What is an anal fissure?
An anal fissure (fissures) is a tear or crack in the lining of the anal canal (anus), which causes extreme pain during bowel movements. Anal fissures affect everyone, from men and women to young and old people. It is the most common cause of rectal bleeding in infancy. A fissure tends to occur when passing hard or large stools during a bowel movement. There may also be spasms in the ring of muscle at the end of the anus.

What is the cause of an anal fissure?
Common causes of an anal fissure include passing large stools, constipation and straining during bowel movements, chronic diarrhoea, inflammation of the anorectal area and childbirth. The less common causes of anal fissures include anal cancer, HIV, tuberculosis, syphilis and herpes.

What are the symptoms of an anal fissure?
The symptoms of an anal fissure include:

• Pain, which can sometimes be severe during bowel movements
• Pain after bowel movements
• Blood on the stool or toilet paper
• Itching or irritation around the anus
• A visible crack in the skin around the anus
• A small lump on the skin near the anal fissure

How is an anal fissure treated?
An anal fissure will often heal within a few weeks if the stool is kept soft through increasing the intake of fibre and fluids. Soaking in a warm bath for 10 to 20 minutes daily, especially after toilet use, helps to relax the sphincter and helps it to heal. A doctor may recommend topical anaesthetic creams for pain relief. A Botox (Botulinum toxic type A) injection can paralyse the anal sphincter muscle and aids in relaxing spasms. Blood pressure medications can also help relax the sphincter.

How to prevent an anal fissure?
By preventing constipation it may help in preventing an anal fissure. Constipation can be prevented when eating high-fibre foods, drinking water and regularly exercising to stop from straining during bowel movements.

Risk factors for developing an anal fissure

• Infancy – experts are not sure why but many infants experience an anal fissure during the first year of their life.
• Aging – as an adult ages there is a decrease in circulation and blood flow to the rectal area.
• Constipation – straining when trying to pass hard stool can increase the risk of tearing.
• Childbirth – anal fissures become common in women after they give birth.
• Crohn’s disease – the inflammatory bowel disease causes chronic inflammation of the intestinal tract and this makes the lining of the rectum vulnerable to tearing.
• Anal intercourse. 

What are benign breast lumps?

A benign breast lump is caused by the excessive growth of normal cells and tissues. The growth is not cancerous; it consists of tissue that helps to support the breast. There are common causes, which include changes in tissue, an infection, injury and medicines. Breast tissue is sensitive to hormone levels that change during the menstrual cycle. The most common types of benign breast lumps are known as fibroadenomas.

Symptoms of benign breast lumps

The main symptom is the appearance of a hard cyst in the breast, which is painless when touched and which, not being attached to the skin, moves around. Other symptoms include breast discomfort and tenderness, irregular nodules or small lumps and dense breast tissue.
 

What are the causes of benign breast lumps?

Currently, the cause is not known, although it is believed that it may be due to a hormonal imbalance. It primarily affects women during puberty, the menstrual cycle and pregnancy. However, it also occurs, at a lower frequency, in postmenopausal women.
 

Can it be prevented?

There are some everyday measures that may help prevent the development of benign breast lumps. These are:

• Monthly breast self-examination and observation.
• A healthy diet.
• Reducing intake of Tran saturated fats and carbohydrates, as these raise the level of oestrogens, which stimulate breast tissue.
• Avoiding caffeine, which contains methylxanthines, a substance that can overstimulate the growth of breast tissue.
• Not wearing bras so tightly that blood circulation is hindered.
   

What is the treatment for benign breast lumps?

A diagnosis is made using ultrasound and further refined with a needle biopsy. Given that benign breast lumps are related to hormonal changes in women, they do not always have to be removed and usually disappear by themselves within a couple of years. Surgery is performed when the lump is growing rapidly, is causing discomfort or for aesthetic reasons. However, medical tests are necessary if a tumour is suspected.

Breast cancer is a form of cancer that develops in the cells of the breasts, mainly in women but men can also be affected. It is the most common type of cancer in the UK, with approximately one in eight women diagnosed with breast cancer during their lifetime, and around one in 870 men develop it. Although it is the most common form of cancer, the recovery rate is high if the cancer is discovered early.

What are the symptoms of breast cancer?

The most notable symptom of breast cancer is the formation of a lump anywhere in the breast area from below the armpits to the centre of the chest. It may appear as a physical lump, or the thickening of breast tissue.

Other symptoms include changes in the size or shape of the breasts, dimpling of the skin of the armpits, a rash around the nipples, discharge from the nipples, or a sunken area in either of the breasts.

What are the causes of breast cancer?

The causes of breast cancer are not known, however it is understood that there are certain factors that can cause an increase in the risk of developing breast cancer.

People more at risk of breast cancer include:

• Those aged over 50 years old
• Those with a family history of breast cancer
• Patients who have previously had breast cancer
• Patients who have had a previous benign breast lump
• Tall people are slightly more at risk from breast cancer
• People who drink alcohol excessively
• People who are overweight or obese

What are the different types of breast cancer?

Cancer can develop in different parts of the breast and in different ways.

