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Breast Cancer: Surgical Perspectives
Published in Raymond Taillefer, Iraj Khalkhali, Alan D. Waxman, Hans J. Biersack, Radionuclide Imaging of the Breast, 2021
Patricia J. Eubanks, Hernan I. Vargas, Stanley R. Klein
Large tumors diagnosed by FNA or core needle biopsy may be treated initially with chemotherapy. This allows potential for breast conservation as well as improved resectability with MRM. Approximately 10% to 15% of breast cancers diagnosed each year are considered locally advanced [63]. Locally advanced cancers are those >5 cm in size with matted axillary nodes or skin/or chest wall involvement. Several studies summarizing the results of mastectomy alone for locally advanced breast cancer show 5-year survival rates of 5.7% to 53% [64-68] with 5-year recurrence rates of 6% to 50%. These studies illustrate the high rate of recurrence and death in patients undergoing radical surgery for advanced disease and confirm that surgery alone is inadequate treatment. Radiation therapy to the breast with and without surgery has been tried as well, with no survival benefit [69]. The combination of surgery with chemotherapy and radiation therapy has been shown to result in the greatest survival [70,71].
Gynaecological cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Radical surgery is the treatment of choice in the form of a radical hysterectomy (Wertheim's hysterectomy) during which, in addition to the removal of the uterus, tubes and ovaries, the upper vagina, parametrium and pelvic lymph nodes are also included in the resection.
The locomotor system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Musculoaponeurotic fibromatosis is seen typically in the muscles of the shoulder and pelvic girdles and in the thigh, where it forms a firm mass, which infiltrates widely through muscle, often further than can be identified at surgery. For this reason complete excision is difficult and repeated recurrences are common, sometimes with involvement of major structures such as the brachial plexus. Recently, it has been suggested that conservative surgery, perhaps supplemented by low-dose chemotherapy or radiotherapy, is as successful as attempts at radical surgery. Abdominal desmoids are similar lesions seen in the rectus abdominis of females during or after pregnancy but tend to be smaller, less aggressive, and less likely to recur. Abdominal desmoid tumours also occur in association with familial adenomatous polyposis (FAP) (see Chapter 10).
Application of robot-assisted radical prostatectomy in men over 75 years: an analysis of comparative outcomes
Published in The Aging Male, 2023
Zhongyou Xia, Xueqin Fu, Jinze Li, Xinzhu Yuan, Ji Wu, Lingtong Tang
These surgical features suggest that RARP is suitable for elderly patients. However, to the best of our knowledge, the European Association of Urology and National Comprehensive Cancer Network guidelines set a life expectancy greater than 10 years as the standard for RP [6,7]. However, in terms of safety and worse biochemical recurrence (BCR) and metastatic progression-free survival rates associated with age, many doctors are reluctant to perform RARP in men aged over 75 years [8,9]. With the advent of better healthcare facilities, the number of people aged over 80 years will triple by 2050. While a greater proportion of men are older, the risk of PCa has increased [10]. Except life expectancy, patients’ health status is also a factor affecting the decision-making of RP. For patients aged over 70 years, if the G8-tool score is > 14, RARP should be offered, similar with younger individuals [11]. Therefore, we need to reevaluate patients who are suitable for radical surgery. Previous studies have proven the safety and excellent oncological and functional outcomes of RARP in this select group of elderly patients with PCa [9,12]. Although RARP logically suggests a potential advantage in the elderly, the feasibility of RARP in elderly patients remains controversial.
Estrogen receptors as potential therapeutic target in endometrial cancer
Published in Journal of Receptors and Signal Transduction, 2023
Payel Guha, Koushik Sen, Piyali Chowdhury, Dilip Mukherjee
The most effective treatment at early stage of this type of cancer is considered to be radical surgery. But in such surgeries, 40% cases still have a risk of recurrence and metastasis [73] resulting in a high mortality rate [74,75]. A close association of epithelial-mesenchymal transition (EMT) with such tumor invasion and metastasis is now known. The molecular mechanism of action of common EMT in ECs includes down-regulation of the E-cadherin level, and other molecular alterations consistent with the mesenchymal phenotype [76]. EMT affects EC through estrogen signaling and microRNAs (miRNAs) have been reported [77]. Studies also indicated that miRNA-424 is able to suppress E2-induced cell proliferation via targeting GPER in EC cells and over-expression of miRNA-424 dramatically reduced E2-induced cell proliferation in EC cell through inactivation of PI3K/AKT signaling mediated by GPER [78]. A very recent finding suggested that miRNA-195 inhibits EMT transition by targeting GPER in endometrial carcinoma [61]. Taken together, all these studies suggests that over-expression of miR-424/miR-195 are able to suppress E2-induced cell growth, migration and invasion of type-II EC mediated by GPER and has a promising role as potential biomarker as well as novel therapeutic target for the treatment of this type of EC.
Hysteroscopy Combined with Laser Vaporesection for Endometrial Polyps
Published in Journal of Investigative Surgery, 2022
Hongyan Ren, Hua Duan, Sha Wang, Yanan Chang
The treatment of endometrial polyps can be divided into conservative treatment, drug treatment and surgical treatment [3]. Conservative treatment is often used for small, asymptomatic polyps that may disappear spontaneously [7]. Endometrial polyps have a limited effect with drug therapy. Surgical treatment includes conservative surgery and radical surgery. Although hysterectomy can cure the lesion radically with almost no risk of recurrence, radical surgery is considered to be a more radical treatment compared with minimally invasive surgery [3, 8]. Traditional blind curettage has a low success rate in removing endometrial polyps, and hysteroscopic surgery is safer and more effective in complete removal of endometrial polyps than traditional blind curettage [7, 9–11]. Hysteroscopic endometrial polypectomy has become the gold standard for diagnosis and treatment [12–14]. At present, the commonly used surgical method is hysteroscopic electroresection of endometrial polyps. With the development of laser technology, the treatment of endometrial polyps by hysteroscopic 2 μm laser vaporesection has shown its unique advantages. This study compared the safety and efficacy of hysteroscopic 2 μm laser vaporesection and hysteroscopic electric resection in the treatment of endometrial polyps, providing more reference information for the treatment of endometrial polyps.