Lump in the chest what to do. Hot, red, painful lump that appears while breastfeeding
A lump in the breast in most cases is a benign formation, however, the aggressiveness of breast cancer and its widespread prevalence require the most careful attention to any unusual symptoms from the breast.
Any woman should master breast self-examination techniques and regularly examine herself in order to promptly notice that a lump has appeared in the breast and consult a doctor.
A lump in the breast can appear not only in an adult woman or girl; pathology of the mammary glands occurs at any age, although it is women who get sick most often. However, a lump in a man’s chest requires no less (and often more) attention than a woman’s. Changes in the mammary glands can also be observed in children, both newborns and adolescents. Having discovered a lump in a child’s chest, the mother is obliged to show it to the doctor as soon as possible. While in a girl the lump may be associated with puberty, in a baby the cause may be hormonal imbalances, inflammatory diseases and even tumors.
Why do lumps appear in the breasts and what should a woman do if she discovers something similar in herself?
The causes of lumps in the mammary gland can be different.Physiological reasons are associated with hormonal changes in a woman’s body during pregnancy, after childbirth, during breastfeeding, as well as in connection with the menstrual cycle. Lumps in the breasts of a nursing mother are usually associated with blockage of the milk ducts. This happens if the breast does not empty completely during feeding or the baby is not latched regularly.
Lumpiness in the breast during feeding, associated with lactostasis, is accompanied by an increase in body temperature, pain and redness of the skin. Despite the pain and tightness in the chest, breastfeeding must be continued; we have already written about how to deal with breastfeeding. If measures are not taken, the consequence of such stagnation of milk can be mastitis with all its unpleasant consequences in the form of an incision, taking antibiotics, and possibly loss of breast milk.
Diseases and tumors
A painful lump in the breast before menstruation occurs with mastopathy. With this disease, which is more common in young girls and women, compacted areas form in the breasts, which can change in size and location during different menstrual cycles. After menstruation, everything goes away, but starting from the second half of the cycle, a lump in the chest appears again and it hurts. In this case, tightness and pain in the chest may be accompanied by discharge from the nipples. This hormone-dependent disease of the mammary gland is the most common in mammology, and is not related to breast cancer.
Lumps in the breasts in women may be accompanied by brown, bloody discharge; this discharge should be especially frightening - this happens with breast cancer. But still, in most cases, the nodes are benign.
They can be called:
. Breast cysts, which are a round cavity in the mammary gland filled with fluid. They are usually smooth, quite hard and move freely under the fingers when palpated. These cysts may not cause discomfort, but they may also be painful. The cause of their occurrence is hormonal changes during a woman’s menstrual cycle; they are also not associated with breast cancer and, as a rule, occur in young women (no older than 50 years). If a cyst is detected, the doctor can puncture it to clarify the diagnosis and relieve pain, removing the contents through a needle.
Sebaceous cysts (atheromas). These are round lumps under the skin of the breast, caused by a blockage of the sebaceous gland duct and the accumulation of sebum in it. They are mobile and usually do not bother; in such cases, treatment is not required, however, if the cyst becomes infected, it can become inflamed, soreness and redness of the skin appear. Then the cyst needs to be removed, and it is completely excised through a small incision, because the remaining part of the sebaceous gland can cause a relapse.
Breast abscesses are possible in breastfeeding women, they rarely occur outside the breastfeeding period. An abscess is a cavity in the mammary gland filled with pus. Such lumps are always very painful, accompanied by swelling and redness of the breast, immobile and dense. Treatment is surgical (incision and drainage of the mammary gland), antibiotic therapy is carried out.
Fat necrosis of the breast- a lump that occurs after trauma to the mammary gland, and weeks or even months may pass before the lump appears. The area of fat necrosis is a round tumor, sometimes quite painful. The skin over it turns blue or red. Typically, fat necrosis goes away without treatment, but scar tissue may remain at the site of the tumor, which will always be detected by mammography.
Breast lipoma- This is a non-cancerous tumor that can be a fairly large lump in the breast, while at first it may be small, but grows quite quickly. Lipomas can be in both mammary glands or only in the right or left breast; they can be single or multiple. Usually they are removed, both because of their tendency to grow, and in order to accurately make a diagnosis.
Breast adenoma– a tumor of glandular tissue, is a hard compaction, mobile, responsive to the menstrual cycle. Sometimes they are quite soft and mobile; this tumor is also not associated with cancer.
Intraductal papilloma– a small tumor in the mammary duct, often causing bloody discharge from the nipple. It can be felt as a small lump in the nipple under the areola.
Breast cancer– can have a variety of manifestations and be similar to any of the tumors described above. Most often, this is a lump in the chest without clear boundaries, lumpy, painless, and often associated with the skin. Cancer can change the shape of the breast and the condition of the skin, can change the forum of the nipple, making it inverted, and can develop anywhere in the breast or nipple.
Breast lumps in young women are more often neoplasms or even physiological changes associated with the menstrual cycle. Older women are more likely to have a unilateral lump in the right or left breast and have a higher risk of cancer.
When examining, it is important to pay attention to the condition of the tissues above the mammary gland, look for a lump under the breast and under the armpit. Here are the lymph nodes, which often enlarge with cancer. A lump in the chest and armpit on the same side is a dangerous combination.
Every month, on days 7-10 of the cycle, perform a self-examination of the mammary glands, palpate and examine them. Of course, doctors have different attitudes towards such self-diagnosis, but as a fact, women often discover cancer at an early stage on their own. If a lump or other changes appear in the breast, you should consult a mammologist. After the examination, the doctor will make an accurate diagnosis of what your lump in the chest is, and you and him will decide what to do in this or that situation. Delay, and especially treatment with traditional methods, is dangerous.
It is difficult to find a woman who has never experienced pain in the mammary glands. In most cases, these pains are physiological, that is, associated with normal biological processes in the body, such as the menstrual cycle, pregnancy and lactation.
However, in some cases, breast tenderness is one of the manifestations of their disease. Most often pathological pain observed in diffuse fibrocystic mastopathy, mastitis and breast cancer. In more rare cases, pain can be caused by Mondor's disease, hematomas, herpes zoster, etc. In addition, chest pain due to diseases of the spine and heart can imitate pain in the mammary glands. Some mental disorders, such as cancer phobia, can cause functional pain in the mammary glands. These important points must be taken into account when carrying out differential diagnosis.
Due to the high incidence of breast cancer, it is extremely important to diagnose the cause of pain as early as possible and begin targeted treatment.
Anatomy of the mammary glands
Knowledge of the anatomy of the mammary glands is necessary for a detailed understanding of the various causes of pain that arise from certain diseases of both the gland itself and the anatomical structures surrounding it. Anatomical structure of the mammary glands
The mammary gland is a paired anatomical formation located on the anterior surface of the chest and pectoralis major muscles. It is located in the space between the periosternal and anterior axillary lines. The upper border of the mammary glands is located at the level of the 3rd rib, and the lower border is located at the level of the 6th - 7th rib. With age, as well as during pregnancy and breastfeeding, the boundaries of the mammary glands can shift, and this process is considered physiological. Approximately in the center of each mammary gland there is a nipple with a surrounding isola (areola). Both nipples and areolas are pigmented. Their size and degree of pigmentation may change during pregnancy.Anatomically, the mammary gland consists of three parts - glandular, fatty and connective tissue. The glandular part of the mammary gland is directly adjacent to the anterior chest wall. It consists of 15 - 20 lobes, each of which, in turn, consists of several small lobes. Each lobule opens into the milk duct. Thus, at least one milk duct departs from each lobe of the mammary gland. Subsequently, some of them unite into larger ducts that approach the nipple. In the space behind the nipple, the milk ducts expand, forming the lacteal sinus, after which they narrow at the point where they pass through the nipple and then expand again, forming from 8 to 15 funnel-shaped lacteal openings. Through this system of ducts, milk is formed in the mammary glands and flows out. When conducting special studies, it is sometimes possible to detect accessory mammary glands in some patients.
The fatty part of the mammary gland covers the glandular part from the outside. From an evolutionary point of view, adipose tissue is designed to protect the glandular part of the mammary glands from adverse effects ( bruises, concussions, frostbite, overheating, etc.), which can affect the process of feeding offspring.
The connective tissue part of the mammary glands is represented by numerous partitions that separate their lobes and lobules. As a result, these partitions create a frame for the mammary glands, which determines their shape and size. The process of formation of this framework is controlled by complex genetic mechanisms. In addition to numerous fascia and septa, the connective tissue part of the mammary glands includes ligaments that support the mammary glands. The above-mentioned ligaments are attached to the pectoral fascia and collarbone. From the side of the gland, these ligaments expand, and their fibers pass into its connective tissue frame.
Externally, the mammary gland is covered with stratified squamous keratinizing epithelium. On the surface of the areola, small tubercles are sometimes visible, which are rudimentary mammary glands that open into small single ducts. In addition, large hair follicles, as well as sebaceous and sweat glands, are often located along the perimeter of the areola.
Blood supply, innervation and lymphatic system of the mammary glands
Evolutionarily, the mammary gland is supplied with blood from several arterial basins independent of each other. This feature allows the gland to function unhindered if the blood supply to several of the arteries has deteriorated for certain reasons.Blood supply to the mammary glands is carried out through the following arteries:
- milk branches of the 3rd - 7th posterior intercostal arteries;
- milk branches of 3 - 5 perforating branches extending from the internal mammary artery;
- lateral mammary branches of the lateral thoracic artery ( branch of the axillary artery).