The most common types of breast cancer are:

• Non-invasive breast cancer (carcinoma in situ)

  
  Non-invasive breast cancer forms in the milk ducts within the breast. It does not grow to the normal surrounding tissues. This form of cancer is usually detected with a mammogram, and doesn’t usually show as a lump.

• Invasive breast cancer

  
  Invasive breast cancer is the most common form of breast cancer, and also the most dangerous. This form of breast cancer can spread to the surrounding tissues. It often shows as a lump or thickening of the breast tissue.

How is breast cancer treated?

It is important to detect breast cancer early, as early detection means that it can be treated more effectively before it is able to spread.

Treatment usually consists of three components: surgery to remove part or all of the breast tissue where the cancer is located, known as either a mastectomy to remove the complete breast, or a lumpectomy to remove the lump. Chemotherapy and/or radiotherapy to kill any remaining cancerous cells follows, along with the possibility of hormone or biological treatments.

To make an appointment with a breast cancer specialist, click here.

Breast cancer has various surgical treatment options and all are best done when the cancer is in its early stage. The surgery depends on the size, location and extent of the tumour(s).

• Lumpectomy: removal of the tumour only.
• Quadrantectomy: removal of the quadrant of the breast where the tumour is located.
• Mastectomy: removal of the entire breast.

There are many types of breast surgery, including reconstructive surgery, augmentation (breast implants), and reduction. Undergoing surgery is a major decision which should be reflected upon and discussed in detail with a specialist before surgery is decided upon. People may seek cosmetic breast surgery for many reasons, and nowadays there are many options to choose from, meaning the procedure can be truly tailored to the patient. 

What is a breast ultrasound?

A breast ultrasound is an imaging technique used to screen for tumours and abnormalities in the breast tissue, such as cysts. An ultrasound uses sound waves to form images of the inside of the body. The sound waves bounce or echo off surfaces in the body which are recorded and transformed into videos or photographs.

What does a breast ultrasound involve?

Prior to a breast ultrasound a doctor will have conducted a physical exam of the breast. Then you will have to undress from the waist up and lie down on the examination table. A clear gel is applied to the breast being examined. This gel is harmless and helps the ultrasound produce clearer images. A paddle-like probe instrument is applied to the breast and moved across it. A test will take between 10-20 minutes. Once the relevant images have been recorded, the gel is wiped off and the procedure is complete.

Why is a breast ultrasound done?

A breast ultrasound is most commonly performed if there is a suspicious lump found in the breast. This lump could be a sign of breast cancer and an ultrasound will help determine whether it is a tumour or a fluid-filled cyst. Although a breast ultrasound can detect a tumour, it is not able to determine if it is cancerous or not. A biopsy will be performed to determine this, which can also be guided by ultrasound.

Preparation for a breast ultrasound:

No preparation is required for a breast ultrasound, however, it is advised not to apply perfumes or lotions to the breast skin. It might also be helpful to wear a two-piece outfit to the test to aid undressing.

What does it feel like during a breast ultrasound? 

A breast ultrasound is painless, however, the gel applied can feel a little bit cold.

What do abnormal results mean?

The ultrasound images are black and white, and a lump or abnormality will usually show up as dark. 

The following are potential findings from a breast ultrasound:

•    Fibrocystic breasts – painful and lumpy breasts caused by hormonal changes.
•    Adenofibroma – a benign, non-cancerous breast tumour.
•    Intraductal papilloma – benign tumour of the milk duct.
•    Malignant tumour – a cancerous breast lump.

A cancerous tumour will be tested further, usually by an MRI scan and then a biopsy. These further tests will confirm whether or not the lump is cancerous.

What is an epigastric hernia?

An epigastric hernia is when fat or body tissue protrudes through the abdominal wall, between the sternum of your rib cage and your belly button. Often there are no symptoms with this type of hernia and they often go unnoticed. This type of hernia is usually small and you can have more than one at a time. Despite showing few symptoms, they can sometimes cause pain in the upper abdominal region. 

What are the symptoms of an epigastric hernia?

Although symptoms with an epigastric hernia are uncommon, a noticeable bulge might present especially when you cough, sneeze, laugh or strain. Sometimes this type of hernia can cause pain and tenderness in the affected area. 

What causes an epigastric hernia?

This type of hernia is usually present from birth due to incomplete abdominal wall development. 

What is the treatment for an epigastric hernia?

These hernias do not heal themselves and surgery is required to repair them.  However, unless the hernia becomes an emergency surgery can be delayed until the patient feels ready, or when a child becomes older. Often when adults are diagnosed with an epigastric hernia, it has become problematic due to obesity, muscle weakness or frequent strain on the abdominal wall due to heavy lifting or straining. 

Surgery can be peformed either openly, or laparoscopically. General anaesthesia is used. If the defected muscle opening is small then sutures usually suffice to close the hole. However, for larger muscular defects, an inserted mesh might be needed to restore strength to the abdominal wall. Such a mesh is permanent and stops the hernia from returning. 

Most patients are able to return to their normal activities within two to four weeks following surgery. 

What is a femoral hernia?

A femoral hernia is fairly uncommon and is most commonly found in women. Femoral hernias are found in the groin region and can appear as a painful lump on the inner, upper thigh. The lump can be pushed back in and can sometimes become more prominent when straining or coughing. It is estimated that only 1 in 20 groin hernias are femoral hernias, and are mostly inguinal hernias. They are more common in women because women have a wider pelvis. 

