Thursday, September 24, 2015

MUST READ: Diseases of the breast

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The breast is an important organ in everyone, most especially so in women because of its dual function as a means of feeding the young and is a sexual organ. It is a modification of the sweat gland, which originates from the skin and its appendages. The eventual size the breast attains is dependent on the age of the person, the sex, race and genetic disposition. The breast is a very important organ in all mammals and is the focus of our discussion today.
Normal cyclical changes in the breast are associated with puberty, menstruation, pregnancy, lactation and postmenopausal involution. The pre-menstrual enlargement is due to increased proliferation of blood vessels and these are usually manifested by the subjective feeling of tingling sensations and fullness of the breast. Every woman needs to know about their breasts and also form a habit of examining them at least once a month either in the bathroom or during their quiet time in the bedroom. It is so easy to perform and should be over within minutes. The knowledge thus gained with respect to any abnormality is so vital that it is often life-saving.

Continue reading after the cut.....
The breast is believed to extend from the collar bone, the clavicle, at its top to the top of the straight muscles on the abdomen below known as the rectus sheath. It also extends from the sides of the breast bone, called the sternum, to the border of the large muscles of the upper back. There is also an extension into the armpit, the axilla, which is called the axillary tail of the breast. The size and the prominence of that extension depend a lot on the actual size of the breast. In real life, the breast may not appear to be as large as what has just been described but must be taken into consideration during such an examination as has been referred to above.The structural unit of the breast is the glandular tissue, the acinus. These occur in groups which form the lobule. That lobule is in turn surrounded by fat and drained by branching ducts into smaller ducts where milk is drained from. Groups oflobules coalesce to form 15-20 larger lobes which drain into the major ducts that open separately and in ring fashion aroundthe summit of the nipple. The duct dilates before it opens at the nipple.
This description has been done in some detail because anytrouble which begins in the breast occurs in those structures mentioned above. The males also have breasts and while they never get to be as large as the female species, they are equally capable of harbouring disease. The male breast has no small sacs that characterise the female breast and its supportive connective tissue is usually buried in fat.
Common breast diseases are often divided into two groups. There are the benign conditions, which are not cancerous, and the ones which are called cancers; that ought to worry every woman. Some of the non-cancerous ones are as follows;
1) Inflammatory breast disease: This is often a consequence of breast-feeding during which the nipple gets cracked and a bacterial infection overcomes the injury. The usual organism involved is Staphylococcus aureus. The inflammation may get to be so severe with chills and fever and pain that antibiotic treatment will have to be instituted. Sometimes, and this is common, the diagnosis is delayed because the breast is usually so full at this time and the infection may progress to form an abscess. A breast abscess must be drained in order to get rid of the pus.
2) Fibroadenoma: These are firm lumps felt in the breasts of young women in their reproductive age. It is therefore more likely to be seen most commonly between 20 and 45 years. It has also been seen in much younger females, some as early as 13 years. They vary in size from tiny to giant size. The cause is uncertain but may be due to unusual sensitivity to the circulating female hormones. It is important to excise such lumps for more detailed histological analysis at a laboratory so as to be certain of the diagnosis. The removal can be done in a variety of ways by an operationknown as lumpectomy.
3) Adolescent mammary hyperplasia: This occurs in the young girl just getting into puberty. The breast enlarges hideously. Commonly, one side alone is involved but sometimes also, it is both breasts. The proper way to treat this is through a reductive operation.
4) Mammary hyperplasia of pregnancy: In this condition, the breasts enlarge very quickly during the early months of pregnancy. The increase is grotesque and even when not treated, the breasts fail to return to their normal size after delivery. Usually, both breasts are involved. The size may be so huge that no bras will fit them. Pressure from other apparels can then cause some kind of skin damage leading to pressure necrosis. The best solution is surgical reduction.
5) Cysts: These essentially are sacs filled with fluids secreted from the breast. Therefore, breast milk is an important contributor to this development. Other contributors would be resolved blood clots from injuries sustained on the breast and incompletely resolved breast abscess cavities. Where these are felt, they should also be removed surgically to enable microscopic evaluation. The lesions which all women fear the most are the various kinds of breast cancer that now afflict with increasing frequency, a significant proportion of our young women.
Cancer of the breast occurs in men as well. When that happens, the deterioration is very rapid and many are dead within a short span of time. Therefore, men should also examine their breasts regularly. That ought to be easy because of the smaller nature of the organ in males. It is not usual to feel any kind of lump in the male breast and so any one so felt should be given all due speed from diagnosis to treatment. In women, the offending lump is most commonly found in the upper pole of the breast in the outer quadrant. This means that if a breast is divided into four parts, the region closest to the armpit is often more commonly involved in the development of this disease than any of the other quadrants .It is frequently associated with a hard lump that may be relatively not mobile. Such a lump may be painless. Its presence may be heralded by a nipple discharge from brownish to frankly bloody. Sometimes, these other features are not present and yet it must be suspected when any lump is examined until it is confirmed by surgical removal and microscopic examination.
Breast cancer is a major disease from the onset. Early detection and treatment offer the best hope of getting cured. Late detection due to late presentation to the hospital, which is the usual occurrence in our country, often lead to catastrophic consequences no matter what is done afterwards. Some women will tell you at the point of diagnosis that they want to report the matter to God. Others will say they reject it. Yet others will tell you that they want to consult with their family or their spiritual guide. One common thread holds true for all these women; they do what they say they wanted to do but return when the mass would not stop getting bigger and/or an ulcer has developed. At that point, there is nothing any human being or hospital can do to improve survival.
In women, breast cancer is seen from the teenage years into the menopausal period. In the younger age groups, it is particularly aggressive. It is less so in those advanced in age. The treatment offered is usually in three parts and there is no short-cut to this. There must be initial surgery to remove the breast or the mass depending on the size of the lump. That operation is followed by chemotherapy which is an attempt to remove the remaining cancer cells that were not obvious to the naked eye during the operation. Also, this step is followed by radiotherapy which is a means to bombard the bed of the cancer and prevent their further growth or development or regeneration.
Finally, hormone therapy is utilised to maintain the status quo following all the above so as to add value to life. To be sure, some women survive this ordeal described so graphically by a breast cancer survivor with these words: “first the surgeons cut you up. Then they fry you. Finally they burn you.” Sadly, there is still no alternative to this combination of treatments.

- Dr. Sylvester Ikhisemojie/Punch

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