Uncomfortable breast symptoms could be caused by a number of problems, most of which are not serious. For example, normal hormone changes in a woman’s monthly cycle can sometimes cause breast pain or even lumps that turn out to be nothing. Still, new breast symptoms can be a sign of cancer, so it’s important to see a doctor if you develop any symptom.

Women can have different kinds of problems with their breasts. The important thing to know is that for most but not all women, most breast related problems are not caused by breast cancer. Even so, if you develop any problem with your breasts, see a doctor or nurse to have it checked out.

Some common breast problems include:

• Breast lumpiness
• Single breast lump (which doctors call a “mass”)
• Breast pain
• Breast tenderness
• Nipple discharge (meaning fluid is leaks from the nipples, such as clear, white, yellow, green, or red fluid)
• Nipple inversion (meaning the nipples point inward instead of outward) and that is new and has occurred in just one breast
• Changes in the skin of the breast, such as redness or puckering

These problems can happen in women of all ages. If you develop any of these problems, see your doctor or nurse. Breast problems are not usually an emergency, but you should get checked out as soon as possible. If there is something serious going on, it’s important to find out quickly. Your doctor or nurse might be able to tell what’s happening just by doing an exam. If not, he or she can order some tests, or send you to a specialist.

Which tests might I need?

Your doctor or nurse will decide which tests you need based on your individual situation. Common tests used to evaluate breast problems are listed below:

• Breast ultrasound – This is an imaging test that uses sound waves to create pictures of the inside of your breast. Among other things, it can show if a lump is solid or filled with fluid.
• Breast biopsy – During a biopsy, a doctor takes 1 or more tiny samples of suspicious breast tissue using a needle. The samples then go to the lab to be checked for cancer or other problems.
• Mammogram – Mammograms are special X-rays of the breast. They can help doctors find breast cancer.

What could be causing the problem?

The breast symptoms listed above could be caused by a number of problems, most of which are not serious. For example, normal hormone changes in a woman’s monthly cycle can sometimes cause breast pain or even lumps that turn out to be nothing. Still, new breast symptoms can be a sign of cancer, so it’s important to see a doctor if you develop any symptom.

Having an abnormal screening (initial) mammogram can cause concern. Fortunately, most women with abnormal mammograms do not have breast cancer. An abnormal mammogram may be due to a mass, a collection of calcium deposits (called calcifications), or other factors.

If you have an abnormal screening mammogram, the next step depends on the type of abnormality found.

• If the abnormality is probably benign (not cancerous), you may be advised to have a follow up mammogram in six months.
• If the mammogram shows an area that is abnormal, the next step is to have additional imaging, with a diagnostic mammogram. During a diagnostic mammogram, a mammography technician works with a radiologist to study the area that feels or appears abnormal. The radiologist can usually review the mammogram immediately and discuss the results with you. In some cases, an ultrasound may be performed to better define the abnormality.

In many cases, the diagnostic mammogram shows that the abnormality is benign (not cancerous), and no further testing is needed. However, if the diagnostic mammogram is indeterminate or suspicious for cancer, a breast biopsy is recommended.

The most common type of breast pain is caused by the hormones that control the menstrual period. These hormonal changes can cause pain in both breasts several days before the menstrual period begins. Because the pain can come and go with the menstrual cycle, it is called “cyclical” breast pain. Cyclical breast pain is not usually caused by breast cancer or other serious breast problems.

Less commonly, a woman can have breast pain that does not come and go with the menstrual cycle (also called noncyclical breast pain). This type of pain is not related to the menstrual cycle and might occur in only one breast or one area of the breast. Noncyclical breast pain is usually caused by a problem outside the breast, such as muscle or connective tissue strain, skin injury, spinal conditions, or problems in another organ system (eg, heart burn, chest pain). Noncyclical breast pain is caused by breast cancer in only a very small percentage of women.

If you are worried about breast pain, speak to your doctor to determine if you need further testing. If testing shows no signs of a serious problem, you can try one or more of the following treatments:

• Pain relief medicines, such as panadol or ibuprofen. Women with very severe breast pain are sometimes treated with a prescription medicine.
• Decrease the dose or stop taking medicines that contain estrogen (after a discussion with your healthcare provider)
• Wear a well-fitted support or sports bra
• Consider making changes to your diet. Elimination of caffeine and a low fat, high complex carbohydrate diet is helpful for some women. Dietary supplements such as vitamin E and evening primrose oil have also been suggested for breast pain, however, this is not effective in everyone.

Having a milky-colored discharge (also called galactorrhea) from both nipples is common, especially during the first year after giving birth. Nipple discharge from both breasts can also occur in women with an underactive thyroid (hypothyroid), as a side effect of certain medications, or because of a growth in the pituitary (a part of the brain), causing an increase in a hormone called prolactin.

As with other ducts in the body, breast ducts make and carry secretions. Many women can express (squeeze out) a small amount of yellowish, greenish, or brownish discharge. This is often called “physiologic” discharge and is not a cause for concern. Physiologic discharge is not bloody.

Spontaneous nipple discharge (discharge that occurs without squeezing) or nipple discharge that is clear or bloody may be caused by an abnormal growth within the breast or, less commonly, by breast cancer.

Any woman with nipple discharge should be evaluated by a healthcare provider. A mammogram, breast ultrasound will be recommended for evaluation.

Many women are born with nipples that naturally invert (pull in) at times and evert (poke out) at other times. Other women find that this happens after breast feeding. Nipple inversion of this type is not cause for concern.

If your nipples have always been everted, however, and begin to invert for no obvious reason, this should be evaluated by your healthcare provider. Most causes of nipple inversion are not a cause for concern, but occasionally this is the first sign of a breast cancer. New nipple inversion is usually evaluated with a breast examination and mammogram as a first step.

Skin problems can develop on or near the breast, some of which cause itching, scaling or crusting, dimpling, swelling, redness, or changes in skin color. While most of these changes are not caused by a serious breast problem, it is important to be evaluated if a skin problem on your breast does not resolve within a few days.

More serious causes of skin changes on the breast can include less common forms of breast cancer, such as Paget disease or inflammatory breast cancer.

Other, more common skin problems, such as rashes, moles, cysts, or skin infections can occur on the skin of the breast, as well.

The evaluation of breast skin changes usually includes a breast examination and may include a mammogram. A skin biopsy may be needed to confirm the diagnosis.

If you find a new breast problem, you should make an appointment with your doctor within a few weeks. Although breast problems are not usually an emergency, delaying the evaluation for months can potentially allow the problem to worsen.

In some cases, this evaluation will be all that is needed. In other cases, you may be referred for further testing or evaluation with a breast surgeon.

If your initial evaluation shows no sign of a problem but you remain concerned, talk to your healthcare provider. Further testing, follow-up over time, or referral to a breast specialist may be recommended.

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

A breast biopsy is procedure that checks the area of abnormal tissue in the breast. There are different methods to do breast biopsies.

• Fine Needle aspiration – samples of cells is taken out for microscopic examination.
• Core biopsy – Use a large needle to take 1 or more small samples of tissue from the breast.
• Excisional biopsy – Do an operation to take out part or all of the abnormal tissue in operating theatre

You might get a breast biopsy if you or your doctor can feel a change in your breast, or if an area looks abnormal on your breast imaging – eg Mammogram or ultrasound.

All biopsy should be done under image guidance.

• Fine needle biopsy is usually done with ultrasound. A small needle is used to obtain fluid or cells. This is usually performed in doctor’s room and no anaesthetics is required.
• Core biopsy is usually done by radiologist under local anaesthetics with a special device with larger bore needle. This will take approximately 30 mins visit to the radiologist. After a core biopsy, radiologist may place a clip in your breast to mark where the biopsy was taken. You cannot feel the clip and it will not cause problems during future imaging tests, including airport screening tests.
• Stereotactic biopsy is needed when the calcifications is not seen well on ultrasound and only seen on mammogram. During the biopsy, you will be lying face down on a special table with an opening for your breast. The breast which is pressed between 2 metal plates, just like it is during a mammogram. The biopsy is performed using a special needle and the position of needle is checked with X-rays.
• Surgical Open biopsy you will need to be at a hospital facility for the surgeon to take out the abnormal tissue with a small cut in your breast.

