GOMEL REGIONAL CLINICAL
ONCOLOGICAL DISPENSARY

Over the past decade, oncology has stepped far ahead. Now breast cancer is no longer such a terrible diagnosis. 

If before a malignant tumor of the mammary gland - this was a hundred percent removal of the organ, nowadays such an operation is resorted to in rare, rare cases. Changing traumatic mastectomy according to Halstead-Meyer in the 90s, functional-sparing operations on Madden came, and since 1993 - organ-preserving operations in the volume of radical resections of the breast, as well as radical operations with a one-stage breast reconstruction that allow preserving the dairy Iron in compliance with the principles of cancer radicalism.

Our department has accumulated a great practical experience in the treatment of breast cancer using the latest advances in oncology, plastic surgery, radiation and chemotherapy. Doctors of the department will do their best to cure you of the disease, while maintaining a high level of quality of life.

Doctors of the department together with you will make a detailed plan of diagnostic and therapeutic activities and will spare their time to explain any detail.

For morphological confirmation of the tumor, we use only minimally invasive, painless breast biopsies with immunohistochemical examination (determination of the receptors of estrogens (ER), progesterone (PR), oncoprotein HER-2 \ neu, etc.).

The complex approach of the specialists of the department to the treatment of breast cancer, uniting surgeons, pathologists, radiologists, radiation oncologists and chemotherapeutists into one team allows to achieve the best results, making the treatment in the department more rapid and comfortable.

You can get a qualified consultation of the doctor of our department in one of the polyclinic's offices about the treatment of benign breast formations.

Ordinatorskaya tel. + 375 232 21-12-75

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Head of the department Leonkov Alexander Leonidovich

Leonkov

+375 44 5445658 
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Useful articles

Diffuse mastopathy Diffuse mastopathy

Methodical manual for doctors

Etiopathogenesis, clinic, diagnosis, treatment

Gomel, 1998.

Compilers: VN Belyakovsky, TV Davidovich, IV Mikhailov, TI Prigogaya, IK Krivenchuk, DB Rod'ko.

Benign changes in the mammary gland are among the most common diseases in women and include various processes in clinical, morphological, and etiological aspects. Exact diagnosis of breast diseases is greatly hampered by individual, age and cyclic variability of organ anatomy.

ANATOMY AND PHYSIOLOGY.

The mammary glands develop from the ectoderm and are altered by cutaneous sweaty apocrine glands. The mammary glands distinguish proper glandular formations - parenchyma (parenchyma glmammariae), and connective tissue stroma (stoma g1.mammarage). The mammary gland of a sexually mature woman consists of 15-25 lobes (ob g1.mammarya), each of them is a complex alveolar gland with a lobular duct (dystus? Act? Peer? Ogar? S) opening at the top of the nipple (parella Mammae). Before reaching the nipple, the ducts expand and form the lacteal sinuses (sinus? Act? Fere?), In which the milk formed in the alveoli accumulates. Between the streaks there are layers of loose fibrous connective and adipose tissue with vessels and nerves passing through them. The shares are made up of lobules (? Obu ?? g1.mammargae), Formed repeatedly by branching milky ducts. The milky ducts of the lobules outside the lactation period terminate in the blind ducts - the lacteal alveolar ducts (duvetulo alveolaris lactifer?), During which the alveoli develop (aloeolum g1.mammargae). The lobules are separated from one another by interlobular connective tissue septa (Serta-nterogularia, Kupera ligaments). The walls of the alveoli are lined with a single-layered cubic epithelium, outside of which lie basket-shaped myoepithelial cells (muer? Thel ?, convolus). During lactation, the epithelial cells are transformed into large secretory cells - lactocytes (lactocut?), Which have a prismatic shape, with vertices facing the lumen of the alveoli. The cytoplasm of these cells is replete with filamentous mitochondria, droplets of fat accumulate at the tops of cells, Protein granules and vacuoles. The secretion of milk is accomplished by the apocrine type due to the unscrewing of the tops of the cells together with the accumulated inclusions. The formation of milk occurs in the cavity of the alveoli. The small branches of the lacteal ducts are lined with a cubic or prismatic branch, and the large ducts are lined with a multilayered epithelium. Mammary glands undergo changes in connection with the menstrual cycle, pregnancy, childbirth, lactation, age involuntary processes. In the old age, as a result of the disappearance of the alveoli, the collapse of the ducts and the shrinking of the lobules, the glandular tissue of the organ is replaced by fibrous and fatty tissue. All these processes are determined by the function of endocrine organs: ovaries, adrenals, pituitary gland, thyroid gland. Their interaction is regulated by the hypothalamus and the cortex of the brain.

Etiopathogenesis

According to WHO 1983, mastopathy is fibrocystic breast disease, characterized by a wide range of proliferative and regressive changes with pathological correlation of epithelial and connective tissue components. Mutations are a heterogeneous group of diseases having a complex clinical and histological picture, which complicates not only the diagnosis, but also the terminological designation of diffuse processes. There are more than 30 names of mastopathies: cystic mastopathy. Cystic fibroadenomatosis, Reclus disease. Schimmelbusch's disease, Velyaminov's disease, dyshormonal hyperplasia, fibrocystic mastopathy, hysterical tumor, fibrocystic disease, etc. Mastopathy is most common in women aged 30-45 years. Its frequency ranges from 24 to 43% in the popula- tion, And in women with various gynecological diseases - up to 55%. The etiopathogenesis of mastopathy has not been fully investigated. The disease occurs both with a deficiency of progesterone in anovulation, and with a normal menstrual cycle. An important role in the occurrence of mastopathy belongs to both a change in the synthesis of hormones, and the increase in the sensitivity of steroid receptors to their effects. The most severe forms of dyshormonal pathology of dairy malignancies are developed in women suffering from hyperplastic gynecological diseases (endometriosis, fibroids, persistent hyperplasia of the endometrium, polyps in isolated or combined variants). It is in this category of patients that severe forms of diffuse and nodal mastopathy develop, often proliferative in nature (according to some data, more than 70% of cases). The most severe changes in mammary glands occur in patients with endometriosis with a two-phase rhythm of menstruation, the smallest - with persistent hyperplasia of the endometrium in the conditions of anovulation and insufficiency of the luteal phase. The level of estradiol and the ratio of estradiol to progesterone in patients with severe parenchyma hyperplasia is significantly higher than in women with intact glands. Functional and morphological cycles of mammary glands and female genitalia are regulated by a single endocrine system, so that the same hormonal disorders lead to a combined pathology of target organs. Estrogen stimulation of the glandular tissue of the mammary gland leads to its hyperlasia, accumulation of interstitial fluid, venous and lymphatic stasis. The fascial case prevents a significant increase in the volume of the hyperplastic and edematic panenchyma. The intraloble pressure is increasing, the microcirculation is disturbed, resulting in ischemia and then the death of part of the glandular tissue. The fields of ischemic necrosis are replaced by cicatricial stratifications that squeeze the milk ducts, the drainage of the glands is broken, the secret stagnates, the ducts expand, false and true cysts are formed. Disturbance of outflow strengthens ischemia and a vicious circle appears with alternation of swelling, hyperplasia and proliferation, and then necrosis and degenerative transformation of the gland tissue.

