PRIMARY CARE ON BREAST CYST

A breast cyst is a fluid-filled sac within the breast. One breast can have one or more breast cysts. They're often described as round or oval lumps with distinct edges. In texture, a breast cyst usually feels like a soft grape or a water-filled balloon, but sometimes a breast cyst feels firm.

Breast cysts can be painful and may be worrisome but are generally benign. They are most common in pre-menopausal women in their 30s or 40s. They usually disappear after menopause, but may persist or reappear when using hormone therapy. They are also common in adolescents. Breast cysts can be part of fibrocystic disease. The pain and swelling is usually worse in the second half of the menstrual cycle or during pregnancy.

Treating breast cysts is usually not necessary unless they are painful or cause discomfort. However, most cysts, regardless of their size cannot be identified during physical exams.

Breast cysts are not to be confused with "milk cysts" (galactoceles), which usually appear during weaning.

DIAGNOSIS

A breast lump can be confirmed by ultrasound examination, aspiration (removal of contents with needle), or mammogram. Ultrasound can also show if the cyst contains solid nodules, a sign that the lesion may be pre-cancerous or cancerous. Examination by a cytopathologist of the fluid aspirated from the cyst may also help with this diagnosis. In particular, it should be sent to a laboratory for testing if it is blood-stained.

Needle biopsy being performed to determine nature of lump either fluid-filled cyst or solid tumor

Breast cysts may remain stable for many years or may resolve spontaneously. Most simple cysts are benign and do not require any treatment or further diagnostic workup. Some complex cysts may require further diagnostic measures such as fine needle aspiration or biopsy to exclude breast cancer however the overwhelming majority is of benign nature. That is, cysts will usually resolve on their own after the fluid is drained.

Symptoms

Signs and symptoms of breast cysts include:

A smooth, easily movable round or oval breast lump with distinct edges

Breast pain or tenderness in the area of the lump

Increased lump size and tenderness just before your period

Decreased lump size and resolution of other signs and symptoms after your period

Having one or many simple breast cysts doesn't increase your risk of breast cancer.

Lumps in the breast are often not found during self-examinations or physical exams.

Treatment

Breast cysts do not require treatment unless a cyst is large and painful or otherwise uncomfortable. In that case, draining the fluid from a breast cyst can ease your symptoms.

Typical treatment involves a Needle aspiration biopsy. Aspirated cysts often recur (come back); definitive treatment may require surgery.

Draining the fluid and then waiting for the cyst to resolve it is the main treatment applied in these cases. Moreover, cysts that are aspirated and the fluid looks normal do not require any other medical attention apart from following-up to make sure it completely disappeared. Yet, hormone therapy by the means of oral contraceptives is sometimes prescribed to reduce their recurrence and to regulate the menstrual cycle of the patient (which is likely to cause them in the first place). 

Surgical removal of a breast cyst is necessary only in a few unusual circumstances. If an uncomfortable breast cyst recurs month after month, or if a breast cyst contains blood-tinged fluid and displays other worrisome signs, surgery may be considered

Prevention

The development of breast cysts may be prevented to some degree, according to the majority of the specialists. The recommended measures one is able to take in order to avoid the formation of the cysts include practicing good health and avoiding certain medications, eating a balanced diet, taking necessary vitamins and supplements, getting exercise, and avoiding stress

Although caffeine consumption does not have a scientifically proved connection with the process of cyst development, many women claim that their symptoms are relieved if avoiding it. Some doctors recommend reducing the amount of caffeine in one's diet in terms of both beverages and foods (such as chocolate). Also reducing salt intake may help in alleviating the symptoms of breast cysts, although, again, there is no scientific linkage between these two. Excessive sugar consumption as well as undetected food allergies, such as to gluten or lactose, may also contribute to cyst development.

Epidemiology

It is estimated that 7% of women in the western world develop palpable breast cysts

There is preliminary evidence that women with breast cysts may be at an increased risk of breast cancer, especially at younger ages.