After a biopsy, you might have bruising, bleeding, or get an infection. These problems are less common with fine or core needle biopsy than after a surgical biopsy. You will likely get the results of your biopsy between 2-7 days depending on where the test is performed. The result will be discussed at the next appointment and appropriate action taken.

When normal cells in the breast change and grow out of control. Most common presenting symptoms were a new a lump or change of contour or the breast. Breast cancer is much more common in women than in men, but men can also have breast cancer. Breast cancer sometimes runs in families. If you feel a lump in your breast, see your doctor right away. Breast lumps can be caused by conditions that are not cancer. But it is a good idea to have any lumps checked out as early as possible.

Mammogram is the most common used test to check for breast cancer in patient over 40. Other tests including ultrasound or MRI is also available if indicated. If a Xray finds a spot that is unusual, it will often be needing a tissue diagnosis, and a biopsy will be performed. During a biopsy, a doctor takes 1 or more small samples of tissue from the breast. That way the doctor can look at the cells under a microscope to see if they have cancer.

Blood test is generally not specific enough for breast cancer, but genetic testing for DNA mutation can be done in selected setting.

Cancer staging is a way in which doctors find out how far a cancer has spread. This will help to decide what would be the right treatment for you.

The following treatments are available and will be recommended for you by your specialist depends on what you need.

• Surgery – Surgery to remove the cancer. Most women with breast cancer can have the option of either mastectomy and breast conserving therapy or lumpectomy depending on your cancer.
• Mastectomy is surgery to remove the whole breast. Depending on the cancer, reconstruction of the breast can be discussed
  Breast conserving therapy / lumpectomy is surgery to remove the cancer with a section of healthy tissue around it. This option must have radiation therapy after surgery to achieved optimal cure rate.
• Radiation therapy – Radiation kills cancer cells. this usually takes a course either 3-5 weeks, which is daily from Monday to Friday. You will be referred to a Radiation Oncologist either in the public or private hospital depending on where you live and your insurance cover.
  Chemotherapy – Chemotherapy is a toxic medicine that designed to kill cancer cells.
• Hormone therapy – Some forms of breast cancer grow in response to hormones. Your doctor might give you treatments to block hormones or to prevent your body from making certain kinds of hormones.
• Targeted therapy – Some medicines work only on cancers that have certain characteristics. Your doctor might test you to see if you have a kind of cancer that would respond to this kind of therapy.

+/- reconstruction with own tissue or implant. Usually done by breast reconstructive breast surgeon

After treatment, you will need to be checked regularly to see if the cancer comes back. You should watch for symptoms that could mean the cancer has come back. Examples of these symptoms include new lumps in the breast area, pain (in the bones, chest, or stomach), trouble breathing, and headaches. If you start having any new symptom, mention it to your doctor. Mammogram and Ultrasound are done on the yearly basis. CT scan and bone scan are needed only in selected circumstances. Blood test is usually not needed in breast cancer followup.

That depends on where the cancer is. Most people get hormone therapy or chemotherapy. Some people also have surgery to remove new tumors.

Women who are at high risk of getting breast cancer can sometimes take a preventive medicine to help reduce the risk of the disease. If you have a strong family history of breast cancer, ask your doctor what you can do to prevent cancer.

Many people with breast cancer do very well after treatment. The important thing is to take your medicines as directed and to follow all your doctors’ instructions about visits and tests. It’s also important to talk to your doctor about any side effects or problems you have during treatment.

Getting treated for breast cancer involves making many choices. Besides choosing which surgery to have, you might have to choose which medicines to take and when.

Always let your doctors and nurses know how you feel about a treatment. Any time you are offered a treatment, ask:

• What are the benefits of this treatment?
• Is it likely to help me live longer?
• Will it reduce or prevent symptoms?
• What are the downsides to this treatment?
• Are there alternatives to this treatment?
• What happens if I do not have this treatment?

Breast reconstruction is surgery to rebuild a breast that was removed to treat or prevent cancer. Reconstruction can be done using implants, or using tissue taken from other parts of your body, called “flaps.”

If you are planning to have surgery to remove a breast, called a mastectomy, talk to your surgeon about reconstruction before you have the mastectomy. Your mastectomy might need to be done in a certain way for you to be able to have the type of reconstruction you want.

No, you do not need it. The decision to have reconstruction is totally up to you. Some women do not mind having only 1 breast. Other women feel better about themselves or feel like they look more normal if they have reconstruction after mastectomy. Having reconstruction also helps with posture and the way clothes fit. The important thing is that you have a choice about what to do.

If you decide not to have reconstruction, the side of your chest that had surgery will be flat and have a scar on it. If you want, you can wear a special bra with a pocket for a soft plastic breast. That way you’ll look more even, and your clothes will probably fit better.

Breast reconstruction can be done at the time of mastectomy or later. The timing for you will depend on the stage of your cancer and what other treatments you need. Also, if you want to delay reconstruction for personal reasons, you can ask your doctor about doing that.

Women with early-stage cancer or who are having mastectomies to prevent cancer can have the reconstruction at the same time as their mastectomy. This is called “immediate reconstruction.” The skin that is left after a mastectomy can be used like a pocket to hold the tissue that will make up the new breast.

Women with a later-stage or large cancer sometimes need to have radiation after mastectomy. (Radiation is a treatment that kills cancer cells.) These women sometimes need to delay reconstruction until the radiation treatment is finished. This is 1 type of “delayed reconstruction.” The delay is needed because the reconstructed breast could keep the radiation from reaching the right areas. Plus, radiation could damage the reconstructed breast.

The 2 main ways are with implants or with flaps. Plus, there are several kinds of flaps, each named for the muscles they are made of. The best reconstruction approach for you will depend on:

• How big your breasts are to begin with
• How much extra body fat you have and where
• Whether you smoke, are overweight, or have health problems, such as diabetes, or heart or lung disease
• Whether you have had surgery before and on what part of your body, because scars might affect which tissue can be used

A breast implant is basically a breast-shaped container that is filled with salt-water (called “saline”) or something that feels like Jell-O (called “silicone”). The implant is inserted under a layer of muscle in the chest.

Getting an implant usually involves 2 steps. First, the surgeon inserts a device called an “expander.” This device stretches the skin and muscle in the chest, so that they can hold the implant. Doctors gradually add more and more fluid to the expander until the skin and muscle are stretched enough for the implant. Then, the surgeon does another surgery to insert the implant. Implants are best for women with smaller breasts that don’t droop.

That depends on which type of flap is used. The most commonly used flaps are:

• TRAM flaps – A TRAM flap is taken from the belly and is made up of skin, fat, and muscle. When the muscle in the flap stays attached to the blood vessels that supply it, it is called a “pedicled TRAM flap”. This type of flap is tunnelled under the skin from the belly to the new breast pocket.
• When the flap is completely disconnected from the belly and its blood vessels, it is called a “free TRAM flap”. This type of flap is attached to a new set of blood vessels in the chest. It doesn’t stay connected, so it does not have to be tunneled to its new location.
  Both kinds of TRAM flaps can be done only in women who have enough belly fat to make a flap. After surgery, the belly looks flatter, like it does after a “tummy tuck.” Women who have this type of flap have a scar along their bikini line from hip to hip.
• Lat flap – A Lat flap is taken from the back and is made up of skin, fat, and muscle. The flap stays attached to its own blood supply and is tunnelled under the skin from the back to the chest. Women who have this kind of flap have a scar on their back beneath the bra line. They also often also get an implant, because there is not enough fat on the back to make a new breast.
• DIEP flap – A DIEP flap is taken from the belly, but it is different from a TRAM flap because it is made up of skin and fat but NOT muscle. Connecting these flaps to a good blood supply is harder than it is for other flaps. That means the surgery can be more complicated and take longer.
• Flaps taken from other places –Women who do not have enough belly fat to make good TRAM or DIEP flaps can have flaps taken from other parts of their body. For instance, doctors sometimes take flaps from the rear end or inner thigh.

If you want it to be, yes. Nipple reconstruction is usually done a few months after the breast construction is done. To make a new nipple, the surgeon can rearrange the tissue that is already there or use tissue from another part of the body. Surgeons also sometimes tattoo the nipple and the area around the nipple to make it the right colour.

