As the nation grapples with the increasing burden of breast cancer, Dr. Rohan Khandelwal, a prominent Breast Onco-Surgeon discusses 2 common patient presentations related to breast problems.

With the expertise of a breast surgeon, Dr. Khandelwal writes about two common issues he sees among his patients and guides on how best the two conditions can be managed.

Nipple discharge

Nipple discharge is a common problem with which ladies present to our Breast Clinic. Nipple discharge can be of many types ranging from clear fluid to frank blood. Greenish nipple discharge is commonly seen in ladies between the ages of 40-55 years. It is common in ladies who smoke and those suffering from diabetes.

Diagnosis

Breast Cancer should be ruled out in all these patients by doing a triple assessment, i.e. clinical examination, imaging & biopsy

Management

• Once cancer has been ruled out, patient should be re-assured, and if there is any inflammation, antibiotics can be given
• In case of persistent discharge and a lump, the implicated ducts can be surgically removed

Axillary Lymph node (underarm gland) enlargement

Axillary Lymph node (underarm gland) enlargement is a common problem among Indian women. Patients usually present with complaints of pain in the armpit and/or lumps in the underarm area. Majority of the times these lumps are reactive in nature, that means they enlarge due to non-specific causes like mild hair follicle infection, which can occur after shaving or waxing of hair.

On the other hand, these glands can also become enlarged due to:

• Infections like tuberculosis, which can be associated with weight loss & fever
• Cancers – commonest cancer which gives rise to underarm nodes is breast cancer

Axillary lymph nodes are the first point of spread from breast cancer.

Diagnosis

An ultrasound can confirm the diagnosis of axillary lymph node enlargement and if these glands do not resolve after a course of antibiotics, they require a FNAC (fine needle aspiration cytology or in simple terms a ‘needle test’)

Management

• If FNAC is inconclusive, then an axillary lymph node biopsy is required to confirm the diagnosis
• Axillary lymph node biopsy is a minor procedure, which can be performed as a day care surgery

Disclaimer-The information and views set out in this article are those of the author(s) and do not necessarily reflect the official opinion of M3 India. Neither M3 India nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein.