Diagnosis of breast diseases

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About Breast Cancer

Breast cancer is the most common cancer in women. Breast cancer occurs as a result of cells acquiring the characteristics of cancer (unlimited and uncontrolled proliferation and growth). Breast cancer, which is the most common cancer in women in the world and in our country, occurs in one of every 8-10 women throughout life. However, few people realize the importance of this or realize that it is at risk. Although new treatment options are increasing gradually, success in breast cancer requires early diagnosis. If breast cancer is diagnosed early, the chance of getting rid of the disease is 96 percent. For this reason, it is necessary to have early screening tests and to know the symptoms that will warn you early and enable you to consult a doctor. Are you at risk? The risk of breast cancer increases with the exposure time to the hormone called estrogen secreted in women. Factors that increase the risk of breast cancer: Age: With advancing age (especially after the age of 50), the risk of breast cancer increases. While breast cancer is seen in one in every 20,000 women at the age of 25, this risk increases to one in every 8 women in women reaching the age of 80. Family history: The risk increases in those with breast cancer and / or ovarian cancer in their family, especially in their first degree relatives. Menstrual onset and menopause age: In those who start menstruating at an early age (before 12 years of age) and late menopause (after the age of 50), breast cancer risk increases because the breast tissue is under the influence of estrogen hormone longer. Birth and breastfeeding: Not giving birth at all, giving birth late (after the age of 30) and not breastfeeding increases the risk. Hormone treatments: Uncontrolled hormone treatments used after menopause increase the risk. Weight: Being overweight and eating a fatty diet increase the risk. Genetics: Only 5-10 percent of breast cancers are due to a genetic disorder. Genetic tests are recommended for people who have more than one relative with early breast cancer in their family, a relative with breast cancer and ovarian cancer, or a history of bilateral breast cancer or breast cancer in a male relative. Contraceptive pill: It has not been shown to increase risk. Diet: Avoiding animal foods, avoiding fatty foods, eating mostly fruits and vegetables and maintaining ideal weight reduce the risk. Physical activity: Prevents weight gain and reduces risk. Alcohol: Regular use increases the risk. What are the symptoms? The most common symptom of breast cancer is the feeling of a painless mass in the breast. However, up to 10 percent of patients feel pain without a mass. Less common symptoms of breast cancer are nipple symptoms, including non-transient changes in the breast (for example, thickening, swelling, skin irritation or distortion), discharge, abrasion, tenderness or inversion of the nipple. Early breast cancers, which are the easiest to treat, typically show no symptoms. For this reason, it is very important for women to apply the control programs recommended for early diagnosis of breast cancer. Early diagnosis of breast cancer significantly increases the number of treatment options and the chances of success and survival. What are screening tests for early diagnosis? There are basically three complementary methods recommended for early diagnosis: Personal (self-performed) breast examination: After the age of 16, menstruation 7-10. It is recommended to do it once a month between days. See Figure 1-4 for how to perform breast self-examination. Clinical (by a doctor) breast examination: It is recommended to have a breast examination by a doctor every 1-3 years between the ages of 20-40 and annually from the age of 40. Mammography: In women with standard risk, annual mammography from the age of 40 ensures that breast cancer is detected at an early stage. Breast cancer with a diameter of 0.7 cm is detected in those who have their monthly breast examination and annual mammography regularly, while those who have their own examination from time to time and have irregular mammography are 1.4 cm in diameter when the tumor is detected. The size of tumor detection is 2.3 cm in those who do not do their own breast examination and have irregular mammography, and the tumor detection diameter is 3.8 cm in those who have never had these examinations and mammography. These data show that breast cancer can be detected at a very early stage in those who have regular monthly self-examination and regular mammography. How can the risk of breast cancer be reduced? Breast cancer risk can be reduced with some changes in daily life. Be careful not to gain weight, do sports, not eat foods with high fat content, avoid smoking and alcohol, and post-menopausal hormone replacement risk can be reduced by not taking sman treatments. Surgical removal of both breasts and replacing them with a prosthesis, ovarian removal or drug therapy may be used in patients with a genetic analysis to be performed in patients with a high risk of genetically transmitted