Seal in the chest what to do. Hot, red, painful lump during breastfeeding
Breast lumps are in most cases benign, but the aggressiveness of breast cancer and its high prevalence warrant careful attention to any unusual breast symptoms.
Any woman should know the methods of self-examination of the breast and regularly examine herself in order to notice in a timely manner that a seal has appeared in the breast and consult a doctor.
Compaction in the chest can appear not only in an adult woman or girl, the pathology of the mammary glands occurs at any age, although it is women who get sick most often. However, a man's chest tightness requires no less (and often more) attention than a woman's. Changes in the mammary glands can also be observed in children, both in newborns and in adolescents. Having found a seal in the child's chest, the mother is obliged to show it to the doctor in the near future. If a girl's compaction can be associated with puberty, in an infant, hormonal disorders, inflammatory diseases, and even tumors can be the cause.
Why do seals appear in the chest and what should a woman do if she finds something similar in herself?
The causes of seals in the mammary gland can be different.Physiological causes 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. Compaction in the breast of a nursing mother, as a rule, is associated with blockage of the milk ducts. This happens if the breast does not empty completely during feeding, or if the baby is applied irregularly.
Compaction in the breast during feeding, associated with lactostasis, is accompanied by fever, 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 it. If no action is taken, the consequence of such milk stagnation can be mastitis with all its unpleasant consequences in the form of an incision, antibiotics, and possibly loss of HB.
Diseases and tumors
Painful compaction in the chest before menstruation occurs with mastopathy. With this disease, which is more common in young girls and women, compacted areas are formed in the chest, which can change their size and place in different menstrual cycles. After menstruation, everything goes away, but, starting from the second half of the cycle, there is again a seal in the chest and it hurts. In this case, compaction and pain in the chest may be accompanied by discharge from the nipples. This hormone-dependent disease of the breast is the most common in mammology, and is not related to breast cancer.
Breast seals in women may be accompanied by brown, bloody, these discharges 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 is a rounded cavity in the mammary gland, filled with fluid. They are usually smooth, fairly hard, and move freely under the fingers when palpated. These cysts may not cause discomfort, or they may hurt. The reason for their occurrence is hormonal changes during the woman's menstrual cycle, they are also not associated with breast cancer and, as a rule, occur in young women (not older than 50 years). If a cyst is detected, the doctor can puncture it to clarify the diagnosis and relieve pain by removing the contents through a needle.
Sebaceous cysts (atheromas). These are rounded seals under the skin of the breast, caused by blockage of the duct of the sebaceous gland and the accumulation of sebum in it. They are mobile and usually do not bother, in such cases treatment is not required, however, when the cyst becomes infected, it can become inflamed, soreness and redness of the skin appear. Then the cyst must be removed, while it is completely excised from a small incision, because the remaining part of the sebaceous gland can cause a relapse.
Breastfeeding women may develop breast abscesses, rarely they are outside the period of breastfeeding. An abscess is a cavity in the breast filled with pus. Such seals are always very painful, accompanied by swelling and redness of the chest, not mobile and dense. Surgical treatment (incision and drainage of the mammary gland), antibiotic therapy is performed.
Fat necrosis of the breast- a seal that occurs after injuries to the mammary gland, and before the appearance of a seal, weeks and even months can pass. The area of fat necrosis is a round tumor, sometimes quite painful. The skin over it turns blue or red. Usually, fat necrosis resolves without treatment, but scar tissue may remain at the site of the tumor, which will then always be detected on mammograms.
Breast lipoma is a non-cancerous tumor that can be a rather large lump in the breast, while at first it may be small, but it 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 the tendency to grow, and in order to accurately diagnose.
breast adenoma- a tumor of glandular tissue, is a solid seal, 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 duct of the mammary gland, often causes bloody discharge from the nipple. It is felt as a small seal of the nipple of the breast under the areola.
breast cancer- can have a variety of manifestations and be similar to any of the above tumors. Most often, this is a seal in the chest without clear boundaries, bumpy, painless, often associated with the skin. Cancer can change the shape of the breast and skin, can change the nipple fora, making it retracted, 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 are at 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 seal under the breast and under the armpit. Here are the lymph nodes, which often increase with oncopathology. Seal in the chest and armpit on the same side is a dangerous combination.
Every month on the 7th-10th day of the cycle, conduct a self-examination of the mammary glands, probe and inspect 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 there is a seal or other changes in the chest, you should consult a mammologist. After the examination, the doctor will make an accurate diagnosis of what your breast lump is, and together with him you will decide what to do in this or that situation. Delay, and, moreover, treatment with folk methods is dangerous.
It is difficult to find a woman who would never experience 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, soreness of the mammary glands is one of the manifestations of their disease. Most often pathological pain noted 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 in diseases of the spine and heart can mimic pain in the mammary glands. Some mental disorders, such as cancerophobia, can cause functional pain in the breast area. These important points must be taken into account when conducting 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 start 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 occurs with 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 parasternal 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 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 is the nipple with the surrounding areola. Both the 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 lobules. 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 are combined into larger ducts that fit the nipple. In the space behind the nipple, the lactiferous ducts expand, forming the lactiferous sinus, after which they narrow at the point of passage through the nipple and then expand again, forming from 8 to 15 funnel-shaped lactiferous openings. Through such a system of ducts, milk is formed in the mammary glands and flows out. When conducting special studies in some patients, it is sometimes possible to detect additional mammary glands.
The fatty part of the mammary gland covers the outside of its glandular part. 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.) that 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 the frame of 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 of the mammary glands includes ligaments that support the mammary glands. The aforementioned ligaments are attached to the thoracic 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 keratinized epithelium. On the surface of the areola, small tubercles are sometimes visible, which are rudimentary mammary glands that open with 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 freely if the blood supply in several of the arteries has deteriorated for certain reasons.The 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 the 3rd - 5th perforating branches extending from the internal mammary artery;
- lateral mammary branches of the lateral mammary artery ( branch of the axillary artery).
Sensory innervation is carried out by intercostal nerves ( ThII-th IV), as well as supraclavicular nerves from the cervical plexus. Sympathetic innervation is carried out from several sources, and the nerve fibers accompany the above arteries and, together with them, enter 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 breast. The capillary lymphatic network is located most superficially. It is localized in the skin of the mammary glands and in the subcutaneous adipose 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 in the thickness of the gland and originates from the lobular ducts. All of the above networks are interconnected. In addition, special mention should be made of the superficial lymphatic plexus of the areola ( areola). 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 the large arteries, so the main part of the lymph flows to the armpits and only a small part of it to the intrathoracic lymph nodes.