Sensory innervation is carried out by intercostal nerves ( Th II -Th IV), as well as supraclavicular nerves from the cervical plexus. Sympathetic innervation comes from several sources, with nerve fibers accompanying the above arteries and, together with them, entering the gland.
The lymphatic system of the mammary glands consists of networks of lymphatic vessels and lymph nodes. There are three lymphatic networks of the mammary gland. The capillary lymphatic network is located most superficially. It is localized in the skin of the mammary glands and in the subcutaneous fatty tissue, called premammary tissue in this area. Somewhat deeper, on the surface of the glandular part of the mammary glands, there is a superficial intraorgan network of lymphatic vessels. The deep lymphatic network is located deep in the gland and originates from the lobular ducts. All the above mentioned networks are interconnected. In addition, special mention should be made of the superficial lymphatic plexus of the isola ( areolas). This plexus also connects to the aforementioned lymphatic networks.
The outflow of lymph occurs in the direction from the surface of the gland to the chest wall. The largest lymphatic vessels accompany large arteries, so the main part of the lymph flows to the armpits and only a small part of it flows to the intrathoracic lymph nodes.
Lymphatic vessels ultimately carry lymph into the venous bed, but before entering it, the lymph is filtered and purified in the lymph nodes. The main cluster of lymph nodes that cleanse the lymph of the mammary glands is located in the armpits. In each axilla there are about 20 - 40 nodes, which are organized into five groups - pectoral, central, subscapular, humeral and apical. First of all, the lymph from the mammary glands passes through the chest lymph nodes, called the nodes of Zorgius. These lymph nodes are the first to enlarge in case of malignant neoplasms of the mammary glands, so their detection should serve as a signal for urgent consultation with a doctor. However, when these nodes are detected, you should not panic, since their enlargement is not always a consequence of a malignant process. It can be observed during inflammatory processes, some autoimmune diseases, etc. Sometimes these nodes are confused with benign tumors ( fibromas, lipomas, etc.). Unfortunately, there are also cases when breast cancer develops without the reaction of the lymph nodes in the axillary region ( internal localization, immunodeficiency states, etc.).
Pain in the mammary glands before menstruation
Pain in the mammary glands preceding menstruation occurs in almost every second woman. However, the intensity of the pain is usually not so great that you need to seek medical help. However, sometimes pain becomes an obstacle to a normal lifestyle. This problem becomes especially significant if severe pain recurs monthly. Causes of pain in the mammary glands before menstruation
Soreness of the mammary glands 5-8 days before the onset of menstruation is a normal physiological process. However, there are some diseases that lead to increased pain. One of them is fibrocystic mastopathy - a condition characterized by hormonal imbalance, as a result of which structural changes occur in the mammary glands.There are two forms of fibrocystic mastopathy - diffuse and nodular. As a rule, the diffuse form appears first, when small, millet grain-sized, painful lumps appear in the tissues of the mammary glands. The cause of these seals is an imbalance between sex hormones. In most cases, there is a predominance of estrogens against the background of insufficient secretion of progesterone in the second phase of the ovulatory-menstrual cycle. In this case, the epithelium of the acini, ducts and connective tissue of the mammary glands grows. Due to the fact that the connective tissue frame and skin over the mammary gland retain their size, the proliferation of gland tissue leads to an increase in tension in it. An increase in tension entails irritation of nerve endings, resulting in severe pain.
The nodular form of fibrocystic mastopathy develops against the background of a diffuse form, when small compactions increase, forming larger nodes. These nodes can reach sizes up to several centimeters in diameter. The area of their primary localization is the upper-outer quadrant of the mammary gland.
The mechanism of pain in the mammary glands before menstruation
Pain in fibrocystic mastopathy is caused by swelling of the glandular and connective tissue part of the mammary gland, while the surrounding tissue and skin do not increase significantly. As a result, the gland becomes tense to the touch. The nerve endings located in its thickness are compressed, causing pain. Touching the mammary glands leads to an additional increase in pressure in them and to a sharp increase in pain.The immediate cause of an increase in the volume of the gland is the excessive effect of estrogen. As a rule, the increase in the influence of estrogens is relative, that is, developing against the background of reduced progesterone production. A decrease in progesterone production can be observed in certain diseases of the hypothalamus and pituitary gland, in diseases of the kidneys, liver, and after taking certain medications ( derivatives of phenothiazine, rauwolfia, meprobamate, combined oral contraceptives, etc.). It is also believed that a decrease in the function of the corpus luteum, which produces progesterone, is observed with a long absence of pregnancies, a large number of abortions, alcohol abuse and smoking. The severity of the pain described above is somewhat higher in people with a parasympathetic type of autonomic nervous system. It is these patients who may experience increased pain with negative emotions and even with changes in weather.
Is it necessary to treat pain in the mammary glands before menstruation?
As a rule, ordinary pain before menstruation does not limit women’s daily activities and does not require treatment. However, if the pain is unbearable and lasts more than 6-8 days a month, then you should contact a gynecologist or mammologist to study the hormonal levels and structure of the mammary glands. Depending on the diagnosed cause, treatment is selected.If the cause is a tumor of the pituitary gland or hypothalamus, then neurosurgical intervention is indicated. If the cause is a side effect of certain medications, then they should be stopped. If the cause remains unknown, then they resort to hormonal correction by suppressing estrogen and stimulating progesterone receptors with certain medications. In some cases, lifestyle changes aimed at eliminating factors that provoke changes in hormonal levels are sufficient. These adjustments include avoiding sun tanning and excluding physiotherapy ( especially electrical), eliminating temperature changes ( saunas), quitting smoking and drinking alcoholic beverages, proper nutrition, adherence to sleep and wakefulness, minimizing stress, etc.
Due to the fact that some forms of fibrocystic mastopathy increase the likelihood of breast cancer, careful monitoring of their condition is recommended. Thus, each patient should be able to independently palpate her breasts for lumps, if detected, she should seek medical help. You can learn how to properly self-monitor your mammary glands at any antenatal clinic.
In addition to self-monitoring of the mammary glands, every woman over the age of 35 is recommended to undergo mammography – an X-ray examination of the duct system of the mammary glands – once every 2 years. After 50 years, this study should be performed annually.
Painful lump in the breast
Painful lumps in the mammary glands are one of the most common reasons why women turn to a mammologist and gynecologist. Differential diagnosis of these space-occupying formations is especially important, since the type of treatment and its effectiveness directly depend on their nature. It is especially important to promptly diagnose breast cancer, which is the second most common after lung cancer. Causes of lumps in the mammary glands
Painful thickening of the mammary glands may be a sign of:- cancer;
- hematomas;
- mastitis;
- Mondor's disease;
- breast cysts, etc.
Pain due to breast cancer
Pain due to breast cancer may initially be absent or very mild and insignificant. Unfortunately, this leads to women turning to a specialist only in the later stages of the disease, when treatment options are limited. Typically, cancer begins as a small lump, which can easily be confused with a fibroadenoma ( benign tumor). This compaction acquires its characteristic density and inactivity already at stages 3-4 of cancer, and at first it is soft, mobile, sometimes even jelly-like.As the tumor grows, it spreads to surrounding tissues and metastasizes to regional lymph nodes. In 80% of cases, metastasis occurs in the lymph nodes of the armpit, which can be easily examined by touch. In 20%, metastasis occurs in the intrathoracic lymph nodes, which cannot be palpated. The growth of a tumor on the chest wall is manifested by constant pain. Pain in the mammary gland may be present before it spreads to the chest wall, but it is usually not constant and is directly related to menstruation. Also, during menstruation, a small amount of orange-red secretion may be released from the nipple. When the tumor spreads to the skin and superficial lymphatic networks, the cancer becomes visible to the naked eye in the form of nipple retraction or orange-colored skin changes ( lemon) crusts ( significantly enlarged skin pores, with swelling of the skin located between them).
Pain in the mammary glands due to hematoma
Breast hematoma is usually caused by trauma. The likelihood of its occurrence increases in patients taking anticoagulant drugs ( heparin, warfarin, thrombostop) or suffering from diseases accompanied by decreased blood clotting ( hemophilia, liver cirrhosis), as well as increased vascular fragility ( avitaminosis).Pain in the mammary gland due to a hematoma differs in several ways. If the healing process is favorable, the peak of pain occurs in the first days after the formation of the hematoma. Subsequently, the hematoma gradually resolves and pain decreases. In the first hours after its formation, they have a pulsating character. The pain is more dull than sharp, but of high intensity. Its localization is clearly determined by the site of injury. When you try to apply pressure, the pain increases sharply.
In a certain percentage of cases, the hematoma may fester. The likelihood of this complication increases with an increase in the volume of damaged tissue, as well as if there are foci of chronic infection in the body ( chronic amygdalitis, cholecystitis, etc.). A festering hematoma becomes an abscess or phlegmon, while the intensity of the pain syndrome increases significantly and acquires other characteristics.
Pain in the mammary glands due to an abscess
An abscess is a limited purulent inflammation. Its independent occurrence in the mammary glands is a fairly rare phenomenon. Mostly abscesses of the mammary glands are secondary, developing against the background of a hematoma, boil, mastitis, etc. The pain in this disease is quite severe, since the abscess is always tense and puts great pressure on the nerve endings located in its capsule and in the surrounding healthy tissues. The nature of the pain is usually sharp, throbbing. Around the abscess there is always a zone of inflammatory tissue infiltration, often larger than the abscess itself. The skin over the abscess is tense, shiny, congested and hot to the touch.In addition to local symptoms, there is almost always a pronounced syndrome of general intoxication, manifested by remitting fever ( body temperature more than 38 degrees with daily fluctuations of more than 2 degrees), chills, fatigue, severe loss of strength, etc.