A special form of dyshormonal pathology of glands arises in patients with hyperprolactinemia. In this case, disorders in the glands develop involuntary processes, which are caused by hypoestrogenia and progesterone-deficient states, which develop against a background of high secretion of prolactin.

Hyperprolactinemia manifests itself as a transparent or colostrum discharge from the nipples, often very abundant, sometimes simulating lactation. Galactorrhea can be the first sign of a disease and a reason to call on doctors, and pains in the glands are extremely rare. Differences in the nature of glandular changes in the functional and organic forms of hyperprolactinaemia are related to the volume of excess prolactin synthesis. True ma-stopatiya with this disease is rare.

Because of the initial disturbances in the pituitary-hypothalamic activity, many patients with mastopathy have neuropsychiatric disorders and dysfunctional disorders of the peripheral endocrine organs.

CLINIC AND DIAGNOSIS

Mastopathy is manifested by pain, a feeling of bursting and burning in the glands, which are amplified or appear in the second phase of the menstrual cycle. Patients may be disturbed by periodic discharge from the nipple of a colostrum, serous or mucous. When the palpation of the gland is determined by tyazhistost, rough lobulation, the foci of densification of irregular shape, without clear boundaries, changing its volume and shape when changing the position of the body and pressing against the chest wall (negative König symptom). Pregnancy, childbirth and breastfeeding in patients with mastopathy can bring significant relief or even complete relief from painful suffering.

In 1988, the "Clinical-morphological classification of fibrocystic mastopathy (FCM)" was suggested by the "Methodical recommendations of the Ministry of Health of the RSFSR":

1. PKM with a predominance of the glandular component (adenosis) is a highly differentiated unrestricted hyperplasia of the lobes of the jelly. Is manifested by soreness, engorgement and diffuse sealing of the entire gland or its site. The boundaries of the seal smoothly pass into the surrounding tissues. Clinical manifestations intensify in the premenstrual period. It is observed in young girls at the end of the puberty period, as well as in women at the early stages of pregnancy as a transient condition. On the mammogram - multiple shadows of irregular shape with indistinct borders.

2. PCM with a predominance of fibrosis - fibrosis of interlobular connective tissue, proliferation of intraluminal tissue and narrowing of the lumen of the duct of the gland until complete obliteration. Clinically manifested by soreness, palpation is determined by compact, tapering areas. On the mammogram, there are layers of dense homogeneous regions with pronounced narrowness.

3. PCM with a predominance of the cystic component - multiple cystic formations of elastic consistency, well-bounded from the surrounding gland tissue. Clinically, it manifests itself as a disease that intensifies before menstruation. Morphological picture: a multitude of cysts formed from atrophied lobules and enlarged mammary ducts. On the mammogram, a large-bladed pattern with multiple bleeds with a diameter of 0.3 to 6 cm with clear contours.

4. Mixed form - lobular hyperplasia, sclerosis of intra-lobular and interlobular connective tissue and atrophy of alveoli with dilatation of ducts and their transformation into cystic formations.

5. Nodal form of PKM - changes are mainly local in nature; One or several seals are defined in the form of a flattened in the antero-posterior dimension of the strand without clear boundaries, coarse-lobed or granular in nature. The node increases in size and decreases (but does not disappear) after the end of menstruation, it is not soldered to the skin; When pressed to the chest, the palm is usually not detected (a negative König symptom). The diagnosis of mastopathy is established on the basis of complaints, anamnesis, clinical data (palpation of the breast), and confirmed by the results of special research methods (cytological investigation of nipple discharge, mammography, ultrasound, puncture biopsy). It is very important for timely diagnosis of the regular conduct of all women self-examination of the mammary glands. It should be carried out regularly,

Radiation diagnostics

The dominant technique for visualizing the mammary glands is mammography, ultrasound is used as an auxiliary method. Radiography of the mammary gland is performed on the X-ray apparatus intended for this purpose, using reinforcing shields and a special X-ray film. The study is carried out in the first phase of the menstrual cycle (from the 6th to the 12th to the 14th day from the onset of menstruation). It is necessary to direct women to mammography only with clear clinical suspicions of the pathology of the gland. Mammography must be performed in 2 projections. To clarify the state of individual sections of the breast, visualize the smallest details, they perform targeted radiography with the help of special tubes, and also use targeted X-ray imaging with a direct magnification of the image. The radiographic image of the female breast depends on the age, the condition of the reproductive system, the hormonal background of the woman and the phase of the menstrual cycle. Radiographically, with mastopathy, you are two forms: diffuse and local-nodal. With the first form against the background of diffuse tissue reconstruction, multiple focal proliferates are detected, most often on both sides. With a local-nodal form, on the background of a diffusive rearrangement of the structure of the mammary gland, there is a separate condensation of an irregular shape, an inhomogeneous structure with indistinct vague contours, smoothly passing into the surrounding tissue. The size of the formation and the intensity of its shadow often change depending on the phase of the cycle, which can be considered an important differential diagnostic feature. The microcalcinates for the x-ray picture of mastopathy are not typical. Since the density of nodular mastopathy, as a rule, is inferior to the density of other nodal formations, such as fibroadenoma and cyst, a structural pattern of the breast, often superimposed on the image of a pathologically altered site, is often observed on the roentgenogram. A kind of roentgenologic picture of nodular mastopathy is possible: a localized area of ​​a reconstructed structure of large dimensions with an uneven alternation of fat, fibrous and glandular tissues is surrounded by a "girdle" of enlightenment with a width of up to 2-4 mm, which resembles fibrolipoma according to the X-ray picture. If a differential diagnosis with cancer is required, a needle-needle aspiration biopsy is used under the X-ray gene control. On the roentgenogram, a structural pattern of the mammary gland, superimposed on the image of a pathologically altered site, is often traced. A kind of roentgenologic picture of nodular mastopathy is possible: a localized area of ​​a reconstructed structure of large dimensions with an uneven alternation of fat, fibrous and glandular tissues is surrounded by a "girdle" of enlightenment with a width of up to 2-4 mm, which resembles fibrolipoma according to the X-ray picture. If a differential diagnosis with cancer is required, a needle-needle aspiration biopsy is used under the X-ray gene control. On the roentgenogram, a structural pattern of the mammary gland, superimposed on the image of a pathologically altered site, is often traced. A kind of roentgenologic picture of nodular mastopathy is possible: a localized area of ​​a reconstructed structure of large dimensions with an uneven alternation of fat, fibrous and glandular tissues is surrounded by a "girdle" of enlightenment with a width of up to 2-4 mm, which resembles fibrolipoma according to the X-ray picture. If a differential diagnosis with cancer is required, a needle-needle aspiration biopsy is used under the X-ray gene control. The localized portion of the restructured large-sized structure with uneven alternation of fat, fibrous and glandular tissues is surrounded by a "girdle" of enlightenment with a width of up to 2-4 mm, which resembles fibrolipoma according to the X-ray picture. If a differential diagnosis with cancer is required, a needle-needle aspiration biopsy is used under the X-ray gene control. The localized portion of the restructured large-sized structure with uneven alternation of fat, fibrous and glandular tissues is surrounded by a "girdle" of enlightenment with a width of up to 2-4 mm, which resembles fibrolipoma according to the X-ray picture. If a differential diagnosis with cancer is required, a needle-needle aspiration biopsy is used under the X-ray gene control.