The lymphatic vessels ultimately carry the lymph into the venous system, but before entering it, the lymph is filtered and purified in the lymph nodes. The main accumulation of lymph nodes that cleanse the lymph of the mammary glands is located in the armpits. In each armpit, there are about 20 - 40 nodes, which are organized into five groups - thoracic, central, subscapular, humeral and apical. First of all, the lymph of the mammary glands passes through the thoracic lymph nodes, called Zorgius nodes. These lymph nodes are the first to increase in malignant neoplasms of the mammary glands, so their detection should serve as a signal for urgent medical attention. However, when these nodes are found, one should not panic, since their increase is not always the result of a malignant process. It can be observed in 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 of 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 syndrome is usually not so great as to seek medical help. However, sometimes pain becomes an obstacle to a normal life. This problem becomes especially significant if severe pain is repeated 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 data. 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, a diffuse form first appears, when small, millet-sized, painful seals 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 the skin over the mammary gland retain their size, the growth of gland tissues leads to an increase in stress in it. An increase in tension entails irritation of the nerve endings, manifested by severe pain.
The nodular form of fibrocystic mastopathy develops against the background of a diffuse form, when small seals increase, forming larger nodes. These nodes can reach sizes up to several centimeters in diameter. The area of their predominant 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 parts 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 the increase in the volume of the gland is the excessive action of estrogens. As a rule, the increase in the influence of estrogens is relative, that is, it develops against the background of reduced progesterone production. A decrease in progesterone production can be observed with certain diseases of the hypothalamus and pituitary gland, with diseases of the kidneys, liver, 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 noted with a long absence of pregnancies, a large number of abortions, alcohol abuse and smoking. The strength of the pains 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 the weather.
Is it necessary to treat pain in the mammary glands before menstruation?
As a rule, the usual pains before menstruation do not limit the daily activities of women and do not need 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 background and the structure of the mammary glands. Depending on the diagnosed cause, the treatment is selected.If the cause is a tumor formation of the pituitary or hypothalamus, then neurosurgical intervention is indicated. If the cause is a side effect of certain medications, then they should be discontinued. If the cause remains unidentified, then they resort to correcting the hormonal background by suppressing estrogens and stimulating progesterone receptors with certain medications. In some cases, it is enough to change the lifestyle, aimed at eliminating the factors that provoke a change in the hormonal background. These adjustments include the avoidance of sunburn, the exclusion of physiotherapy ( especially electrical), exclusion of temperature differences ( saunas), quitting smoking and taking 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 chest for seals, upon detection of which she should seek medical help. You can learn how to properly exercise self-control of the mammary glands in any antenatal clinic.
In addition to self-monitoring of the mammary glands, every woman over the age of 35 is recommended to undergo mammography once every 2 years - an x-ray examination of the duct system of the mammary glands. After age 50, this study should be done annually.
Painful lump in the breast
Painful compaction in the mammary glands is one of the most common reasons for women to visit a mammologist and gynecologist. Differential diagnosis of these mass formations is especially important, since the type of treatment and its effectiveness directly depend on their nature. In particular, it is important to timely diagnose breast cancer, which is the second most common after lung cancer. Causes of seals in the mammary glands
Painful hardening of the mammary glands may be a sign of:- cancer;
- hematomas;
- mastitis;
- Mondor's disease;
- breast cysts, etc.
Pain in breast cancer
Pain in breast cancer at first may be absent or very weak and insignificant. Unfortunately, this leads women to see a specialist only in the later stages of the disease, when treatment options are limited. The cancer usually starts as a small lump that is easily confused with a fibroadenoma ( benign tumor). This seal acquires a characteristic density and inactivity already at 3-4 stages 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 the 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 they are usually not permanent and are 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 skin changes ( lemon) crusts ( significantly enlarged skin pores, with swelling of the skin located between them).
Pain in the mammary glands with hematoma
The cause of breast hematoma is usually trauma. The likelihood of its occurrence increases in patients taking anticoagulants ( heparin, warfarin, thrombostop) or suffering from diseases accompanied by a decrease in blood clotting ( hemophilia, cirrhosis of the liver), as well as increased vascular fragility ( beriberi).Pain in the mammary gland with a hematoma is distinguished by several features. With a favorable course of the healing process, the peak of pain falls on the first days after the formation of a hematoma. Subsequently, the hematoma gradually resolves, and pain decreases. In the first hours after its formation, they have a pulsating character. The pain is rather dull than sharp, but of high intensity. Its localization is clearly determined by the site of injury. When you try to press the pain increases dramatically.
In a certain percentage of cases, the hematoma may suppurate. The probability of this complication increases with an increase in the volume of damaged tissues, and also 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 with an abscess
An abscess is a limited purulent inflammation. Its independent occurrence in the mammary glands is quite rare. 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 strong, since the abscess is always tense and puts a lot of 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 exceeding the size of the abscess itself. The skin over the abscess is tense, shiny, full-blooded and hot to the touch.In addition to local symptoms, a pronounced syndrome of general intoxication is almost always noted, manifested by remitting fever ( body temperature over 38 degrees with daily fluctuations over 2 degrees), chills, fatigue, pronounced loss of strength, etc.
The opening of the abscess leads to almost instantaneous disappearance of pain and relief of the general condition of the patient. For abscesses of the mammary glands, a tendency to self-opening into the lumen of the milk ducts is characteristic, while pus can be released from the mouths of the ducts. On the one hand, this feature leads to an alleviation of the patient's condition, but on the other hand, it leads to a rapid spread of infection to healthy breast tissues and a chronic process.
Pain in the mammary glands with mastitis
Mastitis is any inflammation of the breast. Unlike an abscess, the main cause of mastitis is the stagnation of the secretion of the mammary glands, combined with the ingress of pathogenic microorganisms into the stagnant masses. In the vast majority of cases, mastitis is caused by Staphylococcus aureus. The most common way for infection to enter the mammary gland is nipple cracks if a sufficient level of hygiene is not observed.In connection with the above-mentioned features of the development of mastitis, the frequency of this disease is highest among women who breastfeed their children. Moreover, primiparous women dominate among all women in labor. Somewhat less often, mastitis occurs in pregnant women and much less frequently in other female representatives. Occasionally, there are cases of mastitis in men. In most of them, this pathology develops against the background of trauma, infection of the nipple and areola. In the rest, it is associated with cancer or endocrine diseases leading to galactorrhea ( secretion from the mammary glands, outside the process of feeding a child, i.e. pathological secretion of breast milk). In pediatrics, there is also mastitis in newborns, which develops in the first few days after childbirth. The reason for the development of such mastitis is the excess content in the blood of the child of oxytocin and prolactin, which entered his body through the placenta while still in the womb. This condition usually resolves without treatment as the aforementioned hormones break down.