As much as possible, yes. But the new breast will never be like the one you had before or like the other breast. Plus, you won’t have normal feeling (sensation) in the new breast. Your surgeon might need to operate on your healthy breast to make the two breasts look as similar as possible.

Yes and no. Only some of the reconstruction types will be appropriate for you. But if you think you would rather have one type of reconstruction over another, ask your surgeon if that approach would work for you. They can tell you if your choice makes sense, and if not, why not.

Ductal carcinoma in situ, often called “DCIS,” is an early form of breast cancer. It forms inside the ducts that carry milk to the nipple.

When a cancer is “in situ,” it means it has not spread beyond the place where it first formed. In the case of DCIS, it means the cancer is only in the duct and has not spread into the tissues around it. DCIS is curable in most cases.

DCIS does not usually cause symptoms, but in some cases, women feel a lump in their breast, or have blood coming from the nipple.

Yes. Most cases of DCIS are found during a mammogram. DCIS usually shows up on a mammogram as tiny spots, or “calcifications,” or as a “density.” If a woman has a mammogram showing an area that looks suspicious, she will usually have more detailed mammograms.

If your mammogram shows a suspicious area, you will need a “biopsy.” That means that a doctor will take samples of breast tissue and send them to the lab to be checked for cancer. This is usually done using a needle, but some women must have a type of biopsy that involves surgery. Surgical biopsy, also called “excisional biopsy,” is done if the needle biopsy can’t be done safely or accurately.

To do a needle biopsy, the doctor will use X-rays to find the exact spot on the breast that looks suspicious. Then, he or she will insert a needle to take samples. Next, he or she will put a tiny metal clip into that spot. That way, a surgeon can easily find the same spot later.

The treatment for DCIS is surgery. The type of surgery will depend on the size and location of the tumor. If the DCIS is contained within a small area of the breast, the surgeon can usually save the breast using “breast conserving surgery.” If the DCIS is taking up a large area, the surgeon will probably have to remove the whole breast with a “mastectomy”

• Breast conserving surgery, also called “lumpectomy,” is surgery to remove the cancer and a section of healthy tissue around it. Women who have this option keep their breast. But they usually also need radiation therapy after surgery to help keep the cancer from coming back. Women who have breast conserving surgery and radiation live just as long as those who have mastectomy. Still, women who have breast conserving surgery have a slightly higher chance than those who have mastectomy of having their cancer come back in the breast.
• Mastectomy is surgery to remove the whole breast. Women who have this option can also have surgery to reconstruct the breast. If a mastectomy is done for DCIS, radiation is not needed.

Some women are offered treatments after surgery to lower the chances of that cancer coming back (either as DCIS or invasive breast cancer). These treatments do not reduce the chances of dying from cancer any more than surgery alone. Options include:

• Radiation therapy (RT), which is usually offered to women after breast conserving surgery. Women who undergo a mastectomy for DCIS usually do not need RT.
• Hormone therapy to block the hormones, estrogen and/or progesterone, from acting on breast cells. Women with tumors that test positive for estrogen (ER) and/or progesterone (PR) receptors are most likely to benefit from treatment.

After treatment, you will need to be checked on a regular basis to see if the cancer comes back. You will have mammograms once a year and breast exams at least twice a year. If you are taking hormone therapy, you will need special lab tests to follow up on how the medicine is working. You should also watch for symptoms that could mean the cancer has come back, such as a new breast lump or pain. If you start having any new symptom, tell your doctor.

When DCIS comes back, it will be the same DCIS half the time and more serious invasive cancer half the time. Either way, if your cancer comes back, you will need more surgery. If you previously had breast conserving surgery and radiation, you will need a mastectomy, because you can’t get radiation more than once in the same area of the body. If the cancer comes back as an invasive cancer, you will need more intensive treatment.

Most women with DCIS do very well after treatment. If you are on hormone therapy, it is very important to take your hormone medicines as directed. Talk to your doctor if you have any side effects from the medicines. It’s also important to follow all your doctors’ instructions about follow up exams and tests.

Always let your doctors and nurses know how you feel about a treatment. Any time you are offered a treatment, ask:

• What are the benefits of this treatment?
• Is it likely to help me live longer?
• Will it reduce or prevent symptoms?
• What are the downsides to this treatment?
• Are there alternatives to this treatment?
• What happens if I do not have this treatment?

Your doctor can tell you what your treatment choices are. Every woman and every cancer is different. But, in general, women with early-stage breast cancer need two treatment directly to the breast, which is called “local treatment,” and they need treatment to the whole body, which is called “systemic treatment.”

Local treatment is surgery and radiation. Systemic treatment is chemotherapy, hormone therapy, or both.

For surgery, women can often choose between these two options:

• Mastectomy – Surgery to remove the whole breast. Most women who have a mastectomy can also have surgery to reconstruct the breast that is removed.
• Breast-conserving therapy (also called “lumpectomy”) – Surgery to remove the cancer and a section of healthy tissue around it (called a “margin”). Women who choose this option keep their breast. But they usually must have radiation therapy after surgery to kill any cancer cells that might still be in the breast area.

At the same time as they have lumpectomy or mastectomy, most women also have surgery to remove lymph nodes under the arm. Lymph nodes are bean-shaped organs that filter and trap cancer cells. Depending on what kind of cancer a woman has and how far it has spread, she might also need systemic treatment with medicines that can slow or prevent the growth of cancer.

No. Studies show that women who choose lumpectomy live just as long as those who choose mastectomy.

Yes. Women who choose lumpectomy have a slightly higher chance of having their cancer come back. But if cancer comes back, it can usually be treated successfully.

No. Lumpectomy is not an option for some women. For example, lumpectomy is sometimes not an option for women who:

• Have more than one tumor in different areas of the same breast
• Have cancer that has spread throughout the breast tissue and the surgeon can’t get all the cancer out with a margin of normal tissue around it
• Cannot have radiation therapy, for example because they are pregnant or have certain forms of skin cancer
• Already had radiation to the area. (Radiation can only be given to an area of the body once.)

First, make sure you understand all the facts about the different treatment options. Ask your doctor any questions you might have. Then think about how you feel about these issues:

• The way you will look – Is it important to you to keep your own breast? How would you feel if your chest was flat and you had to wear a plastic breast in your bra? Ask to see pictures of women who have had the different kinds of surgery. Remember, women who choose mastectomy can have their breast reconstructed if they want
• The risk that cancer will come back – Women who choose lumpectomy live just as long as women who choose mastectomy. But women who choose lumpectomy have a slightly higher risk of cancer returning in the breast. Women whose cancer comes back after lumpectomy go on to have a mastectomy.
• The time involved and the side effects of radiation – After lumpectomy, most women must have radiation therapy. This usually involves getting treatments 5 days a week for 3 to 6 weeks, depending on the woman’s age and other factors. This type of radiation will not make you sick or make your hair fall out. But it will tan and possibly even burn the skin on your chest. This burn is like a sunburn and goes away fairly quickly. Toward the end of treatment, radiation can make you feel a little tired, but this is not very common and usually doesn’t last long.

Recovery from surgery

• Women who have lumpectomy go home from the hospital the same day as their surgery. For a week or two after surgery, they must rest and avoid sports, swimming and heavy lifting.
• Women who have mastectomy stay in the hospital for 1 to 2 days after surgery. If they also have breast reconstruction, they might stay a day or two longer. They go home with drains that must be emptied twice a day. After about 2 weeks, the surgeon takes the drains out in the office. If more fluid or blood builds up after the drains come out, the doctor will drain it with a needle in the office. During the draining process and for a few weeks more, women who have a mastectomy must rest and avoid sports, swimming, or heavy lifting. Even after they recover, women who have mastectomy will not have normal feeling in the chest. Women who have mastectomy can have the breast that was removed reconstructed right away or later.

Regardless of which surgery you have, you will probably need to have biopsies of your lymph nodes. This part of the surgery usually does not cause problems. But in some cases it can cause arm swelling, pain, or stiffness; shoulder pain or stiffness; or a nerve injury. If any of these happen to you, you might need to do special exercises or have physical therapy (work with an exercise expert) to get back to normal.

