Dr. Tulasi

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. If you wish to discuss about any specific problem, you can consult an oncologist.

Galactorrhea is not a disease per se, but more of an underlying medical condition or a symptom that involves discharge of a milky fluid from the nipples, which is not the breast milk. It becomes especially crucial owing to the similarity of the two, when breastfeeding the baby is concerned. It may happen even while you are not lactating or not even pregnant, mostly in menopausal women. Strangely, the syndrome has also shown to have occurred to men and children, irrespective of gender.

What are the contributing factors to the development of Galactorrhea?

1. Galactorrhea is a major side effect of certain kinds of medication that leads to hormonal imbalance and ultimately leads to quasi-lactation.
2. Increase in the levels of prolactin can result in Galactorrhea which may be due to a number of reasons ranging from excessive stimulation in the nipples and chest area (during sexual activities), or pituitary and thyroid problems. The former is not a major cause of worry. The latter can be fixed with proper medication.
3. Kidney disease and spinal cord surgery may also result in this phenomenon.
4. Substance abuse and birth control pills may also be responsible for breast discharge.
5. At times, the causes for Galactorrhea may not be certifiably determined.

Various symptoms of Galactorrhea include:

1. Milky discharge from one or both breasts simultaneously.
2. Discharge may be continuous or intermittent.
3. Density and amount of discharge may also vary.
4. In case of women, this may have a direct effect on periods, leading to irregular menstruation.
5. The discharge may occur without pressure or when an external agency is involved.
6. Headaches and worsening vision are also said to occur.

When you experience a nipular discharge, the most common tests you should undergo include a pregnancy test, prolactin level exam, mammography, ultrasounds, even an MRI for the pituitary gland evaluation. Based on the result, your physician prescribes the required medicines or advises you to stop taking a particular medicine that might be causing this discharge in the first place.

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

Beet juice: apart from being a nutritional powerhouse, beet juice is a great source of nitric acid. The latter helps with blood flow in the body. A smooth blood flow, on the other hand, helps the brain in functioning properly. A study has found that people who consume beet juice have an increased circulation in the white matter resulting from an increased brain activity. This juice is sweet in taste and can be consumed every alternate day.

Berry smoothies: acai is a fruit which has a south african origin and hits the top of the list when it comes to brain assisting food. It increases the flow of the blood and dilates the blood vessels. However, this is extremely expensive. Berries also have a similar effect on the brain, but they are less powerful in nature. What can be done is to mix a little ingredient of acai in frozen berries juice and drink the same every day. Frozen berries retain the freshness and the nutritional benefits. This drink will improvise your brain and increase blood flow in the body.

Pomegranate juice: pomegranate is a great antioxidant and it very aptly limits the free radicals from damaging the brain cells. Antioxidants are also credited with increased blood flow and protection of the heart. A healthy cardiovascular system is synonymous to an increased brain function. What is surprising is the fact that pomegranate has more antioxidant content compared to red wine and green tea. Pomegranate juice can be consumed daily during the morning or afternoon.

Carrot juice: carrot is known for its healthy components that are beneficial for the eyes. Recent studies have revealed that they are great for the brain too. Like other colored vegetables, they are a great source of antioxidant and have a high content of beta-carotene. Carrot juice can reduce the inflammation of the brain cells and improve memory. Carrot juice is not at all bitter and the same can be consumed every alternate day after your meal.

Cocoa: a harvard study revealed that two cups of cocoa on a daily basis greatly helps a person in improving memory. Cocoa contains flavanols that keep the blood pressure normal and relaxes the blood vessel linings. Cocoa is also known to be a great antioxidant agent that limits the free radical to affect the brain cells. Cocoa should not be overloaded with sugar and should be consumed hot before starting your day.

It is perfectly normal for women to experience the periodic monthly bleeding cycle. However, if a woman experiences uterine bleeding which is abnormal and dysfunctional, it could be a symptom of infection. Other causes of abnormal uterine bleeding include hormonal imbalance, infection in cervix and cancer of the uterus. Many women can also experience abnormal uterine bleeding during first trimester of pregnancy.

The following are considered to be abnormal or dysfunctional uterine bleeding:

1. A menstrual cycles occurs between 21 to 35 days, anything shorter or longer than this is abnormal
2. No period for 3–6 months (amenorrhea) is abnormal
3. Spotting or bleeding between periods
4. Spotting or bleeding after intercourse
5. Bleeding that is heavier or lasts longer than usual
6. Spotting or bleeding after menopause

What can cause such a situation?

Some of the common causes leading to abnormal bleeding are as follows:

1. Miscarriage
2. Ectopic pregnancy
3. Pregnancy
4. Cervical or uterine infections
5. Fibroids
6. Hormonal imbalances
7. Problems with blood clotting
8. Polyps
9. Polycystic ovarian
10. Endometrial hyperplasia
11. Cancer of the reproductive tract

How to Diagnose it?

Most women tend to ignore abnormal bleeding, taking it as something to do with age or hormones. A detailed physical examination and history is done to understand menstrual cycle patterns and family history. In addition, the following would be used.

1. Ultrasound: The pelvic organs are examined through sound waves to locate the problem area
2. Hysteroscopy: Through a thin device that is inserted into the vagina, the doctor takes a look at the inside of the organs and identify the cause for the bleeding
3. Endometrial biopsy: The uterine lining tissue is removed and examined under microscope to look for tissue changes that could be causing the bleeding

How Best to Treat It?

This would depend on the reason for the abnormal bleeding. However, in most cases, combinations of the following are useful in treatment.

1. Hormone replacement can be done depending on the age and gynecological history, the type and the dose of the hormone would be decided upon. These could be in the form of tablets, vaginal creams, injections, or through an intrauterine device
2. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are useful in reducing bleeding and controlling cramps during excessive menstrual bleeding.
3. Antibiotics may be useful if there is infection of the pelvic organs.
4. Polyps, cysts, cancers, and other growths can be removed via hysteroscopy and sent for biopsy to confirm they are not cancerous.
5. Endometrial ablation where the endometrial tissue is treated with heat can be used to control bleeding permanently.
6. Hysterectomy would be done if other forms of treatment have failed. This could depend on their gynecologic history and other considerations as she cannot get pregnant after this.

Do not ignore if you see a change in the pattern of your uterine bleeding. It definitely calls for medical attention and if identified early, can be managed in much simpler ways. If you wish to discuss any specific problem, you can consult a gynaecologist.