Pain during mastitis, as a rule, is of high intensity, arching character. The mammary gland or part of it is edematous, red, elastic and hot to the touch. Touching it causes a sharp increase in pain. The superficial venous network clearly shows through the skin. Sometimes, with a large volume of inflamed tissue, a fluctuation phenomenon can be noted ( overflows) pus inside the gland.
Pain in the mammary glands with Mondor's disease / syndrome
Mondor's disease or syndrome is called thrombophlebitis of the veins of the anterior and lateral chest wall. There are many reasons for the development of this condition. Among the main ones are breast cancer, frequent injuries and purulent inflammatory processes. Among the secondary causes, such as complications of past viral infections and previous surgical interventions, genetic predisposition, diseases of the cardiovascular system, etc.Pain in this syndrome is usually dull, but clearly localized. Palpation in the depth of the mammary gland is determined by a dense painful roller. In severe cases, blockage of the vein and its suppuration occurs. The tissue around it becomes tense, hot to the touch, as in mastitis. At the site of inflammation, the patient may feel some pulsation.
Pain in the mammary glands with fibroadenoma
Fibroadenoma is a benign tumor of the glandular part of the breast. It is most typical for women aged 20 to 40 years, however, these seals are also found at an earlier and later age. 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 soreness 8-10 days before the onset of menstruation and a sharp disappearance of pain with their onset. However, in patients with irregular menstrual cycles, the time of onset of pain and its intensity may vary depending on the hormonal background. In rare cases, breast fibroadenoma pain is permanent. During the increase in pain, the entire gland thickens, and the fibroadenoma itself becomes extremely sensitive to touch. However, unlike suppurative diseases, external signs of inflammation over fibroadenoma are almost never determined.Pain with a breast cyst
Breast cyst in most cases is one of the complications of fibrocystic mastopathy. This cavitary 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 origin 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, acini ( the smallest structural units of the gland capable of independently forming a secret) continue to work and accumulate fluid in themselves, increasing the pressure in their cavity. Over time, due to periodically increasing pressure, the acinus cavity increases and becomes overgrown with connective tissue.As a result of the above changes, a cyst is formed with a capsule surrounding it. Since the cyst originated from the acinus and retained the ability to form a secret, it remains hormone-dependent. In other words, it becomes tense and painful just before menstruation. In the postmenopausal period, the cyst may persist, but usually it decreases somewhat in size and does not bother the woman.
Methods for examining breast seals include:
- mammography ( radiological);
- ultrasound ( ultrasound procedure);
- 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, such as 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 degree of information content of this method has increased significantly after the start of using digital media instead of film ones. The disadvantage of this method is a certain dose of radiation received during the study.
ultrasound
Ultrasound examination of the mammary glands is often practiced to determine the nature of its seals. It is especially useful in the diagnosis of cysts. The undeniable advantage is the relatively high availability and absolute harmlessness. In connection with these features, this study can be safely prescribed to pregnant and lactating women. In addition, this study is often used to pinpoint suspicious tissue during a 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, in a pathology such as Mondor's disease/syndrome, this study allows you to determine the area of \u200b\u200bblocked and inflamed vein, causing inflammatory changes and soreness.
Scintigraphy
Scintigraphy is used to diagnose malignant tumors of the mammary glands and their metastases. The principle of the method is to introduce a certain radiopharmaceutical into the patient's bloodstream, which has an affinity for the tissues of a malignant tumor. As a result, after a short period of time, the radiopharmaceutical concentrates in the tumor tissues and emits waves of a certain spectrum. With the help of highly sensitive equipment, this radiation is recorded and a projection of the distribution of the radiopharmaceutical in the body appears on the screen of the device. The accumulation of a radiopharmaceutical in one focus indicates in favor of 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 breast pathologies. In particular, this method is used in the detection of 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 as a multi-colored silhouette, in which the hottest areas are represented by red and yellow hues, and the coldest areas are blue and green.
Tissue temperature directly depends on the degree of its vascularization ( number of blood vessels per unit volume of tissue) and intensity of blood flow. Inflammatory processes are distinguished by increased blood flow, while increased vascularization ( growth of new blood vessels) is found 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 status of regional lymph nodes. Among these methods, the advantage is given to MRI, since it better displays the soft tissues of the mammary glands. In addition, MRI does not imply 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 CT 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. With its use, the chance of diagnosing malignant tumors, which, as you know, are abundantly supplied with blood, increases significantly. However, along with this, there is a risk of side effects due to the introduction 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 compaction in the mammary glands. Typically, a biopsy piece of tissue to be examined) is taken with a long hollow needle. This study is carried out under the control of ultrasound and under mandatory anesthesia. In the future, the resulting tissue is studied under a microscope, after creating several dozen histological preparations from it, treated with various dyes and reagents. Depending on the degree of cellular atypia ( anomalies) confirms or refutes the diagnosis of malignancy. Its histological type is also indicated, based on which one can judge the prognosis of the disease and choose the most effective method of its 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 you know, 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 the diagnosis, but in many ways it helps the doctor choose the direction in which to continue his search.
In particular, in inflammatory diseases of the mammary glands, the concentration of leukocytes is most likely to be increased, especially the fraction of stab neutrophils. Also, with an inflammatory disease, an increase in ESR should be expected ( erythrocyte sedimentation rate) .
Depending on the severity, cancerophobia is treated by a psychologist or psychiatrist. In simple cases, patients get rid of obsessive ideas after they examine their body in as much detail as possible with the maximum number of methods, consult a large number of medical luminaries and receive a conclusion that there is no malignant neoplasm. Unfortunately, such cases are rare. Usually the fear of cancer is so deep in the mind of the patient that it changes his personality. In such cases, the intervention of a psychiatrist is required. The method of choice in the treatment of this disorder is psychoanalysis, which takes from several weeks to several years, and it is far from always possible to achieve a cure. Some patients may respond positively to other therapies, such as hypnotherapy, gestalt therapy, occupational therapy, etc.
Why does the mammary gland hurt and the temperature rises?