What are the symptoms of a femoral hernia?

Some people with a femoral hernia do not notice any bulge, lump or pain, however, larger femoral hernias produce a visible bulge in your upper thigh which can be painful, especially when straining.

What causes a femoral hernia?

A femoral hernia is the result of fatty tissue or a section of the bowel protruding through into the groin on the top of your inner thigh. The section where the protrusion can occur is called the femoral canal and is considered a weak spot in the abdominal wall muscles. The actual causes of a femoral hernia are:

• heavy-lifting
• straining on the toilet
• obesity
• a persistent, heavy cough
• childbirth

What is the treatment for a femoral hernia?

Unlike other types of hernia, femoral hernias usually require treatment straight away due to potential complications associated with them. Surgery can be performed to put the bulge back into place and to fix the weakened abdominal wall. Complications that can result from femoral hernias include:

Obstruction where part of the bowel can become stuck in the femoral canal resulting in nausea and pain.
Strangulation where the stuck section of bowel has its blood supply cut off (ischaemia), which required immediate surgical attention so that blood supply is restored and the tissue doesn’t die.

Surgery for treating femoral hernias can either be open surgery, or it can be performed laparoscopically. Patients can usually return home either the same day or the following day. 

What is gynaecomastia?

Gynaecomastia, occasionally referred to as ‘man boobs’, is the medical term for enlarged male breasts. It is a common hormonal disorder that only affects males, making their breasts larger than normal due to an excess quantity of male breast tissue. It usually occurs more in teenage boys and older men.

The extent of gynaecomastia symptoms varies from person to person. Some males find they have a small amount of excess breast tissue around their nipples, whilst others may have noticeably larger male breasts. In some cases, gynaecomastia may cause discomfort or tenderness in the breasts.

What are the causes of gynaecomastia?

There are several causes of gynaecomastia. One of the main causes is believed to be hormone imbalance, when more oestrogen is produced than normal and less testosterone. Oestrogen causes male tissue to grow at an abnormal rate. Although all males produce a certain amount of oestrogen, they also produce bigger quantities of testosterone which prevents the growth of breast tissue. In some cases, the reason for this hormonal balance is not known.

Obesity can also cause gynaecomastia, as being overweight may increase oestrogen production making the breasts larger. For this reason, patients who have dieted and done exercise to lose weight may find that they still have enlarged breasts.

Gynaecomastia in newborn babies occurs due to oestrogen passing from the mother through the placenta and to the baby. The breasts usually return to a normal size a few weeks after the baby’s birth. During puberty, some male adolescents may also find that their breasts grow as their hormone levels vary, but this usually stabilises as they grow older. Gynaecomastia in older men is caused by decreased production of testosterone. As older men often have more body fat, their oestrogen production increases thus causing the breasts to enlarge.

Other possible causes of gynaecomastia include drinking too much alcohol, and consuming illegal drugs or prescribed medications, among others.

Can gynaecomastia be prevented?

Although the condition is not always avoidable, there are some measures one can take in order to prevent gynaecomastia. These include following a proper diet, exercising, drinking less alcohol, avoiding certain drugs and medications such as steroids and marijuana (which has been linked to increased levels of oestrogen production).

What is the treatment for gynaecomastia? 

In some cases, treatment for gynaecomastia may be recommended. Gynaecomastia treatment includes breast reduction surgery to remove the excess male breast tissue, or medication aimed at correcting the hormonal imbalance behind enlarged male breasts. 

What is an inguinal hernia?

A hernia occurs when part of the internal organs or tissue pushes through a weakness in the muscle wall. An inguinal hernia is said to occur when part of the bowel or fatty tissue pushes into the groin at the top of the thigh. It is also the most common type of hernia, particularly in a male. Inguinal hernias are rare in females.

What are the symptoms of an inguinal hernia?

Symptoms of an inguinal hernia are a swelling or a lump in the groin or an enlarged scrotum. There may also be associated pain or discomfort, pain when coughing or lifting, or a dragging sensation in the groin. A bulge either side of the pubic bone could also be a sign of an inguinal hernia.

The hernia may be pushed back in when lying down, however complications can occur whereby the hernia gets stuck or trapped and obstructs the bowel, or the hernia becomes strangulated, whereby the blood supply gets cut off. This is potentially very serious, even life-threatening and requires immediate attention. Symptoms of a strangulated hernia include vomiting and nausea, fever, sudden pain, a bulge that turns red or purple, or an inability to pass stools or gas.

What causes an inguinal hernia?

In males the testicles descend during development via a small opening in the groin. This process leads to a weakness in the abdominal wall and is the cause for inguinal hernias. In a boy there is usually a sac which accompanies the testis. Generally it is supposed to close but occasionally the sac remains, leading to a hernia.

In adults, undue straining such as heavy lifting, violent coughing or prolonged straining on the toilet may cause the hernia to develop due to the underlying weakness in the groin. Loss of elastic tissue due to the ageing process also leads to inguinal hernias. It is not unusual for hernias to occur in both groins. 

How can an inguinal hernia be prevented?

