For decades now breast cancer tissue resection has been the primary method of choice for treating the disease, however this was not the case throughout the history of medicine. For centuries breast cancer was considered to be incurable via surgical approaches and that only early, low grade, lesions can be removed safely. Not until the 19 th century, an increase in primary surgical therapy for the disease (mainly radical mastectomies) was becoming evident due to the teachings of Morgagni, in addition to a complete re-conceivement of the etiological process of the disease by Le Dran. Currently, practitioners have achieved a very high level of proficiency in treating the disease via continuous refinement of the aforementioned facts. This resulted in tissue and organ sparing local surgical approaches, including wide local excisions through para-areolar incisions and even skin and nipple-sparing mastectomies, which have long overpassed the unnecessary and primitive high morbidity approaches performed in the earlier attempts to treat breast cancer. KEYWORDS breast surgery techniques, breast cancer treatment, breast history Early history of breast cancer Currently, breast cancer (BC) surgical excision remains the gold standard for treating the disease and due to its significant social and economic impact, researchers and clinicians have attempted to identify the pathogenic processes giving rise to the disease. However it took centuries for medical practitioners to reach these conclusions. Nonetheless, even throughout the ages breast cancer has been capturing the attention of medicine and surgery practitioners universally, with the Smith Surgical Papyrus (3000-2500 b.c.
The Gail model is a statistical tool, which assesses breast cancer probability, based on nonmodifiable risk factors. In contrast, the evaluation of mammographic breast density is an independent and dynamic risk factor influenced by interventions modifying breast cancer risk incidence. The aim of the present study is to compare the possibilities for risk factor integration and analysis and to search for a correlation between mammographic density and the Gail model for breast cancer risk evaluation. The subject of this prospective study is a cohort of 107 women at ages from 37 to 71 years, who have had benign breast diseases, digital mammograms, and Gail model risk evaluation. Mammographic density is evaluated in craniocaudal projection subjectively visually and objectively using the computer imaging software. (Image J software) The Gail risk evaluation is completed using the standardized NCI questionnaire (Breast Cancer Risk Assessment Tool). In concordance with the Breast Imaging Reporting and Data System (BI-RAD) by ACR, mammographic density is evaluated using a four-grade scale. Low density D1 (less than 25%) was determined in 24 cases, D2 (25-50%) in 36 cases, D3 (51-75%) in 31 cases and high density D4 (greater than 75%) in 16 cases. According to the Gail model, 80 (74,8%) of the examined patients did not have an increased risk (less than 1,67% for a five-year period), whereas the remaining 27 (25,2%) had a statistically significant increase in risk (greater than 1,67% for a term of five years). Women with increased risk more often present with denser breast (34% with D3, D4 versus 18,3% for D1, D2). The Gail model does not fully explain the correlation between breast density and statistically calculated risk. The development of more detailed tools, which take into consideration breast density, as well as other risk factors, may be helpful for a more accurate evaluation of the individual risk for breast cancer.
The first in a series of reviews discusses the literature published so far relating to breast cancer including: epidemiology of the disease, economic impact, pathology of breast cancer as it remains the most common cancer diagnosed in women, the main molecular mechanisms of tumorigenesis accepted today, the invasion & metastasis cascade and the concerning relationship between benign and malignant disease. KEYWORDS breast cancer; breast disease; breast cancer impact EpidemiologyBreast cancer is the most common occurring malignancy in women of the developed world, comprising almost a third of all malignancies in females. It is defined as a malignant proliferation of the epithelial cells from which the breast ducts and milk-producing lobules constitute. The latest Western European statistics have shown that on average about 100,000 incidents of invasive breast carcinoma and, though slowly declining, 25,000 deaths due to the subsequent late stage metastatic spread occur annually (European region) [1]. On the other hand the incidents of the disease in eastern European countries were found to be somewhat lower, though still demonstrating a significant mortality factor [2], and unfortunately as the research shows there has been no significant improvement in breast cancer morbidity rates in that region.Globally, the lifetime risk of a woman developing invasive breast cancer is 13%, Meaning that one out of eight females will develop breast cancer at some point in their life [4]. The mortality rates have been shown to be highest in the ancient (>75
Breast cancer can metastasise to a vast array of organs, but in rare cases, cancer can form secondary lesions in the uterus and cervix. In our case report we have a 56-years-old female with gynecologic bleeding, bloating, and difficulty in breathing, fatigue, weakness and polyuria. After performing of dilatation and curettage, the result was endometrial and cervical metastases which show histopathological and immunohistochemical findings suggesting invasive lobular carcinoma of the breast that leads to primary breast cancer. Her status estimated the treatment. This case demonstrates the importance of adequate clinical behaviour and treatment of each of the gynaecological symptoms for establishing a cause of extragynecological origin, clarifying the patient's overall status. It is essential to have proper and timely clinical behaviour for menopausal patients in gynaecological diseases, as the primary cause may be of extragenital origin.KEYWORDS invasive lobular breast cancer, endometrial metastases, cervical metastases, extragynecological origin HOW TO CITE THIS ARTICLEChupryna E, Ganovska A, Kirilova I, Kovachev S, Baytchev G. Endometrial and cervical metastases leading to the diagnosis of a primary breast cancer: A case report. Int J Surg Med. 2017; 3(4): 253-256. doi:10.5455/ijsm.endometrial-and-cervical-metastasesprimary-breast-cancer
Breast cancer is a heterogenous disease, showing as several different clinical and histologic types. Most of breast cancers express hormone receptors for estrogen and progesterone, which are considered as estrogen receptor-positive and progesterone-receptor-positive, respectively. Endocrine therapy was the first class of target-directed therapy approved for treating breast cancer and is still very important for the treatment of HR+ breast cancer because of its effectiveness and good toxicity profile. It targets receptormediated signaling pathways implicated in cell survival and proliferation, such as those mediated by hormone receptors. Although these approaches have improved the management of advanced breast cancer, many patients either fail to respond to initial therapy (primary or de novo resistance) or eventually become resistant to treatment (secondary or acquired resistance). To expand the use of existing endocrine treatments and their efficiency, new methods are needed. Such new approaches would boost the benefit of existing endocrine therapy by extending time to disease progression, avoiding or overcoming resistance to endocrine treatment, and delaying the use of chemotherapy. This article will review the central role of the PI3K inhibitors in driving ER+/HER2-breast tumors. Also, schemes to combine pathway inhibitors with endocrine therapy for better patient outcome, and approaches to identify patient populations that would benefit most from inhibition of the PI3K/AKT/mTOR pathway will be assessed.
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