Tell your doctor how you feel about the different treatment options. If there is something specific that worries you, tell your doctor about that, too. Then listen to what your doctor has to say about his or her experiences with women who had situations similar to yours. Together you can decide which treatment option is right for you. When you choose your treatment, you can find out more details about that option.

Genetic testing is a medical test done to find out if you have certain abnormal genes. Genes are basically the body’s recipe book. They tell your cells how to make different proteins, and they give your body instructions about how you should look and how your body should work. Unfortunately, genes can sometimes have “mutations,” mistakes in the recipes that change the way your body makes proteins. These mutations can sometimes put you at risk for disease.

There are genetic tests that look for specific mutations that are linked to lots of different diseases. This article is about mutations that increase the risk of breast and ovarian cancer specifically.

There are probably several genes that affect a person’s risk of breast or ovarian cancer. The 2 genes that are especially important for both breast cancer and ovarian cancer risk are called BRCA1 and BRCA2.

People with certain mutations in either of these genes are at high risk of breast or ovarian cancer. Even some men who carry a BRCA1 or BRCA2 mutation have an increased risk of breast cancer.

Genes are passed down in families, so women who have family members with breast or ovarian cancer sometimes have genetic tests to find out if they carry abnormal versions of the BRCA genes. By having these tests, women can find out whether they need to take special steps to protect themselves from cancer.

Doctors recommend genetic testing only for women who have a strong family history of breast or ovarian cancer.

Testing might make sense for you if you fit any of these descriptions:

• You have 2 or more close relatives with breast or ovarian cancer, especially if 1 or more of the relatives were diagnosed with cancer before they turned 50. (Close family members include your mother, sister, or daughter, and can include men with breast cancer, such as your father, brother, or son.)
• You have a close family member with more than 1 cancer, such as cancer in both breasts, or cancer in the breast and the ovary.
• You have family members from different generations with breast or ovarian cancer. (For example, your grandmother, mother, and sister, all with cancer.) Family history on your father’s side is as important as your mother’s side.

Keep in mind, though, that having a strong family history of a disease does not always mean you have abnormal genes. Most women with a family history of breast or ovarian cancer do NOT have an abnormal gene.

If you are thinking about genetic testing because a family member has cancer, ask if she or he has been tested or is willing to be tested first. If the person with cancer does not have the mutation, it is less likely that you do..

Before you get tested, talk with a genetic counselor or your doctor. A genetic counselor is a person who can help you understand what the results of the test could mean for you and your family, and what costs might be involved with getting tested. He or she can also help you deal with the feelings you have about being at risk for cancer and can help you understand your results. The results are not always clearcut.

If you test positive, try to stay calm. Finding out you carry a mutation can be scary. But there are ways to lower the chances that you will get cancer.

Ask your doctor and your genetic counselor what your results mean for you. Then ask what you can do to lower your chances of getting cancer.

If you test positive for a BRCA1 or BRCA2 mutation, tell your family about the results. It affects their health as well as yours. Some family members might also want to get tested.

If you have a BRCA mutation, you can lower your chances of getting breast or ovarian cancer by:

• Getting screened for breast and ovarian cancer often. This will not keep you from getting cancer, but it will increase the odds that you will find it early, when it is easier to treat.
• Having your breasts and ovaries removed. (For the biggest benefit, the ovaries should be removed by age 40.)
• Taking medicines that help prevent cancer
• Combining some or all of these choices.

Gynecomastia is the medical term for when boys or men develop breasts. The condition can be embarrassing and sometimes even painful. Luckily, it often goes away on its own. If it doesn’t go away, or if the condition is very uncomfortable, there are treatments that can help.

Boys and men who develop breasts can have growth in both breasts or just one. Sometimes the area behind the nipple is tender (hurts when it is touched).

See a doctor or nurse if your breast or breasts:

• Are growing very fast
• Have grown a lot (more than 2 to 3 inches of tissue under the nipple)
• Are very painful
• Worry or embarrass you a lot
• Have grown and you also have a lump on one of your testes, or you think you might have another illness

You should also see a doctor if you are an adult man and you have a lump in your breast that is off to the side instead of under the nipple.

This could be a sign of breast cancer. It is very rare, but men can sometimes get breast cancer.

Yes and no. If you are male and have what look like breasts, your doctor or nurse will feel them to check if what you have is really breast tissue or if it is fat, which is not the same thing. Doctors and nurses can usually tell the difference just by examination. But sometimes they need to order a special kind of X-ray of the breast called a mammogram. Doctors and nurses sometimes also order blood tests to check hormone levels in boys and men who develop breasts.

There are a number of treatments. But treatment is often not needed. The one that’s right for you will depend on the cause of your condition, how long it has lasted, how severe it is, and how much it hurts or bothers you.

• In teenage boys, breast development is usually caused by normal hormone changes that happen at that age. In these cases, breasts usually go away on their own without treatment. Still, doctors sometimes give a medicine called tamoxifen to boys with very large or painful breasts.
• In adult men, breast development is usually caused a health problem or by a drug the man takes. In these cases, treating the health problem or stopping the drug usually makes the breasts go away. But if the doctor can’t figure out the cause of breast development, they might prescribe tamoxifen.
• In adult men who have had breasts for more than a year, tamoxifen does not usually help. These men can instead have surgery to reduce the size of their breasts.
• Men with prostate cancer whose cancer is treated with certain types of hormone therapy sometimes develop breasts. They can take tamoxifen or have radiation treatment before getting the hormone therapy to reduce the chances that this will happen.

Regardless of which surgery you have, you will probably need to have biopsies of your lymph nodes. This part of the surgery usually does not cause problems. But in some cases it can cause arm swelling, pain, or stiffness; shoulder pain or stiffness; or a nerve injury. If any of these happen to you, you might need to do special exercises or have physical therapy (work with an exercise expert) to get back to normal.

A hernia is an area in a layer of tissue that is weak or torn. Often when there is a hernia, other tissues that are normally held in by the damaged layer bulge or stick out through the weak or torn spot.

Hernias can happen in different parts of the body. When they happen where the thigh and body meet (called the groin), they are called inguinal or femoral hernias. Inguinal hernias are a bit higher on the groin than femoral hernias. Both of these types of hernias can form a sac that holds a loop of intestine or a piece of fat pad that normally sits inside the belly. The fat pad is called the omentum. In women, the sac can hold female reproductive organs.

Not all hernias need treatment right away. But many do need to be repaired with surgery. Femoral hernias, in particular, usually need repair. They are more likely than inguinal hernias to cause tissue damage.

Surgeons can repair groin hernias in 1 of 2 ways. The right surgery for you will depend on the size of your hernia, whether this is the first time it is getting repaired, and what your general health is like. The 2 types of surgery are:

• Open surgery – During an open surgery, the surgeon makes an incision near the hernia. Then he or she gently pushes the bulging tissue back into place. Next, the surgeon sews the weak tissue layer back together, so that nothing can bulge through. In some cases, surgeons will also patch the area with a piece of mesh. The mesh can take some of the strain off the tissue wall. That way the hernia is less likely to happen again.
• Laparoscopic surgery – During laparoscopic surgery, the surgeon makes a few incisions that are much smaller than those used in open surgery. Then he or she inserts long thin tools into the area near the hernia. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The surgeon can look at the picture on the screen to guide his or her movements. Then he or she uses the long tools to repair the weak tissue layer either with stitches alone or with mesh.

If your hernia has reduced the blood supply to a loop of intestine, your doctor might need to remove that piece of intestine and sew the 2 ends back together.

Yes. See a doctor or nurse if you:

• Feel or see a bulge in your groin, or
• Feel a pulling sensation or pain in your groin even if you have no bulge
  In most cases, doctors can diagnose a hernia just by doing an exam. During the exam, the doctor will ask you to cough while pressing on the bulge. This can be uncomfortable, but it is necessary to find the source of the problem.

Most of the time, the contents of the hernia can be “reduced,” or gently pushed back into the belly. Still, there are times when the hernia gets trapped and can’t be pushed back in. If that happens, the tissue that is trapped can get damaged.

If you develop pain around the bulge or feel sick, call your doctor or surgeon right away.

