BREAST TUMORS by

DR. SAGIRA CHIMTHANAWALA

Prof  &  Head,  Dept  of  Hom  Gynecology  &  Obstetrics  

THE  NATIONAL  ACADEMY  OF  HOMOEOPATHY  INDIA  

SHAAD  HOSPITAL  COMPLEX  &  RESEARCH  CENTRE,  

NEAR  ITWARI  RAILWAY  STATION  NAGPUR-­‐440002,  INDIA  www.  homeoacad.org  

Dept of Homoeopathic Gynecology & Obstetrics

THE NATIONAL ACADEMY OF

HOMOEOPATHY,INDIA Shaad Homoeopathic

Hospital Near Itwari Railway Station, NAGPUR

INDIA

Breast : Anatomy & Physiology    � Modified  sweat  gland.  � Present  in  pectoral  region  in  mammals  &  human  body.  

� Functional  during  lactation  � Fully  develops  during  puberty  � Rudimentary  in  males  

Mammary gland consist of • Complex  network    of  branching                                ducts  i.e.  tubes    or  channels  • Lobules  • Breast  ducts  • Surrounding  fatty  tissues  • Suspensory  ligaments  • Connective  tissue  fibers  • Blood  vessels  &  lymphatic

• Each Breasts has 15 - 20 lobes of glandular tissue, arranged like the petals of a daisy. • The lobes are further divided into smaller lobules that produce milk during pregnancy & breast feeding. • Small ducts conduct the milk to a reservoir that lies just beneath the nipple. • Supporting this network is a deeper layer of connective tissue called stroma. • Each breast also contains blood vessels and vessels that carry lymphà small bean-shaped organs called lymph nodes, clusters found-- • under the arm, • above the collarbone • in the chest & many other parts of the body.  

 

TYPES OF BREAST MASSES Benign  or  Malignant  85%  are  benign  esp.  in  women  under  age  40.  Benign  causes  of  breast  lumps:  * Breast  infections  (abscess)  * Fibrocystic  breasts-­‐  Lumpy  masses  * Fibroadenoma-­‐  age  grp  16-­‐30,  small  masses  * Fat  necrosis  (Fat  tissue  destruction)          

Breast lumps • Breast  abscess  • Cyst  • Cancer  • Fat  necrosis  (oil  cyst)  • Radial  scar  • Fibroadenoma  (mouse  in  breast)  • Breast  lipoma  • Fibroma  • Haematoma  • Fibroadenolipoma  • Lymphoma  • Milk  tumor  • Fibroadenosis  

Phyllodes tumor

Calcified oil cyst

Breast cancer

Fibroadenolipoma

CA BREAST – PREDISPOSTION • Family H/O of breast cancer • A/F Humiliation, Indignation • Stress - Job, Family, Environment • Trauma (Bellis per) / Hematoma (Kent 881) • Surgery or Excision of Benign Tumor (medical & cosmetic ) • Infertility • Multipara (Loss of Vital Fluids) • Repeated Mastitis • Vaccination • Secondary to Ca Cervix / Endometrium • Early onset of menstrual cycles. • Late menopause. • First pregnancy at older age

EXCITING  FACTORS  -­‐  Any  acute  condition  which  triggers  the  malignancy  * Stress  * Shock  –  physical  or  mental  * Mechanical  interventions  * Mastectomy  /  Tubectomy  /  LSCS    MAINTAINING  FACTORS  * Suppression  of  emotions  * Repression  of  sexual  desire  (sepia,  conium,  staph)    FUNDAMENTAL  CAUSES  Miasm  –  Psoro-­‐sycotic  –  any  1  organic  miasm  

Symptoms Depends  on  underlying  cause  of  lump  1)Painless  /  painful  lump        firm  or  hard  in  consistency  with  irregular  borders  2)Nipple  –  pulling  inwards,  swelling,  itching,  color              changes  3)Nipple  discharge  –  bloody  /  straw  colored  4)Skin  changes  –  dimpling  or  orange  peeled              color,  redness,  visible  veins,  ulceration,  etc  5)Wt  loss  6)Bone  pain    

Age  dependant  lumps  • New  born  infants  –  enlarged  breast  tissues  beneath  nipples  stimulated  by  mother’s  hormone.  (These  disappear  within  few  months  of  birth).  • Beginning  at  early  age  of  8  yrs,  girls  may  develop  tender  lumps  beneath  one/both  nipples.  These  lumps  are  breast  buds  &  are  one  of  the  earliest  sign  of  the  beginning  of  puberty.  Note  –  Hormonal  changes  just  prior  to  menstruation  may  give  a  lumpy  or  granular  feeling  to  the  breast  tissues.    

Investigations "  Haemogram  "  Breast  USG  "  Breast  biopsy  "  FNAC  "  Mammogram  "  MRI  

BREAST  ABSCESS  Def:  A  painful  collection  of  pus  that  forms  in  the  breast.  Aetiopathogenesis:  Infected  by  bacteria  (commonly  staphylococcus  aureus)    Bacteria  enter  through  a  crack  in  the  breast  /  on  nipple                                                                  Mastitis                            Invades  the  fatty  tissue  of  breast                          Swelling  or  pressure  on  the  milk  duct                        Causes  abscess  filled  with  pus  

Breast  abscess  

Common  causes  are  • Skin  of  the  nipples  can  crack.  Usually  a  result  of  the  baby’s  gums  pinching  the    nipple    • Staphylococcus  aureus  usually  get  into  the  breast  through  cracks  or  abrasions  in  the  nipple.    • Greater  Risk  -­‐  Females  with  Diabetes,  or  who  have  under  gone  Nipple  piercing  or  Lumpectomies  or  breast  irradiation,  or  are  using  corticosteroids,  or  have  silicone  breast  implants  or  are  smokers    

Sign  and  symptoms  • Breast  pain  • Breast  Lump,    • Breast  enlargement  on  one  side  only,    • Swelling,  tenderness,  redness,  and  heat  in          breast  tissue.    • Nipple  discharge  (may  contain  pus),    • Nipple  sensation  changes,    • Itching,    • Tender  and/or  enlarged  lymph  nodes  in                    armpit  on  the  same  side,    • Fever.    

