breast disorders
women s health issues
Nipple Discharge
Nipple discharge is a cause for concern when it Is accompanied by a lump that can be felt Is bloody or pink Comes from only one breast Occurs without the nipple's being squeezed or stimulated by other means (when it occurs spontaneously) Occurs in women aged 40 or older Occurs in a boy or man If a nipple discharge continues for more than one menstrual cycle or if any of the warning signs are present, women (or men) should see a doctor. Delay of a week or so is not harmful unless there are signs of infection such as redness, swelling, and/or a discharge of pus. Women with such symptoms should see a doctor within 1 or 2 days. Doctors first ask questions about the woman's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the discharge and the tests that may need to be done (see Table below). To help identify the cause, doctors ask about the discharge and about other symptoms that may suggest possible causes. They ask Whether the discharge comes from one or both breasts What the discharge's color is How long it has lasted Whether it is spontaneous or occurs only when the nipple is stimulated Whether a Breast Lumps or Women are also asked whether they have had disorders or take drugs that can increase prolactin levels. Doctors examine the breast, looking for abnormalities, including Warning signs . If the discharge does not occur spontaneously, the area around the nipples is gently pressed to try to stimulate a discharge. Doctors also feel the lymph nodes in the armpits and above the collarbone to check for enlarged lymph nodes. If doctors suspect that a hormonal disorder is the cause, blood tests are done to measure the levels of prolactin and thyroid-stimulating hormone. If a pituitary or brain disorder is suspected, magnetic resonance imaging (MRI) or computed tomography (CT) of the head is done. If the discharge is not obviously bloody, it is analyzed to determine whether it contains small amounts of blood. If blood is present, a sample of the discharge is examined under a microscope (called cytology) to look for cancer cells. If a lump can be felt, ultrasonography or mammography is done. Testing is similar to that for any breast lump. Cysts are drained (by aspiration), and the fluid is tested. If the fluid is bloody, it is checked for cancer cells. If lumps are solid, mammography is done, followed by a biopsy. When there is no lump but cancer is still suspected or when other test results are unclear, mammography is done. If test results after aspiration, ultrasonography, or mammography are abnormal, a biopsy is done. If ultrasonography and mammography do not identify a cause and the discharge occurs spontaneously and comes from one milk duct, doctors usually do a special type of mammogram (called a ductogram, or galactogram). For this procedure, a contrast agent (which helps make images clearer) is injected into the duct, and images are taken, just as for a regular mammogram. This test can help rule out or identify cancer. If no lump can be felt and the mammogram is normal, cancer is highly unlikely. Sometimes a specific cause cannot be identified. If women have any of the following, they should see a doctor who is experienced in managing breast disorders: A lump in the breast A bloody or pink discharge A spontaneous discharge from one breast An abnormality previously detected by mammography or ultrasonography 