Ultrasound examination of the mammary gland is performed in situations with unclear abnormalities detected during physical examination or mammography.

Indications for breast ultrasonography:

  • Evaluation of a well-defined nodule on a mammogram for differentiation between cystic and solid formation.
  • The occurrence of any discrepancies between the results of physical examination and mammography.
  • Impossibility of mammography for anatomical reasons.
  • Preoperative marking of localization of nonpalpable lesions in the mammary gland.
  • Conducting a fine needle aspiration biopsy.

TREATMENT OF MASTOPATHY

Treatment of patients with mastopathy should be carried out only after the establishment of leading etiopathogenetic factors of the disease, the hormonal and metabolic status of the patient and premorbid background.

Treatment of patients with a localized form of mastopathy should begin with diagnostic sectoral resection of the mammary gland with urgent histological examination. If a histological study indicates the presence of fibroadenomatosis, then the patient is shown to follow conservative therapy.

Conservative treatment of patients with diffuse forms of mastopathy should be directed to: a) elimination of etiological factors; B) normalization of the neurohumoral status; C) enhancing the adaptive capacity of the body. At the first stage of therapy, the disappearance or stihana of pain, burning and burning in the glands, as well as the reduction of compacted areas should be achieved. Treatment at the 2nd stage consists in conducting maintenance medication, maintaining normal working and resting hours, preventing psychotraumatic situations.

In patients with neuropsychological disorders it is necessary to carry out the following measures:

  • Liquidation of domestic conflicts;
  • Change in the psychological climate;
  • The resolution of sexual conflicts;
  • Psychotherapy;
  • Medical sedation.

Patients under 40 years without severe neurotic disorders can be prescribed the following sedatives: tincture of valerian 20 drops 2-3 times a day; Tincture of motherwort on 20 drops 2-3 times a day; Drops Morozov 20 drops 2-3 times a day; A decoction of soothing tea in 100 ml 1-2 times a day, Quater's medicine for 1 tbsp. Spoon 2-3 times a day. The duration of one course should be at least 1-2 months. If necessary, the course of treatment is repeated. Tranquilizers should be used if sedatives are not effective enough. Assign trioksazin 1 t. 3 times a day, elenium 1-3 tablets a day, meprotan I t. 3 times a day, diazepam, seduksen (single dose of 1.5-5 mg, daily dose of 5-15 mg ), Oxazepam (tazepam, nosepam) - a single dose of 2.5-10 mg, daily - 5-20 mg.

Patients with liver dysfunction should be recommended the following measures: adherence to the protein-vitamin diet, with the exception of alcohol, coffee, tea, chocolate, the use of enzymes, vitamins and lipotropic drugs (panzinorm-forte 1 t. 3 times daily with meals; methionine - 250-500 mg 2-3 times a day, sirepard 3 ml intramuscularly once a day, 45-60 injections, legalon - 1 t. 2-3 times a day after meals, L? V-52 - 2 t. 3 times a day, hofitol 2-3 days 3 times a day). Cholagogue preparations are shown: allochol on 1 -2 t. 2-3 times a day after meal, cholenzim-1-2 t. 2-3 times a day after eating; Hologol etc.

In the presence of concomitant endocrine pathology, treatment must be coordinated with the endocrinologist.

When carrying out vitamin therapy, intramuscular injections of vitamins B1, B6, C, multivitamins in tablets or powders, vitamins E and A or their substitutes are prescribed. As a rule, a full course of vitamine therapy begins with intramuscular injections. In the first day, with various syringes and needles, intramuscularly injected vitamin B1 60-120 mg, vitamin C 100-500 mg. On the second day - vitamin B6 50-100 mg for one and a half months. After that, they are administered by polyvitamins in the form of powders according to the following prescription: ascorbic acid 200-500 mg, nicotinic acid 40-50 mg, vitamin B1, B2, B6 10-20 mg, diphenhydramine 10-20 mg, calcium lactate 10-20 Mg, glucose 300-500 mg; 100 powders are being prepared, taking the first two weeks every day - 3, the second two weeks - 2, and then -1 powder per day. Instead of powders, any tableted multivitamins can be used in profile doses. Assign vitamin A in an oily solution of 50,000-100,000 IU once a day after meals for 1-1,5 months. At a high level of prolactin, with habitual spontaneous abortions, it is advisable to use tocopherol in capsules of 50-100 mg in the middle of the lutein phase of the cycle together with progestogen preparations. The Institute of Oncology and Med- radiology of the Ministry of Health of the Republic of Belarus has proposed a method for treating mastopathy with an antioxidant complex according to the scheme: during? 0 days 1 time a day after meals, vitamin A 10COOOO ME, vitamin E ZOO mg, vitamin C 2 g, then one dose 2 times a week for 3-6 months is prescribed. With habitual spontaneous abortions, it is advisable to use tocopherol in capsules of 50-100 mg in the middle of the lutein phase of the cycle together with progestogen preparations. The Institute of Oncology and Med- radiology of the Ministry of Health of the Republic of Belarus has proposed a method for treating mastopathy with an antioxidant complex according to the scheme: during? 0 days 1 time a day after meals, vitamin A 10COOOO ME, vitamin E ZOO mg, vitamin C 2 g, then one dose 2 times a week for 3-6 months is prescribed. With habitual spontaneous abortions, it is advisable to use tocopherol in capsules of 50-100 mg in the middle of the lutein phase of the cycle, together with progestogen preparations. The Institute of Oncology and Med- radiology of the Ministry of Health of the Republic of Belarus has proposed a method for treating mastopathy with an antioxidant complex according to the scheme: during? 0 days 1 time a day after meals, vitamin A 10COOOO ME, vitamin E ZOO mg, vitamin C 2 g, then one dose 2 times a week for 3-6 months is prescribed.

