-not having breastfed or breastfeeding for less than a year
-starting your periods early (under 12) or having a late menopause (after 50)
-taking the contraceptive pill (but the risk reduces if you stop taking it).
Ways To Examine Your Breasts :
.jpg)
* Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
* Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. A firm ridge in the lower curve of each breast is normal. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot
* Lie down and place your right arm behind your head. The exam is done while lying down, and not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and it is as thin as possible, making it much easier to feel all the breast tissue. In such a state any abnormality will be noticed easily.
.
* Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone.(sternum or breastbone). Be sure to check the entire area. Breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
* There is some evidence to suggest that the up and down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast without missing any breast tissue.
* Repeat the exam on your left breast, using the finger pads of the right hand.
* While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
* Examine each underarm and armpits while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm fully straight up tightens the tissue in this area and makes it difficult to examine.
-and one more thing..Do those examination after your menses..If possible not a week before your date.You might confuse with the tenderness and swelling which is actually due to hormonal changes..
Let me explain the differences between the tests.
-Sometime,one of the early signs of breast cancer are certain types of microcalcifications. Microcalcifications are tiny deposits of calcium...and remember,swelling or sensation of lump in breast tissue doesn't mean that it's cancer.It might be due to infection,inflammation,cyst ,or any other cause other than cancer.In worst case even it is cancer,it might be benign ..So don't worry much.. .
Breast ultrasound is good at distinguishing between a fluid-filled cyst and a solid mass. Ultrasound cannot image the entire breast at once, so it's used for a diagnostic spot check of areas that a screening mammogram has already revealed.These can be seen fairly well on mammograms, but cannot be seen at all with ultrasound. If the only sign of breast cancer are these microcalcifications, an ultrasound will not see it.
Also, a mammogram provides a good image of the entire breast, where as an ultrasound of the breast is highly directed. It mean, ultrasound is very good if the patient can feel a lump.
Mammography is superior for less dense breasts (usual after the menopause) and is almost invariably performed. A combination of ultrasound and mammography can detect more invasive tumours.
Ultrasound is very effective (especially in younger women). It is particularly useful when breast tissue is dense. In young patients it can be diagnostically more useful than mammography.
MRI tends to be used in difficult cases such as dense breast tissue (especially in young women), cases of familial breast cancer associated with BRCA mutations, silicone gel implants, positive axillary lymph node status with occult primary tumour in the breast or where multiple tumour foci are suspected. A positive result on MRI alone should not result in operation.
Honestly ,you cannot possibly self-diagnose a breast cancer. Even doctors, including oncologist, can't confirm until the appropriate tests have been done.So if you suspect that you might have it,then without delay,go to the nearest hospital.
by Lakdhes ..
Thanks for sharing this great info.Keep sharing my son.
ReplyDeleteHow to test it..?Name of the tests?
ReplyDeletewell..if you suspect having breast cancer,those test can be done..
ReplyDelete1.x ray,blood count(sometime hemoglobin level will decrease )
2.mammogram
3.ultrasound
4.ct scan
then for better confirmation ,fnac can be done with histocytology ..
and Melinda ,tanx for this question..Let me update the rest of the details in my post..it will be more convenient for those who reading this..check the bottom of the post again.
Why there is high chance for b.c in obese ladies after menopause ?
ReplyDeleteincrease risk has been found in postmenopausal obese women and this is due to increased synthesis of estrogen (oestradiol) in the body fat..usually fat droplet will be the source of estrogen after menopause..estrogen induce cancer can occur in obese women due to this.tanx
DeleteMixture of valuable information for girls in a single post.Great piece of work.
ReplyDeleteValuable information for all ladies. Nice to know that a guy do care for females. Thumbs up!
ReplyDeleteHow genetic problem related to breast cancer?
ReplyDeleteBRAC is a human caretaker gene that produces a protein called breast cancer type 1 susceptibility protein, responsible for repairing DNA.BRCA1 is expressed in the cells of breast and other tissue, where it helps repair damaged DNA, or destroy cells if DNA cannot be repaired. If BRCA1 itself is damaged, damaged DNA is not repaired properly and this increases risks for cancers...
Delete