Opening the abscess leads to almost immediate disappearance of pain and relief of the patient’s general condition. Abscesses of the mammary glands are characterized by a tendency to spontaneously open into the lumen of the milk ducts, while pus may be released from the mouths of the ducts. On the one hand, this feature leads to relief of the patient’s condition, but on the other hand, it leads to the rapid spread of infection to healthy breast tissue and chronicity of the process.
Pain in the mammary glands with mastitis
Mastitis is any inflammation of the mammary gland. Unlike an abscess, the main cause of mastitis is stagnation of mammary gland secretions, combined with the entry of pathogenic microorganisms into the stagnant masses. In the vast majority of cases, mastitis is caused by Staphylococcus aureus. The most common route for infection to enter the mammary gland is nipple cracks if a sufficient level of hygiene is not maintained.Due to the above-mentioned features of the development of mastitis, the incidence of this disease is highest among women who breastfeed their children. Moreover, primiparous women dominate among all women giving birth. Mastitis is somewhat less common in pregnant women and much less common in other females. There are occasional cases of mastitis in men. In most of them, this pathology develops against the background of trauma, infection of the nipple and areola. For others, it is associated with cancer or endocrine diseases leading to galactorrhea ( secretion from the mammary glands, outside the process of feeding the child, i.e. abnormal secretion of breast milk). In pediatrics, mastitis of newborns is also found, developing in the first few days after birth. The reason for the development of such mastitis is the excess content of oxytocin and prolactin in the child’s blood, which entered his body through the placenta in the womb. This condition usually resolves without treatment as the aforementioned hormones break down.
Pain during mastitis is usually of high intensity and bursting in nature. The mammary gland or part of it is swollen, red, firm and hot to the touch. Touching it causes a sharp increase in pain. The superficial venous network clearly appears through the skin. Sometimes, with a large volume of tissue affected by inflammation, a fluctuation phenomenon may be observed ( overflow) pus inside the gland.
Pain in the mammary glands due to Mondor's disease/syndrome
Thrombophlebitis of the veins of the anterior and lateral chest wall is called Mondor's disease or syndrome. There are many reasons leading to the development of this condition. Among the main ones are breast cancer, frequent injuries and purulent inflammatory processes. Among the secondary reasons may be complications of previous viral infections and previous surgical interventions, genetic predisposition, diseases of the cardiovascular system, etc.The pain in this syndrome is usually dull, but clearly localized. Palpation reveals a dense, painful ridge deep in the mammary gland. In severe cases, the vein becomes blocked and becomes suppurated. The tissue around it becomes tense and hot to the touch, as with mastitis. At the site of inflammation, the patient may feel some pulsation.
Pain in the mammary glands with fibroadenoma
Fibroadenoma is a benign tumor formation of the glandular part of the mammary gland. It is most typical for women aged 20 to 40 years, but these compactions occur at earlier and later ages. The predominant localization is the upper outer quadrant of the mammary gland. One of the obligatory features of fibroadenoma is an increase in its size and pain 8-10 days before the onset of menstruation and a sharp disappearance of pain with its onset. However, in patients with an irregular menstrual cycle, the time of pain onset and its intensity may vary depending on hormonal levels. In rare cases, pain due to breast fibroadenoma is constant. As the pain intensifies, the entire gland becomes denser, and the fibroadenoma itself becomes extremely sensitive to touch. However, unlike suppurative diseases, external signs of inflammation over fibroadenoma are almost never detected.Pain due to breast cyst
A breast cyst in most cases is one of the complications of fibrocystic mastopathy. This cavity formation occurs in many women as a result of numerous cycles of growth and involution of breast tissue during the menstrual cycle throughout life. The formation of a cyst occurs when one of the ducts of the mammary gland is compressed by connective tissue septa that form as part of fibrocystic mastopathy. At the same time, the acini ( the smallest structural units of the gland capable of independently forming secretions) continue to work and accumulate liquid in themselves, increasing the pressure in their cavity. Over time, due to periodically increasing pressure, the acini cavity enlarges and becomes overgrown with connective tissue.As a result of the above changes, a cyst is formed with a surrounding capsule. Since the cyst originated from the acinus and retained the ability to form secretions, it remains hormonally dependent. In other words, it becomes tense and painful only before your period. In the postmenopausal period, the cyst may persist, but usually it decreases somewhat in size and does not bother the woman.
Methods for studying breast lumps include:
- mammography ( X-ray);
- Ultrasound ( ultrasonography);
- Dopplerography of the veins of the chest wall;
- scintigraphy;
- thermography;
- computed tomography and magnetic resonance imaging;
- histological examination.
Mammography almost always means a special x-ray examination of the mammary glands. This method is the gold standard for diagnosing pathologies of this organ and breast cancer in particular. There are other types of mammography, for example, tomosynthesis, magnetic resonance mammography, optical mammography, ultrasound mammography, etc.
Despite the high potential of these methods, their use is limited due to high cost or insufficient information content, while X-ray mammography is simple, cheap and informative. The level of information content of this method has increased significantly since the beginning of the use of digital storage media instead of film. The disadvantage of this method is a certain dose of radiation received during the research process.
Ultrasound
Ultrasound examination of the mammary glands is often practiced to determine the nature of its seals. It is especially useful in diagnosing cysts. The undeniable advantage is its relatively high availability and absolute harmlessness. Due to these features, this study can be safely administered to pregnant and breastfeeding women. In addition, this test is often used to accurately localize suspicious tissue during biopsy ( taking tissue for analysis).
Dopplerography of the veins of the chest wall
Dopplerography of the veins of the chest wall can rarely be used to diagnose pathologies of the mammary glands, since in most cases their nature is not associated with damage to large blood vessels. However, with a pathology such as Mondor's disease/syndrome, this study allows you to determine the area of \u200b\u200ba blocked and inflamed vein, causing inflammatory changes and soreness.
Scintigraphy
Scintigraphy is used to diagnose malignant breast tumors and their metastases. The principle of the method is to introduce into the patient’s bloodstream a certain radiopharmaceutical that has an affinity for the tissues of a malignant tumor. As a result, after a short period of time, the radiopharmaceutical is concentrated in the tumor tissues and emits waves of a certain spectrum. Using highly sensitive equipment, this radiation is recorded and a projection of the distribution of the radiopharmaceutical in the body appears on the device’s screen. The accumulation of radiopharmaceuticals in one lesion indicates a malignant tumor. The detection of several foci is a sign that the tumor has metastasized to the organs and tissues of the patient's body.
Thermography
Thermography is one of the studies that is steadily gaining popularity in the diagnosis of mammary gland pathologies. In particular, this method is used to detect malignant neoplasms and inflammatory processes of the mammary gland. During the study, special sensors capture infrared radiation from every square centimeter of the patient's skin. The sensitivity of the sensor is such that it distinguishes temperature fluctuations of 0.06 degrees. Subsequently, the computer transforms the received information into visible colors of the spectrum and displays it on the screen. As a result, the human body appears in the form of a multi-colored silhouette, in which the hottest areas are represented by red and yellow shades, and the coldest areas are represented by blue and green colors.
Tissue temperature directly depends on the degree of its vascularization ( number of blood vessels per unit volume of tissue) and blood flow intensity. Inflammatory processes are characterized by increased blood flow, while increased vascularization ( growth of new blood vessels) is observed in malignant tumors. Also, this study allows, in addition to primary tumors, to detect their metastases.
CT ( CT scan) and MRI ( Magnetic resonance imaging)
These methods can be used to determine the exact size of the tumor, its density, structure, relationship with surrounding tissues, as well as to determine the condition of regional lymph nodes. Among these methods, MRI is preferred because it better visualizes the soft tissue of the mammary glands. In addition, MRI does not involve radiation exposure of the patient, which is important if there is even the slightest suspicion of pregnancy. If for various reasons it is not possible to undergo an MRI, then a CT scan can provide fairly accurate information about the condition of the mammary glands, but it should be remembered that this method is contraindicated during pregnancy.
Both one and the other method can be used with intravenous administration of a contrast agent. When used, the chance of diagnosing malignant tumors, which, as is known, are abundantly supplied with blood, significantly increases. However, at the same time there is a risk of developing side effects due to the administration of a contrast agent ( acute renal failure, allergic reactions, etc.).
Histological examination
Histological examination is the only method by which a final diagnosis is made regarding the nature of the compaction in the mammary glands. Typically, a biopsy sample ( area of tissue removed for examination) is taken with a long hollow needle. This study is carried out under ultrasound control and mandatory anesthesia. Subsequently, the resulting tissue is studied under a microscope, having previously created several dozen histological preparations from it, treated with various dyes and reagents. Depending on the degree of cellular atypia ( anomalies) the diagnosis of malignancy is confirmed or refuted. Its histological type is also indicated, based on which one can judge the prognosis of the disease and choose the most effective method of treatment.
In addition to instrumental studies, laboratory tests can provide some useful information.
Laboratory tests used to diagnose breast lumps include:
- tumor markers, etc.
A general blood test, as is known, is a “mirror” of the body, reflecting the processes occurring in it. Based on the results of this analysis, it is almost never possible to accurately establish a diagnosis, but in many ways it helps the doctor choose the direction in which to continue his search.
In particular, with inflammatory diseases of the mammary glands, the concentration of leukocytes, especially the fraction of band neutrophils, is likely to be increased. Also, with an inflammatory disease, an increase in ESR should be expected ( erythrocyte sedimentation rate) .