Separately, it is necessary to focus on the treatment of patients with premenstrual tension syndrome, which is a pathological symptom complex that manifests itself in neuropsychiatric, vegetative-vascular and endocrine disorders. Almost all patients complain of painful engorgement, increased maternal tension in the second half of the menstrual cycle, headaches, fatigue, irritability, and sleep disturbances. Due to the fact that in the premenstrual tension syndrome there is hypertrophy of the uterine tissues, mammary glands and electrolyte balance disorders, it is considered expedient to use a diet with a small amount of sodium salts, and in the second half of the menstrual cycle (the last 10-14 days) Reception of diuretics. For dehydration therapy, diuretic extracts and infusions from plants - mochego tea, cranberry leaves, birch buds, bearberry grass and zebrafish should be used; They are gentle means, recommended for patients under the age of 35 years, and also having concomitant pathology of the gastrointestinal tract. In case of insufficient effect of vegetative diuretics prescribe veroshpiron (spironolactone) 25-50 mg (1-2 t.) Once a day (in the morning), triampur 1 t. 1 time in 1-2 days, 2.5% solution Ammonium chloride for 1 tbsp. L. 2-3 times a day after meals (drink milk), furosemide 10 mg (1/4 tablets) once a week, and other diuretics. Simultaneously with saluretics (except for potassium-saving - veroshpirona, triampura) appoint preparations of potassium - 10% potassium chloride solution for 1 tbsp. L. After eating, Panangin 1 t. 3 times a day, or asparks 1-2 t. 3 times a day. In the syndrome of premenstrual tension, accompanied by hypothyroidism of the thyroid gland, secondary amenorrhea, hormone therapy with progestogenic drugs in combination with thyroidin is indicated. With an increased level of prolactin (in the case of pronounced stress stress - and at its normal level) in the second half of the menstrual cycle, it is necessary to prescribe a prolactin inhibitor - bromocriptine (parlodel, bromergone) - 1,25-2,5 mg (with good tolerability - Up to 5 mg) at night, for 10-14 days before menstruation (with a 28-day cycle - from the 16th to the 25th day). Vitamins A, C, E, B6 and preparations that reduce vascular permeability are administered in parallel (rutin 1 t 3 times a day, ascorutin 1 t 3 times a day, cyclo-Zfor 1 capsule 3 times a day, ginkor- Fort by 1 cape.

In recent years, with mastopathy and premenstrual syndrome, the phytotherapeutic drug mastodinone is successfully used. The main active component of mastodinone is Prutnak (Agnus castus). Mastodinone, acting on the lactotrophic cells of the pituitary gland, suppresses the excessive secretion of prolactin (spontaneous and induced), which leads to the reverse development of pathological processes in the mammary glands, relieves pain syndrome, eliminates the imbalance between estrogens and progesterone and restores menstrual function. Thus, mastodinon corrects the state of the mammary glands directly and indirectly through the regulation of steroidogenesis in the ovaries. When taking the drug, women note improvement in health, emotional state and the disappearance of discomfort in the mammary glands. Mastodinone is prescribed for mastopathy and menstrual irregularities for 30 drops in the morning and evening, regardless of the menstrual cycle without interruption for at least 3 months. After 3 months, you can take a break in treatment. Duration of the drug is not limited.

In the development of venous stasis, engorgement of the mammary glands with mastopathy, a certain role is played by prostaglandins. Under the influence of them? Bytkov changes lumen vascular gland, the permeability of vascular walls, impaired hemodynamics and water-salt ratio. In the second phase of the menstrual cycle to the 16th to 25th day should uc polzovat nonsteroidal anti-inflammatories, prostaglandin synthesis inhibiting Suitable?: Naproxen 250 mg 2 times a day, 25 mg indomethacin 3 times a day, 0.25 mg Brufen 3 Once a day, butadiene 0.2 g 3 times a day, aspirin 0.5 g 3 times a day. When ovarian follicular cysts, resulting in anovulatory cycles and luteal nedos? Tatochnosti applied mikroyodterapiya, which aims to stimulate the pituitary luteinizing function, the elimination of cysts and the normalization of the menstrual cycle. Assigned to 0, 25% solution of potassium iodide for 1 tsp. 2 times a day after meals, washed down with milk, for 6-12 months; After 4-5 months, the course can be repeated.

Hormonal treatment

In the absence of the effect of conventional methods of treatment should be run to individual hormone therapy. It can be applied only after the study of the patient's hormonal profile. Such treatment can be resorted to after the elimination of the inflammatory process in the female genital organs, in the absence of pronounced liver or liver failure. Small, physiological doses of hormones are used. The scheme of therapy is chosen depending on the level of estrogen saturation, clinical manifestations of illness, anamnesis, gynecological status, thyroid status. It is known that the use of oral contraceptives reduces the incidence of breast cancer and the development of mastopathy. Among women who used hormonal contraception, the number of patients with mastopathy is less than among those who used other types of contraception.

For the treatment of fibrocystic mastopathy, estrogen-progestative contraceptives containing not more than 0.03 mg of estrogenic genes should be prescribed: rhevidone - contains 0.03 mg of ethinyl estradiol; Triclawar, triregol, femoden, etc. Therapy with these drugs should be administered for 6-12 months.

