Breast Cancer
Mary J. Marian, Gerard E. Mullin in Integrating Nutrition Into Practice, 2017
The American Joint Committee on Cancer’s (AJCC) TNM system is used to stage breast cancer. Five stages of breast cancer are distinguished based on the tumor (T) size and spread to the chest wall or skin; the degree of lymph node involvement (N); and metastasis to distant organs (M).24Stage 0 includes DCIS and LCIS. DCIS is the earliest form of breast cancer, in which the cancer cells are still within the duct and have not invaded the surrounding fatty breast tissue. DCIS is usually treated with lumpectomy, RT, and hormone-modulating medications. LCIS is not considered true breast cancer by most oncologists, but is a marker for increased future risk and is generally treated with Tamoxifen. LCIS may be treated with Tamoxifen in premenopausal women and Raloxifene (Evista) in postmenopausal women.Stages I–IV are classified by increasing tumor size, number of positive lymph nodes, and metastases to distant locations. The most common sites for metastatic breast cancer are the bone, liver, brain, or lung.
Breast Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Would you offer breast-conserving surgery?This is a possible option depending on size of breast and location and extent of DCIS.There is risk of inadequate clearance/poor cosmetic outcome in a small breast unless volume replacement techniques are considered. A central WLE may be possible but the nipple will be removed.Discuss the risks with the patient: Risk of positive margins – need for further surgery, may lead to mastectomy (up to 20%).Defect in breast shape if >20% volume removed.Long-term recurrence risk with BCS versus mastectomy (recurrences after DCIS tend to be invasive cancer).Risk of not treating the DCIS – progression to invasive cancer with metastatic spread.Therapeutic mammoplasty (TM) is an option in large ptotic breasts – need to ensure adequate clearance the first time, excision of margins is difficult to do after TM.
Breast cancer
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
DCIS is curable in the vast majority of patients. However, local treatment must ensure that it is eradicated as there is a high risk of local recurrence; this recurrence may be invasive in breast cancer (approximately half of recurrences after treatment for DCIS are invasive cancer and half DCIS). Traditionally, simple mastectomy was the treatment of choice, and this is still the case for multifocal disease or when clear surgical margins cannot be attained. However, in recent years, the experience of breast conservation for invasive cancers has been extrapolated to DCIS. Whilst small foci of low/intermediate-grade DCIS can be treated with excision alone, if adequate margins of clearance are attained, local excision and adjuvant radiotherapy to the breast alone is now the standard treatment in many centres for unifocal DCIS that has been completely excised. There remains a debate about the role of tamoxifen after definite surgery and radiotherapy for DCIS. It may further reduce the risk of local recurrence within the breast after breast-conserving treatment if, as is usually the case, the DCIS is oestrogen receptor-positive. Pure DCIS should not spread to regional lymph nodes and therefore no axillary surgery is necessary. Similarly, DCIS has no potential for systemic spread, and therefore there is no role for chemotherapy in the management of DCIS.
Multifunctional nanoemulsions for intraductal delivery as a new platform for local treatment of breast cancer
Published in Drug Delivery, 2018
Amanda Migotto, Vanessa F. M. Carvalho, Giovanna C. Salata, Fernanda W. M. da Silva, Chao Yun Irene Yan, Kelly Ishida, Leticia V. Costa-Lotufo, Alexandre A. Steiner, Luciana B. Lopes
Breast cancer is one of the most prevalent types of cancer worldwide. It is estimated that approximately 12% of the women will be diagnosed with this disease in their lifetime (Ward et al., 2015; Groen et al., 2017). Among the diseases’ various types, ductal carcinoma in situ (DCIS) represents approximately 20% of the mammographically detected breast cancers, an incidence that has increased sharply over the last decades mainly due to the improvement in the screening techniques (Ward et al., 2015). DCIS itself displays a wide range of histological diversity, expressed as grades, and is considered a precursor lesion, with up to 50% of the cases progressing to invasive ductal carcinoma (Sagara et al., 2015). Due to the risk of progression, the current standard of care for all grades of DCIS is surgical excision (breast-conserving or mastectomy) followed by radiation therapy and oral tamoxifen for estrogen-positive tumors (Groen et al., 2017).
Addressing the problem of overtreatment in breast cancer
Published in Expert Review of Anticancer Therapy, 2022
The incidence of ductal carcinoma in situ (DCIS) has increased significantly with the widespread use of screening mammography, and DCIS represents approximately 20% of all newly diagnosed breast cancers. Historically, DCIS was considered an obligate precursor to invasive cancer leading to the current standard-of-care approaches of excision, radiation, and anti-estrogen therapy. However, the relative incidence of invasive breast cancer has remained unchanged despite a marked increase in the detection and treatment of DCIS, and breast cancer-specific survival after treatment of DCIS exceeds 95% regardless of treatment approach [70]. These observations have raised concerns that DCIS is not only being overtreated, but also overdiagnosed. Strategies to de-escalate the treatment of DCIS or eliminate treatment altogether are predicated upon the ability to identify subsets of DCIS patients with a low risk of progression to invasive carcinoma.
Toll-like receptor 3 -926T>A increased the risk of breast cancer through decreased transcriptional activity
Published in OncoImmunology, 2019
Lei Fan, Peng Zhou, Ao-Xiang Chen, Guang-Yu Liu, Ke-Da Yu, Zhi-Ming Shao
A total of 1,272 female cancer-free control subjects and 1,031 patients with breast cancer were identified as genetically unrelated Chinese in Shanghai City and its surrounding regions. Each participant was personally interviewed by doctors either in the outpatient department or in the inpatient department to obtain epidemiological and clinicopathological information. These subjects were recruited between January 2012 and June 2015 from the Department of Breast Surgery, Fudan University Shanghai Cancer Center. Patients with a previous history of other cancers (not breast cancer) were excluded. Primary ductal carcinoma in situ (DCIS) or infiltrating ductal carcinoma of the breast was pathologically confirmed. The control subjects were chosen from women who had come to our department for the purpose of breast cancer screening. The control subjects selected were proven to be free of breast cancer by a complete physical examination, ultrasonography, bilateral mammography, and biopsy when necessary. Women who had a previous history of cancer were also excluded. The controls were matched to the case patients on the basis of geographical area and age. All study subjects provided a 3- to 5-ml venous blood sample. All of the data collected were entered into a computerized database established by the Department of Breast Surgery of the Fudan University Shanghai Cancer Center.
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