Depending on the severity, cancer phobia is treated by a psychologist or psychiatrist. In simple cases, patients get rid of obsessions after they examine their body in as much detail as possible using the maximum number of methods, consult with a large number of medical luminaries and receive a conclusion about the absence of a malignant neoplasm. Unfortunately, such cases are rare. Usually the fear of cancer penetrates so deeply into the patient's consciousness that it changes his personality. In such cases, the intervention of a psychiatrist is required. The method of choice for treating this disorder is psychoanalysis, which takes from several weeks to several years, and it is not always possible to achieve a cure. Some patients may respond positively to other treatment modalities, such as hypnotherapy, Gestalt therapy, occupational therapy, etc.
Why does the mammary gland hurt and the temperature rise?
A disease that might explain the connection between breast/breast pain and fever is mastitis. The possibility of parallel development of another non-inflammatory cause of pain in the female breast and a disease manifested by fever ( acute respiratory infection (ARVI), pneumonia, sore throat, etc.). In other words, breast tenderness and temperature can develop independently of each other. The cause of mastitis in most cases is congestion combined with trauma to the nipple and areola ( areola). That is why the main category of women who develop this disease are breastfeeding young mothers and pregnant women. Mastitis also occurs in other categories of women, but much less frequently.
In menopausal women, the likelihood of developing breast cancer increases with age. When developing mastitis in such patients, you should always keep in mind that mastitis can develop due to compression of the gland ducts by the tumor or directly due to the disintegration of the tumor itself. This disease occurs even in children, both female and male, due to hormonal imbalances. In men, mastitis can develop mainly due to the entry of microbes into the rudimentary milk ducts.
The clinical picture of mastitis, as a rule, does not vary much. Part of the mammary gland becomes swollen, elastic, hot to the touch and full of blood. The pain is bursting and dull in nature. Touching the gland or displacing it during movements causes a sharp increase in pain. In most cases, inflammation affects the space behind the nipple and the part of the breast that is located below the nipple. There is no clear boundary between inflamed and healthy tissue. In the absence of timely treatment, inflammation quickly progresses, covering the entire mammary gland.
The link between pain and temperature during mastitis is the inflammatory process. Pain occurs due to irritation of nerve receptors by substances accumulating in the inflammatory focus. These substances lead to swelling of the affected tissue, and the swelling, in turn, increases pressure on the nerve receptors, increasing pain. The increase in temperature is a direct consequence of the destruction of pathogenic bacteria in the inflammatory focus. A substance called endotoxin is released from the cell wall of microbes, which acts on the thermoregulation center located in the hypothalamus ( part of the brain), increasing body temperature.
Diagnosis of mastitis does not cause any particular difficulties due to a fairly clear and unambiguous clinical picture, based on which a doctor of any specialty will be able to make the correct diagnosis. To be completely sure, a general blood test is performed, which reveals leukocytosis of varying severity and a shift in the leukocyte formula to the left ( increase in the number of band neutrophils). The erythrocyte sedimentation rate also usually increases. However, due to the fact that this indicator is studied for at least one hour ( often longer), surgeons do not use it. Mastitis is characterized by rapid spread to healthy tissue, so surgeons cannot afford unnecessary delays and operate on the patient as soon as possible. If there is a possibility that the cause of the increase in temperature is not only mastitis, but also another disease, then they resort to additional studies necessary for differential diagnosis ( chest x-ray, abdominal ultrasound, computed tomography, etc.).
Treatment for mastitis depends on how far the inflammation has progressed at the time you seek medical help. If the patient consults a doctor on time, that is, in the first hours after the onset of inflammation, then mastitis can be cured without resorting to surgery, especially if it developed during lactation. To do this, a bandage soaked in warm water is placed on the areola of the inflamed breast to expand the ducts. After several minutes, the mammary gland begins to be massaged from top to bottom, that is, from the periphery of the gland to the center, provoking the release of stagnant masses. Despite the fact that such manipulations are very painful, they often lead to the softening of stagnant masses and their release naturally.
If the above actions are not successful, you have to resort to surgery. For mastitis in women outside the lactation period, surgical treatment is the method of choice. The use of antibiotics gives results only after opening the purulent focus.
To prevent mastitis, it is recommended to maintain personal hygiene, especially for mothers whose children are breastfed. Before and after giving the breast to your baby, you should wash it thoroughly with warm water and soap. Between feedings, the nipple and areola ( areola) must be lubricated with special oily substances to prevent the formation of microcracks. You should try to attach the baby to the breast so that he captures not only the nipple, but also the areola with his mouth. This advice is especially relevant when the child develops teeth and actively tries them out on the mother’s breast.
How many days before menstruation do your mammary glands hurt?
On average, the mammary glands increase in size, become dense and painful to the touch 7 to 8 days before the start of menstruation. However, these terms can shift in one direction or the other, depending on the individual characteristics of the body and even on the conditions in which the woman finds herself. For example, severe stress and overwork can lead to a delay in menstruation from several days to several months. The menstrual cycle is a complex process in which there is a successive change of changes occurring in the internal organs of women under the influence of sex hormones. In particular, the main hormones causing the above changes are estrogen ( as well as its derivatives) and progesterone. The organs on which these hormones have the greatest influence are the mammary glands and the uterus.
The predominance of estrogens in the first phase of the menstrual cycle leads to the proliferation of the ducts of the mammary glands and their internal epithelium. In the second phase of the menstrual cycle, progesterone predominates, which leads to the growth of the glandular part of the mammary gland. It is in the second phase of the menstrual cycle that breast volume increases the most. Towards the end of the second phase, progesterone levels gradually decrease, and estrogen levels rise again. Approximately at the moment when the influence of these hormones is equalized, the mammary glands begin to shrink, and the endometrium ( inner epithelium of the uterus) begins to be rejected. As a result, almost simultaneously the mammary glands stop hurting, and the first bloody discharge comes from the cervix, which is commonly called menstruation.
The above diagram is superficial and relatively easy to understand. In fact, the cyclical phases of hormone secretion and their effect on target organs are much more complex. This process includes many other effector substances and regulators of this process. Not the least influence on the phases of hormone secretion is exerted by the hypothalamus, a part of the brain that communicates between the conditions in which the body is located and the endocrine system. In other words, the menstrual cycle can speed up, slow down or even disappear for a while due to external factors such as stress, overwork, lack of sleep, through their effect on the hypothalamus.
Why does the girl's mammary gland hurt?
Pain in the mammary gland in a girl ( up to 18 years old) can develop for several reasons. These reasons should be considered in the context of the age at which certain reasons are more relevant. In newborns, both boys and girls, pain in the mammary glands can be caused by neonatal mastitis. In children from 1 month of life to the onset of puberty ( 11 - 13 years) pain in the mammary glands is quite rare and is associated mainly with trauma. With the onset of puberty in predisposed girls, along with the development of the mammary glands, a disease such as fibrocystic mastopathy may appear. This disease can cause the development of cysts, fibroadenomas and mastitis. Despite the fact that malignant neoplasms are quite rare at a young age, the possibility of their occurrence cannot be completely excluded. Unfortunately, they can occur at all ages, even in newborns.
Neonatal mastitis
Neonatal mastitis develops due to the fact that a certain concentration of maternal sex hormones that entered the child’s body in the womb remains in the child’s body for some time after birth. In response to the influence of these hormones, the newborn’s mammary glands increase in size and begin to produce a substance vaguely reminiscent of breast milk. Due to the fact that the milk ducts of newborns are not yet developed, the secretion that forms in them is not released out, further increasing the size of the glands. As the size of the glands increases, the pressure inside them increases, and congestion increases, provoking the development of mastitis and the occurrence of pain. However, mastitis in newborns for the most part is not complicated by purulent inflammation, since the concentration of maternal hormones does not increase, but gradually decreases, which is why the child’s mammary glands return to normal size over time.
Traumatic mastitis
Traumatic mastitis in girls, as well as in boys, can develop at any age. It usually begins with a small scratch in the area of the nipple and areola. Violation of the integrity of the skin in this area can also occur due to rubbing with rough and uncomfortable clothing. In the absence of antiseptic treatment of the skin defect, the infection can penetrate deep into the gland, causing the development of mastitis and the appearance of accompanying pain.
Mastitis during puberty
With the onset of puberty in girls, the number of causes that can cause pain in the mammary glands increases. The onset of menstruation marks the beginning of the process of growth and development of the mammary glands. During each successive cycle, a slow growth of the duct system and glandular part occurs in the mammary glands ( acini of the mammary glands). The process of maturation of the mammary glands may occur with some deviations, due to which cysts and fibroadenomas appear in them. A few days before the onset of menstruation, under the influence of progesterone, the breasts become dense and painful. This process is physiological and does not cause concern. However, cysts and fibroadenomas located in the mammary glands, as a rule, hurt more than the rest of the softer part of the glands, which is why they attract attention. In rare cases, girls at the beginning of puberty may develop mastitis, the cause of which is actively progressive fibrocystic mastopathy.
Mastitis against the background of tumor formation
Unfortunately, no one is immune from tumors, especially given the progressively worsening environmental situation in the world and the ever-increasing pace of life. Despite the fact that statistically the incidence of tumors increases as a person grows older, hyperplastic processes also occur in children’s bodies. Some of them can cause pain in the mammary glands. In particular, we are talking about hormone-producing brain tumors and breast cancer.
