Op. Dr. Semra Polat

Breast cancer is a disease with a high chance of successful treatment when detected early. Regular check-ups and informed follow-up are therefore vital.

Breast Self-Examination

Every woman should perform a breast self-examination once a month, ideally 3–5 days after the end of menstruation. If any lump, skin change, nipple discharge or retraction is noticed, a doctor should be consulted immediately.

Clinical Breast Examination

A clinical breast examination by a doctor is recommended every 3 years from the age of 20, and annually from the age of 40.

Mammography

Annual mammography from the age of 40 is the most effective method for early detection of breast cancer. Ultrasound support may be recommended for women with dense breast tissue.

Ultrasound and MRI

When mammography is insufficient, or in high-risk women, additional imaging methods such as ultrasound and MRI may be used.

Risk Factors

A family history of breast cancer, BRCA1/BRCA2 gene mutations, early menarche, late menopause, long-term hormone use and obesity are the main factors that increase breast cancer risk.

Although there are many non-genetic causes of breast cancer, mutations in BRCA-1, BRCA-2 and PTEN genes have been identified in some family trees.

Is Breast Cancer Genetic?

Approximately 5–10% of breast cancers are hereditary. Women carrying BRCA1 or BRCA2 gene mutations may have a lifetime breast cancer risk of 50–85%. Genetic counselling is recommended for individuals with a family history.

Does Breast Cancer Only Occur in Women?

No. Breast cancer can occur in men too, but it accounts for only about 1% of all breast cancer cases.

Do Breast Implants Increase Cancer Risk?

Scientific research shows that standard silicone or saline breast implants do not increase the risk of breast cancer.

Is Breast Cancer Treatable?

For breast cancer diagnosed at an early stage, the complete recovery rate is very high. The 5-year survival rate for Stage I breast cancer exceeds 95%.

Is Chemotherapy Unavoidable?

Every breast cancer case is different. Depending on the tumour's biological characteristics, stage and hormonal status, chemotherapy, radiotherapy, hormone therapy or targeted therapy may be chosen.

Breast cancer occurs when cells of the milk ducts or milk glands of the breast undergo changes and proliferate uncontrollably for various reasons.

Symptoms

A palpable lump in the breast, shape change around the nipple, orange-peel appearance of breast skin, bloody or clear nipple discharge, and breast pain or tenderness are among the most common symptoms.

Types

Ductal Carcinoma In Situ (DCIS): Begins in the milk ducts and has not yet spread — the earliest stage.
Invasive Ductal Carcinoma: The most common type; spreads from milk ducts to surrounding tissue.
Invasive Lobular Carcinoma: Originates from the milk glands (lobules).

Diagnostic Methods

Mammography, ultrasound, MRI, fine-needle aspiration biopsy and tru-cut biopsy are the main methods used for diagnosis.

Treatment

Surgery (lumpectomy or mastectomy), radiotherapy, chemotherapy, hormone therapy and targeted (biological) therapies are applied alone or in combination depending on the stage and characteristics of the tumour.

Thanks to screening programmes, early diagnosis and advancing treatments, breast cancer mortality rates have decreased by nearly 25% worldwide in recent years. Despite this, many misconceptions persist in society.

Myth: "No lump means no cancer."

Fact: Breast cancer does not always present as a palpable lump. Mammography can detect tumours that cannot yet be felt.

Myth: "Breast cancer only affects those with a family history."

Fact: About 80% of breast cancers develop without a family history. Family history increases risk but is not the sole determinant.

Myth: "Wearing a bra for long periods causes breast cancer."

Fact: There is no scientific evidence to support this claim.

Myth: "Breast cancer always causes pain."

Fact: Early-stage breast cancer is usually painless. Pain may be an indicator of a later stage.

Myth: "Mastectomy is always the best option."

Fact: In many early-stage cases, breast-conserving surgery (lumpectomy) plus radiotherapy is as effective as mastectomy.

In men, breasts may enlarge and become prominent due to hormonal causes or excess weight. The enlargement of breast tissue in men due to an imbalance of oestrogen and androgen hormones is called gynecomastia.

Causes

Puberty (physiological), old age, obesity, liver disease, renal failure, hyperthyroidism, certain medications (spironolactone, digoxin, chemotherapy drugs) and anabolic steroid use are among the most common causes.

Symptoms

Swelling, tenderness or pain in the breast area, and palpable breast tissue are the most prominent findings.

Diagnosis

Assessment includes physical examination, hormone levels (testosterone, oestrogen, LH, FSH, prolactin), liver and kidney function tests, and mammography or ultrasound.