breast cancer with a family history. How is the diagnosis made? The diagnosis of breast cancer is made by imaging units and clinical examination findings. The main pillar of imaging is the annual mammography. Breast ultrasound can be added to mammography according to the structural features and findings of the breast. Mammographies, which were taken with analog devices in the past, are now made with digital devices. Mammography and breast ultrasound should be performed by a specialized breast radiologist and at least 20 minutes apart. Can tissue diagnosis be made without surgery? Today’s imaging possibilities allow the tissue diagnosis of a 1-millimeter cyst or mass in the breast with ultrasound guidance. Fine needle aspiration biopsy is one of the methods that diagnoses as soon as possible, is the easiest and has the least risk for the patient. From the smallest foci (such as 1 mm) that seem radiologically suspicious, samples are taken by a radiologist with a needle without an ultrasound-guided surgical intervention, the material taken is immediately evaluated by the pathologists, the adequacy of the tissue taken is determined and the patient is diagnosed as soon as possible. What is the importance of pathological examination of parts (biopsy) taken in the diagnosis of breast cancer? Does it matter where this review takes place? The patient can be diagnosed as a result of examining the cell and tissue samples taken in breast cancer. Laboratory techniques applied are very important to give the most accurate and fast result for the patient. The technical preparation of cells obtained from fine needle aspiration biopsies in our hospital depends on the cooperation of our radiology and pathology team. Biopsy tissue samples taken from the patient under surgical intervention or ultrasound are processed as soon as possible, and the report is delivered to the patient in the evening or the next day. Our hospital has a very large immuno-histochemistry study panel. The markers necessary to determine the treatment and prognosis of the disease in patients with breast cancer are investigated and reported immunohistochemically. Does biopsy have a negative effect on the progression of the disease? The definitive diagnosis of cancer can only be reached when the biopsy samples are examined in the pathology clinic. Without biopsy, cancer can be suspected only by looking at physical examination and films, but a definite cancer diagnosis cannot be made and treatment cannot be started. There are some rumors among the public such as “They did a biopsy, it did not get better again”, “The disease got worse” by showing other people as examples. These are very wrong interpretations and can cause many patients to be unnecessarily afraid, delayed diagnosis, and therefore lose their existing treatment chances. Biopsy procedure does not have a negative effect on the disease. This process only makes the diagnosis. What are the stages of the disease (Staging)? After the diagnosis of cancer, your physician will first determine the extent of the disease or in other words, the stage (stage) of the disease. This staging is necessary to decide on the treatment methods to be applied and the order. Breast cancer can be in 4 main stages. Tests such as abdominal ultrasonography or tomography, computed tomography or magnetic resonance imaging for the lung or brain, bone scan (whole body bone scintigraphy), PET may be required to determine the correct stage. How is breast cancer treated? According to the stage of the disease and the tumor characteristics detected after pathological examination, treatment is performed using surgery, chemotherapy, radiotherapy, hormonal therapy, and biological treatments alone or together. What is the role of surgical treatment in breast cancer? The most effective treatment in the early stage of breast cancer is surgery. Due to popular misconceptions, patients may refuse treatment when surgery is recommended. Those who are recommended surgical treatment in breast cancer constitute the group of patients whose diseases are in early stages and when the cancerous tissue can be completely removed by surgery, the patient group has the highest chance of life. Should everyone diagnosed with breast cancer need to have their entire breast removed? No. The size and location of the tumor and its appearance on mammography determine the size of the surgery. If the tumor is small and in its initial stage, it may be sufficient to remove only a small part of the breast. In the same situation, there is a second option. This is to evacuate the inside of the breast by protecting the skin and nipple and making a new breast in the same session. What types of surgical treatments are applied in breast cancer? Breast cancer surgery including breast conserving surgery and other surgical methods


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Op. Dr. Akın Kocaoluk


Op. Dr. Akin Kocaoluk | Resume


He graduated from 19 Mayıs University Faculty of Medicine in 1998. He is currently continuing his active career in Turkish Red Crescent Altıntepe Medical Center.




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