Lege Artis Medicinae

[Complex pathological diagnosis of breast cancer and the patient care based on it over the past 20 years]

CSERNI Gábor

JANUARY 20, 2012

Lege Artis Medicinae - 2012;22(01)

[The diagnosis of breast cancer has become more complex in the past 20 years. Intraoperative diagnosis has been mostly replaced by multidisciplinary preoperative/ nonoperative diagnostics. Surgical treatment can be planned in advance for the breast as well as for the axilla. In many cases, routinely performed radical surgery has been replaced by selectively applied, less radical, conservative operations (sectoral or wide local excisions, sentinel lymph node biopsy) that are suitable for smaller tumours mostly detected by screening. In addition to prognostic markers listed in the pathology reports (lymph node status, tumour size, vascular invasion, status of resection margins), an increasing emphasis has been placed on predictive markers (estrogen receptors, progesterone receptors, HER-2, basal and proliferation markers) that allow molecular typing of breast carcinomas and that mostly influence systemic treatment. Tools to predict the efficiency of treatment have become increasingly available, and these might also help in planning neoadjuvant therapies, a modality which has also been introduced in the past 20 years. The present article gives a brief, subjective, thematic insight into some of these changes, selected on the basis of their relation to the pathological diagnosis of breast carcinoma.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Impact of mometasone furoate nasal spray on the ocular symptoms of allergic rhinitis - Short presentation of a meta-analysis]

TAMÁS László

Lege Artis Medicinae

[Playing with Passion]

PINTÉRNÉ Ambrusz Aliz, CSIKY-MÉSZÁROS Mária

Lege Artis Medicinae

[Antidiabetic therapy of patients with type 2 diabetes - The role of incretin mimetics]

GERŐ László

[Incretin mimetics represent a new group of antidiabetic drugs. They bind to their own receptor on the beta-cell membrane and increase insulin secretion in a glucosedependent manner. Thus, they rarely cause hypoglycaemia. Furthermore, they significantly reduce body weight and other cardiovascular risk factors. Accordingly, they can be considered as an optimal group of antidiabetic drugs. The author reviews the clinical efficacy and safety of currently available incretin mimetics.]

Lege Artis Medicinae

[I Had Neither Mood, Desire, Impulse or Condom – Curiosities about the Practice of Géza Csáth as a Bath Physician]

KISS László

Lege Artis Medicinae

[Optimalisation of basal insulin regimen for adolescent patients with type 1 diabetes]

BLATNICZKY László

[INTRODUCTION - During the total phase of type 1 (insulin-dependent) diabetes mellitus (T1DM), both the quantity and the quality of daily insulin doses must be determined to help the daily blood-glucose profile approach normoglycaemia, derived from the patient’s diet and regimen. Adolescence for young people with T1DM is a rather stressful - often shocking - psychosomatic state, due not only to the increased - but erratic - secretion of contrainsular hormones (predominantly growth hormone), but also to the special mental state of the child. Accordingly, choosing the right kind and amount of basal insulin to compensate the contrainsular effect is crucial for optimal treatment during this stage of life as well. CASE REPORT - We describe the process of optimising metabolic balance and basal insulin demand in a 11-year-old, adolescent girl with T1DM for 7.5 years using glargine insulin. In order to achieve this goal, both the dosage of glargine and the daily schedule of its administration needed to be modified. CONCLUSIONS - To achieve optimal metabolic results, both the quantity and the efficacy curve of basal insulin must and can be adapted to the actual stage of general somatic development. The demand for basal insulin during puberty may be well beyond the widely approved limit of 50%. Adapting the administration of glargine insulin to a daily schedule has the potential to counterbalance increasing contrainsular effects.]

All articles in the issue

Related contents

Clinical Oncology

[Treatments of brain tumors in adults – an up-date]

BAGÓ Attila György

[The prognosis of brain metastases is very poor. Surgery and radiotherapy provides the fi rst line treatment, while systemic therapy has limited value. Nevertheless, our knowledge is increasing: normal cells contribute signifi cantly to the homing and growth of tumor cells; the molecular profi le of the primary tumor and its metastases could be different, which infl uences the therapeutic strategies; the type of blood supply can change during the tumor growth. It would be very important to optimize the cooperation of the different therapeutic modalities, and to fi nd markers which could predict the risk of metastatization.]