A disease that could explain the association between breast/breast pain and temperature is mastitis. The possibility of a parallel development of another non-inflammatory cause of pain in the female breast and a disease manifested by fever ( acute respiratory infection (ARVI), pneumonia, tonsillitis, etc.). In other words, breast tenderness and fever can develop independently of each other. The cause of mastitis in most cases is congestion, combined with injuries of 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 occurs in other categories of women, but much less frequently.
Menopausal women are more likely to develop breast cancer with age. With the development of mastitis in such patients, it should always be borne in mind that mastitis can develop due to compression of the gland ducts by the tumor or directly due to the collapse of the tumor itself. This disease occurs even in children, both female and male, due to hormonal disorders. 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 edematous, elastic, hot to the touch and full-blooded. The pains are bursting, dull in nature. Touching the gland or its displacement 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 below the nipple. There is no clear boundary between inflamed and healthy tissue. In the absence of timely treatment, inflammation progresses rapidly, covering the entire mammary gland.
The link between pain and temperature in mastitis is the inflammatory process. Pain occurs due to irritation of nerve receptors by substances that accumulate in the inflammatory focus. These substances lead to swelling of the affected tissue, and swelling, in turn, increases pressure on nerve receptors, increasing pain. An 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 thermoregulatory center located in the hypothalamus ( part of the brain) by raising body temperature.
The diagnosis of mastitis does not cause any particular difficulties due to a fairly clear and unambiguous clinical picture, focusing on which a doctor of any specialty can make a correct diagnosis. For complete certainty, a general blood test is performed, in which leukocytosis of varying severity and a shift of the leukocyte formula to the left are noted ( an increase in the number of stab neutrophils). Also, the erythrocyte sedimentation rate usually increases. However, due to the fact that this indicator is examined for at least one hour ( often longer), surgeons do not use it. Mastitis is characterized by rapid spread to healthy tissues, 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 temperature rise is not only mastitis, but also another disease, then resort to additional studies necessary for differential diagnosis ( chest x-ray, abdominal ultrasound, computed tomography, etc.).
Treatment for mastitis depends on how advanced the inflammation is at the time you seek medical attention. If the patient goes to the 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 a few 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 softening of stagnant masses and their release in a natural way.
If the above actions are not successful, you have to resort to surgical intervention. With mastitis in women outside the lactation period, surgical treatment is the method of choice. The use of antibiotics gives a result only after the opening of the purulent focus.
As a prevention of mastitis, it is recommended to observe personal hygiene, especially for mothers whose children are breastfed. Before and after giving the breast to the baby, it should be thoroughly washed 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. The child should be tried to be applied to the breast so that he captures not only the nipple, but also the areola with his mouth. This advice is especially relevant when a child has teeth, and he actively tries them on his mother's breast.
How many days before menstruation do the mammary glands hurt?
On average, the mammary glands increase in size, become dense and painful to the touch 7 to 8 days before the onset of menstruation. However, these terms can shift both in one direction and in 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 delay your period from a few days to several months. The menstrual cycle is a complex process in which there is a succession of changes occurring in the internal organs of women under the influence of sex hormones. In particular, the main hormones that cause the above changes are estrogen ( as well as its derivatives) and progesterone. The organs most affected by these hormones are the mammary glands and uterus.
The predominance of estrogens in the first phase of the menstrual cycle leads to the growth 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. By 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 decrease, and the endometrium ( inner lining of the uterus) starts to be rejected. As a result, almost simultaneously, the mammary glands stop hurting, and the first spotting 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 complicated. This process includes many other substance-effectors and regulators of this process. Not the last influence on the phases of hormone secretion is 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 a girl have breast pain?
Pain in the mammary gland in a girl ( under 18) 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 old) pain in the mammary glands is quite rare and is associated mainly with injuries. With the onset of puberty, predisposed girls, along with the development of the mammary glands, may develop a disease such as fibrocystic mastopathy. This disease can cause the development of cysts, fibroadenomas and mastitis. Despite the fact that at a young age, malignant neoplasms are quite rare, the possibility of their occurrence cannot be completely ruled out. Unfortunately, they can occur at all ages, even in newborns.
Mastitis in newborns
Mastitis in newborns develops due to the fact that in the child's body for some time after birth, a certain concentration of maternal sex hormones that entered his body in the womb remains. In response to the influence of these hormones, the mammary glands of the newborn increase in size and begin to produce a substance that vaguely resembles breast milk. Due to the fact that the milk ducts of newborns are not yet developed, the secret formed in them is not released to the outside, further increasing the size of the glands. With an increase in the size of the glands, the pressure inside them increases, and stagnation intensifies, 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, due to which the child's mammary glands eventually return to normal size.
Traumatic mastitis
Traumatic mastitis in girls, however, as in boys, can develop at any age. It usually starts with a small scratch on 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 a 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 next cycle in the mammary glands, there is a slow growth of the duct system and the glandular part ( mammary acini). The process of maturation of the mammary glands can take place 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 breast becomes 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 onset of puberty may develop mastitis, the cause of which is an 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, there are also hyperplastic processes in children's organisms. Some of them can cause pain in the mammary glands. In particular, we are talking about hormone-producing brain tumors and breast cancer.
A prolactinoma is a tumor of the pituitary gland that secretes the hormone prolactin. Under its influence, there is a functional restructuring of the mammary glands and the beginning of milk secretion. The process of secretion of milk 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 in galactorrhea is associated with an increased risk of mastitis, due to congestion and the development of infection in the mammary glands.
Another tumor process, manifested by pain in the mammary glands, is cancer. Its occurrence in girls and girls in most cases is associated with a 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 causes such 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 the pathology of other organs, such as angina pectoris, osteochondrosis, etc. With the onset of menopause, the 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 in 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, an increase in local and general body temperature, as well as characteristic pains.
Another serious cause of pain in the mammary glands during menopause is their malignant degeneration, that is, cancer. Statistically, with aging, the likelihood of cancer increases due to the weakening of the activity of cellular systems that carry out the destruction of mutated cells. In other words, anti-cancer immunity weakens with age, and a variety of mutations accumulate in the body. Some of them lead to the development of malignant tumors. In the initial stages, breast cancer can manifest itself very poorly. A moderately painful dense formation can be palpated, which does not cause any particular inconvenience. As the tumor grows, soreness around it increases, axillary lymph nodes swell, and visible symptoms appear ( retraction of the nipple, the release of a bloody secret when pressing on the nipple, the symptom of "lemon peel", etc.). For early detection of breast cancer, starting at the age of 35, it is recommended to do a mammogram once every two years. Starting from the age of 50, this study should be done 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 above compression can occur with osteochondrosis, herniated discs, spondylolisthesis ( displacement of the vertebrae), etc. Should not be written off from the accounts of diseases of the cardiovascular system. Pain in angina pectoris can radiate ( give away) in the chest, giving the impression of pain in the mammary glands.
