Patient Education :

BREAST DISEASES

LUMP IN THE BREAST
Any noticeable change, thickening, or localized swelling in your breast that was not there before, may be a lump are benign, (which means they are localized and do not spread elsewhere). Not every lump found in the breast is cancerous in origin. Eight out of ten breast lumps are not cancerous, and if breast cancer is diagnosed early, it is usually successfully treated. Malignant (cancerous) lumps are usually single, hard and painless. They develop most often from Mammary glands or ducts and are commonly found in upper, outer portion of the breast, but may appear anywhere in the breast. Unlike benign lumps, cancerous lumps continue to grow in uncontrolled manner, and in time spread beyond the breast.

Some of the benign (non cancerous) lumps are :
1. Fibrocystic breast disease :
These lumps or cysts are fluid filled sacs that enlarge and often become tender just before a menstrual period.
2. Fibro adenoma :
It appears most often in young women between 15 and 30 yrs of age. They are firm, oval shaped and movable.
3. Lipoma :
Consists of fatty tissue

What is Cancer ? Cancer is an abnormal and uncontrolled growth of cells. Sometimes cells grow into tumors. Tumors may be benign (non-cancerous) or malignant (cancerous). Breast cancer is a cancer that develops within the breast tissue. Every woman carries with her the risk of breast cancer. Breast cancer is one of the leading causes of cancer deaths in women.

Be Alert To Possible Symptoms
 Lump or thickening of the breast
 Dimpling or puckering of the skin
 Change In skin color of the breast or its texture
 Change in breast shape
 Swelling, redness or heat in the breast
 Discharge from the nipple
 Retraction of the nipple

How is breast Disease Evaluated ? A woman who finds a lump in her breast should seek help from her physician at once. The physician evaluates the lump and gives further advice. Usually, if breast cancer is suspected, then one or more of the following investigations are asked for,

1. Mammography : Mammogram is a safe low dose, X-ray picture of the breast where two views of each breast are taken. Aim is to produce detailed images of the internal structures of the breast for early detection of breast cancer. The radiographer will position your breast on the x-ray plat and apply pressure.

2. Ultrasound Examination : Ultrasound is complimentary to mammography to determine nature of the lump. This is a test similar to the scan used on pregnant women. Clear jelly is applied on the breast and the scan is performed. It is painless.

3. Aspiration : Fine Needle Aspiration Cytology (FNAC) A lump felt by examination and/or identified on a mammogram can be examined by aspiration. During this procedure, a fine needle is inserted in the lump and the aspirate is examined microscopically for presence of cancer cells. FNAC can also help in differentiating a solid from a cystic (fluid filled) lump.

4. Biopsy : If the lump is composed of solid tissue, biopsy may be performed to check for the presence of cancer cells. Biopsies can also be helpful in determining the best method of treatment.

What Is the Treatment ? If the biopsy or FNAC confirms the presence of cancer, there are various modes of treatment and the treatment is chosen depending on a lot of other factors.

A. Operative Procedures :
Various operative modes are used for treatment of breast cancer :
Lumpectomy : This means removal of the lump in the breast. This is usually the preferred mode of treatment in benign (non cancerous) lumps.
Partial Mastectomy : This involves removal of the cancerous lump with part of the surrounding breast tissue and the glands under the arm.
Simple Mastectomy : This operation involves removal of only the breast.
Modified radical Mastectomy : This involves removing the entire breast and the lymph nodes or glands under the arm.
Radical Mastectomy : This includes removal of all breast tissues, the lymph nodes and the chest muscles. This operation is rarely performed these days.

B. Radiotherapy : Treatment of breast cancer with radiation therapy can destroy cancer cells. The type of radiation is chosen to suit the requirements of individual patient. A course of radiation is given over a period of weeks.

C. Chemotherapy : Chemotherapy is treatment of cancer with special drugs, which are able to kill cancer cells. Chemotherapy may be used alone or in combination with surgery or radiation therapy, depending on the extent of the tumor.

Early Detection Saves Lives Early detection is an important key to curing and surviving breast cancer. Try and follow the following guidelines.
1. Perform monthly breast self exams
2. Have regular breast examinations by a doctor annually
3. Request screening mammograms, yearly if the age is more than 50 and alternate years if the age is between 40 to 50.
4. Look for symptoms of breast cancer

How To Examine Your breast ?
1. Look at your breast in a mirror. Look for any changes in size or shape, retraction of nipple, dimple or thickening of skin or any obvious lump.
2. Raising both your arms, look for any asymmetry in your breasts.
3. Keep your hands around your waist and press them firmly. These positions may help in showing any retraction or dimpling present over the skin of the breast.
4. Lie down with one of your arm stretched behind your head. Examine your left breast with your right hand and vice versa as shown in picture. While palpating keeps your fingers close to each other, use the flat surface of the fingers to feel for any lumps in the breasts. Do not feel the breast between the finger tips and the thumb. Press firmly enough to know how your breast feels. A firm ridge at the lower curve of each breast is normal.
5. Feel the whole breasts in a systematic manner. The breasts is divided into 5 parts. The upper inner area, upper outer area, lower inner area, lower outer area and the central area beneath the nipple. Feel all the parts of the breast without missing any area.
6. In the same manner examine the other breast. If you find any changes, see your doctor right away. Lumps need to be investigated further.

 REMEMBER, BREAST SELF EXAMINATION IS NOT A SUBSTITUTE FOR ROUTINE MAMMOGRAMS AND REGULAR EXAMINATION BY A DOCTOR YOU CAN LEAD A NORMAL LIFE. EARLY DETECTION IS THE KEY.