Avoiding undue pressure in the abdomen by straining when passing stool or urinating or carrying and moving heavy loads can reduce the risk of an inguinal hernia, however many hernias may be unavoidable as they have no apparent cause. Strain on the abdominal muscles can be reduced by maintaining a healthy weight, eating a high-fibre diet and stopping smoking.

What is the treatment for an inguinal hernia?

Surgery is the usual treatment for inguinal hernias. In some patients a non-surgical option, such as a hernia truss, may be appropriate. Occasionally it may be appropriate to wait and watch and monitor the hernia. Surgery becomes an emergency for hernias that cause severe pain or that have developed complications. Strangulation, where the bowel has become trapped, is one such complication and it requires immediate treatment to restore the blood supply via surgery. 

A lipoma is a benign lump that forms under the skin, usually made from fatty tissue. They usually grow slowly and are situated between the skin layer, and the muscle layer beneath.

Lipomas are more common in middle age, are usually painless, and most commonly appear on the upper back, shoulders and abdomen.

What causes a lipoma?

The cause of lipomas is unknown. It is believed that they may be genetic, so if your parents or other members of the family had lipomas, then you may also be prone to developing them. They can often appear after an injury, though the reason they form is unknown.

What are the symptoms of a lipoma?

As previously mentioned, lipomas are usually painless, though can cause some pain if they press on nearby nerves. They appear as soft, doughy lumps ranging in size from around the size of a pea to as big as a grapefruit. The lumps may move slightly if pressed.

Who is more at risk of developing lipomas?

Although people of any age can develop lipomas, they are more prevalent in adults aged between 40 and 60 years of age.

People with the following conditions are more at risk of developing one or more lipomas:

• Madelung’s disease
• Gardner’s syndrome
• Cowden syndrome
• Adiposis dolorosa

What is the treatment for lipomas?

Lipomas don’t usually cause any problems if left alone, however they can be treated if required.

The most common way of treating lipomas is to have them surgically removed. This can be done by either a dermatologist, or by a plastic surgeon.

Surgery involves making an incision to remove the fatty tissue, before suturing the opening. Though there is a risk that the lipoma may return, it is uncommon.

Another treatment option to reduce the size of the lipoma is liposuction, where a needle is used to remove some of the fat from within the lipoma.

Finally, steroid injections may be used to treat the lipoma. The steroid injection works to shrink the lipoma, though this treatment doesn’t completely remove the lipoma.

What is a lumpectomy?

Lumpectomy is a surgical procedure carried out with general anaesthetic that removes cancer and abnormal tissue from the breasts. It is also known as breast-conserving surgery because compared to a mastectomy only a section of the breast is removed.

Why is a lumpectomy done?

The aim of a lumpectomy is to remove the cancerous tissue whilst conserving the appearance of the breast. Recent studies have indicated that lumpectomy is as effective at preventing cancer returning as a double mastectomy. 

A specialist might recommend a lumpectomy if the cancer found through biopsy is in its early stages and small, as well as being in a suitbale position and only in one area of the breast. Often lumpectomy will be complemented by radiotherapy as well which aims to destroy any remaining cancer cells still in the breast following surgery.

What does a lumpectomy involve?

A lumpectomy is performed using general anaesthesia, meaning you are unaware during the surgery. Firstly the area for excision is located, using a mammogram and biopsy. Once located, the radiologist will place a thin wire or radioactive marker into the section of cancerous breast tissue. This wire placement guides the surgeon in surgery. 

During lumpectomy, the lymph nodes are also often removed. This allows the specialist to determine if the cancer has spread beyond the breast tissue. This will either be done through an axillary node dissection or a sentinel lymph node biopsy. Once tested, if no further cancer is found then no more lymph nodes need to be removed. If there is more cancer, then either further surgery or radiation treatment will be needed.

In surgery, the surgeon makes an incision where the wire is and removes the cancer and surrounding tissue. The incision is closed using stitches, taking care to preserve the appearance of the breast.

How do you prepare for a lumpectomy?

Before surgery, you will have met with your surgeon and discussed how the surgery is performed, as well as expectations for healing and scarring. When you meet your surgeon it is important to have a list of questions you may have so that you understand the procedure and any risks it may carry. 

A lumpectomy can often be carried out as a day-case procedure so a hospital stay is not always required. Prior to surgery certain medications will have to be stopped, and 8-12 hours before surgery you will have to stop drinking and eating. 

Aftercare following a lumpectomy

Following surgery, you will be released from hospital once you are stable and the anaesthesia has mostly worn off. It is important to have someone take you home from the hospital. You can expect the following:

• A dressing over the excision area
• Pain medication (and sometimes antibiotics)
• Some pain or pinching in the armpit area

Getting the results from the lymph nodes will take a week or so and will be discussed in the follow-up appointment with your doctor. Potential further treatment will be discussed in this appointment.

The wound generally takes 2-3 weeks to heal, and it will be bruised and swollen initially. You will be told how to look after the wound at home. It is important to avoid heavy lifting, driving and exercise until your wound has healed.

Are there any alternative treatments to a lumpectomy?

Your breast cancer treatment will depend on where the cancer is located, the size of the cancer, the size of your breasts and your own wishes. Sometimes it is necessary to have a mastectomy (surgery that removes the whole breast). Discussing your options with a specialist will be essential in making your treatment decision.

