Breast and Endocrine Unit

Breast cancer


What are the symptoms:

  • Palpable or visible lump
  • Nipple discharge
  • Retraction of the nipple
  • Skin dimple
  • Pea d’orange- this is where the skin resembles an orange peal
  • Nodes under the arm
  • Paget’s disease of the nipple – the appearance of the nipple changes and resembles a rash, eczema or psoriasis
  • In this day and age most cases are diagnosed by screening mammogram and are symptomless.

Types of breast cancer


The breast is made up of ducts and lobules. Both of these elements can become cancerous, but are very differing nature. The most common type is ductal carcinoma arising from the ducts. Lobular carcinoma can occur in both breasts and arise from the lobules. Other rarer types also occur, most notable of these is “inflammatory breast cancer”. This can be of any type of breast cancer, but refers to how it presents. This form breast cancer presents like an infection or abscess of the breast.

What determines my risk of getting breast cancer?


The most important risk factor is a family history of breast cancer. If you have a first degree relative ( mother, sister , grandmother) who had breast cancer, you have a higher risk of developing breast cancer. The risk increases with age. Breast cancer is not limited to female, but males have a much lower risk.

What determines prognosis?


Many factor can influence this. It is not just as simple as previously thought. The following factors need to be taken into account

  • Age
  • Type of cancer
  • Hormone sensitivity of the cancer
  • Growth rate of the cancer – Ki67
  • Spread(metastases)
  • Staging of cancer
  • Compliance with treatment
  • Comorbidities

Screening


Breast tomosynthesis, sometimes referred to as a 3D mammogram, is slowly replacing traditional mammogram and is now the investigation of choice. This should always be done in conjunction with a sonar/ultrasound. Patients without any risk factors should start screening from the age of 40.

Treatment


The multimodal approach should be adopted and the most appropriate treatment plan should be determined by a multidisciplinary team.

  • Surgery
  • Reconstruction
  • Dermapigmentation
  • Scar enhancement

Non-cancerous (benign) breast disease

  • Fibrodenoma
  • Ductal ectasia
  • Papiloma
  • Mastitis
  • Gynecomastia
  • Accessory breast tissue
breast-disease

Thyroid


The thyroid gland sits in front of your trachea (air pipe).
What are the symptoms thyroid pathology?

  • A nodule/mass that enlarges.
  • Pressure on the air pipe or swallow pipe.
  • Choking.
  • Difficulty with swallowing.
  • Pain (seldom).
  • Weight loss or weight gain.

A thyroid nodule or mass is usually not cancerous, but cancer is the important diagnosis that has to be ruled out. See your local doctor if you experience any of these symptoms.

Screening


A sonar is usually sufficient to make a diagnosis. Often a fine needle biopsy of the nodule needs to be done.

In certain cases a thyroid scan is also needed. This is usually in cases where the thyroid is over or under active.

Surgery is needed if the nodule is a proven cancer. If there is doubt whether the nodule is cancerous or not after the biopsy, surgery is usually done to make sure of the diagnosis, especially in cases where the sonar has features that could point towards cancer.

Surgery is also needed where the thyroid is large and causing pressure symptoms, or if it becomes a cosmetic problem.

If the thyroid is over or under active it is usually treated with medication and not surgery.

Parathyroid


The parathyroids are small glands behind the thyroid gland that controls the calcium levels and metabolism in your body.

Hyperparathyroidism

Symptoms:

  • Stones: Gallstones, kidney stones.
  • Bones: Leg and arm pain.
  • Moanes: Feeling depressed and tired.
  • Groanes: General weakness.

An increased parathyroid hormone level can lead to these symptoms.

Surgery


If a single parathyroid gland is enlarged and overactive, surgery is the treatment of choice.

There are more complicated cases of hyperparathyroidism, where the treatment is more complex, but in most cases, surgery is the mainstay.

Adrenal glands


Small glands located above both kidneys. They are involved with metabolic functions, stress hormone release and blood pressure control. These glands have two distinct functional areas that could be over or under active and present in different ways.

Dr. Abraham Bezuidenhout

Dr. Abraham Bezuidenhout

Specialist Surgeon
Dr.Marthinus J G.-Smit

Dr. Marthinus J. G. Smit

Specialist Surgeon