Groin hernias do not always cause symptoms. But when symptoms do occur, they can include:

• A heavy or tugging feeling in the groin area
• Dull pain that is worst when straining, lifting, coughing, or otherwise using the muscles near the groin
• A bulge or lump at the groin

Hernias can be very painful and even dangerous if the tissue in the hernia becomes trapped and unable to slide back into the belly. When this happens, the tissue does not get enough blood, so it can get damaged or die. This is more likely with femoral hernias than with inguinal hernias.

An abdominal hernia is an area in that abdominal wall that is weak or torn. When there is a hernia, internal organs or tissues that are normally held in place by the abdominal wall can bulge or stick out through the spot.

There are many different kinds of abdominal wall hernias, the most common ones are from groin, umbilicus and previous operation sites.e.

Regardless of which surgery you have, you will probably need to have biopsies of your lymph nodes. This part of the surgery usually does not cause problems. But in some cases it can cause arm swelling, pain, or stiffness; shoulder pain or stiffness; or a nerve injury. If any of these happen to you, you might need to do special exercises or have physical therapy (work with an exercise expert) to get back to normal.

Hernias do not always cause symptoms. When they do, they can cause some or all of these symptoms:

• A bulge somewhere on the trunk of the body – This bulge can be so small that you don’t even realise it’s there.
• Pain, especially when coughing or using or straining nearby muscles
• A pulling sensation around the bulge

Abdominal wall hernias can balloon out and form a sac. That sac can end up holding a loop of intestine or a piece of fat that should normally be tucked inside the belly. This can be painful and even dangerous if the tissue in the hernia gets trapped and unable to slide back into the belly. When this happens, the tissue does not get enough blood, so it can become swollen or even die.

Regardless of which surgery you have, you will probably need to have biopsies of your lymph nodes. This part of the surgery usually does not cause problems. But in some cases it can cause arm swelling, pain, or stiffness; shoulder pain or stiffness; or a nerve injury. If any of these happen to you, you might need to do special exercises or have physical therapy (work with an exercise expert) to get back to normal.

Hyperthyroidism is a condition that can make you feel shaky, anxious, and tired. The most common cause of hyperthyroidism is called Graves’ disease.

There is a gland in your neck called the thyroid gland. It makes thyroid hormone. This hormone controls how the body uses and stores energy.

Hyperthyroidism is the medical term for when a person makes too much thyroid hormone. People sometimes confuse this condition with HYPOthyroidism, which is when a person does not make enough thyroid hormone.

Some people with hyperthyroidism have no symptoms. When they do occur, symptoms can include

• Anxiety, irritability, or trouble sleeping
• Weakness (especially in the arms and thighs, which can make it hard to lift heavy things or climb stairs)
• Trembling
• Sweating a lot and having trouble dealing with hot weather
• Fast or uneven heartbeats
• Feeling tired
• Weight loss even when you are eating normally
• Frequent bowel movements

Hyperthyroidism can also cause a swelling in the neck called a “goiter.” If it is caused by Graves’ disease, the condition can also make the eyes bulge.

Untreated hyperthyroidism can cause a heart rhythm disorder called “atrial fibrillation,” chest pain, and rarely, heart failure.

In women, hyperthyroidism can disrupt monthly periods. It can also make it hard to get pregnant. In men, hyperthyroidism can cause the breasts to grow or lead to sexual problems. These problems go away when hyperthyroidism is treated.

Yes. Your doctor or nurse can test you for hypothyroidism using a simple blood test.

Hyperthyroidism can be treated with:

Medicines

• Two types of medicines can be used to treat hyperthyroidism:
  Anti-thyroid medicines reduce the amount of hormone your thyroid gland makes.
• Beta-blocker medicines help reduce the symptoms of hyperthyroidism. Beta-blockers can make you more comfortable until the thyroid imbalance is under control.

Radioactive iodine

• Radioactive iodine comes in a pill or liquid you swallow. It destroys much of the thyroid gland. Pregnant women should not use this treatment, because it can damage the baby’s thyroid gland. But the treatment is safe for women who are not pregnant and for men. The amount of radiation used is small. It does not increase the chance of getting cancer, and it does not cause problems getting pregnant in the future or increase the risk of birth defects in future pregnancies

Surgery

Most people who are treated with radioactive iodine or who have surgery end up making too little thyroid hormone after treatment. They must take thyroid hormone pills after treatment — for the rest of their life.

Doctors can do surgery to remove part or all of the thyroid gland. Doctors do not often recommend surgery, because the other treatment choices are safer and less costly. But surgery is the best choice in some cases

If you take anti-thyroid medicine, talk to your doctor or nurse before you start trying to get pregnant. You will probably need to take different medicines at different times in your pregnancy. Plus, your doses may need to be adjusted.

If you were treated with radioactive iodine, wait at least 6 months before you start trying to get pregnant. This will give your doctor enough time to find out if your thyroid is making enough thyroid hormone after the radioactive iodine treatment. If the radioactive iodine caused the thyroid to make too little thyroid hormone, you will need to take thyroid hormone pills. It is important to have a normal amount of thyroid hormone in your body before getting pregnant.

Whatever treatment you use, you should have your thyroid hormone levels checked often during pregnancy. Thyroid hormone levels must be at the right level during pregnancy to avoid risks to both the mother and the baby.

Lymphedema is a buildup of fluid in the hand or arm. It happens in some women who have had surgery or radiation treatment for breast cancer. Not all women treated for breast cancer get lymphedema.

The body has a network of vessels called the called the “lymphatic system” that carries a clear fluid called “lymph”. The lymphatic system is similar to the system of blood vessels. But instead of blood, the lymphatic system carries lymph, which contains infection-fighting cells. Lymphedema happens when the flow of lymph through the lymphatic system gets backed up. This can happen after cancer treatment, and can be a common problem in patients treated for breast cancer.

The most common symptoms of lymphedema are:

• Swelling in your fingers, hand, or arm
• Aching pain
• Tight or heavy feeling in your arm
• Trouble moving your arm
• The symptoms can come on slowly. It might be weeks, months, or even years after your cancer treatment before you have symptoms of lymphedema.

No, there is no test. Your doctor or nurse can figure out if you have lymphedema by talking to you about your symptoms and doing an exam. An important part of the exam will be to measure the length around your arm (called your arm circumference).

Yes. It is very important to avoid injury or infections of your affected arm. There are also actions you can take to help prevent more swelling.

To avoid injury

• Keep your skin clean. Wash with a mild soap every day.
• Be careful with your nails. Don’t pick at the skin around your nails or cut your cuticles.
• Use lotion to keep your skin from getting dry and cracked.
• Use an electric razor instead of a manual razor to shave under your arms.
• Always use sunscreen when you go outside.
• Wear gloves when gardening, cooking, or doing other things that could hurt your skin.
• If you do get a small cut, scrape, or bite on your arm or hand, clean it well with soap and water. Then use an antibiotic cream, such as bacitracin.
• Call your doctor or nurse if it does not heal quickly or if you have signs of an infection.
• Do not have shots, blood draws, IV lines, or acupuncture in your affected arm.
• Avoid having your blood pressure taken on your affected arm.

To prevent swelling:

• Wear loose fitting clothes and jewelry. You don’t want to wear anything tight on your affected hand or arm, unless it is a special garment or bandage your doctor or nurse gives you.
• If you use a purse, carry it on your non-affected arm.
• Avoid saunas, steam baths, and hot tubs. Heat can cause more swelling.
• Keep your weight under control. Being too heavy can make your lymphedema worse.
• Do not let your arm hang at your side for long periods of time (more than 15 minutes) without moving it.
• Keep your arm raised on pillows when you’re sitting down.

You should call your doctor or nurse if you have:

• Increased swelling of your hand or arm
• Redness or a rash on your arm
• Your arm feels warm to the touch
• You have a fever higher than 100.4°F (38°C) that is not due to a cold or other illness

There is no cure for lymphedema. But there are treatments that can help reduce the swelling and make you more comfortable. These treatments work best if you start them early, so see a doctor or nurse as soon as you notice any swelling. It is best to go to clinics that have people who have experience treating lymphedema.

