Today, breast diseases are increasing rapidly, but successful results can be achieved with early diagnosis and appropriate treatment. For this reason, it is important that breast problems are resolved by experienced physicians.
Especially women after the age of 40 need to have their breast checked periodically.
BREAST DISEASES
Fibrocystic Breast
It is a breast structure seen in more than 80 percent of women.
It consists of cysts of different numbers and sizes (fluid accumulation in a round thin membrane) and nodular structures that are manifested by increased connective tissue.
Cysts are featureless, simple cysts that generally do not require follow-up:
1. Especially before menstruation, there may be stinging, throbbing, fullness-like pain due to the increase in edema in the breast and the fluid in the cysts. Sometimes these pains can continue for the whole month. Breast pain should always be evaluated by a breast surgeon and it should be determined by appropriate radiological examinations that there is no different structure in the breast causing the pain.
2. In the presence of many cysts in the breast, newly formed masses may not be noticed or may be neglected as they are thought to be cysts. can be done. For this reason, it is recommended that the woman perform a breast self-examination once a month in order to recognize her own breast structure and notice new formations, and to be followed up with a doctor's examination and radiological imaging once a year.
• Sometimes, thickening of the cyst wall occurs within the cyst. A different lesion or an increase in the consistency of the fluid is detected. In the presence of these cysts, which are called complicated and complex cysts, closer follow-up (3-6 months), biopsy or removal of the entire lesion and histopathological evaluation are recommended. • Ultrasound shows the internal structure of the cysts best in fibrocystic breast structure. Additional examinations such as magnetic resonance imaging (MRI) may be recommended when necessary.
Benign Breast Lesions
•Fibroadenoma:
- It is the most common benign tumor of the breast. Transformation into cancer is not expected.
- Most of the time, radiological appearance is sufficient to make a diagnosis. In case of radiological or clinical suspicion, diagnosis is made by needle biopsy or surgical biopsy. - Close relatives of the patient have blood If there is a tumor, if the fibroadenoma is large in size, if growth or shape change is detected during follow-up, if it causes deformity that creates an aesthetic defect in the breast, and if the patient does not want to follow-up, it is removed surgically. - Apart from this, in cases where biopsy is not required, it is removed at least every 6 months. It is recommended to follow the mass with ultrasonography for 2 years and to remove it surgically if growth or shape change is detected during follow-up.
• Phyllodes Tumor of the Breast (cystosarcoma phyllodes):
- It forms a special group. It grows quickly and can replace all breast tissue. Benign ones must be removed extensively, otherwise they will recur. For malignant ones, risk analysis is performed according to the pathology result.
• Ductal Ectasia:
- It is the enlargement of the milk ducts. It is common, especially in breastfeeding women.
- It is evaluated by ultrasonography whether there is an accompanying lesion and other lesions on the wall of the enlarged duct.
- It may cause complaints such as discharge from the nipple and pain.
- Accompanying In the presence of a lesion and in patients with complaints, it is treated by removing the enlarged duct or all the ducts behind the nipple.
• Inflammatory Diseases of the Breast (Mastitis):
- It is characterized by redness, swelling and warmth in the breast.< br /> - It develops due to milk accumulation in breastfeeding women. Most of the time, it regresses without the need for treatment after the breast is emptied by pump and breastfeeding.
- Mastitis that develops outside the breastfeeding or pregnancy period must be evaluated by a surgeon and the cause must be revealed through radiological examinations.
Most of the time, it is due to inflammatory diseases, but in some cases It may appear as a symptom of breast cancer.
• Gynecomastia:
- It is breast enlargement in men.
- It occurs with the deterioration of the estrogen/testosterone ratio in the body.
- Side effects of various drugs. If it is seen as an effect, it disappears when the drug is discontinued. However, it can sometimes be seen in conditions such as liver disease, tethys tumor and thyroid disorders.
- If there is breast enlargement in a man, it must be evaluated by a surgeon and it must be understood that this is not due to a mass (male breast cancer).
When necessary, the diagnosis is confirmed with radiological examinations. . Afterwards, the endocrinologist An investigation is carried out to determine the cause. If the cause is found, it is treated; if there is no reason, surgery may be recommended.
• Lipoma/hamartoma/radial scar/intraductal papilloma:
- Lipomas (fat glands) are benign, if they do not raise suspicion, biopsy or removal is not required.
- Hamartomas are rare benign tumors of the breast. They form a mass. Since they contain breast tissue, these lesions may turn worse. Treatment is to remove the lesion as a whole.
- Radial scars are lesions of the breast that can be confused with breast cancer clinically and radiologically. It can be seen together with breast cancer. Surgical removal is recommended. - Intraductal papillomas are lesions that occur in the milk ducts of the breast and are often characterized by bloody discharge from the nipple. It is usually benign, but there may be accompanying malignant lesions in the breast, especially in peripherally located and numerous ones. In case of clinical/radiological suspicion and when nipple bleeding becomes annoying, it should be surgically removed.
Malignant Breast Lesions
• Proliferative breast lesions
- In pathological examination, especially “ If atypia is detected, the potential for cancer increases. There may be accompanying malignant lesions. It must be removed surgically.
• Lobular carcinoma in situ
- In its presence, there is a risk of developing breast cancer in both breasts and any focus. Breast screening and follow-up should be done well. For people with a strong history of cancer in their relatives, medication or surgery (bilateral preventive mastectomy) may be recommended to prevent cancer development.
• Ductal carcinoma in situ
- If not removed, it turns into cancer. If there is no accompanying cancer, surgical removal is sufficient.
- Adding radiotherapy to the treatment prevents recurrence.
• Breast cancer
- The most common finding of breast cancer is a mass in the breast. Therefore, every woman should do a breast self-examination once a month and get to know her breast. When she feels a difference in her breast, she should definitely consult a surgeon for examination. - Breast cancer screening starts at the age of 40. In some special cases, it can be started at an earlier age. Mammography is used in screening. Malignancy that cannot be detected during mammography, manual examination, or ultrasonography Precursor lesions of breast cancer can be detected before they turn into cancer or cancer can be detected at a very early stage.
- Cancer diagnosis can be made by biopsy or by histopathological examination of the removed lesion during surgery or after surgery.
- In case of clinical or radiological suspicion, needle Even if the biopsy result is clear, the lesion in the breast must be surgically removed and its entirety examined. - It is treated with the appropriate surgical method. Chemotherapy may be applied before surgery to reduce the mass, and postoperative radiation therapy and/or chemotherapy and/or hormone therapy may be required.
- After the treatments are completed, follow-up is continued at regular intervals to evaluate disease recurrence.
Breast cancer screening
- Breast cancer screening is done with mammography.
- Screening can be started before the age of 40 in high-risk women. Magnetic resonance imaging (MRI) can be used as a screening method in people who are young and have dense breast structure.
- In women without risk factors, screening starts at the age of 40 and is performed once a year. If clinical or radiological necessity, other radiological examinations can be added to mammography.
- Base mammography can be performed beforehand for comparison purposes.
- The radiation rate received by mammography once a year is low.
- Every woman from the age of 20 onwards One should do a breast self-examination once a month and start seeing a doctor over the age of 30. - Since the risk of breast cancer increases with age, it is recommended to continue screening as long as the person can come to the screening center.
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