What to do when the mammary gland in men hurts?
The mammary glands can also hurt in men, but much less often than in women. This fact explains the early appeal of men for medical help, in contrast to women who are accustomed to endure pain in the mammary glands throughout their lives. Thus, most men, without further questions, immediately act most responsibly - they go to the doctor. One of the main tasks of the doctor in this case is the exclusion of a malignant process, that is, breast cancer. To do this, the anterior chest wall should be carefully palpated and, if suspicious seals are found, additionally examined using ultrasound. To make a definitive diagnosis, a biopsy of this seal should be performed ( get a tissue sample with a fine needle) and examine the resulting tissue by histochemical methods. According to the results of the biopsy, it is possible to accurately conclude whether the seal 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 reproduction 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 be hiding breast cancer.
A rarer cause of mastitis in men is prolactinoma, a tumor of the pituitary gland that produces the hormone prolactin. This hormone stimulates the development of breast tissue and the beginning of their milk production, provoking a phenomenon called galactorrhea ( pathological flow 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 nature, are more conflicted creatures than women and are more engaged in physical labor. The above factors are the cause of more frequent injuries, including the chest. Heavy physical activity negatively affects the condition of the spine, leading to its diseases and the development of radicular syndrome, which causes pain in the chest area. Also, men are slightly ahead of women in the incidence of cardiovascular diseases, the pain in 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 visits a doctor with breast diseases at least once in her life. Researchers attribute the growth of breast pathologies to an increased psycho-emotional load. Unhealthy diet, mental and physical overload, stress - all this leads to hormonal imbalance. A change in the hormonal background affects the condition of the mammary glands. A rounded seal 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 an increased concentration of female hormones. Changes in the mammary glands are observed during pregnancy and during menopause. You can find a solid area in the mammary gland 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, soreness on palpation.
- Concomitant symptoms from the reproductive system: abdominal pain, menstrual irregularities.
- Puffiness, inflammation, fever, headaches.
- Discharge from nipples.
If at least one of these symptoms is detected, you should immediately consult a doctor.
Strictly speaking, any neoplasm requires a mandatory visit to a specialist, but there are signs that indicate good quality and minimal danger:
- The ball is small, does not hurt.
- The seal is even in shape, not soldered 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 lends itself well to conservative treatment. However, the final diagnosis can only be made by a doctor after an examination.
If the rolling ball appeared at the age of puberty, there is little reason to worry. Seeing a doctor is worth it, but most likely it is gynecomastia, which is often observed in adolescence and does not require treatment.
If you go to the doctor, you will have to undergo a series of examinations:
- Mammography
- Laboratory tests
If any neoplasm is detected, it is necessary to find out its origin and choose an adequate treatment.
Common causes of lumps in the chest
Doctors identify primary causes that most often lead to the formation of seals 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 seal.
- Laktostasis. This is true 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 in the depths of the tissues. Associated symptoms: pressure and swelling, pain and inflammation. Untreated lactostasis can lead to the development of mastitis.
- As a consequence of an injury or surgery. The chest 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 trauma, then this is a dense hematoma, which will resolve sooner or later, 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 seal is caused precisely by the medication, and not by the disease.
- During menstruation, seals can form in the mammary gland. However, they are quite rarely the correct form. If by the middle of the cycle the bump has not resolved or reappeared by the new cycle, it is worth undergoing an examination.
More than 90% of seals are caused by one of these causes.
Five secondary reasons
There are also secondary causes that are much less likely to lead to the formation of seals, 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 are more often manifested by a tumor of an indefinite 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.
- Elevated estrogen levels due to any non-physiological causes. It can lead to stress and nervous strain, taking hormonal drugs, pregnancy.
- The 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 in women, the breasts may become inflamed. Then there is a seal at the exit of the duct of the mammary gland. These are the lobules of the breast, which will return to normal again by the beginning of the cycle.
If a girl has felt a seal that causes discomfort and starts to hurt, you should contact 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 form of a ball.
Sign of a malignant tumor of the mammary glands:
- When touched, the bump causes pain.
- In the chest, not one seal, but several.
- Seals increase over time, regardless of the menstrual cycle.
- In women, the emotional state is disturbed, fatigue, irritability appear.
- The shape of the breast changes, over time it becomes noticeable. There is asymmetry of the breast or nipples.
- Discharge from the nipple.
- Retraction of the nipple, change in appearance.
- Enlarged lymph nodes in the armpits.
If at least two symptoms are detected at the same time, it is worth visiting the hospital without delay. In the early stages, oncology is treatable with a minimal risk of recurrence.
Diagnostic methods
In order to make the correct diagnosis, the doctor may prescribe a number of examinations. It is important to find out the nature of the neoplasm, evaluate the growth rate, make sure it is good, and choose the most effective method of treatment.
Currently, for breast diseases, the following instrumental examination methods are used:
- Mammography
- Ultrasound procedure
- Ductography (radiocontrast study)
The patient may also be referred for laboratory tests:
- General blood test
- Blood test for hormones
- histology
- The 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 for the selection of therapy. All modern diagnostic methods give a highly accurate result (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. The operation may be prescribed in the absence of the effect of conservative treatment or with pronounced tumor growth.
- If the neoplasm is caused by hormonal dysfunction, then the decision to operate is made after a course of hormone treatment.
- If the formation does not bother, does not hurt and does not increase, the patient may refuse the operation. If the neoplasm is dangerous, then doctors will insist on intervention.
- Some types of neoplasms, such as fibroadenomas and cysts, appear 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 the operation is not required, the doctor will prescribe treatment and recommend monitoring the disease in dynamics. For any disease, it is important to visit a specialist regularly 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 any medication is unacceptable to take on its own. It is important to choose the drug in such a way 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 in the event that there is no specific treatment and the bump should go away on its own, and the symptoms need to be removed. Bromocriptine and Danazol are often prescribed for breast pain.
- Mastitis, abscesses, infectious diseases of the mammary glands are treated with antibiotics. You can choose an antibiotic only after a microbiological analysis of the pathogen.
- In case of mastopathy or diseases caused by elevated estrogen levels, antiestrogen and hormonal preparations are prescribed to correct the hormonal background.
Treatment is selected individually. It is enough for someone to be observed regularly and get rid of bad habits, while someone will have to undergo a serious course of treatment.
