If you need to pass urine often in large amounts, you are producing too much urine. Possible causes include kidney failure, sugar diabetes (perhaps due to corticosteroids), diabetes insipides and too much calcium in the blood. Diabetes insipides is a condition where you pass large amounts of very weak urine. It can follow attempts to destroy the pituitary gland — see page 295.

Your doctor should quickly be able to find out why you are passing urine too often by testing your urine and blood.

I’ll just explain a bit more here about one of the possible causes. Too much calcium in the blood is a complication of cancer which we have not discussed in detail so far. If this is the reason for you passing a lot of urine often, you are likely to have other symptoms as well— nausea, unusual thirst, a metallic taste in the mouth, constipation, muscle weakness, drowsiness and confusion.

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A variation of lumpectomy, this operation is done for a larger tumour and involves the removal of a larger wedge of normal tissue. Auxiliary lymph nodes may also be removed.

The advantage of this operation for women with larger breasts is that most of the breast tissue is preserved. There is also unlikely to be much swelling of the arm as most of the auxiliary lymph nodes remain intact. However, the breast may be left flattened or distorted, particularly the nipple.

Radiotherapy is likely to be necessary after a partial mastectomy in case any cancer remains in the breast tissue left behind. Again, radiotherapy must be avoided if all the auxiliary lymph nodes have been removed.

Mastectomy

In simple or total mastectomy, the entire breast is removed, usually together with some or all of the auxiliary lymph nodes. Breast reconstruction should be possible following this operation. Its advantages include the retention of the muscles of the chest wall, which are removed in a radical mastectomy. The risk of arm swelling is increased if the auxiliary lymph nodes are completely excised, or if some of them are removed for staging and then radiotherapy is given.

There is controversy about how many of the auxiliary lymph nodes should be removed. Some surgeons claim that complete removal leads to a very low recurrence rate and makes radiotherapy unnecessary. Others prefer to perform a wide lump excision (removing the lump itself as well as a wedge of the normal tissue surrounding it), with sampling of the auxiliary nodes for prognostication, and follow it up with radiotherapy to a large area around the breast and armpit. This is a quicker operation, involving less risk of damage to the nerves responsible for sensation in the arms.

For pre-menopausal women whose auxiliary nodes are involved, surgery may be followed by adjuvant chemotherapy for 6 to 12 months.

Radical mastectomy

This operation is now uncommon. It involves the removal of the entire breast, the auxiliary lymph nodes, fat, and the pectoral muscles of the chest wall. If metastasis has not already occurred, radical mastectomy can completely remove the malignant cells. However, it does leave a long scar, a hollow chest, restricted movement of the shoulder, and loss of arm strength due to the removal of the muscles which normally allow arm movement.

Modified radical mastectomy (Patey)

In this operation the entire breast, all the lymph nodes in the armpit and the smaller of the two chest muscles are removed.

As all the auxiliary lymph nodes are removed, swelling may occur in the arm, but muscle strength is retained.

Super-radical mastectomy

Another uncommon operation, this involves radical mastectomy as well as removal of further lymph nodes known as the internal mammary and supraclavicular nodes. However, there is no evidence to prove that this operation is more effective than radical mastectomy alone.

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