Treatments can include:

• Exercise – Doctors used to think that people with lymphedema needed to avoid exercising the affected arm. Now research shows that exercise can actually help with the condition. During exercise, people with lymphedema should always wear a compression bandage or sleeve (see below).
• Compression bandaging – Compression bandaging is a special kind of bandaging that puts gentle, steady pressure on the swollen area. This helps keep the swelling down.
• Compression “sleeves” – Compression sleeves work a lot like compression bandaging. They put gentle, steady pressure on the affected arm to keep swelling down.
• Manual lymphatic drainage – For this treatment, a physical therapist massages your arm in a special way to help move the fluid that has built up.

Lymphedema cannot always be prevented, but if you treat it early, you might be able to keep it from becoming too severe.

A multinodular goiter is a swelling in the neck. It is caused by abnormal growth of the thyroid gland, plus 1 or more growths called “thyroid nodules.” Thyroid nodules are round or oval-shaped growths in the thyroid gland. The thyroid gland is in the middle of the neck.

Thyroid nodules are common and not usually harmful to a person’s health. But sometimes thyroid nodules are caused by a serious condition, such as cancer.

The thyroid gland makes a hormone called “thyroid hormone.” Most thyroid nodules do not change the amount of thyroid hormone in the body. But some thyroid nodules cause the thyroid gland to make too much thyroid hormone. If a multinodular goiter has this type of thyroid nodules, it can cause symptoms.

Most people with a multinodular goiter do not have symptoms. The swelling might be found during an imaging test, such as an X-ray, that is done for another reason. Or a blood test to check thyroid hormone levels might show that a person has too much thyroid hormone. Having too much thyroid hormone can be a sign of a multinodular goiter.

Some people with a multinodular goiter feel or see a lump in their neck. Or they have symptoms from having too much thyroid hormone, such as:

• Feeling worried or upset, or having trouble sleeping
• Feeling weak or tired
• Losing weight without trying
• Having a fast heartbeat
• Having frequent bowel movements

If a multinodular goiter presses on the throat or airway, it can cause:

• Trouble breathing – Especially during physical activity, at night, or when reaching or bending
• Wheezing
• Coughing
• A choking feeling
• Trouble swallowing

Yes. Your doctor will want to make sure that the multinodular goiter is not going to harm your body. You need tests to find out if nodules in the goiter are causing your thyroid gland to make too much hormone. Your doctor will also check the nodules to see how big they are and if they need to be taken out.

Tests usually include blood tests and an imaging test of the thyroid called an “ultrasound.” This test uses sound waves to create a picture of the inside of your body. Sometimes, people need more tests. These include:

• Fine needle aspiration – For this test, a doctor uses a thin needle to remove a small sample of tissue from 1 nodule in the goiter, usually the largest. He or she might take tissue from more than 1 nodule. Then, another doctor looks at the tissue under a microscope.
• Thyroid scan – People get this test only if they have too much thyroid hormone in the body. For this test, a person gets a pill or a shot with a small amount of a radioactive substance. Then a special camera takes a picture of the thyroid gland. This test is not safe for women who are pregnant or breastfeeding.

Many multinodular goiters do not need treatment. If the nodules are small and do not look harmful, your doctor might watch and wait to see if the swelling gets bigger or needs to be treated. A multinodular goiter needs treatment if:

• It causes the thyroid gland to make too much hormone
• It causes problems with breathing, swallowing, or other body functions – or is very large
• It contains cancer
• Treatments for multinodular goiter include:
• Antithyroid medicines – If your thyroid blood tests show that the thyroid gland is making too much thyroid hormone, doctors can use medicines to lower the amount of thyroid hormone it makes. These medicines control thyroid hormone levels until doctors can do other treatments.
• Medicines to help with symptoms caused by too much thyroid hormone, such as atenolol (brand name: Tenormin®)
• Surgery to remove the multinodular goiter
• Radioactive iodine – Radioactive iodine comes in a pill or liquid that you swallow. It has a small amount of radiation in it. The radiation treats the problem by destroying a lot of the thyroid gland, so it does not make so much hormone. Radioactive iodine is used only to treat nodules that make too much thyroid hormone. It is not safe for women who are pregnant or breastfeeding.
• Injections (shots) of alcohol to shrink nodules, or laser treatment to destroy them. The alcohol used in this treatment is not the kind people drink.

If you want to get pregnant, talk with your doctor or nurse. They can make sure your multinodular goiter is not making too much thyroid hormone before you get pregnant.

Women who are pregnant should not be treated with radioactive iodine. This is because radioactive iodine can cause serious harm to a baby.

This is also known as “key-hole” surgery. It is a type of surgery that uses several small incisions to carry out a surgical procedure.

Specially designed instruments are used along with a “scope” which allows a surgeon to look inside the body and also operate in it without opening it up.

The scope used is a long, thin tube, which has a light and tiny camera on the end of it. The camera relays the pictures of the inside of the body to a TV monitor. While looking at the picture on the screen, the surgeon carries out the operation.

Some of the surgical conditions that can be treated via key-hole surgery include:

• Gallstone disease (Laparoscopic cholecystectomy)
• Appendicitis (Laparoscopic appendicectomy)
• Hernia surgery (eg Laparoscopic inguinal hernia repair)

Generally the surgery is the same, however this type of surgery can make the recovery easier and quicker due to:

• Several smaller incisions rather than one long one.
• The insides of the body don’t get handled as much and exposed to the “open air” as it would in regular surgery.

No, Many procedures can be performed this way but it is not always up to the patient to choose what type of surgery to have.

Whether or not the surgery can be done via key-hole surgery can depend on various factors, such as:

• The type of surgery involved
• Why the surgery is needed – for example a patient with a perforated appendix may not be a suitable candidate for key-hole surgery
• Whether they have had previous surgery in the same region
• The other health issues a patient may have

Not all surgery can be completed via key-hole surgery. Sometimes surgery is started out this way but then the surgeon realizes they have to switch (convert) to open surgery. Sometimes this can be due to

• Finding something unexpected
• Not being able to see well enough to perform the surgery safely through the scope
• Bleeding
• The important fact to remember is that if a surgeon does convert to open “regular” surgery it is usually to protect the safety of the patient.

It sounds like a silly question, but people often don’t know why their doctor has recommended surgery or a procedure. More important, doctors sometimes offer surgery or a procedure to people who might benefit from them but who could instead be treated in other ways.

In some cases, surgery or procedure is one of several treatment options. If you have a choice of treatments, and surgery or a procedure is just one option, you will have to decide (with input from your doctor) what to do. People decide whether to have surgery or a procedure based on:

• How much your problem bothers you
• How likely the surgery or procedure is to help
• How worried are you about the risks involved
• Whether you have someone at home who can help take care of you afterwards
• How long the recovery period might be
• Whether the surgery or procedure will relieve pain you currently have
• How much pain the surgery or procedure might cause
• Whether you would be able to miss work

Some conditions that are treated with procedures or surgery get worse without treatment; some get better; and some stay the same. If the surgery or procedure is not absolutely necessary and your symptoms don’t bother you too much, you might decide to try other treatments.

Sometimes a condition can be treated in more than one way. Ask your doctor what options you have and what the differences are between them. Below are examples of some of the main surgery and procedure options.

• Open surgery – For open surgery, the surgeon makes a cut big enough so that he or she can work directly on the parts of your body.
• Minimally invasive surgery – For minimally invasive surgery, the surgeon makes smaller cuts and uses special tools that go inside your body and can be controlled from the outside.
• Percutaneous procedures – For percutaneous procedures, the surgeon or another doctor called an interventionalist gets access to a part of the body through the skin. He or she inserts a special tool and advances them to the area with the problem. One special type of percutaneous procedure is an endovascular procedure where the doctor gets access to the heart or a blood vessel by accessing a blood vessel in the leg or arm through the skin. Special tools are advanced within the blood vessel to the area with the problem.
• Endoscopic procedures – For endoscopic procedures, the doctor uses a thin tube with a tiny camera on the end. The tube goes into the natural openings in the body to look at or treat conditions of the stomach or intestines (gastrointestinal endoscopy), bladder (cystoscopy), or uterus (hysteroscopy).

Every surgery or procedure, no matter how “minor,” carries risks. Make sure you understand what you stand to gain from the surgery or procedure and what you stand to lose.