Prolactinoma is a tumor of the pituitary gland that secretes the hormone prolactin. Under its influence, a functional restructuring of the mammary glands occurs and the secretion of milk begins. The process of milk secretion from the mammary glands outside the period of pregnancy and lactation is called galactorrhea. The appearance of galactorrhea in a girl is an alarming sign that requires urgent examination. However, before sounding the alarm, a normal pregnancy should be excluded, in which the restructuring of the mammary glands and the onset of lactation is a physiologically normal process. Soreness with galactorrhea is associated with an increased risk of mastitis, due to congestion and the development of infection in the mammary glands.
Another tumor process that manifests itself as pain in the mammary glands is cancer. Its occurrence in girls and young women in most cases is associated with genetic predisposition. Pain in breast cancer occurs due to irritation of nerve receptors by a growing tumor node.
What causes breast pain during menopause?
After the onset of menopause ( menopause) pain in the mammary glands in women can be caused by such reasons as mastitis and cancer. In addition, we should not forget that over the age of 50, women may experience pain in the mammary glands associated with pathology of other organs, for example, angina pectoris, osteochondrosis, etc. With the onset of menopause, breast tissue undergoes gradual involution. The epithelium of the milk ducts sloughs off and forms clots or plugs that block the ducts themselves. Despite the fact that during menopause the movement of secretions in the mammary glands is minimal, the resulting plugs can lead to congestion and overstretching of the ducts. As a result, mastitis develops, manifested by swelling, redness, increased local and general body temperature, as well as characteristic pain.
Another serious cause of pain in the mammary glands during menopause is their malignant degeneration, that is, cancer. Statistically, as you age, the likelihood of cancer increases due to the weakening of the activity of cellular systems that destroy mutated cells. In other words, with age, anticancer immunity weakens, and various mutations accumulate in the body. Some of them lead to the development of malignant tumors. In the initial stages, breast cancer can manifest itself extremely poorly. A moderately painful, dense formation may be palpated and does not cause any particular inconvenience. As the tumor grows, pain around it increases, the axillary lymph nodes become enlarged, and visible symptoms appear ( retraction of the nipple, discharge of bloody secretion when pressing on the nipple, “lemon peel” symptom, etc.). For early detection of breast cancer, starting at the age of 35, it is recommended to have a mammogram every two years. Starting from the age of 50, this study must be completed annually.
In addition to diseases of the mammary glands, some other pathologies can cause pain in the chest area. One of the most common examples is radicular syndrome, which develops due to compression of the spinal nerves. The compression described above can occur with osteochondrosis, herniated discs, spondylolisthesis ( vertebral displacement) etc. Diseases of the cardiovascular system should not be written off. Angina pain may radiate ( give away) into the chest, creating the impression of pain in the mammary glands.
What to do when the mammary gland hurts in men?
Breast pain can also occur in men, but much less frequently than in women. This fact explains the early appeal of men for medical help, in contrast to women who are accustomed to enduring pain in the mammary glands throughout their lives. Thus, most men, without asking any questions, immediately do the most responsible thing - consult a doctor. One of the main tasks of the doctor in this case is to exclude a malignant process, that is, breast cancer. To do this, the anterior chest wall should be carefully palpated and, if suspicious lumps are detected, further examined using ultrasound. To make a final diagnosis, a biopsy of this lump should be performed ( obtain a tissue sample with a fine needle) and examine the resulting tissue using histochemical methods. Based on the results of the biopsy, you can accurately conclude whether the lump is a malignant tumor or something else.
Men can also develop mastitis. In most cases, it is associated with the entry of pathogenic bacteria into the rudimentary milk ducts. They create conditions for the proliferation of microbes and the development of the inflammatory process. The clinical picture of such mastitis is quite clear and does not cause diagnostic difficulties, however, it should be borne in mind that mastitis in men may well conceal breast cancer.
A more rare cause of mastitis in men is prolactinoma, a tumor of pituitary gland cells that produces the hormone prolactin. This hormone stimulates the development of mammary gland tissue and the onset of milk production, causing a phenomenon called galactorrhea ( pathological leakage of milk from the mammary glands). Since the male mammary glands are not adapted to lactation, the secretion formed in them often stagnates, leading to the development of mastitis.
Finally, we should not forget that men, by their nature, are more conflicted creatures than women and do more physical labor. The above factors are the cause of more frequent injuries, including to the chest. Heavy physical activity negatively affects the condition of the spine, leading to its diseases and the development of radicular syndrome, causing pain in the chest area. Men are also slightly ahead of women in the incidence of cardiovascular diseases, the pain of which can spread to the chest.
What to do if you find a lump in the mammary gland in the form of a ball? Why is it dangerous? According to statistics, every third girl consults a doctor with breast diseases at least once in her life. Researchers associate the increase in breast pathologies with increased psycho-emotional stress. Unhealthy diet, mental and physical overload, stress - all this leads to hormonal imbalance. And changes in hormonal levels affect the condition of the mammary glands. A round-shaped compaction can be a symptom of a variety of diseases, fortunately most often benign tumors. Let's figure out why balls appear in the chest.
The mammary glands are constantly changing. They experience the greatest load with increased concentrations of female hormones. Changes in the mammary glands are observed during pregnancy and menopause. A hard spot in the mammary gland can be detected at any time, at any age and at any stage of the menstrual cycle.
There are signs that indicate a serious illness:
- Sharp and aching pain, tenderness on palpation.
- Associated symptoms from the reproductive system: abdominal pain, menstrual irregularities.
- Swelling, inflammation, fever, headaches.
- Nipple discharge.
If you notice at least one of the listed symptoms, you should immediately consult a doctor.
Strictly speaking, any neoplasm requires a mandatory visit to a specialist, but there are signs that indicate benignity and minimal danger:
- The ball is small and doesn't hurt.
- The seal is evenly shaped and not fused to the surrounding tissues (it can “roll” inside the breast tissues).
- The menstrual cycle and psycho-emotional state are without disturbances, there are no other signs of pathology.
The main thing is not to panic; in most cases, the ball turns out to be a benign formation that responds well to conservative treatment. However, only a doctor can make a final diagnosis after examination.
If the rolling ball appeared at the age of puberty, there is little reason to worry. It’s worth seeing a doctor, but most likely it’s gynecomastia, which often occurs in adolescence and does not require treatment.
If you see a doctor, you will have to undergo a number of examinations:
- Mammography
- Lab tests
If any neoplasm is detected, it is necessary to find out its origin and select adequate treatment.
Common causes of breast lumps
Doctors identify the primary causes that most often lead to the formation of lumps in the mammary gland.
Among these reasons:
- Fibrocystic mastopathy. One of the most common breast diseases among women of all ages. The disease is manifested by the proliferation of connective tissue with the formation of a compaction.
- Lactostasis. This is relevant for nursing mothers. Stagnation of milk can provoke the formation of a cyst. In this case, the ball can be found near the nipple or deep in the tissue. Associated symptoms: pressure and swelling, pain and inflammation. Untreated lactostasis can lead to the development of mastitis.
- As a consequence of injury or surgery. The breast is very sensitive to mechanical influences. Therefore, it is important to wear loose underwear and avoid injury to the mammary glands. If the compaction is caused by injury, then it is a dense hematoma, which will sooner or later resolve, the main thing is to provide rest to the affected area.
- Wrong choice of oral contraceptives, which can lead to hormonal imbalance. In this case, you should consult a doctor and change the drug, and also make sure that the thickening is caused by the medication and not by the disease.
- During menstruation, lumps may form in the mammary gland. However, they are quite rarely the correct shape. If by the middle of the cycle the lump has not resolved or appears again before the next cycle, it is worth getting examined.
More than 90% of compactions are caused by one of the listed reasons.
Five Minor Reasons
There are also secondary reasons that lead to the formation of compactions much less frequently, but they also need to be remembered:
- Neoplasm: benign or malignant. Characterized by gradual tumor growth. Benign ones are usually regular in shape and resemble a ball; malignant ones often manifest as a tumor of indeterminate shape.
- Menopause. Menopause is considered stress for the female body and is characterized by a sharp change in hormonal levels.
- Thrombophlebitis. It usually develops against the background of tissue inflammation and is an inflammation of the veins of the mammary gland. This is a dangerous disease that requires immediate treatment. Signs: severe pain, inflammation, fever, symptoms of an infectious disease.
- Increased estrogen levels due to any non-physiological reasons. It can be caused by stress and nervous tension, taking hormonal medications, and pregnancy.
- Presence of gynecological and endocrine diseases.
There are also completely harmless diseases that do not require treatment:
- A small white ball on the nipple is a normal physiological phenomenon.
- Before menstruation, women may experience breast inflammation. Then a compaction appears at the exit of the mammary duct. These are lobules of the mammary gland that will return to normal again at the beginning of the cycle.
If a girl feels a lump that causes discomfort and begins to hurt, she should consult a mammologist.
Signs of a malignant tumor
It is important to know the signs of cancer in order to start treatment on time. It is worth noting that most often a malignant neoplasm is irregular in shape, but in rare cases it can be in the shape of a ball.
Sign of a malignant tumor of the mammary glands:
- When you touch the lump, pain occurs.
- There is not one lump in the chest, but several.
- The lumps increase over time, regardless of the menstrual cycle.
- Women's emotional state is disturbed, fatigue and irritability appear.
- The shape of the breast changes, and over time this becomes noticeable. Asymmetry of the breasts or nipples occurs.
- Discharge from the nipple.
- Nipple retraction, change in appearance.
- Enlarged lymph nodes in the armpits.
If you detect at least two symptoms at the same time, you should immediately visit the hospital. In the early stages, oncology is treatable with minimal risk of relapse.