Widespread use in mastopathy have progestins (progestogens, gestagens) - the hormones of the yellow body and their analogs. Preparatives of progestogens give progestagen, antigonadotropic, antiestrogenic and antiandrogenic effect. In the treatment of mastopathy usually used narcotics, turinale, progesterone, 17-OPK. Progestins are prescribed at the 28-day cycle from the 17th to the 25th, with the 30-day cycle from the 20th to the 28th day, respectively; 2-3 days before menstruation, therapy is discontinued. Progestins are used with a deficiency of gonormons of the yellow body, with anovulatory uterine bleeding accompanying mastopathy for a long time (1 year or more). Oily 1% solution of progesterone is used for 10-30 mg (1-Zml) in the form of IM injections; Pregnin - 10-20 mg 2-3 times a day inside. Synthetic analogue of the hormone of the yellow body-17 OPK - is a preparation of prolonged action. Enter intramuscularly 10 days before the start of menstruation in the form of 12.5% ​​solution of 0.5-1 ml; Narcotics 5-10 mg daily on the same days of the menstrual cycle when prolonged drugs are used. Turinal is administered transbuccally no more than 5 mg (1 ton per day) only to the second, luteal, phase of the cycle. Organometr is an oral preparation of the synthetic progestogen of linestrenol, administered from 10 to 25 days; The total dose is 5-10 mg. To strengthen the hormones of gestagenic action, the administration of vitamins E, A and C. Turinal is administered transbuccally no more than 5 mg (1 ton per day) only to the second, luteal, phase of the cycle. Organometr is an oral preparation of the synthetic progestogen of linestrenol, administered from 10 to 25 days; The total dose is 5-10 mg. To strengthen the hormones of gestagenic action, the administration of vitamins E, A and C. Turinal is administered transbuccally no more than 5 mg (1 ton per day) only to the second, luteal, phase of the cycle. Organometr is an oral preparation of the synthetic progestogen of linestrenol, administered from 10 to 25 days; The total dose is 5-10 mg. To strengthen the hormones of gestagenic action, the administration of vitamins E, A and C.

Androgenic drugs for mastopathy should be used only for hyperestrogenic conditions in women over 45 years of age. It is preferable to use androgens with a weak enzymatic, artificially weakened specific action and more pronounced anabolic properties - methylandrostenediol, me-tandrostenolone or a combined preparation of testbromolecite. The duration of the course is from 2-6 to 12 months, the doses vary: metilandrostenediol - a single dose of 10 mg, daily - 20-30 mg; Methandrostenolone - a single dose of 5-10 mg, daily -10-20 mg; Testbromolecite -1 tons 2-3 times a day; Danazol - a derivative of testosterone - a dose of 100-600 mg per day. Androgenic drugs are prescribed daily from the 6th to the 7th to the 11th-12th day of the cycle, depending on the duration and cycle of menstrual bleeding.

Antiestrogenic drugs inhibit the binding of estradiol to its cytoplasmic receptors in target organs. We have the most recognized tamoxifen (zitazonium, nolvadex). It should be used at the age of 45-65 years only in complex therapy in the diffuse form of mastopathy and in the absence of the effect of it? Rmonal methods of treatment. The daily dose - from 5 to 10-20 mg per day - is prescribed in 1 -2 admission, after a meal, the duration of treatment is from 5 months to 4 years.

A special place in the treatment of mastopathy is occupied by thyroid hormones, which have multifaceted biological activity; They regulate fatty, carbohydrate, protein metabolism, stimulate the activity of the sympatho-adrenal system, support the stressor capabilities and reactivity of the organism. The most common drug is thyroidin. Recommended single doses - 25-50 mg, not more than 100 mg per day, the duration of treatment - 10-24 months.

Phytotherapy

The medicinal plants used in the complex treatment of mastopathy can exert a multifaceted influence on the body.

Adaptogens stimulate the body's defenses, increase the body's general resistance to unfavorable exogenous factors, have immunomodulatory properties and are used for asthenic conditions.

  • Tinctures of Chinese magnolia vine, ginseng, aralia, zamaniha (15-20 drops 1-2 times a day), eleutherococcus extract (25-30 drops 1-2 times a day); The most pronounced effect of these drugs in the spring-autumn period, in summer it is practically absent.
  • Collect equal parts of the string, raspberry, oregano and St. John's wort (pour in water (in a ratio of 1/10), boil for 30 minutes on a small fire in enameled dishes with a closed lid, cool for 10 minutes, filter, add boiled water to the original volume Take 1/4 cup 2-3 times a day).
  • Chaga (birch mushroom) - insist 4-5 hours, grind on a grater or pass through a meat grinder, the resulting mass is poured with the same water (in a ratio of 1/5), heated to 50 ° C; Insist for 48 hours and filter through cheesecloth, water is added to the received liquid to the original volume and take up to 3 glasses of infusion per day, in fractions; Apply and official extract of chaga - befungin. When treating patients, it is necessary to comply with the dairy-vegetable diet with restriction of fats, meat, pickles, spicy seasonings, smoked products; Incompatible mushroom with penicillin and glucose.

    Hepatoprotectors and cholagogue are used for diseases of the liver and biliary tract, accompanying mastopathy.

  • Flowers of marigold, St. John's wort, immortelle, ergot, chamomile, bark of buckthorn taken evenly, pour cold water (1 tablespoon collection per 2 cups water), insist 10 hours, then bring to a boil, insist another 20 minutes, filter; Drink during the day.
  • Mix one st. Spoon of corn stigmas and mint, 1 dess. A spoonful of St. John's wort and a valerian root, and 2 tbsp. Spoon of dog rose (crushed); 1 tbsp. Spoon collection pour a half cups of boiling water, insist in a thermos for 12 hours, filter; Take 1/2 cup 2-3 times a day for 30 minutes. before meals.
  • Two st. Spoons of leaves or one st. A spoonful of birch buds is poured into 0.5 liters. Boiling water (add a little baking soda to dissolve tarry substances), insist 5 hours; Take 1/4 cup 3 times daily before meals.
  • One dess. A spoon of crushed dandelion root medicinal pour a half cup of boiling water, insist 5 hours; Take 1/4 cup 3 times daily before meals.
  • Two teaspoons of sage are poured with 2 cups of boiling water, insist 40 minutes, filter; Take 2 tbsp each. Spoons 5 times a day.
  • Two teaspoons of crushed flowers of marigold are brewed with 1 glass of boiling water, insist for 1 hour, filter; Take 1/2 cup 3 times a day.

    In addition to the above, for many years in the Moscow mammological dispensary with mastopathy with a positive effect, special charges are used. Compositions recommended for diffuse PCM.