Here are some related questions to ask:

• What are the chances that I will benefit and how long is the benefit likely to last?
• What are the most common risks, and how long do their effects last?
• What are the most serious risks, even if they are not very common?

Do not be afraid to ask for a second opinion, if you would like one. No doctor should ever be worried or bothered if you want a second opinion. In fact, your doctor should be willing to help you find the best surgeon or interventionalist to suit your needs.

You can also get the names of other doctors who perform the surgery or procedure from your primary care doctor or from people you know who have had a similar surgery or procedure.

Some of the risks of surgery or procedures come from the type of anaesthesia that is used. Even “minor” surgeries or procedures have risks related to anaesthesia.

People do not always know what to expect in the recovery period after surgery or a procedure. It’s very important to find out (ahead of time) the answers to these questions:

• How much pain can I expect in the days and weeks afterward?
• How will my pain be treated or managed?
• How long will I be in the hospital?
• Will I need help when I return home?
• Will I need to have someone drive me home?
• After surgery or the procedure, will I be able drive, work, go up and down stairs, and do all the things I normally do? If not, how long will I be unable to do these things?
• When will I be able to return to work?

Ask your surgeon or interventionalist, “How many of these surgeries or procedures have you done in the last year?” Find out, too, if the hospital where you will have surgery or the procedure has a lot of experience handling people having the kind of surgery or procedure you need. You want a doctor and hospital with a lot of experience.

Before you have your surgery or procedure, ask if there are treatment centers that specialize in the type of surgery or procedure you need. You might decide to get treated at a specialty center, or you might not. But knowing how your options compare will help you make the decision that’s right for you.

For some types of surgeries or procedures, it’s best to go to a place that specializes in the type of surgery or procedure you need. For example, weight loss surgery is best done at a “center of excellence” that is dedicated to this type of surgery. That’s because people having weight loss surgery often need to be seen by a lot of different healthcare providers with a special interest in obesity. Plus, people who need weight loss surgery often have special needs because of their size.

Even with insurance coverage, people often have to pay some costs themselves when they have surgery or a procedure. It’s a good idea to find out ahead of time what you might have to pay. For that information, call your insurance company directly. When you speak with them, ask if they have to “pre-approve” your surgery or procedure. If cost is a concern for you, ask your insurance provider and your doctor whether there are less expensive treatment options that could help you.

Hyperparathyroidism is a disorder of the parathyroid glands in your neck. These glands make a hormone that helps control the amount of calcium in the blood. This hormone is called “parathyroid hormone,” or “PTH.”

Hyperparathyroidism is when your parathyroid glands make too much PTH. This causes too much calcium to build up in your blood. Primary hyperparathyroidism, the most common form of hyperparathyroidism, can happen when one or more of the glands get bigger than they should, or when a gland develops an abnormal growth. Cancer is another possible cause of hyperparathyroidism, but this is very rare.

Most people with this condition have no symptoms. But some people do have symptoms that might be related to having more calcium in their blood than normal. These symptoms include:

• Pain in the joints
• Feeling tired or weak
• Loss of appetite
• Feeling depressed
• Trouble concentrating

If your PTH and blood calcium levels get very high, you might get constipated, feel very thirsty, or urinate more often than usual. Some people have more serious symptoms, such as:

• Problems with how the kidneys work
• Kidney stones
• Weak bones
• Gout (a kind of arthritis) or other problems in the joints
• Chemical imbalances in the blood

“Parathyroid crisis” is a rare but serious problem. It can happen if you have hyperparathyroidism and get sick with something that causes you to lose fluids (like vomiting or diarrhoea). This causes the amounts of PTH and calcium in the blood to go up suddenly. If this happens, you might have belly pain, nausea, and sometimes problems thinking clearly and staying alert. It is important to see a doctor or nurse right away if you have hyperparathyroidism plus lasting vomiting or diarrhoea, and can’t keep fluids down.

Yes. A doctor or nurse can tell if you have hyperparathyroidism by measuring the levels of PTH and calcium in your blood. Many people with hyperparathyroidism do not notice any symptoms. The condition is often found when a doctor or nurse does a blood test for some other reason.

If you have hyperparathyroidism, your doctor or nurse might do other tests, too. You will probably get a special kind of X-ray to see if your bones are weaker than normal. Plus, you might get checked for kidney stones, if you have had kidney stones in the past.

Yes. Even if you do not have any symptoms, there are things you can do to help prevent problems:

• Drink plenty of liquids, and try not to get dehydrated. This can help to prevent kidney stones.
• Stay active. This can help keep your calcium levels normal and your bones healthy.
• Try to get about 1000 milligrams of calcium each day. It is better to get your calcium from foods and drinks rather than supplements. But if you aren’t getting enough calcium from the foods you eat, you might need a supplement. Your doctor will let you know.
• Try to get about 400 to 600 international units (IU) of vitamin D each day. Not having enough vitamin D can weaken your bones.
• Do not take certain medicines that can affect the amount of calcium in the blood. Your doctor or nurse can tell you which medicines to avoid.

Even if you feel healthy, your doctor or nurse should still check your blood calcium every 6 months. He or she will also do regular tests to check your kidneys and bones. (People whose bones are weakened because of their condition can get medicines to help protect their bones.)

The main treatment is surgery to remove the gland or glands that are causing the problem. (In most cases, surgery cures the hyperparathyroidism.) Still, people who have no symptoms do not always need surgery.

You will most likely need surgery if:

• The amount of calcium in your blood is much higher than normal;
• Your hyperparathyroidism is causing problems with your kidneys or bones;
• You are younger than 50; or
• You are not able to get regular checkups and tests.

A sentinel lymph node biopsy for breast cancer is an operation to check if your breast cancer has spread to your lymph nodes. Lymph nodes are bean-shaped organs found all over the body, including the armpits, neck, and groin. They are part of a network of vessels called the called the “lymphatic system” that carries a clear fluid called “lymph” When breast cancer cells spread, they usually travel through the lymph to one or more lymph nodes (called sentinel lymph nodes) in the armpits.

During a sentinel lymph node biopsy (also called “SLNB”) a surgeon finds, takes out, and checks the sentinel lymph nodes for cancer cells. Knowing whether cancer is in the sentinel lymph nodes helps your doctor choose the right treatment for your breast cancer.

The operation is usually done under general anesthesia.

There are 2 different techniques to find the sentinel node

• Blue dye – For this technique, the doctor injects blue dye into your breast near the cancer in the operating room. The dye travels through the lymph and turns the sentinel node blue.
• A radioactive substance – For this technique, the doctor injects a radioactive substance into your breast near the cancer and the coloured area around your nipple, before you go to the operating room. Then, a special device is used to find radioactive substances to locate the sentinel lymph node.
  Most surgeons use just one technique, but some use both. After finding the sentinel nodes, the surgeon makes a small cut to take them out and sends them to a lab.

Most people do not have cancer in their sentinel lymph nodes. But if they do, a second operation might be needed to take out more nodes.

After an SLNB, you might have pain, bruising, bleeding, or get an infection. Your doctor will prescribe pain relievers or other medicines to treat any symptoms.

If your doctor used blue dye, part of your breast will be blue until all of the dye disappears from your body. Your urine will also turn green for one day.

In rare cases, people are allergic to the dye used for SLNB. Your doctor will tell you about this risk and answer any questions you have before the operation. The allergic reaction happens in the operating room and is treated right away with medicines given through an IV.

If your doctor used a radioactive substance, the amount of radioactivity is very low and not harmful. It leaves your body quickly through your urine. You are not “radioactive” or dangerous to other people near you.

Thyroid cancer happens when normal cells in the thyroid change into abnormal cells and grow out of control. The thyroid is a gland in the middle of the neck. The thyroid gland makes thyroid hormone.

There are different types of thyroid cancer. Some types are more serious than others.

Early on, people might not notice any symptoms. They might find out they have thyroid cancer after their doctor does an imaging test of their neck for another reason. Imaging tests create pictures of the inside of the body.

When thyroid cancer causes symptoms, the most common symptom is a growth (called a “nodule”) on the thyroid gland. This growth usually gets bigger in a short amount of time. In some cases, people see or feel the growth themselves. In other cases, their doctor or nurse feels the growth during a routine exam.