Treatment

The underlying cause is treated. Stopping the offending drug is often sufficient in drug-induced cases. Surgical treatment (breast tissue excision or liposuction) may be applied in pathological cases or for cosmetic concerns.

The thyroid gland is a butterfly-shaped, hormone-secreting organ located at the front of the neck, in front of the trachea.

Goitre

Abnormal enlargement of the thyroid gland is generally called goitre. Round or elliptical formations in the thyroid gland are called nodules. Nodules may be single or multiple, benign or (rarely) malignant.

Hypothyroidism

This is the condition where the thyroid gland produces insufficient hormones. Fatigue, weight gain, feeling cold, constipation, dry skin and hair loss are the main symptoms. Synthetic thyroid hormone (levothyroxine) is used in treatment.

Hyperthyroidism

This is when the thyroid gland produces excessive hormones. Palpitations, sweating, weight loss, irritability and diarrhoea are common symptoms. Graves' disease is the most common cause. It is treated with antithyroid drugs, radioactive iodine or surgery.

Thyroid Cancer

It is the most common endocrine cancer. There are four main types: papillary, follicular, medullary and anaplastic thyroid cancer. Complete recovery is generally achieved with early diagnosis and surgical treatment.

The thyroid gland produces thyroxine (T4) and triiodothyronine (T3) hormones that play a critical role in regulating carbohydrate, fat and protein metabolism and body temperature.

Functions of Thyroid Hormones

They increase the basal metabolic rate, support growth and development, regulate heart rate, contribute to the maturation of the nervous system, and maintain body temperature.

Hypothyroidism: Symptoms and Treatment

Symptoms: fatigue, weight gain, feeling cold, constipation, dry skin, facial puffiness, bradycardia and depression.
Diagnosis: elevated TSH, low free T4.
Treatment: Daily oral levothyroxine is used to bring TSH to the normal range.

Hyperthyroidism: Symptoms and Treatment

Symptoms: palpitations, excessive sweating, weight loss, irritability, tremor, diarrhoea and eye problems (in Graves' disease).
Diagnosis: suppressed TSH, elevated free T3/T4.
Treatment: Methimazole or propylthiouracil, beta-blockers, radioactive iodine therapy or surgical thyroidectomy.

Thyroid hormones (T3 and T4) affect almost all metabolic processes in the body.

Carbohydrate Metabolism

Thyroid hormones accelerate glucose absorption, glycogen synthesis and glycolysis; they potentiate insulin action.

Fat Metabolism

They affect fatty acid mobilisation, oxidation and cholesterol synthesis. Cholesterol levels rise in hypothyroidism and fall in hyperthyroidism.

Protein Metabolism

In physiological amounts, they increase protein synthesis; in excess, they cause protein breakdown (catabolism).

Calcium and Phosphorus Metabolism

They affect bone turnover; prolonged hyperthyroidism may increase the risk of osteoporosis.

Interaction with Other Hormones

They modulate the effectiveness of growth hormone, insulin, adrenal cortex hormones and catecholamines. Thyroid hormone deficiency adversely affects growth hormone secretion.

Haemorrhoids are normal anatomical structures with a vascular plexus structure that act as cushions at the anal outlet. They contain blood vessels, smooth muscles and connective tissue.

Internal and External Haemorrhoids

Internal haemorrhoids: Located above the dentate line; cause painless bleeding and prolapse. Classified into 4 grades.
External haemorrhoids: Below the dentate line, outside the anus; cause severe pain when thrombosed.

Symptoms

Bright red bleeding after defecation, anal itching, burning, moisture, tissue prolapse from the anus and pain (especially with thrombosis).

Causes

Chronic constipation, prolonged sitting on the toilet, low-fibre diet, pregnancy, obesity and a sedentary lifestyle.

Treatment

Dietary changes (increased fibre, plenty of water), sitz baths, topical creams; office procedures (rubber band ligation, sclerotherapy, infrared coagulation); haemorrhoidectomy in refractory cases.

An anal fissure is a small tear in the skin covering the anal area, causing pain, bleeding and itching. Because the anal skin contains dense nerve endings, a fissure is very painful.

Causes

Passage of hard stools, chronic diarrhoea, birth trauma, Crohn's disease or surgical procedures on the anal region may cause anal fissures.

Symptoms

Severe burning pain during and after defecation, bright red blood on toilet paper, anal itching and cramping.

Acute and Chronic Fissure

Fissures lasting less than 6 weeks are considered acute; those lasting longer are considered chronic. In chronic fissures, a sentinel pile and hypertrophic anal papilla may develop.

Treatment

Conservative: Increasing fibre and water intake, sitz baths, topical anaesthetics and nitrate/calcium channel blocker creams.
Office procedure: Botulinum toxin injection.
Surgery: Lateral internal sphincterotomy (LIS) is the gold standard in refractory cases.