  • Mix 1 des. Spoon yarrow, juniper berries and field horsetail, 1 tbsp. A spoonful of corn stigmas; 1 tbsp. Spoon collection pour 1 cup boiling water, insist 30 minutes, filter; Take 1/3 cup 3 times daily after meals.
  • Mix 1 tbsp. Spoon of nettle leaf and herbaceous grass, 1 des. A spoonful of three-colored violet grass, field horsetail and valerian root; 1 tbsp. Spoon collection pour 1 cup boiling water, bring to a boil, cool and filter; Take 1/3 cup 2 times a day.
  • Mix 1 des. Spoon of eucalyptus and string, 1 ts.lostok chistotela; 1 tbsp. Spoon collection pour 1 cup boiling water, insist 30 minutes, filter; Take 2 tbsp each. Spoon 3 times a day.
  • Mix 1 tbsp. A spoonful of St. John's wort and plantain, 1 dessert of valerian, 2 tbsp. Spoons of the sequence; 1 tbsp. Spoon collection pour 1 cup boiling water, insist 40 minutes, filter; Take 2 tbsp each. Spoon 3-4 times a day after meals.
  • Partitions 20-25 walnuts pour 1/2 cup of 70% alcohol, insist 10 days; Take 15-20 drops 3 times a day for 2 months.

    Composition recommended for adenosis.

  • Mix 10 grams of sage leaf, plantain and nettle, 5 g of wormwood; 1 tbsp. Spoon collection pour 1 cup of boiling water, insist 20 minutes, filter; Take on? A glass a day after a meal.

Compositions recommended for cysts

 Mix 1 tbsp. A spoonful of field horsetail and a blackcurrant leaf, 1 dess. Spoon flowers centaury; 2 teaspoons of collection pour 1 cup boiling water, insist 30 minutes, take 1 tbsp. L. 3-4 times a day.

  • Mix 1 des. Spoon of nettle leaf and juniper berries, 1 teaspoon of bitter wormwood, 1 tbsp. Spoon yarrow and field horsetail; 1 tbsp. Spoon collection pour 1 cup boiling water, insist 10 minutes, filter; Take 1/4 cup 3 times daily before meals.
Benign tumors of mammary glands Benign tumors of mammary glands

1. Fibroadenoma - is one of the forms of nodal dyshormonal proliferates, it develops on the basis of the violation of the hormonal activity of the female body. Fibroadenomas are more common at a young age (16 to 40 years).

The nodes of fibroadenomas usually have a smooth surface, round or somewhat oval, clearly separated from the skin and surrounding tissues, painless. Fibroadenomas can be of various sizes, up to the giant, occupying almost the entire mammary gland. Often there are multiple fibroadenomas in the same or both mammary glands. Treatment is surgical.


2.Kista - is an expanded excretory duct filled with liquid. The skin above the cyst is not altered or retracted. Has an oval or round shape with clear, even contours and smooth surface, elastic consistency. With the prolonged existence of the cyst, the compaction and thickening of the capsule, it can be defined as a dense formation that retracts the skin and deforms the nipple. Treatment is mostly conservative with the use of aspiration fine needle biopsy with large cysts, with doubt in the diagnosis - surgical.


3. Galactocele - a cyst of the breast, filled with milk-like contents. Occurs in women during the period of feeding due to blockage of the dairy. Clinical symptoms are the same as cysts.


4.Lipoma - a benign tumor that emanates from adipose tissue. This round or oval soft-elastic formation, well delimited from surrounding tissues, is painless. Characterized by extremely slow growth.


5.Oleogranulema - the focus of chronic inflammation, characterized by small cysts, containing fatty masses, occurs in the area of ​​necrosis of adipose tissue. It often develops after trauma. Clinically it sometimes has a similarity to breast cancer.

Clinical signs of breast cancer Clinical signs of breast cancer

There are 3 forms of breast cancer:

1.Uzlovaya

2. Diffuse

3. Paget's disease

The most common form of breast cancer is the nodular form. Nodular form manifests itself in different ways depending on the stage of the process. Clinical manifestation of this form is the appearance of a dense knot in a given breast portion which is felt even when the magnitude of 1 cm, if it is situated close beneath the skin, more than 2 cm. The tumor has a dense texture, bumpy surface, painless, partially displaced with respect to The tissues of the mammary gland itself. The uppermost quadrants are most often affected, the lesion of the right and left mammary glands occurs almost identically.

When trying to take the skin over the tumor into the fold, there is an attraction (symptom of the site) or wrinkling. With further growth of the tumor, germinating the skin, may cause its retraction deeper (umbilikatsii symptom), breast deformation, edema (symptom lemon peel over the tumor or outside), retraction of the nipple; Often thickens the nipple, there is edema of the areola (Krause symptom). The presence of single or several dense, round, painless nodules in the armpit basin of the same side is revealed.

Further development of the tumor leads to complete germination of the skin, which can lead to ulceration and decay of the tumor. Formed an extensive ulcer with vyvorochennye dense and bumpy edges, deep, easy bleeding bottom covered with dirty gray necrotic tissue with bad odor. The ulcer gradually increases, deepens, until the defeat of the ribs, sternum. There is bone destruction and severe pain.

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Diffuse form.

In some cases, the tumor grows in the form of a diffuse infiltrate that permeates the mammary gland in all directions. There are several forms of diffuse breast cancer:

1.Rozhist like. The clinical picture resembles erysipelas. The mammary gland is edematous, enlarged, diffuse reddening of the skin of the mammary gland is noted, the reddening spreads beyond the mammary gland to the chest wall. However, unlike erysipelas, skin temperature, if it is elevated, is insignificant. Axillary lymph nodes, which acquire a rounded shape, are painless.

2. Mastitis-like form is characterized by the presence in the mammary gland of a dense infiltrate without clear boundaries with edema of the tissues and skin hyperemia. Unlike true mastitis, with this form of cancer there is no high temperature, enlarged regional lymph nodes are painless. Foci of decay may occur with the addition of a secondary infection, which presents great difficulties for differential diagnosis.

3.Pantsirnaya form - the breast is reduced, deformed and becomes much less healthy. It is dense, tuberous.

4.Otchechno-infiltrative form is characterized by the presence in the mammary gland of a dense infiltrate, which has no clear boundaries. She is characterized by edema of the skin, an increase in the mammary gland that hangs below the healthy one. The skin looks like a lemon peel. In the axillary zones can be determined large dense lymph nodes.

Paget's disease.