Breast  abscess  -­‐  Appearance    

Diagnosis  In  women  who  are  not  breast-­‐feeding,  testing  may  include:    Mammography  It  is  an  X-­‐ray  picture  of  the  Breasts,  it  is  used  to  detect  tumors  and  cysts,  and  to  identify  benign  (non-­‐cancerous)  and  malignant  (cancerous)  growths.        

Complications  • Fistula  • Gangrene  • Cellulitis  • Mastitis  • Spread  of  infection          leads  to  sepsis  • Extra  mammary  skin      infection,  etc  

Prevention  1. Continue  Breast  feed.  Infected  milk  will  not  harm  the  baby.  Bacteria  in  the  infected  breast  milk  are  killed  in  baby’s  Stomach.    2. If  breastfeeding  is  too  painful  -­‐use  a  breast  pump  to  empty  the  milk  from  the  infected  breast.    3. Massaging  the  affected  breast  may  also  increase  milk  flow.    

Fibroadenoma  • Most  common  benign  tumor  of  breast  • Proliferation  of  stromal  +    glandular  elements  • Seen  in  first  3  decades  of  life  • Do  not  change  during  the  menstrual  cycle  and            regress  at  menopause  Symptoms  Usually  single  &  rarely  several  lumps  that  may  be  in  1  or  both  breasts  Lumps  are  Easily  moveable  under  the  skin,  Firm,  Painless  &  have  a  Rubbery  consistency  with  smooth,  well-­‐defined  borders.    Grow  in  size  during  pregnancy  or  if  Pt  on  Hormone  replacement  therapy            

Investigations:  After  a  physical  examination,  one  or  both  of  the  following  tests  are  usually  done:  Ø Breast  ultrasound  Ø Mammogram    Complications:  Breast  cancer  

Breast  cancer  Ø Second-­‐leading  cause  of  Ca  deaths  in  women  Ø Can  also  occur  in  men  Ø The  cells  divide  more  rapidly  than  healthy  cells  do   and  may  metastasize   through   the   breast,   to  lymph  nodes  or  to  other  parts  of  the  body  

 Types Ductal Ca - starts in the tubes (ducts) that move

milk from the breast to the nipple. Lobular Ca - starts in lobules that produce milk  

Breast  cancer  

Sign  And  Symptoms:  Ø Painless  Lump  or  thickening  in  the  breast  Ø Spontaneous   clear   or   bloody   discharge   from  the  nipple  associated  with  a  breast  lump    

Ø Retraction  or  indentation  of  the  nipple    Ø Change  in  the  size  or  contours  of  the  breast    Ø Any  flattening  or   indentation  of   the   skin  over  the  breast    

Ø Redness  or  pitting  of  the  skin  over  breast,   like  the  skin  of  an  orange    

 

Screening  &  Diagnosis  Ø Self  breast  examination  beginning  at  age  20        

Investigations Computer-aided detection (CAD) Digital mammography Magnetic resonance imaging (MRI) Breast ultrasound (ultrasonography)

MANAGEMENT  Preventive  –  Carcinocin  Therapeutic  –      Curative  :  In  Predisposed  state              Growth  –  less  than  2cm,  movable,  tender,            No  constitutional  symptoms,                Menses  unaltered     {Disease   in   functional   state   –   lots   of   sensation,  modalities   and   or   concomitants:   Calc   carb,   Lyco,  Thyroidinum,  etc}  

   Difficult  to  Cure  –  Growth  bigger  in  size,  firm  to  hard,  

   Fixed  and  with  constitutional  symptoms    {Disease  is  still  in  the  hold  of  the  constitution  and  the  Body   is   vital   enough   to   revert   the   pathology.   Graph,  Phytolacca,  Cistus  can  etc}        

MANAGEMENT  Incurable  –   Pathology  Advanced,   stony   hard,  Ulcerated

    Fixed   with   metastasis   with   gross          constitutional  symptoms  

{Disease   has   enveloped   the   entire   constitution:   Thuja,  Iod,  Conium,  Carbo  Anamalis,  Asterius,  etc}        

RUBRICS For Breast Tumours: Tumors Mammae (1346) Nodule / Lumps (835, 838) Ulcer (882) Swelling (881) Distension (829) Induration / hardness (834) Discoloration Mammae (829) Schirrous / Epithelioma (824) Emaciation (829) Hypertrophy (835) Fistulous Opening (832) Nipple – aphthae (823), atrophy (824), Bleeding(824),

Cracks (828), Deformed (828), Discharge (829), Dryness (829), Excoriation (831), Ulcer (882)

RUBRICS For Metastasis: Ca Axilla: Nodes (824), Induration (835), Exostosis (832), Ca Sternum (824), Pain (845)