What are lymph nodes?

Lymph nodes, also known as lymph glands, are small glands found throughout the body and form a part of the lymph system. The lymph system is a network of organs and vessels the carries a fluid around the body between tissue and the blood. The fluid contains white blood cells called lymphocytes.

The lymph system plays an integral part of the immune system, fighting against disease and infections.

Where are they found in the body?

Lymph nodes can be found on their own, or in groups. You can feel groups of lymph nodes in the neck, groin and underarms. You generally cannot feel most lymph nodes in the body, however, if they are swollen in the neck, you are able to feel them.

What do lymph nodes do?

Lymph nodes help to fight disease and they do so by filtering the lymph fluid and trapping any bacteria or viruses that pass through them. They are then destroyed by the lymphocytes, in an effort to destroy such substances before they infect other parts of the body. When lymph nodes are swollen, it usually means that they are exposed to bacteria and viruses and fighting an infection.

What does it mean if my lymph nodes are swollen?

It means that they are likely fighting an infection. However, more rarely, swollen lymph nodes could be caused by an underlying condition such as cancer. Swollen lymph nodes can feel tender or painful.

Depending on which lymph nodes are swollen, it can help determine what the problem might be.

Neck:

• Commonly swollen if you have a cold or sore throat.
• If there is a tumour or infection in the mouth, head or neck.

Armpit:

• These lymph nodes might swell due to injury or infection in the hands or arms.
• Less common causes of swollen armpit lymph nodes are breast cancer and lymphoma.

Groin:

• These will likely swell is there is an infection or injury to the feet, legs, groin or genitals.
• Less common causes of swelling in the groin lymph nodes are lymphoma, melanoma or testicular cancer.

Collarbone:

• If the glands just above your collarbone are swollen, then there is likely an infection or injury in the breasts, neck, lungs or abdomen.

When you should see a specialist

If you are concerned at all, then you should see a doctor, however, it is recommended that you see a doctor if:

• They have been swollen for more than two weeks.
• They are swollen, but for no apparent reason such as infection or injury.
• They feel hard.
• The swollen lymph nodes have been accompanied by a fever.

What is adenopathy (lymphadenopathy)?

Adenopathy is a term that refers to swelling of a gland, typically the lymph nodes (lymphadenopathy). A lymph node is an oval or kidney-shaped organ that forms part of the lymphatic system - a network of nodes, organs and lymphatic vessels situated all over the body. The lymph node’s primary function is to fight infection. The lymphatic system is in fact a vital part of the immune system, helping to identify sources of infection and preventing other parts of the body becoming infected also.

What are the symptoms?

Lymph nodes are located all over the body and consequently, swelling can appear in a number of locations. Common signs of a lymphadenopathy are swelling in the neck, groin, and armpits and under the chin. The swelling can be accompanied by tenderness in the lymph nodes, fever, sore throat and runny nose.

If the swelling has been present for two to four weeks and the lymph nodes continue to get bigger, or the nodes are hard and rubbery and don’t move when pressed, it may be an indication of something more serious. Symptoms might also include night sweats.

What causes it?

Swollen lymph nodes can have multiple underlying causes. Usually, a common infection like measles, common colds, tonsillitis, ear infections, and strep throat is the root cause of lymphadenopathy. Less commonly, certain STIs, tuberculosis, infection from a cat scratch or toxoplasmosis can lead to swelling of the lymph nodes. HIV infection is also a potential underlying cause.

Aside from infections, occasionally autoimmune conditions like rheumatoid arthritis and lupus will cause swollen lymph nodes. In rare instances, swelling of the lymph nodes can indicate cancers such as leukaemia (cancer of the blood and bone marrow) or lymphoma, cancer of the lymph system.

Swelling can also result as a side effect of certain medications. Anyone concerned about the cause of lymph node swelling should see a doctor to establish the cause.

What is the treatment?

Lymph nodes are not treated directly, rather the underlying condition is treated. If the underlying cause is an infection, then the lymph nodes will normally return to normal after the infection clears up.

If swollen lymph nodes are caused by an autoimmune disorder or cancer, then the underlying conditions are targeted.

If the lymph nodes themselves are tender or painful, the symptoms are often treated with over-the-counter pain medication, plenty of rest and warm compressions to help with the swelling. 

A mammography, or mammogram is a breast cancer screening to look for signs of breast cancer in women who otherwise show no signs or symptoms, but can also be used when a breast lump has been detected. Mammography uses x-ray imaging to detect signs of breast cancer in the early stages before they become noticeable.

What happens during a mammography?

A mammography takes two x-ray images of each breast. Each breast is scanned individually, and involves placing the breast on a clear plate on the x-ray machine, where it is gently compressed by another clear plate to flatten the breast. The x-ray images are then taken of each breast.

It may be advisable to wear a skirt or trousers and a separate top, rather than a dress as it will be necessary to strip to the waist. The test is usually carried out by a female mammographer. The images only take a few seconds each time.

Why should you have a mammography?

Breast cancer is the most common form of cancer in the UK, with around one in eight women diagnosed with breast cancer during their lifetime.

Breast cancer screening is really important in finding signs of breast cancer early. An early diagnosis of breast cancer greatly improves the prognosis.

