Dr. Triveni K. L

Detecting a lump on your breasts can be stressful for any women. Breast cancer is a common type of cancer and is said to affect primarily affect women though 1% of breast cancer cases affect men. Breast cancer can be categorized into different types based on their capability to affect surrounding tissues.

The most common amongst these are:

• Ductal carcinoma in situ
• Invasive ductal carcinoma
• Invasive lobular carcinoma

Breast cancer is caused by mutations of a person’s DNA cells. This could be inherited from one’s parents or acquired by an unhealthy lifestyle. These DNA mutations cause cells in the breast tissue to multiply rapidly and turn cancerous. The risk factors for breast cancer can be categorized as modifiable and non-modifiable.

Modifiable risk factors:

• Excessive alcohol consumption
• Obesity
• Use of combined hormone therapy after menopause
• Lack of exercise

Non-modifiable risk factors:

• Age
• Family Medical History
• Personal Medical History
• Atypical hyperplasia
• Early start of menstruation cycle
• Presence of dense breast tissue
• Inherited genetic mutations

As with any other type of cancer, the earlier it is diagnosed, the easier it is to treat. In its early stages, breast cancer is not painful and has negligible symptoms. In most cases, it is detected only by finding a lump on the breast or through a mammography. This lump may also be present in the armpit or above the collar bone. Some of the other symptoms of breast cancer include:

• Nipple inversion
• Discharge from the nipples
• Changes in the colour and texture of skin covering the breast

Breast cancer has five stages beginning from 0 and going up to 4. This is based on the size of the tumour, involvement of lymph nodes and whether or not metastasis has occurred.

• Stage 0: At this stage, the tumour does not affect the lymph nodes and has not metastasized. Thus at this stage, it is noninvasive.
• Stage I:  In this case the tumour is smaller than 2 cm in diameter and has not spread to any of the surrounding tissues.
• Stage II: In this stage, the cancerous tumours are still fairly small in size but also affect the surrounding lymph nodes.
• Stage III: These tumours are larger than 5 cm in diameter and involve the lymph nodes to a greater extent.
• Stage IV: This is also known as metastatic breast cancer. In this stage, the cancer cells metastasize to other parts of the body.

Surgery is the most preferred form of treatment for breast cancer. This may be combined with radiation, chemotherapy, targeted therapy or hormone therapy depending on the stage and type of cancer, the patient's overall health, age and personal preferences. In case you have a concern or query you can always consult an expert & get answers to your questions!

Any kind of bleeding from the uterus, which is not normal, can be termed as abnormal uterine bleeding. This refers to bleeding between periods or before periods, bleeding after having sex, spotting, abnormally heavy bleeding or bleeding after attaining menopause. If you are suffering from any of these issues, you need to consult with the doctor. 

Diagnosis
It is very important to diagnose abnormal uterine bleeding. There are several examinations and tests that have to be carried out, depending on age. For irregular spotting, a pregnancy test can be undertaken in case you think you could be pregnant. If your uterine bleeding is very heavy, a test has to be performed to check blood count. This is done to observe whether you have anemia. An ultrasound test of the pelvic region will also be advised by your doctor to know the cause of the bleeding. Several hormonal tests and thyroid function tests are required as well.

Other diagnostic tests include:

1. Sonohysterography: When fluid is placed within the uterus and ultrasound images of the uterus are taken. An image of the pelvic organs is obtained.
2. Hysteroscopy: It can be carried out when a device is inserted via the vagina and enables the doctor to examine the uterus internally.
3. Magnetic resonance imaging: This is also used to get images of the organs.
4. Endometrial biopsy:  It involves insertion of a catheter to take out a tissue which is microscopically observed. 

Treatment
There are different types of treatment for abnormal uterine bleeding depending upon factors such as the cause of bleeding and the age of the patient.

1. Medications: Several medicines are used to treat abnormal uterine bleeding. Sometimes hormonal medicines are used. Birth control pills are also used to improve the regularity of periods. Hormonal infections, vaginal creams and an IUD device releasing hormone can be used. Non steroidal anti-inflammatory drugs are also used to control bleeding. Several antibiotics may also be prescribed.
2. Surgery: In some cases of abnormal uterine bleeding, a woman has to undergo a surgery for the removal of growth such as polyps and fibroids, which results in bleeding. While some fibroids can be removed via hysteroscopy, others require different techniques for treatment.
3. Endometrial ablation: It can be undertaken to control bleeding. This mode of treatment aims at reducing the bleeding permanently. In case all treatment methods fail, hysterectomy has to be carried out. This is a serious surgery and after it is performed, a woman does not have periods anymore and will not be able to conceive a child.