In most cases, seals 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 identified neoplasm. Almost all types of benign tumors are subject to surgical removal, since the only reliable method for determining malignant cell transformation is a histological examination of the removed tissues.
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- 1. Raise your left hand, take it behind your head, with your right hand deeply feel the left mammary gland in a clockwise direction. This procedure can be done standing or lying down.
- 2. Lower your hand, feel the chest from the side, under the arm 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 knots and strands;
- heterogeneous tissue of the gland in the form of a "cobblestone pavement", different sizes of formations;
- rounded or oblong seals;
- soreness in the presence of large nodes and fibrocystic mastopathy;
- gradual growth of formations up to 3-4 cm, an 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 a different nature (from serous to bloody);
- chest pain a few days before the onset of menstruation. With the progression of the disease, the symptom persists after menstruation.
- psycho-emotional stress;
- burdened heredity;
- abortions;
- late births or their small number;
- inflammatory pathologies of the pelvic organs;
- late start 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 disease;
- diabetes;
- metabolic syndrome;
- dysfunction of the adrenal cortex.
- oval shape of the node (in 90% of cases) or rounded;
- sizes are on average 1-2 cm;
- smooth or large-hilly contours;
- dense texture;
- good mobility during palpation, since fibroadenoma is not associated with 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 the size of the original.
- fast growth;
- adhesion to the skin (during palpation, it does not move);
- a clear delimitation from the rest of the tissues of the gland;
- layered structure;
- painlessness or slight pain when pressed;
- with a significant size of the tumor - thinning of the skin above it and the acquisition of a cyanotic hue;
- the most common localization is in the upper part of the mammary gland.
- the form of a dense node (less often - a diffuse appearance, spilled into the surrounding tissues);
- the location is most often in the upper outer part of the gland or above the chest;
- soft to the touch texture, but if there is a lot of connective tissue, then more dense;
- when pressed - the ability to strongly compress;
- 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 stretching the skin over the formation - its "retraction" deep into.
- 1. Angioma- round or oval, soft to the touch, bluish or pink subcutaneous tumor. If it is located deep in the tissues, then the symptoms are almost indistinguishable from a lipoma.
- 2. Leiomyoma- according to external signs, it is similar to fibroadenoma, the diagnosis can only be established by histological examination of a remote neoplasm.
- 3. Chondroma- a benign dense tumor formed from cartilage tissue. Diagnosis is carried out using ultrasound, mammography, puncture biopsy.
- 4. Osteoma- a tumor that appears from the bone tissue near the chest wall. Occurs extremely rarely.
- 5. Lipogranuloma- a formation that develops with aseptic necrosis of the fatty tissue of the breast as a result of injuries, excessive physical exertion, after operations, injections. Initially, it appears as a tumor, often soldered to the skin and retracting the nipple. Subsequently, damaged tissues are scarred and compacted.
- 6. Mondor disease- a cord formed under the breast from the mammary gland to the armpit or navel. Consolidation appears as a result of vein thrombosis.
- insufficient emptying of the breast;
- prolonged lying on one side in a dream, a position on the stomach, in which the mammary glands are compressed;
- improper attachment of the child 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 the mammary glands of a woman.
- take a warm shower and lightly massage the damaged breast before feeding the baby;
- attach the baby to the sore chest so that his eyes look towards the seal;
- Express manually the rest of the milk if the baby has not completely emptied the breast.
- 1. Serous. Characterized by a slight swelling, pain, elasticity and soreness of the tissues of the gland, skin color does not change. Body temperature can rise up to 39 degrees.
- 2. Infiltrative. A painful formation with fuzzy contours appears, the lymph nodes under the armpits increase and hurt. There are chills, sweating, deterioration of the general condition, body temperature reaches 40 degrees.
- 3. Abscessing. Her symptoms are the same as in the previous case, characterized by increased signs of intoxication. The contours of education become clearer.
- 4. Phlegmonous. The mammary gland turns red, when pressed with fingers, a fossa is formed, “swelling” is felt, the nipple is retracted. The intoxication syndrome grows even more, turning into sepsis.
- 5. Gangrenous. With the further development of the process, tissue necrosis begins, the mammary gland increases, acquires a blue-purple color, becomes covered with blisters and areas of necrosis.
- pumping milk (manually or with a breast pump);
- applying cold compresses for 10-15 minutes (only on the first day);
- decrease in fluid intake;
- taking drugs that suppress lactation (based on bromocriptine, a combination of estrogens with androgens);
- antibacterial therapy;
- dry heat (starting from the second day of treatment);
- physiotherapy: UV, UHF, ultrasonic exposure;
- in the presence of an abscess - a surgical operation.
- dense texture;
- fuzzy contours;
- limited mobility;
- enlarged axillary lymph nodes;
- some women have soreness (5-20% of cases).
- the formation of a flat area on the surface of the mammary gland, resulting from the 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 a violation of the lymph flow in the tissues;
- nipple retraction;
- swelling, thickening of the skin;
- the appearance of ulceration in advanced cases, when the tumor is already growing 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 delivery;
- the woman's age is over 50;
- the presence of hyperplastic processes in the breast.
- lipoma: Vietnamese "Asterisk", Vishnevsky's ointment, egg films, compress with raw onion and aloe leaf;
- fibroadenoma: compresses based on honey, verbena, raw potato juice;
- mastopathy: compress from the bark and leaves of birch; beets and honey laid out on a cabbage leaf; gruels from a leaf of a burdock, castor oil and honey;
- cyst: infusion of red brush, chaga, compresses from St. John's wort, burdock root, large-leaved gentian;
- mastitis: compresses from honey with wheat flour, chopped cabbage leaves, camphor oil, baked onions, sweet clover, coltsfoot leaves;
- crayfish: potato flowers, hemlock, celandine, aronnik root, chaga (ingestion).
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Causes of lumps in the chest and self-diagnosis
A lump in the chest can appear for various reasons. The greatest fear in women is breast cancer, one of the features of which is that in the early stages of its occurrence, as a rule, there are no painful sensations and the disease can be asymptomatic. The earlier a woman discovers a malignant tumor in herself, the more favorable the prognosis - removal of a cancerous tumor at an early stage, when there are no metastases yet, provides 95% of 10-year survival.
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, seals in the chest are detected by patients on their own. Smaller formations are diagnosed only with the use of instrumental methods (ultrasound, mammography). Since outwardly benign tumors cannot be distinguished from cancer at the initial stage, women over 35 years of age should be screened annually.