What are the risks of mammography?

Mammograms can often cause anxiety, especially if something is found, which can lead to extra testing. Mammography is not perfect, and often signs of breast cancer may be found which prove to be incorrect, otherwise known as a false positive. Conversely, the opposite can occur where signs are missed, giving a false negative.

Despite this, the test is very worthwhile, as the benefits greatly outweigh the negatives, and detecting breast cancer early is the desired outcome, other than receiving an all clear.

What happens after a mammogram?

Following the mammography test, you should receive your results within two weeks. Around one in 25 women are called back for further testing, with a further one in four women going on to be diagnosed with breast cancer.

Although this can be a very scary time if you are diagnosed, as previously mentioned, an early diagnosis is still preferred as the cancer can then be treated. The recovery rate is high in those patients who have been diagnosed early.

What is mastalgia?

Mastalgia is the medical term for breast pain. There are two main types of mastalgia – cyclic and non-cyclic.

Cyclic pain is connected to the menstrual cycle and, as such, usually occurs monthly. It usually manifests in both breasts, but can be limited to just one, or can also radiate to the armpit and/or arm.

Non-cyclic pain is not linked to the menstrual cycle. It most commonly occurs in women in the 30-50 age range. It is usually limited to one part of one breast and is usually present all the time.

What are the symptoms of mastalgia?

Mastalgia is a symptom rather than a diagnosis, and presents in different ways depending on the type.

Cyclic mastalgia:

• Tends to be a feeling of soreness or heaviness
• Tends to occur in both breasts, and sometimes the associated armpits and arms
• Occurs monthly

Non-cyclic mastalgia:

• Sharp, burning pain
• Usually occurs in one part of one breast
• Usually present at all times

Mastalgia is more common before the menopause.

What causes or produces it?

Cyclic mastalgia is thought to be caused by the normal monthly changes in hormones, but the reasons why this should cause pain, or why it affects some women to different degrees, while not affecting others at all are not fully understood. Research is ongoing, with various theories regarding hormone levels.

Non-cyclic mastalgia may be caused by trauma (a blow to the breast), pain in the chest of neck (perhaps caused by arthritis) radiating to the breast, or possibly a cyst or fibroadenoma (a firm, noncancerous tumour).

It is unusual for breast cancer to cause breast pain, but in some cases painful lumps may be cancerous.

Sore breasts may also be a sign of pregnancy, or brought on by breastfeeding.

How can it be prevented?

You cannot prevent all causes of breast pain, but it is possible to prevent some tenderness and discomfort caused by exercise by wearing a well-fitting sports bra.

What is the treatment for mastalgia?

Treatments vary depending on the cause of the mastalgia.

For cyclic mastalgia, dietary changes, such as cutting out caffeine, reducing fat intake, and taking vitamin E are sometimes recommended. In some cases, medication in the form of hormone supplements, or conversely, hormonal blockers may be prescribed to try to correct a hormone imbalance, but due to possible side-effects, these options should be thoroughly discussed with your doctor. Painkillers may also be recommended, depending on the case.

Non-cyclic breast pain could have a number of different causes, so treatment is very much dependant on the diagnosis. Painkillers, anti-inflammatories, and compresses are often ways to manages the symptoms, but if the cause is a cyst of fibroadenoma, surgery may be necessary. The treatment always depends on the individual case, so you should always consult a doctor when confronted with mastalgia.

What is a mastectomy?

A mastectomy is a surgical procedure performed using general anaesthetic that removes an entire breast. This is used to treat breast cancer and often involves removing most of the breast tissue, skin and the nipple. Depending on where the cancer is present, a single or double mastectomy will be performed. Mastectomy is often followed by breast reconstruction surgery. 

Why is a mastectomy done?

A mastectomy will be recommended if the breast cancer is in a large area of the breast, has spread throughout the breast tissue and if the breast has pre-cancerous cells in it. Also, some women will have a mastectomy if they have a very high risk of developing breast cancer, even if no cancer is currently present.

What does a mastectomy involve?

The surgeon starts by making an incision across the breast so that the tissue can be removed (including the nipple and some skin) as well as tissues that cover the chest muscles. Once the tissue is removed, a drainage tube is placed to prevent fluid build-up within the breast space in the first few days following surgery. The incision will be closed with stitches, eventually leaving a scar that stretches across the chest and into the armpit.

There are different types of mastectomy:

• Standard mastectomy – all breast tissue and skin covering the breast is removed.
• Skin-sparing mastectomy – all breast tissue and nipple is removed, but skin covering the breast is left.
• Subcutaneous mastectomy – a skin-sparing mastectomy, but no nipple is removed.
• Radical mastectomy – a rare procedure where all tissue, skin and nipple is removed as well as the muscles behind the breast and the lymph nodes in the armpit.
• Modified radical mastectomy – the same as above, except the muscles behind the breast are not removed.

How do you prepare for a mastectomy?

Prior to surgery you will have met with the surgeon to ask any questions and be made aware of how the operation is carried out and potential risks to be aware of. You will also be given advice on bras and inserts, if required. You may be receiving complementary chemotherapy as well to reduce the size of the tumours, which you will discuss with your specialist.