Abnormal uterine bleeding is a serious health condition, which may lead to severe complications. Immediate diagnosis and appropriate treatment methods should be undertaken in case of any abnormal uterine bleeding.

Breast cancer is an abnormal growth of cells in the tissues of the breast. Mainly it occurs in females but less than 1% of all the breast cancer cases develop in males. The majority of breast cancers start in the milk ducts. A small number start in the milk sacs or lobules. It can spread to the lymph nodes and to the other parts of the body such as bones, liver, lungs and to the brain.

With more reliable early detection methods as well as the trend towards less invasive surgery, there is hope that even more women with breast cancer will be treated successfully and will go on to resume their normal lives.

Signs & Symptoms 
It is painless, especially, during the early stage. Watch out for the following changes in the breast:

1. A persistent lump or thickening in the breast or in the axilla. 
2. A change in the size or shape of the breast. 
3. A change in the colour or appearance of the skin of the breast such as redness, puckering or dimpling. 
4. Bloody discharge from the nipple. 
5. A change in the nipple or areola such as scaliness, persistent rash or nipple retraction (nipple pulled into the breast).

Consult a doctor immediately if you notice any of these changes.

Risk Factors 
Being a woman puts you at risk of getting breast cancer. There are certain factors that increase the risk of breast cancer. Some of them have been listed below:

1. The risk increases with age; most cases of breast cancer develop after the age of 50 
2. Genetic alterations in certain genes such as BRCA1 and BRCA2 
3. Family history of breast cancer 
4. Being overweight 
5. Early menarche (onset of menstruation before the age of 12) 
6. Late menopause (after the age of 55) 
7. Never had children 
8. Late childbearing 
9. No breast feeding 
10. Excessive consumption of alcohol 
11. Use of hormonal replacement therapy (HRT) for a long period of time

However, most women who have breast cancer have none of the above risk factors. Likewise, not having any of these risk factors does not mean that you will not get breast cancer.

Early Detection and Screening

More treatment options are available when breast cancer is diagnosed at an early stage and hence the chances of recovery is also higher. So regular breast screening is important for early detection even if there are no symptoms. Following are the ways of screening:

1. Breast Self-Examination (BSE): Perform BSE once a month about a week after your menses are over. If you no longer menstruate, choose a date each month which is easy to remember e.g. your date of birth or anniversary.
2. Clinical Breast Examination: Get a breast specialist to examine your breast once a year if you are 40 years and above.
3. Mammogram: Go for a screening mammogram once a year if you are 40 to 49 years old and once every two years if you are 50 years and above even if you do not have any symptom. It is not recommended for younger women (less than 40 years of age) as they have dense breasts, making it difficult for small changes to be detected on a mammogram. So ultrasonography of the breasts is advisable to them.

Types of Breast cancer

1. Non-Invasive Breast cancer: These are confined to the ducts within the breasts. They are known as Ductal carcinoma in-situ (DCIS).
2. Invasive Breast cancer: It occurs when cancer cells spread beyond the ducts or lobules. Cancer cells first spread to the surrounding breast tissue and subsequently to the lymph nodes in the armpit (Axillary lymph nodes). These cells can also travel to the other parts of the body such as bones, liver, lungs or brain and hence known as metastatic breast cancer.

Making A Diagnosis 

If you notice any unusual changes in your breasts, you should see a doctor immediately. He will examine you clinically and may ask you to undergo some tests so that a definitive diagnosis can be made. Further, the staging work up is done to find out the stage of the disease and management accordingly.

Treatment options 
Treatment of breast cancer may include various methods such as surgery with or without breast reconstruction, chemotherapy, radiation therapy, hormonal therapy and targeted therapy. Treatment options offered, depend upon the number of factors such as the stage of cancer and likelihood of cure, your general health and your preference.

In case you have a concern or query you can always consult an expert & get answers to your questions!

I’m Dr. Malvika Sabharwal, from Jeewan mala hospital and Apollo Spectra hospital, New Rohtak Road in Karol Bagh. In fact I’ve been a laparoscopic surgeon since the year 92, I introduced it in the North of india. 2000, we had got recognition at this hospital for managing most of the gyne problem laparoscopically.