The most common causes of the formation of a seal 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 of their types are prone to malignancy (fibroadenomas, leaf-shaped tumors). They require regular monitoring.
Tumor types
In young nulliparous women, there are sometimes lumps over 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. Breast engorgement and enlargement during the premenstrual period is normal and disappears 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, because of which it hurts. One or both breasts are affected. This condition is called a chest infarction, and in the absence of medical care, in many cases a purulent process develops with a general intoxication of the body. Treatment is carried out only by a surgical method.
Intraductal papilloma
Intraductal papilloma can be detected by probing the areola of the nipples. These formations are most often small, but with the active growth of papillomas for several months they can reach a size of several centimeters. A characteristic symptom of the disease are serous or bloody discharge from the nipple. Usually this symptom is the only complaint of the patient. 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 (breast gland like "Swiss cheese"). Single small papillomas are more often formed in women over the age of 60, and multiple ones in young women.
Intraductal papilloma
This pathology is considered a precancerous condition and is subject to mandatory surgical removal with subsequent histological examination. The optimal method for diagnosing formations is ductography - an x-ray examination with the introduction of a radiopaque substance.
During the operation, the ducts are cut off from the nipple. An incision is made at the bottom of the nipple along its halo for best access and for cosmetic reasons. If the papilloma has formed in the central ducts, then after the operation, the lactation capacity of the mammary gland is disturbed.
Mastopathy
This is the most common benign disease of the mammary glands (90% of all patients), in which their tissues grow. Depending on what elements prevail in the tissues of the gland, there are several forms of mastopathy:
Symptoms of the disease are:
Until the age of 30, a woman's subjective sensations may be completely absent. 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 degree of risk of developing cancer in this disease increases in the presence of cystic changes and depends on the severity of tissue growth. Treatment for the diffuse form is conservative, with the use of hormonal medications (based on progestin, thyroid hormones, contraceptives) and non-hormonal drugs (vitamins, adaptogens, enzymes, iodine and potassium preparations, hepatoprotectors, diuretics and sedatives, herbal remedies).
Adenoma
Breast adenoma usually does not exceed 3 cm in diameter; on palpation it is detected in the form of a ball, which does not differ much from other tissues in density. In some cases, when pressed, you can feel the lobular structure of the formation. Since the adenoma has a capsule, it is well delimited from the rest of the tissues in the mammary gland.
Education does not hurt when pressed. The tumor is formed most often in the peripheral areas - in the lower part and on the lateral surfaces of the gland. Another characteristic feature is good mobility - the adenoma can be moved with the fingers for some distance.
In pregnant and lactating mothers, the so-called lactating adenoma is found - 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 in the sectoral removal of a part of the gland with an adenoma. It must be eliminated along with the capsule, otherwise a relapse occurs. The surgical material is sent for histological examination to identify altered cells.
In rare cases, an adenoma of the nipple of the mammary gland is detected, which is formed from the epithelium of the sweat glands. In adolescent girls, it can reach a large size 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 disorders or injuries. Formations can appear at any age, most often at 30-50 years old, 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 with a size of 1-1.5 cm are regarded as medium, and more than 2 cm as large.
With hormonal changes, the secretory activity of the gland and the growth of the 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 breast. In case of trauma or swelling of the mammary gland, its adipose tissue is destroyed and an oily fluid accumulates. Cysts also appear with mastopathy. Large formations under pressure have a characteristic "ripple".
breast cyst
Medium-sized cysts can be treated conservatively, while larger cysts are subjected to needle 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 transformation. Atypical cysts are removed surgically.
A type of cyst is a galactocele, the contents of which become milk. When palpating, a smooth formation is detected, which is delimited from the surrounding tissues and easily shifts when pressed. Appears as a result of blockage of the milk passage, often with mastitis, when taking prolactin-stimulating drugs, or with a pituitary adenoma. It is 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 the lobules of the breast, most often in the upper breast. These benign formations are most common in women at a 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 the effect of estrogens during puberty, pregnancy, premenopausal and menopausal periods when using hormone replacement therapy.
Fibroadenoma is characterized by the following symptoms:
Remote fibroadenoma
It differs from adenoma in a denser structure and the absence of pronounced lobulation.
Up to 2-7% of tumors can become malignant. If there is a rapid growth of education, then this is an indication for its removal. As a diagnosis, ultrasound of the mammary glands, mammography, fine-needle biopsy to detect cancer cells are performed. Small tumors less than 1 cm in size may not be removed. At the same time, regular monitoring of fibroadenoma is carried out.
Hamartoma
Hamartoma (fibroadenolipoma) is more dense to the touch than fibroadenoma, and consists of three types of tissues: 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; relative to the surrounding tissues, the hamartoma has good mobility.
Giant hamartoma
When performing a fine-needle biopsy, the aspiration material contains breast tissue, which is a distinctive feature of this formation. The operation to remove it is performed in cases where questionable results are obtained or when the hamartoma is large in order to eliminate a cosmetic defect.
Leaf tumor
A leaf-shaped tumor is one of the varieties of fibroadenoma. Its characteristic features are:
The formation is benign, but it can degenerate into cancer and sarcoma (20-25% of cases), metastases spread to bones, lungs, and other organs. The only treatment is surgical removal (sectoral resection of part of the gland tissue or complete removal if larger than 8 cm).
Tumor growth can be triggered by hormonal disruptions or hormone-containing drugs.
Leaf-shaped tumors are most common at the age of 45-50 years. This kindprone to reappearance 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 for the diagnosis and removal of a leaf-shaped tumor.
Lipoma
Lipoma, or wen, is a benign tumor of adipose tissue. It has the following features:
Lipomas are formed mainly in women in old age. In rare cases, they can develop into liposarcomas, so they need to be monitored (ultrasound 3-4 times a year, mammography and cytological examination of a smear from the nipple). If the lipoma grows rapidly, compresses the surrounding tissues, pain appears in the mammary gland, 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 for Mondor's disease, surgical removal of neoplasms is performed.
lactostasis
During lactation, the outflow of milk may be disturbed in the mammary glands of a nursing mother due to blockage of the ducts, resulting in a painful hardening. The tissues of the gland perceive the return of milk as a foreign substance, an inflammatory process develops with fever, redness and swelling of the breast, and the pain becomes so severe that it is impossible to touch the breast.
The causes of lactostasis can be several factors:
Most cases of lactostasis are noted in the 2-3rd week of a child's life, when the mother actively "comes" milk. This phenomenon is more typical for women who give birth for the first time after 30 years. If left untreated, milk stasis leads to the development of lactational mastitis.