Lege Artis Medicinae

[Treating breast cancer patients with fulvestrant - could it be more efficacious?]

NAGY Zsuzsanna

[Fulvestrant, as an estrogen-receptor antagonist, effectively decreases the estrogen effect, which is a key factor in the development, growth and progression of the breast cancer. Its clinical advantage can appear even after several lines of unsuccessful chemo- or hormonal therapy. In our invasive ductal carcinoma cases, the clinical benefit was obvious over 40%. According to recent data using a higher dose better results can be obtained. The same is expected if the drug would be applied at an earlier stage of the disease.]

Lege Artis Medicinae

[Cervix and breast cancer screening in the districts of Hungary]

SÁNDOR János, SZÜCS Mária, KISS István, BONCZ Imre, SEBESTYÉN Andor, KISS Adrienn, EMBER István

[INTRODUCTION - Life expectancy in Hungary has been increasing recently but in a geographically uneven distribution. The mortality trends has remained disadvantageous for cancer patients and also for the malignancies of cervix and breast that can be preventable with screening. The study aimed to describe the participation at the district level in the screening programmes as well as to investigate the relative role of health behaviour of women and of the health services in determining the screening success. METHODS - Age standardised relative screening participation rates were computed for 150 districts of Hungary using discharge reports of the outpatient services for cervical cytology and mammography. RESULTS - 20,12% of all 25-65 years old women was screened for cervical cytology during 3 years (1. July 1998. - 31. June 2001.) and 17,22% of all women aged 45-65 years participated in mammography in a 23 months period (1. July 1998. - 31. May 2000.). The results scattered in a certain fashion. Summarising the screening results, the highest participation ratios were observed in Bonyhád, Kiskunfélegyháza, Paks, Zalaszentgrót, Pécs while the lowest were in Csengeri, Mór, Nyírbátor, Sárbogárd, Enying districts. The screening performances did not correlate with each other and with the socioeconomic indicators (education, unemployment, income), apart from the significant influence of education on mammography participation rate. The emerging explanation is that the health behaviour was not important determinant of screening participation. In this case, the behaviour of target populations would have affected similarly both screening results resulting in a correlation. CONCLUSIONS - Consequently, the performances of providers responsible for screening organisation have been reflected in the observed screening rates. This result and the wide scattering of screening participation rates, which developed in spite of the uniform legislative-economic environment, emphasises the importance of regular monitoring of screening performance.]

Clinical Oncology

[New results from San Antonio Breast Cancer Symposium, 2017]

KAHÁN Zsuzsanna

[SABCS 2017 has been a 40-year jubilee conference with festive appearance and content. The anniversary provides possibility to look back: today we fi nd the knowledge and practice as of twenty years ago schematic and rough while the changes are overwhelming. Therapy became colorful and personally. There is need for precisious care which means consideration all patient and tumor features when surgical or medical therapy, radiotherapy or even diagnostic issues are decided - this has been the most important message of the conference this year. The Symposium always provides the most modern and breakthrough approaches and attitude that support advancement in patient care.]

LAM KID

[Effect of zoledronic acid treatment on pain and quality of life in patients with metastatic bone disease suffering from breast and prostate cancer - Multicenter, prospective, observational study]

PÁPAI Zsuzsanna, LANDHERR László, SPEER Gábor

[INTRODUCTION - Metastatic bone disease is frequently associated with breast and prostate cancer. Bisphosphonate treatment of bone metastases is palliative: its primary goal is to relieve pain, while it's also important to decrease the risk of bone fractures, prolong survival and maintain physical activity of the patients. Pain is the most common symptom of bone metastases. PATIENTS AND METHODS - In total 845 patients were enrolled in our open, multicenter, prospective, observational study, the first of its kind in Hungary. The agent tested was zoledronic acid (Zometa®). Duration of the study was 20 months and its primary goal was to assess the correlation between pain and quality of life during the treatment of patients with bone metastases from breast or prostate carcinoma. RESULTS - During the 18 months of the study, the average intensity of pain, measured on the visual analog scale showed a 42% reduction (p<0.0001). By the end of the 18. month, the ratio of patients free of symptoms has increased by 15% and the number of patients with substantial complaints has decreased by 73%. CONCLUSION - Our study supports the observation published in the international literature that in patients with bone metastases from breast and prostate cancer, zoledronic acid treatment is beneficial for reducing pain and thus for improving quality of life.]