Aftercare following a mastectomy

Following a mastectomy, you will have a dressing over the wound, with one or two drainage tubes. It is expected to feel sore for a number of days which painkillers will be administered to manage. Wounds take roughly 2-3 weeks to heal, but a few months for the chest and arm area recovers fully. You will be bruised, stiff and swollen initially. 

Most are able to go home either the same day or the day following the operation. If a breast reconstruction was performed the same day, then staying in the hospital for up to a week will be necessary. 

Arm exercises will be recommended to encourage movement back to arms and shoulders. These can be done as soon as they feel comfortable, usually 3 weeks after surgery. It is essential for recovery to avoid strenuous exercise and driving for up to 3-4 weeks following surgery. 

Patients will generally take between 4-8 weeks off work and normal activities.

Are there any alternative treatments to a mastectomy?

Your breast cancer treatment will depend on:

• where the cancer is located
• the size of the cancer
• the size of your breasts
• your own wishes

Sometimes it is not necessary to have a mastectomy and breast-conserving surgery will be more suitable (lumpectomy). Discussing your options with a specialist will be essential in making your treatment decision.

What is mastitis?

Mastitis is an inflammation of the mammary glands caused, usually, by an infection. Common symptoms include swelling, pain, redness and sometimes a mild fever.

What symptoms does it present?

The usual symptoms of mastitis are:

• Breast pain
• Swelling
• The breast is sensitive to the touch and flushed
• Swollen lymph nodes in the armpits
• Fever and chills
• Fatigue

What causes mastitis?

One of the main causes of mastitis is the lack of hygiene. However, this condition often occurs when a woman is breastfeeding. During breastfeeding, the skin of the nipples can crack and allow the bacteria that live on the skin to penetrate the fatty tissue of the breast. The proliferation of bacteria produces a blockage that makes it difficult for milk to exit through the mammary ducts.

Can mastitis be prevented?

Breastfeeding helps prevent mastitis. When the baby sucks, the ducts are emptied and cleaned of possible infections or obstructions that may occur.

What is the treatment for mastitis?

To eliminate the infection, you will usually be prescribed antibiotics and analgesics to relieve pain. Other recommendations are the application of local heat through damp cloths for 15-20 minutes four times a day, good hygiene, avoiding prolonged periods without breastfeeding or using a milk pump. It is also essential to get enough rest and drink plenty of fluids. If mastitis is not treated properly and the infection gets worse, an abscess may occur. The abscesses must be drained, either through outpatient treatment or surgery.

What is metastatis?

Metastasis is a process wherein cancer spreads from one part of the body to the other, affecting one or more organs. This may also be known as ‘secondary’ cancer, and is a late stage, meaning metastatic cancer has a lower possibility of being cured.

How does metastatis happen?

Cancer can spread from the primary cancer site to other areas of the body through the lymphatic system or through the bloodstream. Cancer cells spread from one organ to another in this way, and tumours then form in other parts of the body. This does not create a new cancer, but rather is a metastised form of the orginal cancer, e.g breast cancer which spreads to the lung does not become lung cancer, but is metastatic breast cancer.

What are the symptoms of metastatic cancer?

Metastatic cancer does not always show symptoms. If they are present, the symptoms of metastatic cancer depend on where the cancer has spread to and how large the tumours are. Symptoms may include bone fractures and pain (when the cancer has spread to the bone), headaches, seizures, and dizziness (when the cancer has spread to the brain), being short of breath (spread to the lungs), and jaundice or swelling in the abdomen (spread to the liver).

What is the treatment for metastasis?

Once cancer has started spreading, it is difficult to then control it and treat it. Some metastatic cancers can be treated, but most cannot. The mainstay of treatment in cases where the cancer cannot be cured is to slow the growth of the cancer or to reduce or relieve the symptoms caused by it.

Treatment for metastatic cancer depends on the primary cancer form and where the cancer has spread.

Is metastasis preventable?

The risk of secondary cancer developing depends on many factors, such as the type of cancer and the age the patient develops the cancer. While secondary cancer can develop, it is important to note that the risk is relatively small. It is not yet possible to entirely prevent metastasis.  

Which specialist treats metastatic cancer?

Cancer is often dealt with by various specialists as different specialties are involved in different areas of the treatment – for example, if surgery is necessary, a surgeon will be involved in treatment. However, the doctor who assesses, diagnoses and treats cancer is an oncologist.

What are haemorrhoids?

Haemorrhoids, commonly known as piles, are swollen veins in the anus or lower part of the rectum. They are a very common ailment. Haemorrhoids may be either internal or external. External haemorrhoids generate protuberances in the ring of the anus on the outer side, making them easier to diagnose and can cause pain when sitting, in addition to traces of blood when defecating. On the other hand, internal haemorrhoids occur inside the anus causing bleeding in the stool and itching in the anal region.

What are the symptoms of haemorrhoids?

The main symptoms of haemorrhoids are:

• Bleeding from the rectum
• Anal itching
• Anal pain, especially when sitting
• Pain when passing stool
• Feeling one or more hard and tender bumps near the anus

What causes haemorrhoids?

Haemorrhoids occur due to increased pressure in the anus. They can be caused by:

• Effort during bowel movements
• Constipation
• Sitting for extended periods of time
• Pregnancy or childbirth

Can they be prevented?