In males, the occurrence of breast cysts is rare and may (but need not) be an indication of malignancy.

Cysts and bra support

Some women experience breast pain, especially when engaging in vigorous physical activity. A properly fitted sports bra, which compresses or encapsulates breast tissue, is designed to reduce pain caused by exercise.

GUIDE ON BOILS - CAUSES - TREATMENT

A boil, also called a furuncle, is a deep folliculitis, infection of the hair follicle. It is most commonly caused by infection by the bacterium Staphylococcus aureus, resulting in a painful swollen area on the skin caused by an accumulation of pus and dead tissue. Individual boils clustered together are called carbuncles.

SIGNS AND ISSUES

Boils are bumpy, red, pus-filled lumps around a hair follicle that are tender, warm, and very painful. A yellow or white point at the centre of the lump can be seen when the boil is ready to drain or discharge pus. In a severe infection, an individual may experience fever, swollen lymph nodes, and fatigue. A recurring boil is called chronic furunculosis. Boils can be caused by other skin conditions that cause the person to scratch and damage the skin.

Boils may appear on the buttocks or near the anus, the back, the neck, the stomach, the chest, the arms or legs, or even in the ear canal. Boils may also appear around the eye, where they are called styes. A boil on the gum is called intraoral dental sinus, or more commonly, a gumboil.

CAUSES

1.    Bacteria

Usually, the cause is bacteria such as staphylococci that are present on the skin. Bacterial colonisation begins in the hair follicles and can cause local cellulitis and inflammation.

2.    Family history

People with recurrent boils are as well more likely to have a positive family history, take antibiotics, and to have been hospitalised, anemic, or diabetic; they are also more likely to have associated skin diseases and multiple lesions.

3.    Other

Other causes include poor immune system function such as from HIV/AIDS, diabetes, malnutrition,or alcoholism. Poor hygiene and obesity have also been linked. It may occur following antibiotic use due to the development of resistance to the antibiotics used.  An associated skin disease favors recurrence. This may be attributed to the persistent colonization of abnormal skin with S. aureus strains, such as is the case in persons with atopic dermatitis.

Complications

The most common complications of boils are scarring and infection or abscess of the skin, spinal cord, brain, kidneys, or other organs. Infections may also spread to the bloodstream  and become life-threatening. Unfortunately, these bacteria can reach the bloodstream and end up in many different body sites, causing infections (wound infections, abscesses, osteomyelitis, endocarditis, pneumonia) that may severely harm or kill the infected person. S. aureus strains also produce enzymes and exotoxins that likely cause or increase the severity of certain diseases. Such diseases include food poisoning, septic shock, toxic shock syndrome, and scalded skin syndrome. Almost any organ system can be infected by S. aureus.

Treatment

A boil may clear up on its own without bursting, but more often it will need to open and drain. This will usually happen spontaneously within two weeks. Regular application of a warm moist compress, both before and after a boil opens, can help speed healing. The area must be kept clean, hands washed after touching it, and any dressings disposed of carefully, in order to avoid spreading the bacteria. A doctor may cut open or "lance" a boil to allow it to drain, but squeezing or cutting should not be attempted at home, as this may further spread the infection. Antibiotic therapy may be recommended for large or recurrent boils or those that occur in sensitive areas (such as the groin, breasts, armpits, around or in the nostrils, or in the ear). Doctors that are not specialists tend to treat boils with antibiotics, a less-than-ideal but common treatment, but this method should not be used for longer than one month, with at least two months (preferably longer) between uses, otherwise it will lose its effectiveness.

Furuncles at risk of leading to serious complications should be incised and drained if antibiotics or steroid injections are not effective. These include furuncles that are unusually large, last longer than two weeks, or occur in the middle of the face or near the spine.

Staphylococcus aureus has the ability to acquire antimicrobial resistance easily, making treatment difficult. Knowledge of the antimicrobial resistance of S. aureus is important in the selection of antimicrobials for treatment.

GUIDE ON OVARIAN CYST

An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. Such cysts range in size from as small as a pea to larger than an orange.

The vast majority of ovarian cysts are harmless (benign), most are functional cysts.

Ovarian cysts occur in women of all ages including neonatal period and infancy. They are most prevalent during infancy, adolescence and during the childbearing years. With ultrasonography ovarian cysts can be demonstrated in nearly all premenopausal and approximately 18% postmenopausal women.

Some ovarian cysts cause problems, such as bleeding and pain or may raise concerns of malignancy. Surgery may be required to remove cysts larger than 5 centimeters in diameter

SIGNS AND SYMPTOMS

Some or all of the following symptoms may be present, though it is possible not to experience any symptoms

1.    Abdominal pain. Dull aching pain within the abdomen or pelvis, especially on intercourse.

2.    Uterine bleeding. Pain during or shortly after beginning or end of menstrual period; irregular periods, or abnormal uterine bleeding or spotting.

3.    Fullness, heaviness, pressure, swelling, or bloating in the abdomen.

4.    When a cyst ruptures from the ovary, there may be sudden and sharp pain in the lower abdomen on one side.

5.    Change in frequency or ease of urination (such as inability to fully empty the bladder), or difficulty with bowel movements due to pressure on adjacent pelvic anatomy.

6.    Constitutional symptoms such as fatigue, headaches

7.    Nausea or vomiting

8.    Weight gain

Other symptoms may depend on the cause of the cysts

Symptoms that may occur if the cause of the cysts is polycystic ovarian syndrome may include increased facial hair or body hair, acne, obesity and infertility.

If the cause is endometriosis, then periods may be heavy, and intercourse painful.

HOW TO DIAGNOSE OVARIAN CYST

Ovarian cysts are usually diagnosed by either ultrasound or CT scan, with additional endocrinological tests

TREATMENT

Cysts associated with hypothyroidism or other endocrine problems are treated by treating the underlying condition.

About 95% of ovarian cysts are benign, not cancerous.

1.    Functional cysts and hemorrhagic ovarian cysts usually resolve spontaneously. However the bigger an ovarian cyst is, the less likely it is to disappear on its own. Treatment may be required if cysts persist over several months, grow or cause increasing pain.

2.    Treatment for cysts depends on the size of the cyst and symptoms.

3.    Pain associated with ovarian cysts may be treated in several ways

4.    Painrelievers,including acetaminophen/paracetamol (Tylenol or Panadol), nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil), or narcotic pain medicine (by prescription) may help reduce pelvic pain. NSAIDs usually work best when taken at the first signs of the pain.

5.    A warm bath, or heating pad, or hot water bottle applied to the lower abdomen near the ovaries can relax tense muscles and relieve cramping, lessen discomfort, and stimulate circulation and healing in the ovaries.

6.    Combined methods of hormonal contraception such as the combined oral contraceptive pill – the hormones in the pills may regulate the menstrual cycle, and prevent the formation of follicles that can turn into cysts.(American College of Obstetricians and Gynecologists, 1999c; Mayo Clinic, 2002e). However, a Cochrane review in 2011 concluded oral contraceptives are of no benefit in treating already present functional cysts.

7.    Also, limiting strenuous activity may reduce the risk of cyst rupture or torsion.

Cysts that persist beyond two or three menstrual cycles, or occur in post-menopausal women, may indicate more serious disease and should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgical biopsy. Additionally, a blood test may be taken before surgery to check for elevated CA-125, a tumour marker, which is often found in increased levels in ovarian cancer, although it can also be elevated by other conditions resulting in a large number of false positives.

For more serious cases where cysts are large and persisting, doctors may suggest surgery. This may involve removing the cyst, or one or both ovaries.

 Features that may indicate the need for surgery include

Persistent complex ovarian cysts           

Persistent cysts that are causing symptoms

Complex ovarian cysts larger than 5 cm

Simple ovarian cysts larger 10 centimeters or larger than 5 cm in postmenopausal patients

Women who are menopausal or premenopausal

Please see your doctor for more advise.

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