It occurs in 0.5 - 3% of cases of breast cancer. The disease is relatively slow and can last several years. It begins with the reddening and thickening of the nipple, the appearance of dry and damp crusts and strings. When the latter fall away, a moist, granular surface is found. In the initial stages of this form of cancer it is not much different from the banal eczema, but unlike eczema Paget's disease is not amenable to drug treatment. With the passage of time spreads to the areola, the nipple gradually flattenes, ulcerates, the process extends to the skin of the breast beyond the areola. Infiltration passes to the subcutaneous tissue and breast tissue, and enlarged metastatic lymph nodes in the armpit are defined.

Problems of diagnosis of breast diseases Problems of diagnosis of breast diseases

Any civilization can be judged by its relation to a woman. The role of women in society is multifaceted. It is undeniable that a woman not only brings happiness and joy, but also creates coziness and preserves peace in every home. Women's health is the health of the nation. The state's concern for the health of women manifests a level of development and culture.

Breast cancer is one of the first places in the structure of morbidity and mortality from malignant neoplasms in women. Every ninth woman in the course of her life develops breast cancer.

Over the past 20 years, the incidence of breast cancer has increased by 64%. In the Gomel region, there are 5,200 women cured for breast cancer. Annually in Gomel and Gomel region, an average of 500 new cases of breast cancer in women are detected.

Identification and timely treatment of pathological changes preceding the development of neoplasms in the mammary glands and early diagnosis of malignant tumors in the initial stages of development make it possible to carry out prevention and treatment without the use of crippling methods and achieve full recovery. The mammologic service can not bring the desired results without understanding women's need for timely systematic examination and active attitude to their health.

The mammary gland is an organ whose function is regulated by the endocrine system, which implies the presence of cyclic changes during the period of normal menstrual function. A slight increase in the volume of the mammary glands and their "engorgement" that occurs before menstruation and passes with its onset is a consequence of normal cyclic changes. The appearance of severe pain or a feeling of "raspiraniya" in the mammary glands and a significant increase in their volume, which occurs a few days before the onset of menstruation, is called the syndrome of "premenstrual tension" of the mammary glands. Changes in the mammary glands during pregnancy and lactation: an increase in volume, the appearance of hyperpigmentation, the severity of the vascular pattern are physiological, i.e. Normal for this situation.

In the problem of diagnosing breast cancer, two important aspects should be highlighted.

  • First, the earliest manifestations of breast cancer (non-palpable malignant tumors) can be recognized only in mammography (X-ray of the breast). The mammography is performed by women over 40 years old on the recommendation of a doctor. To teenagers, pregnant and lactating women, mammography is prescribed only on strict indications. The level of radiation exposure of such an investigation is small and does not pose a threat to the health of women.
  • Secondly, with the development of self-examination techniques, women can identify breast cancer at an early stage, when full recovery is possible.

The risk factors for breast cancer include: heredity (the presence of benign and malignant breast tumors in blood relatives on the maternal line); Early appearance of menstruation (up to 12 years) and later onset of menopause (after 55 years); infertility; Frequent termination of pregnancy; Refusal of lactation; Chronic gynecological diseases; Diseases of the endocrine glands; Exposure to ionizing radiation and carcinogens. The presence of cancer in one gland increases its occurrence in the second.

The mammary gland is subject to cyclic changes. The most informative period for the survey is from 6 to 12 days from the beginning of menstruation.

In addition to regular cyclic changes, the breast tissue undergoes changes throughout the life of a woman: from development and maturation to complete resorption (involution), which affects its density and influences the choice of the method of examination in each specific period.

In nulliparous women under 35 years of age, breast tissue is characterized by high density, poorly transmitted X-rays, so mammography is not very informative. At this stage, ultrasound is the main method. With age, after giving birth and breast-feeding, the density of the tissue decreases, which makes it possible to obtain an x-ray image of the gland, so the mammography study comes to the fore.

Cytological examination of breast tissue cells obtained with puncture, and smears of secretions from the ducts allows us to clarify the nature of the disease.

Complete removal of the altered tissue site - sectoral resection with morphological examination - is both a method of diagnosis and surgical treatment.

If there are any symptoms on the part of the mammary glands, any seal and discharge from the nipples should be consulted by the gynecologist in the polyclinic at the place of residence, which will give recommendations for the prevention and treatment of the revealed pathology, or send it to a specialized institution for refining diagnosis. Each woman should apply once a year to the territorial polyclinic for examination of the mammary glands, even in the absence of complaints and symptoms.

Health is the main personal value of a person, care for its preservation must be carried out by every person throughout his life.

Prevention and risk factors for breast cancer Prevention and risk factors for breast cancer

A clear prevention system for most cancers has not yet been developed, since the causes themselves and the triggers for the development of the disease remain unclear. Currently, a huge number of studies are devoted to identifying the cause of breast cancer and its effective prevention. Therefore, doctors can not yet answer the question why some women have a mammary gland, while others do not.

Despite the lack of clear data on the causes of cancer, for each individual disease there are many links with factors that can provoke it. Prophylaxis of breast cancer can be effective only if the factors and conditions that contribute to the onset of the disease are integrated.

Risk Factors for Breast Cancer

  1. Social conditions of risk of breast cancer.

    One of the main features of the development of modern society was the extensive involvement of women in social production, which led to a significant change in its social status and reproductive behavior. The modern type of reproductive behavior, focused on low birth rate, has turned into a factor of cancer risk. By giving birth to a certain number of children, using this or that means of restriction of childbirth, the woman, without knowing it herself, influences the probability of the appearance of breast cancer in her.

    In modern conditions, with a regulated birth rate, women who have married after 30 years on average have significantly fewer children than younger children. Meanwhile, the probability of entering into the first marriage of those over 30 or more years old is now higher compared to the past. In turn, the older a woman, the more reduced her ability to fertilize and bear fruit. This is exacerbated by the spread of abortions before marriage, which often leads to secondary infertility. As a result of this objective factor, the frequency of infertile marriages is significantly greater among those who are late marriage.

    Genital function is a natural process for the female body. A normal pregnancy should be terminated by birth. Abortion is a kind of hormonal stress. Pregnancy, childbirth, abortion have an active influence on the hormonal balance of the woman's body.

  2. Reproductive status of women

    In this concept for the risk group include the early menarche (up to 13 years), the late protracted period of menopause (after 55 years), late first birth or no birth, abortion, inflammation of the pelvic organs.