Diagnostic methods
In order to make a correct diagnosis, the doctor may prescribe a number of examinations. It is important to find out the nature of the tumor, assess the growth rate, make sure it is benign, and choose the most effective treatment method.
Currently, the following instrumental examination methods are used for breast diseases:
- Mammography
- Ultrasonography
- Ductography (X-ray contrast study)
The patient may also be referred for laboratory tests:
- General blood test
- Blood test for hormones
- Histology
- Study of lactate and punctate
As a rule, first of all, the doctor excludes the possibility of oncology, and then finds out the specific disease and evaluates the clinical picture to select therapy. All modern diagnostic methods give highly accurate results (if you follow the doctor’s instructions) and allow you to find out a specific diagnosis.
Surgical intervention
The question of whether surgical treatment is required is decided by the doctor. The generally accepted practice is:
- Benign neoplasms up to 3 cm in size are not removed. Surgery may be prescribed if there is no effect from conservative treatment or if there is significant tumor growth.
- If the tumor is caused by hormonal dysfunction, then the decision about surgery is made after a course of hormonal treatment.
- If the formation does not bother, does not hurt or does not increase, the patient can refuse surgery. If the neoplasm is dangerous, then doctors will insist on intervention.
- Some types of neoplasms, such as fibroadenoma and cysts, go on their own and require only observation.
- For benign tumors, surgery may be prescribed if a high risk of malignancy is identified.
If it is decided that surgery is not required, the doctor will prescribe treatment and recommend monitoring the disease over time. For any disease, it is important to regularly visit a specialist and monitor changes in the mammary glands.
Drug therapy
In most cases, treatment is carried out conservatively, with the help of pharmacological drugs. It is important to remember that it is unacceptable to take any medications on your own. It is important to choose a drug so that it fights the disease as effectively as possible and does not harm the body.
List of commonly prescribed drugs:
- Painkillers, anti-inflammatory drugs. They are prescribed if there is no specific treatment and the lump should go away on its own, and the symptoms need to be relieved. For breast pain, Bromocriptine and Danazol are often prescribed.
- Mastitis, abscesses, and infectious diseases of the mammary glands are treated with antibiotics. An antibiotic can be selected only after a microbiological analysis of the pathogen.
- For mastopathy or diseases caused by elevated estrogen levels, antiestrogens and hormonal drugs are prescribed to correct hormonal levels.
Treatment is selected individually. For some, it is enough to be monitored regularly and get rid of bad habits, while others will have to undergo a serious course of treatment.
In most cases, lumps in the mammary gland are benign formations. Since breast cancer at the initial stage is often asymptomatic, in any case it is necessary to consult a doctor to diagnose the detected tumor. Almost all types of benign tumors are subject to surgical removal, since the only reliable method for determining malignant degeneration of cells is histological examination of removed tissues.
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- 1. Raise your left hand, move it behind your head, and with your right hand deeply probe the left mammary gland in a clockwise direction. This procedure can be done standing or lying down.
- 2. Lower your hand and palpate the chest from the side, under the armpit, to identify an inflamed lymph node.
- 3. Press on the nipple. A small amount of clear or whitish discharge is normal.
- 4. Do the same with the second mammary gland.
- lactostasis during breastfeeding;
- intraductal papillomas;
- cysts;
- adenomas, fibroadenomas, lipomas and fibroadenolipomas;
- leaf-shaped tumor;
- galactocele;
- malignant formations.
- cystic;
- adenosis (glandular tissue);
- diffuse mastopathy (fibrous tissue);
- mixed form;
- sclerosing adenosis.
- at the initial stage - the appearance of numerous small nodes and cords;
- heterogeneous gland tissue in the form of a “cobblestone pavement”, different size of formations;
- round or oblong seals;
- pain in the presence of large nodes and fibrocystic mastopathy;
- gradual growth of formations up to 3-4 cm, increase in their density;
- with adenosis - heterogeneous dense lobules (palpable), which can be grouped in a small area or only in one mammary gland;
- discharge from the nipples of various types (from serous to bloody);
- chest pain a few days before the onset of menstruation. As the disease progresses, the symptom persists even after menstruation.
- psycho-emotional stress;
- burdened heredity;
- abortions;
- late births or a small number of them;
- inflammatory pathologies of the pelvic organs;
- late onset of sexual life;
- unbalanced diet (excessive consumption of proteins and fats);
- alcohol abuse and smoking;
- inadequate sleep.
- menstrual irregularities;
- infertility;
- polycystic ovary syndrome;
- endometriosis;
- uterine fibroids;
- ovarian tumors;
- dysfunctional uterine bleeding;
- amenorrhea;
- hyperprolactinemia;
- thyroid diseases;
- diabetes;
- metabolic syndrome;
- dysfunction of the adrenal cortex.
- oval shape of the node (in 90% of cases) or round;
- sizes on average 1-2 cm;
- smooth or coarse contours;
- dense consistency;
- good mobility when palpated, since the fibroadenoma is not connected to the surrounding tissues;
- slow growth;
- unchanged skin color;
- painlessness;
- both single and multiple nature of the disease;
- the appearance of a feeling of fullness in the chest before menstruation;
- the ability of the tumor to regress during menopause;
- an increase in education during menstruation and pregnancy under the influence of hormones. In a pregnant woman, fibroadenoma can reach 3-5 times its original size.
- fast growth;
- adhesion to the skin (it does not move during palpation);
- clear demarcation from other tissues of the gland;
- layered structure;
- painlessness or slight pain when pressing;
- with a significant size of the tumor - thinning of the skin over it and the acquisition of a bluish tint;
- the most common location is in the upper part of the mammary gland.
- the shape of a dense node (less often – a diffuse appearance, diffused in the surrounding tissues);
- location most often in the upper outer part of the gland or above the chest;
- consistency is soft to the touch, but if there is a lot of connective tissue present, then it is denser;
- when pressed - the ability to compress strongly;
- size – from small to several tens of centimeters;
- shape – round or oval;
- both single and multiple nature of education;
- in rare cases (3% of all patients) - the appearance of a lipoma in both mammary glands;
- painlessness;
- mobility;
- when the skin over the formation is stretched, it “retracts” deeper.
- 1. Angioma– round or oval, soft to the touch, subcutaneous tumor of bluish or pink color. If it is located deep in the tissues, then the symptoms are practically indistinguishable from a lipoma.
- 2. Leiomyoma– similar in appearance to fibroadenoma; the diagnosis can only be established by histological examination of the removed tumor.
- 3. Chondroma– a benign dense tumor formed from cartilage tissue. Diagnosis is carried out using ultrasound, mammography, and puncture biopsy.
- 4. Osteoma– a tumor arising from the bone tissue near the chest wall. It is extremely rare.
- 5. Lipogranuloma– a formation that develops with aseptic necrosis of the fatty tissue of the mammary gland as a result of injuries, excessive physical exertion, after operations, injections. Initially detected as a tumor, often fused to the skin and retracting the nipple. Subsequently, the damaged tissues become scarred and hardened.
- 6. Mondor's disease- a cord formed under the breast from the mammary gland to the armpit or navel. The seal appears as a result of vein thrombosis.
- insufficient emptying of the breast;
- lying on one side for a long time while sleeping, positioning on the stomach, which compresses the mammary glands;
- improper attachment of the baby to the breast, nipple injuries during feeding;
- wearing a tight bra;
- injury to the gland, improper pumping;
- increased fat content of milk;
- anatomical features of a woman’s mammary glands.
- take a warm shower and lightly massage the affected breast before feeding the baby;
- place the baby on the sore breast so that his eyes look in the direction of the lump;
- Manually express the remaining milk if the baby has not completely emptied the breast.
- 1. Serous. Characterized by slight swelling, pain, elasticity and soreness of the gland tissue, the skin color does not change. Body temperature can rise to 39 degrees.
- 2. Infiltrative. A painful formation with unclear contours appears, the lymph nodes under the arms become enlarged and painful. Chills, sweating, deterioration in general condition are observed, body temperature reaches 40 degrees.
- 3. Abscess. Its symptoms are the same as in the previous case, characterized by increased signs of intoxication. The contours of education are becoming clearer.
- 4. Phlegmonous. The mammary gland turns red, when pressed with your fingers, a hole is formed, a “ripple” is felt, and the nipple is retracted. The intoxication syndrome increases even more, turning into sepsis.
- 5. Gangrenous. With further development of the process, tissue necrosis begins, the mammary gland enlarges, acquires a blue-purple color, and becomes covered with blisters and areas of necrosis.
- expressing milk (manually or with a breast pump);
- applying cold compresses for 10-15 minutes (only on the first day);
- reducing fluid intake;
- taking medications that suppress lactation (based on bromocriptine, a combination of estrogens and androgens);
- antibacterial therapy;
- dry heat (starting from the second day of treatment);
- physiotherapy: ultraviolet irradiation, UHF, ultrasound;
- in the presence of an abscess - surgery.
- dense consistency;
- fuzzy outlines;
- limited mobility;
- enlarged axillary lymph nodes;
- in some women it is painful (5-20% of cases).
- the formation of a flat area on the surface of the mammary gland, resulting from fixation of the skin over the tumor;
- the appearance of areas of “indentation” or “retraction”;
- the appearance of a “lemon peel” on the skin due to impaired lymph flow in the tissues;
- nipple retraction;
- swelling, thickening of the skin;
- the appearance of ulcerations in advanced cases, when the tumor has already grown to the surface;
- bloody discharge from the nipple, the formation of crusts on its surface.