Today I will tell you about fibroid uterus. It’s a very very common problem, seen almost in 25% of cases and at all ages, at any age and It causes various problems. In case agar ye bleeding cause kar ra hai, to bleeding k sath to mareez fatafat aatay hain k han g hamay bleeding ho rai hai, un ka diagnosis b ho jata hai. Kabi kabi wo infertility cause karta hai, infertility ka matlab k pregnancy nai ho rai hai. In such cases, agar pregnancy nai ho rai hai to b mareez aa jaat hain sooner or later. Par kai fibroids aise hain jo k hotay hain even after having couple of children. 2, 3 bachay ho gae phr b wo fibroids hai.

Ab basically fibroids hotay ki hai, ye normal uterus hai, 2 tubes hain 2 ovaries hain, ye muscle wall jo hai agar is me se ek bhi fibre barh jata hai, ye fibroid cause karta hai aur fibroids jo hain wo is tarha k tumors hain uterus k andar. Agar ye uterus me fibroid andar ki taraf jhukav de ga, agar 2cm ka b hai, wo bleeding cause karay ga aur us k liye aap fatafat doctor k paas pohnchen gey aur us ka samadhan ho jae ga. Agar fibroid boht barha hai, wo upper ki taraf jae ga aur us ka pata b nai chalay ga aapko. Kabi kabi kuch pata b nai chalta, kabi kabi us se aata hai patient k g hamy urine nai ho paa ra, hum peshaab nai kar pa rae aur ye hamay boht tang kar ra hai, tou tab diagnose hota hai. Any which ways, hamaray paas 2 hi options hain, ya tou uterus ka nikaalna ya fibroid ka nikalna.

Agar hamay uterus ka kaam lena hai, patient young hai, aagay bachay paeda karne hain tou definiteky fibroid ko nikalna hi better hai par agar family complete hai, agar us ko bachay aur nahi chahye aur us ki umer b towards the maybe 40 years or above hai or even otherwise agar boht zaada takleef ho rai hai, many options are there par durbeen se hum fibroid b nikalte hain aur uterus b nikalte hain. Agar fibroid nikala jae tou sirf fibroid ko nikaal kar k hum bolte hain ab aap pregnancy shuru kar sakte hain. Once fibroids are removed laparoscopically ya ek aur tareeka hota hai hysteroscopically, uterus ko andar se ja kar k hum dekhte hain, muaaena karte hain aur jahan fibroid hota hai us ko nikaal letay hain. It’s a non-touch technique hysteroscopy wala.

Laparoscopic jo karte hain, us me 2, 3 holes bante hain pait k andar aur us kop hr morselate kar k tareekay se nikaala jata hai. Ye morselation b boht zaada ajkal controversy me b aaya , is k baaray me tarah tarah k hare k forum me discussions hue k karna chahye ya nai karna chahye aur ye jo fibroid ko nikalne ka tareeka morselation ka hai, aaj kal in-bag b hai matlb aap bag k andar fibroid ko daalo aur us ko nikalo. Is se wo cheez jo hai wo phailti nai hai aur boht araam se wo aap k nikal aati hai. Ye ek din ka stay rehta hai hospital me fibroid nikalne k liye. Laparoscopic fibroid removal me patient is there in the hospital just for one day. Us k baad you’re back to normal and aap ko koi rok thaam nai hai, serhiyon pe jaana utarna, aap ko koi jhukna, travel karna.

Log Hindustan k bahr se b aatay hain is ko remove karwanay k liye. So, this is one thing which is available in our hospital and we’ve been doing it since 92. 2000, we have already got to recognized training center for fibroid removal. Now there are situations jahan pe fibroids nahi nikal paatay, tou us me b koi aisi baat nai hai, it’s not k it’s the end, like k agar tubes k boht paas ho, agar boht zaada paas hai tou kabi kabi situationally aap nai nikaal paatay but that is something jo k aap ko us k liye koi aisi wo baat nai hai as long as the tubes are patent, matlb aap tube ko test karte ho aur pregnancy amooman hojati hai. Fibroid removal k baad sab ka question hota hai hum kab shuru Karen pregnancy? 3 maheenay is the ultimate time jo l hum log detay hain k us k baad hum kehte hain aap zarur us ko shuru karlo and jo ye fibroid ki problems hain this is something which is so common. I feel that we should look into it, regular checkup is the only answer at every age. Har ek umer ki larki ko apna every year checkup kara lena boht zarurui hai.