Why does a breast cyst occur and should it be removed?24.05.2022
A breast cyst is a benign abdominal formation, which is one of the forms of mastopathy. It occurs in 30% of women, and the maximum frequency increases at 45 years. This is due to the peculiarities of the functioning of the hormonal system and the accumulation of concomitant diseases by older age. It is not always necessary to remove the formation, sometimes it responds well to hormone therapy.
Breast cyst is manifested by pain before menstruation
The mammary gland responds to fluctuations in sex hormones, the growth of its tissues is determined by progesterone and estrogens. Outside of pregnancy, during the 2nd phase of the menstrual cycle, there is a gradual increase in the glandular component. The final formation of ducts and interductal tissues occurs during the formation of lactation. Therefore, breastfeeding acts as a protective factor against breast cysts and other neoplasms.
The development of cystic cavities and the growth of connective tissue in the chest occurs under the influence of the following reasons:
- dyshormonal conditions – ovulation disorder, early menarche, late menopause;
- multiple operations to terminate pregnancy in the early stages;
- late first pregnancy (after 30 years);
- infertility associated with anovulation;
- inflammatory diseases of the mammary glands;
- hereditary predisposition;
- menstrual disorders associated with a lack of progesterone;
- hyperplastic processes in the genitals – fibroids, endometriosis, endometrial hyperplasia;
- obesity, especially in combination with diabetes mellitus and arterial hypertension;
- prolonged stressful state;
- lactation period less than 1 month or more than 1 year.
The main causes of development are associated with a violation of the ratio of estrogen and progesterone. Relative hyperestrogenism leads to the growth of the alveoli of the chest, ducts and increased division of the connective tissue. Its strands delimit areas with milk sinuses, bend the ducts and disrupt the outflow of their contents, which accumulate in the ducts, expand them, which ends with the formation of a cyst.
Often fibrocystic mastopathy occurs in patients with polycystic ovary syndrome. There are two main factors in this state:
- lack of progesterone;
- insulin resistance.
Polycystic is combined with insulin resistance of cells, which leads to a violation of the energy balance in tissues, stimulation of the growth of connective tissue elements. Violation of glucose uptake is accompanied by secondary obesity, and adipose tissue acts as an additional source of estrogens, which closes the pathological circle.
A cyst can cause cancer, it is important to visit a mammologist regularly
Mastopathy is classified depending on the severity of cell proliferation – enhanced division, which can lead to an oncological process. There are three degrees:
- 1 degree – fibrocystic mastopathy without proliferation;
- Grade 2 – a benign process with severe proliferation, but without atypical cells;
- Grade 3 – mastopathy with atypical proliferation.
2 and 3 degrees refer to precancerous processes that can cause oncological degeneration.
Depending on the structure, the following types of cysts are distinguished:
- fibrous – diagnosed during menopause, can turn into cancer;
- solitary – benign, often large;
- ductal – a precancerous disease, can be asymptomatic for a long time;
- multi-chamber – a cavity of complex structure, formed by a large number of small cysts.
A neoplasm is more often formed in one breast, but there are pathological processes that manifest themselves bilaterally. The size of the cyst also determines the approach to therapy. Neoplasms up to 20 mm are considered small. A large cyst is diagnosed when this diameter is exceeded.
The first symptoms become noticeable in the second half of the menstrual cycle. Shortly before the onset of menstruation, there is pain in the mammary gland. By nature, it is pulling, bursting, in women there is tension or engorgement of the chest. Many complain of increased sensitivity of the nipples, irritability when in contact with them.
With severe hormonal disorders, the pain syndrome begins to bother from the moment of ovulation. The chest becomes edematous, may increase slightly in size. On palpation, diffuse compaction is felt.
The first symptom of mastopathy can be mistaken for manifestations of premenstrual syndrome. An accurate diagnosis requires observation and self-examination of the breast.