- early menarche (up to 12 years);
- late menopause (after 55 years);
- complete absence or late labor;
- woman's age over 50 years;
- the presence of hyperplastic processes in the mammary gland.
- lipoma: Vietnamese “Star”, Vishnevsky ointment, egg films, compress with raw onion and aloe leaf;
- fibroadenoma: compresses based on honey, verbena, raw potato juice;
- mastopathy: compress from birch bark and leaves; beets and honey laid out on a cabbage leaf; gruel from burdock leaf, castor oil and honey;
- cyst: infusion of red brush, chaga, compresses of St. John's wort, burdock root, large-leaved gentian;
- mastitis: compresses made from honey with wheat flour, chopped cabbage leaves, camphor oil, baked onions, sweet clover, coltsfoot leaves;
- cancer: potato flowers, hemlock, celandine, arum root, chaga (oral intake).
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Causes of breast lumps and self-diagnosis
A lump in the breast can appear for various reasons. The greatest concern among women is breast cancer, one of the features of which is that in the early stages of its occurrence, as a rule, there is no pain and the disease can be asymptomatic. The earlier a woman discovers a malignant tumor, the more favorable the prognosis - removal of a cancerous tumor at the initial stage, when there are no metastases yet, ensures a 10-year survival rate in 95%.
Every eighth woman in Russia is at risk of developing breast cancer. At home, with self-diagnosis, you can find those tumors whose size exceeds 5 mm. In 65-85% of cases, lumps in the chest are detected by patients on their own. Smaller formations are diagnosed only using instrumental methods (ultrasound, mammography). Since apparently benign tumors cannot be distinguished from cancer at an early stage, women over 35 years of age should be examined annually.
The most common causes of lump formation in the mammary gland in women are the following types of pathologies:
In more rare cases, angioma, leiomyoma, osteoma, chondroma, rhabdomyoma and lipogranuloma are detected. Tumors can develop from various tissue structures of the breast. Most often, the detected formations are benign, but some types are prone to malignancy (fibroadenomas, leaf-shaped tumors). They require regular monitoring.
Tumor types
Young nulliparous women sometimes experience lumps above the breasts before the onset of menstruation. This phenomenon occurs due to hormonal changes during menstruation, some milk lobes may increase disproportionately compared to others. Engorgement and enlargement of the mammary glands during the premenstrual period is normal and goes away after the end of menstruation.
In the last stages of pregnancy or after the birth of a child, a dense, large tumor may appear along the edge of the mammary gland. The reason for its formation is too much blood flow, which is why it hurts. Both one breast and both are affected. This condition is called chest infarction, and in the absence of medical care, in many cases a purulent process develops with general intoxication of the body. Treatment is carried out only surgically.
Intraductal papilloma
Intraductal papilloma can be detected by palpating the nipple halos. These formations are most often small, but with active growth of papilloma over several months they can reach several centimeters in size. A characteristic sign of the disease is serous or bloody discharge from the nipple. Usually this symptom is the patient's only complaint. There may also be pain or itching in the nipple area.
The location of the papilloma is in the central or peripheral ducts of the mammary gland. In girls during puberty, numerous papillomas can form (the mammary gland is like a “Swiss cheese”). Single small papillomas are more often formed in women over 60 years of age, and multiple ones - in young women.
Intraductal papilloma
This pathology is considered a precancerous condition and is subject to mandatory surgical removal followed by histological examination. The optimal method for diagnosing formations is ductography - an x-ray examination with the introduction of an x-ray contrast agent.
During the operation, the ducts from the nipple are cut off. An incision is made at the bottom of the nipple along its areola for best access and for cosmetic reasons. If the papilloma has formed in the central ducts, then after surgery the lactation ability of the mammary gland is impaired.
Mastopathy
This is the most common benign disease of the mammary glands (90% of all patients), in which their tissue grows. Depending on which elements predominate in the tissues of the gland, several forms of mastopathy are distinguished:
Symptoms of the disease are:
Until the age of 30, a woman may have no subjective sensations at all. The cause of mastopathy is a disturbed hormonal balance in the body and increased production of estrogen. Risk factors include:
Mastopathy often accompanies such pathologies, How:
The risk of developing cancer in this disease increases in the presence of cystic changes and depends on the severity of tissue proliferation. Treatment for the diffuse form is conservative, using hormonal medications (based on progestin, thyroid hormones, contraceptives) and non-hormonal agents (vitamins, adaptogens, enzymes, iodine and potassium preparations, hepatoprotectors, diuretics and sedatives, herbal remedies).
Adenoma
Breast adenoma usually does not exceed 3 cm in diameter; upon palpation, it is revealed in the form of a ball, not much different in density from other tissues. In some cases, when pressing, you can feel the lobular structure of the formation. Since the adenoma has a capsule, it is well demarcated from other tissues in the mammary gland.
The formation does not hurt when pressed. The tumor forms most often in peripheral areas - in the lower part and along the lateral surfaces of the gland. Another characteristic feature is good mobility - the adenoma can be moved with your fingers for some distance.
Pregnant and lactating mothers are diagnosed with a so-called lactating adenoma - a small lump formed from a hypertrophied lobule of the mammary gland. It requires careful diagnosis, as there is a risk of developing breast cancer.
Treatment consists of sectoral removal of part of the gland with the adenoma. It must be eliminated along with the capsule, otherwise a relapse will occur. The surgical material is sent for histological examination to identify altered cells.
In rare cases, nipple adenoma is detected, which is formed from the epithelium of the sweat glands. In teenage girls, it can reach large sizes and turns into a cancerous tumor in 3% of cases. Treatment is also surgical.
Cyst
A cyst in the mammary gland in women is not a tumor. The causes of its appearance are hormonal imbalances or injuries. Formations can appear at any age, most often at 30-50 years of age, least often in the postmenopausal period.
A characteristic feature of the cyst is the ability to change in size during the menstrual cycle under the influence of female sex hormones. During menstruation it becomes larger. Cysts measuring 1-1.5 cm are considered medium, and cysts larger than 2 cm are considered large.
With hormonal changes, the secretory activity of the gland and the growth of connective tissue of the ducts increase, which can lead to their expansion, accumulation of secretions and the formation of cysts, which are often localized under the breasts. When there is injury or swelling of the mammary gland, its fatty tissue is destroyed and an oily fluid accumulates. Cysts also appear with mastopathy. Large formations have a characteristic “ripple” when pressed.
Breast cyst
Medium-sized cysts can be treated conservatively, while larger ones can be treated with puncture aspiration. Small single formations can spontaneously resolve. Cysts with signs of inflammation and dense contents, intraductal, atypical formations with intramural inclusions have a high risk of malignant degeneration. Atypical cysts are removed surgically.
A type of cyst is a galactocele, the contents of which become milk. When palpated, a smooth formation is detected, which is delimited from the surrounding tissues and easily moves when pressed. Appears as a result of blockage of the milk duct, often with mastitis, when taking prolactin-stimulating drugs or with a pituitary adenoma. Located in the central part of the mammary gland or under the nipple. Treatment is the same as for other cysts.
Fibroadenoma
Fibroadenomas develop from lobules of the mammary gland, most often in the upper part of the breast. These benign formations are most common in women at the young age of 15-35 years with intensive development of the lobular apparatus of the gland, but can also occur during menopause (10% of all cases). The reason for their appearance is exposure to estrogens during puberty, pregnancy, premenopausal and menopausal periods when using hormone replacement therapy.
The following signs are characteristic of fibroadenoma:
Removed fibroadenoma
It differs from adenoma in its denser structure and the absence of pronounced lobulation.
Up to 2-7% of tumors can become malignant. If rapid growth of the formation occurs, then this is an indication for its removal. As diagnostics, ultrasound of the mammary glands, mammography, and fine-needle biopsy are performed to identify cancer cells. Small tumors less than 1 cm in size do not need to be removed. In this case, regular monitoring of fibroadenoma is carried out.
Hamartoma
Hamartoma (fibroadenolipoma) is denser to the touch than fibroadenoma and consists of three types of tissue: adipose, glandular and fibrous. This type of tumor is less common and develops as a result of embryonic malformations of the gland tissue in the form of an isolated island. There are no painful sensations. The shape of the formation is round, with clear boundaries; the hamartoma has good mobility relative to the surrounding tissues.
Giant hamartoma
When performing a fine-needle biopsy, the aspiration material contains breast tissue, which is a distinctive feature of this formation. An operation to remove it is performed in cases where questionable results are obtained or when the hamartoma is large in size to eliminate a cosmetic defect.
Leaf-shaped tumor
Leaf-shaped tumor is one of the types of fibroadenoma. Its characteristic features are:
The formation is benign, but can degenerate into cancer and sarcoma (20-25% of cases), metastases spread to the bones, lungs, and other organs. The only treatment option is surgical removal (sectoral resection of part of the gland tissue or complete removal for sizes greater than 8 cm).
Tumor growth can be triggered by hormonal imbalances or taking hormone-containing drugs.
Leaf-shaped tumors are most common between the ages of 45 and 50 years. This kindprone to reappear afterremoval (in 20%) cases, and relapses become malignant more often.
The survival rate of women, even with a malignant course of the process, is high - up to 75%. Therefore, it is important to consult a doctor in time to diagnose and remove the leaf-shaped tumor.
Lipoma
Lipoma, or wen, is a benign tumor of adipose tissue. It has the following features:
Lipomas form mainly in older women. In rare cases, they can develop into liposarcoma, so monitoring them is required (ultrasound 3-4 times a year, mammography and cytological examination of a nipple smear). If the lipoma grows rapidly, compresses the surrounding tissues, pain appears in the mammary gland, and tissue death is observed, then its surgical removal (sectoral resection) is indicated.