To prevent haemorrhoids, it is necessary to avoid constipation. For this reason, it is important:

• To drink plenty of hydrating liquids
• Eat a diet rich in fibre
• Use stool softeners to prevent straining if you are constipated

How are haemorrhoids treated?

In the case of external haemorrhoids, the treatment consists of applying creams and warm water in the affected area. In cases of severe pain, you can take painkillers. As for internal haemorrhoids, surgical intervention may be necessary to remove them.

This is when the sentinel lymph node (the one closest to the cancer) is identified, removed and tested to test for the presence of cancerous cells. It can decrease the need for further techniques, and is often used with treating breast cancer or melanoma.

The sentinel node is the first of a chain lymphatic draining into a certain tissue territory. This means that before continuing along the chain, lymph coming from that territory must first pass through the sentinel node. The sentinel node is often related to oncology. In the same way that the lymph of a territory must progress through the lymphatic chain ganglia, tumor cells that might be released in that territory must circulate and spread through the lymph chain, the first being the sentry. When cancer cells break away from the primary tumor and circulate through the lymph or blood to other places in the body could form a secondary tumor, a process called metastasis.

What are skin lesions?

Skin lesions are abnormal lumps, bumps, ulcers, sores or coloured areas on the skin. There are two different categories: primary and secondary skin lesions. Primary skin lesions are present from birth or are acquired during a person’s lifetime. Secondary skin lesions appear as a result of irritated primary skin lesions. They occur if someone were to, for example, scratch a mole until it bleeds. Many different conditions such as acne, herpes simplex, allergic eczema and impetigo can cause a skin lesion.
 

What causes skin lesions?

The commonest cause of a skin lesion is an infection on or in the skin, such as a wart or the herpes simplex virus that causes cold sores and genital herpes. Some skin lesions are hereditary, such as moles and freckles. Other causes of a skin lesion can be an allergic reaction or conditions such as diabetes, which causes skin sensitivity.
 

What are the types of primary skin lesions?

The most common types are:

• Moles
• Rashes
• Acne
• Blisters
• Freckles
• Nodule
• Pustule
• Rash
   

What are the types of secondary skin lesions?

The commonest types of secondary skin lesions are:

• Crust
• Ulcer
• Scale
• Scar
• Skin atrophy
   

How are skin lesions diagnosed?

A doctor will examine the skin lesion and ask if there any other symptoms. They may take samples of the skin, perform a biopsy or take a swab of the lesion, which is to be sent for analysis in a lab.
 

How are skin lesions treated?

Treatment of skin lesions is determined by the underlying cause. Topical medications can help treat the inflammation and can stop pain, itching or burning. Some skin lesions, which may become infected, can be drained for relief. There are also home remedies that are recommended such as using lotions for relief from itching and absorbent powders if the skin lesions rub against clothes. Suspicious moles or lesions that may be precancerous are to be removed surgically.
 

How are skin lesions removed?

Lesions can be cut out of the skin, frozen off or removed using heat, laser or light therapy. If a patient has a surgical procedure, it can take up to three weeks for the wound to heal. It takes a few weeks for a lesion to scab and comes off after having cryotherapy.

What is an umbilical hernia?

An umbilical hernia is a type of hernia, which refers to when part of the internal organs protrude through a weakness in the surrounding cavity.

In the case of an umbilical hernia, abdominal fat or part of the bowel passes through an area around the navel.

What are the symptoms of an umbilical hernia?

Umbilical hernias are very common, particularly in babies and are characterised by a bulge around the navel that might get bigger when laughing or coughing. They are usually painless in infants and children, however, in adults who develop an umbilical hernia, the swelling may also be accompanied by pain and discomfort.

What causes an umbilical hernia?

An umbilical hernia develops as a result of a weakness in the abdominal wall at the navel. If the hole through which the umbilical cord passes through during pregnancy doesn’t close properly after birth, it can cause a hernia either at birth or later on in life. In adults, too much pressure in the abdominal cavity can increase the possibility of an umbilical hernia.

How can an umbilical hernia be prevented?

There is little that can be done to prevent umbilical hernias at birth, however, there are certain risk factors for adults. Anything that increases pressure in the abdominal cavity, such as obesity, straining while moving or lifting heavy objects, a persistent heavy cough, ascites (fluid in the abdomen, and having multiple pregnancies (i.e. twins, triplets, etc.), can increase the risk of an umbilical hernia.

What is the treatment for an umbilical hernia?

In infants, an umbilical hernia very often clears up on its own – the hernia goes back in and the muscle reseals over it. In adults, an umbilical hernia will generally get worse over time.

In most cases, it is advised to wait until a child has reached four of five years of age to see if the hernia disappears before considering surgery, except in cases where the hernia is very large or there are other complications.

In most adults, umbilical hernias are treated with surgery to push the abdominal tissue back into place and seal the abdominal wall. Complications can include obstruction where a section of bowel gets stuck outside the abdomen and can cause nausea, vomiting and pain and discomfort. Strangulation, whereby the blood supply to the section of bowel forming the hernia is cut off, is a potentially serious complication and needs emergency treatment to prevent the trapped tissue from dying.