An anal fistula is an abnormal tunnel between the anal canal and the skin that should not normally exist. The most common cause is a previously experienced anal abscess.

Classification

According to Parks classification, there are four types: intersphincteric, transsphincteric, suprasphincteric and extrasphincteric. The classification directly affects the surgical approach.

Symptoms

Continuous or intermittent discharge (purulent or bloody) near the anus, pain, itching and recurrent abscess formation.

Diagnosis

Anoscopy, proctoscopy, MRI fistulography and endoanal ultrasound are used to identify the fistula tract.

Treatment

Fistulotomy (for simple fistulas), seton placement, fibrin glue or anal fistula plug, LIFT (ligation of intersphincteric fistula tract) and flap procedures are used in complex cases.

It is a painful inflammatory mass that develops as a result of infection spreading from mucous glands in the anorectal area.

Types

Perianal, ischiorectal, intersphincteric and supralevator abscesses are the main types. Deeper abscesses require more extensive surgical intervention.

Symptoms

Severe, throbbing pain around the anus; redness, swelling and increased warmth; fever and general malaise; difficulty sitting and walking.

Treatment

The only treatment is surgical: drainage of the abscess under appropriate anaesthesia. Antibiotics alone are insufficient; they are only used additionally in those with signs of systemic infection. Approximately 50% of drained abscesses may later develop into an anal fistula.

Rubber band ligation is a non-surgical haemorrhoid treatment that can be performed in a clinic setting without hospitalisation or anaesthesia, and is usually painless.

How Is It Performed?

During the procedure, haemorrhoidal tissue is grasped with a special device and a small rubber band is placed over it. This band cuts off the blood supply to the tissue; within 7–10 days, the tissue dries up and falls off.

Who Is It Suitable For?

It is effective for Grade I, II and selected Grade III internal haemorrhoids. It is not applied to external haemorrhoids.

Advantages

No anaesthesia required, the procedure is completed in 5–10 minutes, the patient can return to normal activities the same day, it can be repeated and has a low complication rate.

Possible Complications

Mild bleeding, pain or discomfort, bleeding when the band falls off, and rarely infection may occur.

The gallbladder is a pear-shaped organ where bile secreted from the liver is collected and stored, playing a role in the digestion of fats.

Gallstones (Cholelithiasis)

The most common gallbladder disease. Formed by the accumulation of cholesterol or bilirubin crystals. Many people are asymptomatic; however, it can lead to biliary colic, acute cholecystitis, cholangitis or pancreatitis.

Acute Cholecystitis

Inflammation of the gallbladder, usually related to stones. It presents with right upper quadrant pain, fever, nausea and vomiting. Murphy's sign is positive. Treatment: Antibiotics and laparoscopic cholecystectomy.

Chronic Cholecystitis

Thickening and dysfunction of the gallbladder as a result of repeated biliary colic attacks. Surgical treatment is recommended.

Gallbladder Cancer

A rare but aggressive tumour. Long-term presence of gallstones is a risk factor. It is asymptomatic in the early stage and is often discovered incidentally during surgery.

Gallstones are solid particles that form in the gallbladder and can cause various effects on the digestive system.

Do All Gallstones Cause Pain?

No. Many people can live for years without knowing they have gallstones (asymptomatic stones). When a stone becomes lodged in the outlet duct of the gallbladder, severe, cramp-like pain known as biliary colic occurs.

Symptoms of Biliary Colic

Sudden and severe pain starting in the right upper abdomen or epigastric region, which may radiate to the back or right shoulder; nausea, vomiting and sweating may accompany it. Attacks generally occur after fatty meals.

Is Non-Surgical Treatment Possible?

Small cholesterol stones can be dissolved with ursodeoxycholic acid; however, this is a lengthy process and the risk of stone recurrence is high. Shock wave therapy (ESWL) can be applied in limited cases. Laparoscopic cholecystectomy is the gold standard in symptomatic cases.

Gastro-oesophageal reflux occurs when stomach contents leak into the oesophagus. Inadequate function of the lower oesophageal sphincter is the main cause of this condition.

Symptoms

Heartburn (pyrosis), regurgitation (acid coming back into the mouth), chest pain, difficulty swallowing, chronic cough, hoarseness and throat irritation.

Complications

Untreated GORD can lead to oesophagitis, oesophageal stricture, Barrett's oesophagus (a precancerous condition) and oesophageal adenocarcinoma.

Diagnosis

Oesophagogastroscopy (OGS), 24-hour pH monitoring and oesophageal manometry are used for diagnosis.