More rare formations in the mammary gland
In rare cases, the formation of the following tumors is observed:
In all cases, except Mondor's disease, surgical removal of the tumors is performed.
Lactostasis
During lactation, the outflow of milk in the mammary glands of a nursing mother may be disrupted due to blockage of the ducts, resulting in the formation of a painful hardening. The gland tissues perceive the reverse reflux of milk as a foreign substance, an inflammatory process develops with increased temperature, redness and swelling of the breast, and the pain becomes so severe that the breast cannot be touched.
The causes of lactostasis can be several factors:
Most cases of lactostasis occur in the 2-3rd week of a child’s life, when the mother’s milk is actively “coming in.” This phenomenon is more typical for women who give birth for the first time after 30 years. If left untreated, milk stagnation leads to the development of lactation mastitis.
To eliminate a hard formation in the breast and restore lactation, the following measures are recommended:
If you experience a high temperature, severe pain, purulent discharge, or if you are unable to “drain” the breast on your own, you should consult a doctor. A widely known folk remedy for the treatment of lactostasis are cabbage leaves, which are first doused with boiling water or lightly beaten to release the juice, and then applied to the sore breast.
Mastitis
Mastitis is an inflammation in the tissues of the mammary gland, the causative agent of which in 80% of cases is staphylococcus (in the rest - streptococcus, E. coli, anaerobic microorganisms). Most often it develops in the postpartum period in primiparous women.
There are several forms of this disease:
Feeding from the affected breast should be stopped. Treatment is carried out using the following measures:
Mammary cancer
The following symptoms are typical for breast cancer at the initial stage:
In later stages, the following symptoms appear:
Mammary cancer
If a cancerous tumor is detected early, when its size does not exceed 2.5 cm, partial tissue removal is possible. In other cases, subtotal or total resection of the mammary gland is performed.
The main causes of cancer development are estrogen exposure and genetic predisposition. Additional risk factors include:
ethnoscience
Treatment of breast formations can be carried out using folk remedies:
To restore hormonal balance, it is recommended to take phytohormones contained in geranium, marshmallow, plantain, barley, soybeans, calendula, grape seeds, sprouted wheat grains, and ginseng roots.
Appearance in the mammary gland of any compaction, similar to a pea, cherry, plum, etc. - a reason to see a doctor. First of all it could be therapist or gynecologist. If necessary, these specialists will refer you to an oncologist or mammologist, and a visit to whom should never be delayed. If you are concerned about a situation with an incomprehensible lump, and your gynecologist advises you to “just observe,” contact see an oncologist or mammologist on your own. After all, we are talking about your health and peace, which will most likely be disrupted until the situation is completely cleared up. You can drive up to the oncology clinic yourself, where no one will definitely refuse an examination.
Self-examination is the first and very important thing that every woman of any age can do for herself. However, once a year you need to see a specialist - the same gynecologist - even if you have not detected anything in yourself and nothing worries you. Specialists use specific types of examination to confirm the diagnosis, and therefore ultrasound and mammography examinations It is better to carry out as prescribed by a doctor. In general, ultrasound examination of the breast can be performed on women of any age, although in older age it is less informative. Ultrasound allows you to see the condition of the supraclavicular sphere, changes in which may indicate the same cancer. Somewhere after 40 years of age, mammologists recommend annual mammography examinations, which is performed free of charge upon referral from a doctor. It has been proven that annual mammography after age 50 reduces mortality from breast cancer over 20-30 years by 25-30 percent.
Over the past 15 years, we have significantly the incidence of breast cancer has decreased. At stages 3-4, only 20 percent of cancer is detected. It can be argued that the diagnosis of this disease in Belarus - the best in the post-Soviet space. And this was achieved thanks to large-scale educational work among Belarusian women and medical staff. This work was started once and continues today by the head of the department of oncomammology of the Republican Scientific and Practical Center of Oncology and Medical Radiology named after N. N. Alexandrov, Doctor of Medical Sciences, Professor Leonid Putyrsky, who answered your questions during our next medical “direct line”.
Hardening and thickening in the chest
- Brest, Margarita Iosifovna. I was diagnosed with a hardening in my chest. I did an ultrasound examination. The doctor said that this hardening is not attached to anything and, most likely, there is no need to worry. Is it so?
Women should not use the advice of diagnostic doctors about what to do with this or that education. These specialists only have to find something or not find it. And then the question of treatment tactics the oncologist decides. Contact him. Most likely, the tumor will need to be removed.
- Minsk, Svetlana. At the end of September I had surgery due to focal mastopathy. The hardening inside that appeared after the operation still does not dissolve. Is this normal?
This could be one of variants of the norm. The mammary gland, as a rule, swells after surgery and hardening appears in it. But over the next few months they usually resolve. Sometimes they can stay up to six months. Therefore, there is no need to be afraid. The woman who has hardening in the scar area does not resolve for up to three months, you need to see a specialist. Perhaps an ultrasound examination should be done to make sure that nothing new has appeared there.
- Mogilev, Nadezhda. Six months ago I had chest bruise. Recently hardening appeared in this place. Could this be dangerous?
Maybe. 5 to 45 percent of breast tumors appear in the place where it used to be injury. Another thing is that we do not always know whether the tumor appeared as a result of an injury or whether it was there before, and the injury only provoked its faster growth. But the fact remains: trauma is one of the causes of breast tumors. Therefore, you should definitely seek advice from an oncologist. And it is better to have a small operation to remove the hardening. Even if there is nothing bad there, it is better to do it than to waste time and regret it later.
- Minsk, Vera. How seriously should you take breast lumps? How long - weeks, months - can we wait until the situation returns to normal?
A woman who herself has discovered a lump in her mammary gland only has time to find a good doctor, and the search must begin on the same day. The presence of a lump makes a woman think about the worst, but she never needs to diagnose herself. 95 percent of breast problems are not related to cancer. Therefore, first of all, you should think that everything will be fine with you, and there is no cancer, and secondly, you need to see a doctor as quickly as possible. There are two reasons for this: if cancer is still expected, then the sooner treatment begins, the higher the chances of achieving a positive result. Secondly, if a woman puts off visiting a doctor, she will still not get rid of anxious thoughts. There is no need to be afraid of anything. Actually every third woman today undergoes surgery to preserve the mammary glands.
Mastopathy
- Brest, Tatyana Ivanovna. I am 40 years old. At the antenatal clinic they diagnosed - focal mastopathy. How dangerous is this and what should I do?
Mastopathy can be diffuse or focal. With diffuse mastopathy, there are no foci in the chest, but nevertheless, certain changes occur. With focal mastopathy, there is a more or less clear focus that can be identified manually. Mastopathy itself is not life threatening. But the danger may be that sometimes breast cancer is disguised as mastopathy. Therefore, any focal formation is a reason to contact an oncologist and additional examination, up to a puncture biopsy. And if there is hardening, it is usually removed.
- Dzerzhinsky district, Tatyana Nikolaevna, 38 years old. The diagnosis was made - . I was treated for two months, the cysts were cauterized. But now they have grown again. What should I do?
Cysts, as a rule, are not operated on. The liquid is removed from them with a syringe. And then they are treated conservatively. However, if the cysts appear again, then, first of all, you need to determine the cause of their appearance. Cysts do not appear out of nowhere.
- What could be the reasons?
There are three groups of such reasons. And the more of them, the higher the risk of cysts, tumors, etc. The first group of reasons is associated with nerves. Back in the 19th century, Americans called mastopathy “ hysterical breasts", noting that those women who are nervous a lot, as a rule, have various changes in the mammary gland.
The second group of reasons includes hormonal disorders. What matters here is when your periods started and ended. If menopause does not occur before age 52, the risk of breast disease increases. A woman who gave birth for the first time at age 20 has an approximately 1.5-fold reduction in the risk of breast cancer compared to one who gave birth after age 30, and even more so after age 40. The more abortions a woman has had, the higher the risk of the disease. And here the more children she has, the less likely she is to get breast cancer. The function of the thyroid gland and liver is important.
The third group of reasons is related to ecology, physical activity, lifestyle. Of course, bad habits also do not add to your health. Large doses of alcohol - for example, three glasses of wine per day or 50 g of vodka - increase the risk of breast cancer. Smoking is one of these risk factors. Smoke contains many carcinogens that are absorbed into the blood and can affect the condition of any organ.
- Oshmyany, Oksana. 44 years old. What does the diagnosis of fibrous cysts mean? What is the best way to get rid of them?
There is no such diagnosis - fibrous cysts, but there is fibrocystic mastopathy. These are metabolic changes in the mammary gland. More fibrous tissue is formed, and cysts may form among them in the ducts. If they exist for a long time, their walls may become denser, and then they are removed. Just a puncture will not help here, since liquid will collect in the dense walls again and again. Usually cysts with soft walls are removed using a puncture. If after this examination shows that everything is in order, then only conservative, medicinal treatment is prescribed. If the cyst becomes full, it must be removed surgically.
Other questions and answers from this direct line:
- Mammologist answers: benign and malignant breast tumors
Prepared based on materials from the direct line of the Zvyazda newspaper (December 21-24, 2010):
http://zvyazda.minsk.by/ru/archive/article.php?id=71159
http://zvyazda.minsk.by/ru/archive/article.php?id=71230
http://zvyazda.minsk.by/ru/pril/article.php?id=71314
http://zvyazda.minsk.by/ru/archive/article.php?id=71406