With the progression of the condition, a pathological focus is formed in the gland, which can be felt through the skin during the luteal phase. The nodule with a benign flow is dense, not soldered to the surrounding tissues, but painful when pressed. There should be no pathological discharge from the nipples. After the end of menstrual bleeding, the seal in the chest becomes invisible.
In the advanced stage, the cyst is palpated even after the end of menstruation, when the rest of the mammary gland remains soft and painless. The pain becomes permanent, becomes atypical. It is characterized by:
- irradiation to the arm, shoulder;
- strengthening of local sensations, clear localization;
- loss of cycle.
Sometimes pain sensations spread deep into the chest, so the connection with the probable pathology of the mammary gland is lost. This condition may be mistaken for neuralgia, neuritis, or disease of the internal organs. An increase in lymph nodes for a benign cyst is not typical.
In advanced stages, discharge from the nipple may appear. They resemble colostrum, transparent and odorless. A symptom of a dangerous pathology is bloody, purulent, serous-sanitary or fetid discharge. Sometimes they become the first reason that forces you to see a doctor. For normal discharge with mastopathy, it is characteristic:
- appearance on one half of the body;
- fluid flows out of only one duct;
- appear spontaneously.
Chronic pain syndrome affects the mental state of a woman. This leads to the appearance of neurological disorders:
- increased irritability;
- emotional lability;
- increased fatigue;
- emotional imbalance;
- sleep disorders;
- feeling of fear of oncology and depressive disorders.
It is necessary to pay attention if the appearance of the gland changes, it becomes asymmetric, the skin changes over the cystic seal.
A typical symptom in chronic pain is depression and nervousness.
Possible complications and risks
A breast cyst does not necessarily turn into cancer, but it greatly increases the risk. This type of pathology ranks first among the mortality factors in women with oncology due to late diagnosis and delayed therapy.
The risk of developing oncology depends on the type of cysts, predisposing and provoking factors. It is significantly higher among patients who take Tamoxifen on the recommendation of a doctor.
It was previously thought that hormonal oral contraceptives also increase the development of cancer, but studies have shown that long-term continuous use of the pill in patients with a large number of risk factors reduces the likelihood of cancer.
To avoid treatment, it is necessary to carry out early diagnosis of mastopathy. The main role belongs to self-examination of the mammary glands. A woman should independently carry out palpation according to a certain pattern on the 5th-7th day of the menstrual cycle. A scheduled visit to the gynecologist should also be carried out in the first few days after the end of menstruation, so that the doctor can also properly palpate the gland.
For an objective assessment of the neoplasm, mammography is prescribed. It is effective in 95% of cases. The severity of mastopathy on mammography is determined by the ratio of connective tissue and glandular component. It is possible to differentiate a cyst from a fibroadenoma using pneumocystography.
Additionally, the following examination methods are assigned:
- Ultrasound of the mammary glands;
- assessment of hormonal status;
- genetic testing.
Morphological examination requires good access to tissues containing the neoplasm. To study the contents of the cyst, a puncture is performed under ultrasound control. In the breast with a predominance of fibrous tissue, it is replaced by a trephine biopsy. The tissues obtained as a result of the analysis are sent for histological examination. Trepanobiopsy is also performed under the control of ultrasound or mammography. It precedes the removal of the breast sector.
Directions of therapy
Treatment of most neoplasms begins with the use of hormonal drugs. It allows you to establish a connection with a violation of the production of hormones and a change in the menstrual cycle.
What to do with the ineffectiveness of drugs, the doctor should decide. For small cysts without signs of atypia, conservative therapy is possible. Its contents are removed during puncture, and the cavity is sclerosed with ethyl alcohol. If mucosal contents with blood are detected during the sclerotherapy operation, it is necessary to decide on a sectoral resection before receiving the histological results.
For large cysts, larger than 20 mm with signs of proliferation, a surgical operation is necessary. After the intervention, it is not recommended to take hormonal drugs for several cycles to prevent relapse. Also, to reduce the influence of provoking factors, it is necessary to undergo a course of treatment of comorbidities.
See also: how to treat fibrocystic mastopathy