    Most women have menstruation at the age of 13-14. The sooner puberty begins and menstruation begins, the greater the risk of cancer of this organ. Sexual acceleration in the modern world contributes to a number of negative factors: cosmetics, shampoos, hair dye, containing hormones, genetically modified foods and so on. Most often, early maturation is observed in girls with excess weight, and such children early stop growing. The modern generation of girls consumes more sweet high-calorie food than their predecessors, but fewer fresh fruits and vegetables. Modern girls prefer to travel by car, rather than on foot. The combination of a high-calorie diet with a sedentary lifestyle leads to an increase in the incidence of obesity and can be a possible explanation for earlier puberty.

    It is established that the earlier a woman began to live a sexual life, first became pregnant and gave birth to the first child, the less the risk of breast cancer.

    The negative consequences of the interruption of the first pregnancy, its effect on the increased risk of the incidence of breast cancer have been noted. On the contrary, childbirth at the first pregnancy leaves its protective trace on all generations of women. Therefore, a young woman who solves the dilemma to save or not keep the first pregnancy should think about the risk of breast cancer in the future.

    It's no secret that the main purpose of the breast is lactation (formation and excretion of milk). The duration of breastfeeding has a very weak, almost insignificant, connection with the incidence. A more significant role is played not by the duration of lactation, but by the secretory activity of the mammary glands, more precisely, by the usefulness of the secretion of milk, depending both on factors of the internal environment and external. Stimulation of the secretory activity of the mammary glands during the feeding of the child (especially in cases of its insufficiency) can have a significant preventive value.

  3. The influence of nutrition and harmful household habits (smoking and alcohol)

Among the dietary factors, the favorable role of milk consumption has been established. The more often a woman uses milk, the less the risk of morbidity. Fatty food in general has an adverse effect, being a risk factor for cancer of various organs. However, the use of butter in this regard is an exception. It has a positive effect along with milk. Other types of fats, especially lard, play a negative role.

Among the various microelements, iodine is very important in this process. It is necessary for the normal functioning of breast tissue. The breast tissue, in which iodine is inadequate, is more sensitive to the action of carcinogens. Iodine deficiency manifests itself already at the stage of precancerous diseases of the breast.

The increase in the spread of harmful household habits (smoking and alcohol) among the female population occurs in parallel with an increase in the incidence of breast cancer. With the increase in the consumption of alcoholic beverages, the incidence of menstrual function disorders increases. The risk of cancer increases with the increase in the number and strength of alcoholic beverages consumed.

Smoking has a significant effect on reproductive function. Under his influence, the length of pregnancy and the time of conception are lengthened. Smoking affects not only the hormonal balance of the female body, but also the lactational function of the breast. Smoking mothers stop breastfeeding their babies very quickly. This is mainly due to two reasons: the specific taste of breast milk from smoking mothers and the progressively decreasing amount of milk in the breast.

  1. Heredity and breast cancer

It is estimated that about 5% of all cases of this disease are the result of a hereditary predisposition, in which genes that are often found in the population and are transmitted in an autosomal dominant type are involved. The study of DNA in families with breast cancer confirmed the genetic conditionality of it in some of these families. The first mutant breast cancer gene (BRCA I-Breast Cancer Associated gene) was identified in chromosome 17 and the second gene (BRCA II) in chromosome 13.

The carrier of the BRCA I gene (17 chromosomes) increases the risk of developing breast cancer to 80%, and up to 50% at the age of up to 50 years. In addition, up to 44% increased risk of developing ovarian cancer regardless of age;

Carrying out the BRCA II gene (chromosome 13) leads to an increase in the risk of developing a highly differentiated breast carcinoma to 70%.

This fact can be easily established by using the services of genetic counseling. Timely establishment of the presence of this risk factor will allow more carefully (on an individual schedule) to observe dynamically not only the patient herself, but all her blood relatives.

Mutations in somatic cells are reproduced only when they are divided and the offspring are not transmitted. But if the gene mutation occurs in the sex cell of one of the parents, it will be passed on from generation to generation. Such a person will be a carrier of a mutant gene, but this does not mean that he will necessarily fall ill with cancer. This only creates a predisposition to the disease. To have a tumor in the carrier of a hereditary mutation, it is necessary to awaken it. And in this the role may again play a meeting with carcinogens. Consequently, the quality of the environment, the way of life play an important role in the emergence of a tumor in people with a hereditary predisposition to it.

  1. Fibrocystic disease

    Or dyshormonal dysplasia or more habitually - mastopathy. A fairly widespread diffuse process, characterized by an abnormal ratio of epithelial and connective tissue elements in the breast tissue. According to statistics, they suffer from 52 to 63% of women, but this does not mean that, having such a diagnosis, the patient always falls into the group of high risk.

    In terms of the incidence of breast cancer, the degree of proliferative activity of the epithelium in mastopathy matters. So, with atypical proliferation, the risk increases more than 3 times, and when combined with a family history, the higher.

To significantly reduce the risk of developing malignant neoplasms, it is enough to adopt some fairly simple rules. This is all that is included in the concept of a "healthy lifestyle":

  • To give up smoking
  • Fighting overweight
  • Regular exercise
  • Diet with daily consumption of plant foods, dairy products, restriction of consumption of red meat; Refusal from oily and spicy food
  • Regular check-ups and examinations in accordance with age and risk group.
Breast self-examination Breast self-examination

Self-examination should be carried out regularly, in the first 7-12 days from the onset of menstruation. Nenenstraining women should examine their breasts on the same days, once a month.

Self-examination begins with examination in the mirror, with good lighting. Undressing to the waist and standing in front of the mirror, assess the size and shape of the mammary glands, skin condition and nipple. The chest is examined as standing, with hands on the waist, and with the torso tilting, raising the arms to the sides and up. The left breast is felt with the right hand, and the right one with the left; First standing (free hand to put on the belt), then lying (free hand put behind the head). Alternately pressing the palm surface of the closed and straightened fingers of the hand different parts of the gland, "spread out"? Her tissue on the chest wall. After that, the breast tissue between fingers is brushed, paying attention to tautness, granularity and other changes in its structure, moving from the periphery to the nipple. It is necessary to methodically examine the entire mammary gland.

You should consult your doctor if:

  • Asymmetric enlargement or reduction of mammary glands
  • The appearance of seals, bulging or skin tingling reddening and puffiness,? A lemon crust?
  • Retraction, pitting, or discharge from the nipple
  • Presence of dense, enlarged axillary lymph nodes
  • Other changes that occurred after the previous self-examination

 

Gomel regional clinical oncological dispensary

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