Other symptoms of thyroid cancer can include:

• Hoarseness or being unable to talk
• Trouble breathing
• Trouble swallowing
• A cough or coughing up blood

All of these symptoms can also be caused by conditions that are not thyroid cancer. But if you have these symptoms, tell your doctor or nurse.

Yes. If you have a growth on your thyroid gland, your doctor will do tests to see whether the growth is cancer or not. (Many growths on the thyroid gland are not cancer.) These tests can include:

• Imaging tests – The imaging test most often done is an ultrasound, which uses sound waves to create pictures of the thyroid. Some people also have a thyroid scan. For a thyroid scan, a person gets a pill or shot with a small amount of a radioactive substance. Then a special camera takes a picture of the thyroid.
• Blood tests
• Fine needle aspiration – For this test, the doctor uses a thin needle to remove a small sample of tissue from the growth. Then another doctor looks at the tissue under a microscope.

Cancer staging is a way in which doctors find out if a cancer has spread past the layer of tissue where it began, and, if so, how far.

The right treatment for you will depend a lot on the type of thyroid cancer you have, its stage, and your other medical problems.

Thyroid cancer is usually treated with one or more of the following:

• Surgery – In most cases, thyroid cancer is treated with surgery to remove the cancer. Your doctor will remove part or all of your thyroid gland. He or she might also remove nearby lymph nodes, which are bean-shaped organs that are part of the body’s infection-fighting system.
• Radioactive iodine – Radioactive iodine (also called “radioiodine therapy”) comes in a pill or liquid that you swallow. It has a small amount of radiation and can destroy much of the thyroid gland.
• Thyroid hormone – Your doctor will prescribe thyroid hormone medicines after surgery or radioactive iodine treatment. That way, your body will have the correct amount of thyroid hormone.
• External-beam radiation therapy – This treatment uses high doses of X-rays, called radiation, to kill cancer cells. The radiation comes from a machine that is outside the body.
• Chemotherapy – Chemotherapy is the term doctors use to describe a group of medicines that kill cancer cells. This is not often indicated.

After treatment, your doctor will check you every so often to see if the cancer comes back. Regular follow-up tests include exams, blood tests, and imaging tests. Your doctor will also do regular follow-up blood tests to check your thyroid hormone levels.

You should also watch for the symptoms listed above. Having those symptoms could mean your thyroid cancer has come back. Tell your doctor or nurse if you have any symptoms.

If your thyroid cancer comes back or spreads, you might have more surgery, radioactive iodine treatment, external-beam radiation, or chemotherapy.

It’s important to follow all your doctor’s instructions about visits and tests. It’s also important to talk to your doctor about any side effects or problems you have during treatment.

Getting treated for thyroid cancer involves making many choices, such as what treatment to have. Always let your doctors and nurses know how you feel about a treatment. Any time you are offered a treatment, ask:

• What are the benefits of this treatment?
• Is it likely to help me live longer?
• Will it reduce or prevent symptoms?
• What are the downsides to this treatment?
• Are there other options besides this treatment?
• What happens if I do not have this treatment?

Thyroid nodules are round or oval-shaped growths in the thyroid gland. The thyroid gland is in the middle of the neck.

Thyroid nodules are common and are not usually harmful to a person’s health. But sometimes, thyroid nodules are caused by a serious condition, such as cancer.

The thyroid gland makes a hormone called “thyroid hormone.” Most thyroid nodules do not change the amount of thyroid hormone in the body. But some cause the thyroid gland to make too much thyroid hormone. This can cause symptoms.

Some people do not have any symptoms. They might find out that they have a thyroid nodule when their doctor or nurse feels it during a routine exam. Or a doctor might find nodules on an imaging test that was done for another condition. (Imaging tests create pictures of the inside of the body.)

Other people have symptoms. For example, they might feel or see a lump in their neck. Or they have symptoms from having too much thyroid hormone, such as:

• Feeling worried, upset, or having trouble sleeping
• Feeling weak or tired
• Losing weight without trying
• Having a fast heartbeat
• Having frequent bowel movements

Yes. Your doctor will want to make sure that the thyroid nodule is not a threat to your health. Tests usually include blood tests and an imaging test of the thyroid called an ultrasound. Sometimes, people need more tests. These include:

• Fine needle aspiration – For this test, a doctor uses a thin needle to remove a small sample of tissue from the thyroid nodule. Then another doctor looks at the tissue under a microscope.
• Thyroid scan – People get this test only if they have too much thyroid hormone in the body. For this test, a person gets a pill or a shot with a small amount of a radioactive substance. Then, a special camera takes a picture of the thyroid gland. This test is not safe for women who are pregnant or breastfeeding.

Thyroid nodules are treated in different ways, depending on their cause and how much thyroid hormone is in the body. Different treatments include:

• Watching and waiting – Doctors don’t always treat thyroid nodules right away. A doctor might watch a thyroid nodule if it is small and doesn’t look serious. But he or she will follow it closely to see if it grows bigger or needs to be treated.
• Medicines – Doctors can shrink thyroid nodules using thyroid hormone medicines. If you take thyroid hormone medicines, your doctor or nurse will check your thyroid hormone levels on a regular basis.
• Radioactive iodine – Radioactive iodine comes in a pill or liquid that you swallow. It has a small amount of radiation and can destroy a lot of the thyroid gland. It is used only to treat nodules that make too much thyroid hormone. It is not safe for women who are pregnant or breastfeeding.
• Surgery to remove the thyroid nodule
• A procedure to drain fluid from the thyroid nodule, if it is filled with fluid

If you want to get pregnant, talk with your doctor or nurse. Women who are pregnant should not be treated with radioactive iodine. That’s because radioactive iodine can cause serious harm to a baby. If a woman is treated with radioactive iodine, she needs to wait at least 6 months before trying to get pregnant. That way, her doctor can make sure that her nodule is no longer making too much thyroid hormone.

Thyroiditis is a condition that happens when a gland in the neck called the thyroid gets inflamed. This gland makes thyroid hormone, which controls how the body uses and stores energy.

If you have thyroiditis, your thyroid gland leaks large amounts of thyroid hormone into your bloodstream. This causes a condition called HYPERthyroidism. That is the medical term for too much thyroid hormone. Hyperthyroidism lasts only until the thyroid hormone stored in your gland is used up.

After that happens, you may not have enough thyroid hormone in your bloodstream. This causes a condition called HYPOthyroidism. That is the medical term for too little thyroid hormone. But once the inflammation goes away and you thyroid gland heals, it will start to make thyroid hormone again.

Some types of thyroiditis cause the thyroid gland to swell. Sometimes, this can also cause pain in the neck that can spread to the jaw and ears.

Most people with thyroiditis first have symptoms of hyperthyroidism. Common symptoms of hyperthyroidism include:

• Feeling weak or tired
• Losing weight, even when eating normally
• Having a fast or uneven heartbeat
• Sweating a lot and having trouble dealing with hot weather
• Feeling worried
• Trembling

The symptoms of hyperthyroidism might last for up to 6 to 8 weeks. Then, people with thyroiditis might have symptoms of hypothyroidism, which can last for 2 to 8 weeks. Common symptoms of hypothyroidism include:

• Having no energy
• Feeling cold
• Trouble having bowel movements (constipation)

In most people with thyroiditis, thyroid hormone levels return to normal within 6 to 8 months.

Yes. Your doctor or nurse will ask about your symptoms and do an exam. You will need blood tests, called thyroid function tests.

Your doctor might also order other tests. They include:

• Thyroid scan – For this test, you get a pill or shot with a small amount of a radioactive substance. Then a special camera takes pictures of your thyroid.
• Thyroid ultrasound – This test uses sound waves to create pictures of the thyroid

The treatment depends on your symptoms and what caused your thyroiditis. If you do not have symptoms, you might not need any treatment. But your doctor will check your thyroid function every so often to be sure it returns to normal.

If you have symptoms, your doctor might prescribe medicines, including:

• Thyroid hormone pills
• Pain relievers such as aspirin or ibuprofen (sample brand names: Advil®, Motrin®)
• Medicines called “beta blockers,” which slow down the heart rate
• Antibiotics