Treatment

Lifestyle changes: Not eating 3 hours before bed, elevating the head of the bed, quitting smoking and alcohol, losing weight, avoiding fatty and spicy foods.
Medication: Proton pump inhibitors (PPIs), H2 blockers, antacids.
Surgery: Laparoscopic Nissen fundoplication in refractory cases.

IBS is a functional bowel disorder with no known organic cause, closely related to stress, characterised by changes in bowel habits such as abdominal pain, bloating, diarrhoea and constipation.

Rome IV Diagnostic Criteria

Recurrent abdominal pain at least 1 day per week in the last 3 months, associated with at least two of the following: relief with defecation, change in stool frequency, change in stool consistency.

Types

IBS-Constipation predominant (IBS-C), IBS-Diarrhoea predominant (IBS-D), IBS-Mixed (IBS-M) and Unclassified IBS.

Triggers

Stress and anxiety, food intolerances (gluten, lactose, FODMAPs), hormonal changes and previous bowel infections.

Treatment

Low-FODMAP diet, fibre adjustment, probiotics, antispasmodics, laxatives or antidiarrhoeals, and psychotherapeutic support when needed.

Rectal bleeding refers to bright or dark red blood coming from the rectum during defecation or passing gas.

Causes

Common (benign): Haemorrhoids, anal fissure, rectal polyp, diverticular disease.
More serious: Colorectal cancer, inflammatory bowel disease (Crohn's, ulcerative colitis), angiodysplasia.

Red Flags

Over 50 years old, family history of colorectal cancer, bleeding accompanied by weight loss, night sweats and fatigue; dark (melaena) or clotted blood; requires urgent assessment.

Diagnosis

Evaluated with rectal examination, anoscopy, sigmoidoscopy and colonoscopy. CT colonoscopy or CT angiography may be performed if necessary.

Important Warning

Rectal bleeding should never be taken lightly; specialist advice should always be sought, especially in recurring or large-volume cases.

Pilonidal sinus occurs when hair penetrates under the skin in the coccyx region (rarely the navel or axilla), causing wounds, abscesses and fistulas. It is commonly known as "kıl dönmesi" (hair turning) in Turkish.

Risk Factors

Male sex, sedentary work (prolonged sitting), excessive hairiness, deep gluteal cleft anatomy, obesity and poor personal hygiene.

Symptoms

Pain, swelling and redness in the coccyx region; discharging sinus opening; recurrent abscesses; chronic external skin opening in some patients.

Diagnosis

Made by clinical examination. MRI or ultrasound may be used in complicated cases.

Treatment Options

Minimally invasive: Phenol or silver nitrate injection, sinus opening and curettage, pit picking (Bascom I).
Surgical: Wide excision and primary/secondary closure, Karydakis flap, Limberg flap (rhomboid flap) and Bascom II cleft lift procedure are effective in reducing recurrence rates.

It is one of the minimally invasive methods preferred in pilonidal sinus treatment because it can be applied in clinic conditions, does not require general anaesthesia or bed rest, and leaves very little cosmetic scarring.

Phenol Application

The sinus tract is curetted under local anaesthesia; then 80–85% phenol solution is injected into the sinus and left for a set period. The sinus is obliterated through tissue coagulation and fibrosis. More than one session may be required.

Silver Nitrate Application

Silver nitrate sticks are placed in the sinus canal for chemical cauterisation. It is less invasive and can also be preferred in paediatric patients.

Results and Success Rate

Success of 60–70% can be achieved with a single session. Combination with hair depilation increases success. In case of recurrence, the session can be repeated or surgery can be planned.

Patient Selection

Surgery should be preferred in primary or recurrent pilonidal sinus cases with active discharge, complicated or wide fistula cases.

Varicose veins refer to the irregular elongation, widening and twisting of veins in a specific body region.

Causes

Weakening of vein walls, valve insufficiency, genetic predisposition, prolonged standing or sitting, pregnancy, obesity and advanced age are the main risk factors.

Symptoms

Visibly enlarged, twisted veins in the legs; a feeling of heaviness, tension and pain; oedema; skin discolouration and itching; leg ulcers in advanced cases.

Diagnosis

Venous system mapping is performed with colour Doppler ultrasonography; valve insufficiency and reflux are demonstrated.

Treatment Options

Conservative: Compression stockings, weight control, exercise.
Sclerotherapy: Injection of a sclerosing agent into the vessel; suitable for small and medium-sized varicose veins.
Endovenous laser treatment (EVLT) or radiofrequency ablation (RFA): Thermal damage to the vein wall; minimally invasive and effective.
Surgical stripping: Removal of the main saphenous vein; applied for large varicose veins.