To eliminate solid formation in the breast and restore lactation, the following measures are recommended:
If there is a high temperature, severe pain, purulent discharge, or if it is impossible to “dissolve” the breast on your own, you should consult a doctor. A well-known folk remedy for the treatment of lactostasis is cabbage leaves, which are preliminarily doused with boiling water or lightly beaten so that the juice comes out, 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 becomes staphylococcus aureus (in the rest - streptococcus, E. coli, anaerobic microorganisms). Most often it develops in the postpartum period in nulliparous women.
There are several forms of this disease:
Feeding on the affected breast must be stopped. Treatment is carried out with the help of the following activities:
Mammary cancer
For breast cancer at the initial stage, the following symptoms are characteristic:
In the later stages, the following symptoms appear:
Mammary cancer
With early detection of a cancerous tumor, when its size does not exceed 2.5 cm, partial removal of tissues 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 are:
ethnoscience
Treatment of formations in the chest can be carried out using folk remedies:
To restore hormonal balance, it is recommended to take phytohormones contained in geranium, marshmallow, plantain, barley, soy, calendula, grape seeds, germinated wheat grains, ginseng roots.
Appearance in the mammary gland of any seal, similar to a pea, cherry, plum, etc. - an excuse to see a doctor. First of all, this may be therapist or gynecologist. These specialists will refer, if necessary, to an oncologist or mammologist, with a visit to which in no case should be delayed. If you are worried about the situation with an incomprehensible compaction, and the gynecologist advises "just to be observed", contact to an oncologist or mammologist on your own. Still, we are talking about your health and peace, which is likely to be violated until the situation is fully clarified. You can drive yourself to the oncology dispensary, where no one will definitely refuse to be examined.
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 revealed anything in yourself and nothing is alarming you. Specialists use specific types of examination to confirm the diagnosis, and therefore ultrasound and mammography studies It is better to follow the doctor's prescription. In general, an ultrasound examination of the breast can be performed in women of any age, although at an older age it is less informative. Ultrasound allows you to see the state of the supraclavicular sphere, changes in which may indicate the same cancer. Somewhere after 40 years, mammologists advise to undergo an annual mammogram examination which is performed free of charge in the direction of a doctor. It has been proven that the annual performance of mammography after 50 years reduces mortality from breast cancer within 20-30 years by 25-30 percent.
Over the past 15 years, we have significantly decreased incidence of breast cancer. 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 some time ago 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 latest medical hotline.
Hardening and induration in the chest
- Brest, Margarita Iosifovna. I have found hardening in the chest. She did an ultrasound. The doctor said that this hardening is not attached to anything and, most likely, you should not worry. Is it so?
Women should not take the advice of diagnosticians about what to do with this or that education. These specialists should only find something or not find it. And then the question of treatment tactics decided by the oncologist. Contact him. Most likely, the neoplasm will need to be removed.
- Minsk, Svetlana. At the end of September, I had an operation due to focal mastopathy. Hardenings inside that appeared after the operation still do not resolve. Is it normal?
It could be one of norm options. The mammary gland, as a rule, swells after the operation, 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 up to three months hardening in the area of the scar does not resolve you need to see a specialist. It may be necessary to do an ultrasound examination to make sure that nothing new has appeared there.
- Mogilev, Nadezhda. Six months ago I had bruised chest. Recently, hardening has appeared in this place. Could it be dangerous?
Maybe. 5 to 45 percent of breast tumors reappear 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 it was there before, and the injury only provoked its faster growth. But the fact remains: trauma is one of the causes of breast cancer. Therefore, you should definitely seek advice from an oncologist. And it is better to do a small operation to remove the hardening. Let there be nothing wrong with it, but it is better to do it than to waste time and then regret it.
- Minsk, Vera. How seriously should breast lumps be taken? How long - weeks, months - can you wait until the situation returns to normal?
A woman who herself discovered a lump in her breast has only time to find a good doctor, and search must start on the same day. The presence of a seal makes a woman think of the worst, but you never need to self-diagnose. 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 soon as possible. There are two reasons for this: if you still expect cancer, then the sooner treatment begins, the higher the chances of achieving a positive result. Secondly, if a woman delays a visit to the doctor, she still will not get rid of disturbing thoughts. You don't have to be afraid of anything. Actually every third woman in our country today is operated on with preservation of the mammary glands.
Mastopathy
- Brest, Tatyana Ivanovna. I'm 40 years old. In the antenatal clinic, they diagnosed - focal mastopathy. How dangerous is this and what should I do?
Mastopathy is diffuse and 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, which can be determined by hand. By itself, mastopathy is not life threatening. But the danger may be that sometimes breast cancer is disguised as mastopathy. Therefore, any focal formation is a reason for contacting 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. She was treated for two months, the cysts were cauterized. But now they have grown again. How to be?
Cysts, as a rule, do not operate. The liquid is removed from them with a syringe. And then treated conservatively. However, if cysts reappear, then, first of all, you need to determine the cause of their appearance. Cysts do not appear in an empty place.
- And 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 chest”, Noting that those women who are a lot nervous, as a rule, have various changes in the mammary gland.
The second group of reasons are hormonal disorders. It matters when the periods began and ended. If menopause does not occur before the age of 52, then the risk of breast disease increases. A woman who gave birth for the first time at age 20 has about a 1.5 times lower risk of breast cancer compared to one who gave birth after 30 years and even more so after 40. The more a woman has had abortions, the higher the risk of the disease. But the more children she has, the less likely she is to get breast cancer. The function of the thyroid gland, liver matters.
The third group of reasons is related to ecology, physical activity, lifestyle. Of course, bad habits also do not add health. Large doses of alcohol - for example, three glasses of wine a day or 50 grams of vodka - increase the risk of breast cancer. Smoking is one of these risk factors. There are a lot of carcinogens in the smoke, which are absorbed into the bloodstream and can affect the state of any organ.
- Oshmyany, Oksana. 44 years old. What does the diagnosis "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 tissues are formed, and among them, cysts can form in the ducts. If they exist for a long time, then their walls can become denser, and then they are removed. Just a puncture will not save here, since liquid will collect again and again in the dense walls. Usually soft-walled cysts are removed by puncture. If after this examination shows that everything is in order, then only conservative, drug treatment is prescribed. If the cyst is filled, then it must be removed surgically.
Other questions and answers of this direct line:
- Mammologist's answers: benign and malignant breast tumors
Prepared based on the materials of the direct line of the newspaper "Zvyazda" (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
