This document provides guidelines for evaluating and managing benign breast diseases. It discusses conducting a thorough history and physical exam. Imaging studies like mammography and ultrasound may be used. Biopsies should be performed when a mass is solid or abnormalities are found. Specific disorders are addressed, such as evaluating nipple discharge, breast pain, cysts, fibroadenomas, and infections. Management depends on factors like patient age and physical exam findings. The goal is to determine if the abnormality is benign or malignant.
This document discusses breast cancer, including:
1) Breast cancer is the most common cancer in women and the second leading cause of cancer death. It typically presents as a breast mass, skin changes, or abnormal mammogram.
2) Evaluation involves a thorough history, physical exam including lymph node examination, diagnostic mammography, and sometimes ultrasound or MRI. Biopsies are usually done percutaneously.
3) Initial management depends on clinical stage - for early stage it typically involves lumpectomy with radiation or mastectomy, while later stages involve neoadjuvant chemotherapy, surgery, and radiation.
The document discusses several topics related to mastectomy:
1. It defines mastectomy as the surgical removal of the breast, usually done to treat breast cancer and prevent cancer metastasis.
2. Nursing goals after mastectomy include pain management, counseling for disturbed body image, and preventing surgical wound infection.
3. Areas of the neck are at high risk for excessive bleeding due to their high vascularization; hemorrhage is a common surgical complication.
This document provides information on evaluating and managing chest wall masses. It discusses:
1) Performing a thorough history, physical exam, and imaging to determine if the mass is primary or secondary.
2) Obtaining a biopsy for masses ≥3cm or if resection would be extensive to determine if the mass is benign or malignant.
3) For benign primary masses, complete resection is usually curative. For malignant primary masses, radical resection with reconstruction is required.
This document describes a multidisciplinary cancer management course on locally advanced primary breast cancer held in Cairo, Egypt from April 5-6, 2007. It covers the natural history and clinical presentation of locally advanced breast cancer, the diagnostic workup, TNM staging system, treatment options including chemotherapy, radiation and surgery, and survival outcomes based on different treatment approaches. The goal of systemic therapies for breast cancer is to attain cure, prevent recurrence, and eradicate micrometastases.
This document discusses the management of early stage breast carcinoma. It covers the work up, types of surgery including lumpectomy and mastectomy, reconstructive options, complications of surgery, sentinel lymph node biopsy, radiotherapy techniques including whole breast irradiation and boost to tumor bed, and partial breast irradiation methods like intraoperative radiation therapy. It provides guidelines on indications for radiotherapy and highlights several large randomized trials investigating radiotherapy after lumpectomy and breast conservation surgery.
Spindle cell lesions of the breast diagnostic issues 2019 (1)Alejandro Palacio
This document discusses diagnostic issues with spindle cell lesions of the breast. It proposes a two-step approach for classification and diagnosis. The first step is to determine if the lesion contains both spindle and epithelial components (biphasic) or only spindle cells (monophasic). Biphasic lesions are then graded based on the appearance of the spindle cells. Common biphasic lesions with bland spindle cells include fibroadenoma, benign phyllodes tumor, and pseudoangiomatous stromal hyperplasia (PASH). Accurate diagnosis is important as treatment and prognosis varies between entities. Immunohistochemistry and molecular analysis can aid in distinguishing between lesions.
This document discusses breast cancer, including:
1) Breast cancer is the most common cancer in women and the second leading cause of cancer death. It typically presents as a breast mass, skin changes, or abnormal mammogram.
2) Evaluation involves a thorough history, physical exam including lymph node examination, diagnostic mammography, and sometimes ultrasound or MRI. Biopsies are usually done percutaneously.
3) Initial management depends on clinical stage - for early stage it typically involves lumpectomy with radiation or mastectomy, while later stages involve neoadjuvant chemotherapy, surgery, and radiation.
The document discusses several topics related to mastectomy:
1. It defines mastectomy as the surgical removal of the breast, usually done to treat breast cancer and prevent cancer metastasis.
2. Nursing goals after mastectomy include pain management, counseling for disturbed body image, and preventing surgical wound infection.
3. Areas of the neck are at high risk for excessive bleeding due to their high vascularization; hemorrhage is a common surgical complication.
This document provides information on evaluating and managing chest wall masses. It discusses:
1) Performing a thorough history, physical exam, and imaging to determine if the mass is primary or secondary.
2) Obtaining a biopsy for masses ≥3cm or if resection would be extensive to determine if the mass is benign or malignant.
3) For benign primary masses, complete resection is usually curative. For malignant primary masses, radical resection with reconstruction is required.
This document describes a multidisciplinary cancer management course on locally advanced primary breast cancer held in Cairo, Egypt from April 5-6, 2007. It covers the natural history and clinical presentation of locally advanced breast cancer, the diagnostic workup, TNM staging system, treatment options including chemotherapy, radiation and surgery, and survival outcomes based on different treatment approaches. The goal of systemic therapies for breast cancer is to attain cure, prevent recurrence, and eradicate micrometastases.
This document discusses the management of early stage breast carcinoma. It covers the work up, types of surgery including lumpectomy and mastectomy, reconstructive options, complications of surgery, sentinel lymph node biopsy, radiotherapy techniques including whole breast irradiation and boost to tumor bed, and partial breast irradiation methods like intraoperative radiation therapy. It provides guidelines on indications for radiotherapy and highlights several large randomized trials investigating radiotherapy after lumpectomy and breast conservation surgery.
Spindle cell lesions of the breast diagnostic issues 2019 (1)Alejandro Palacio
This document discusses diagnostic issues with spindle cell lesions of the breast. It proposes a two-step approach for classification and diagnosis. The first step is to determine if the lesion contains both spindle and epithelial components (biphasic) or only spindle cells (monophasic). Biphasic lesions are then graded based on the appearance of the spindle cells. Common biphasic lesions with bland spindle cells include fibroadenoma, benign phyllodes tumor, and pseudoangiomatous stromal hyperplasia (PASH). Accurate diagnosis is important as treatment and prognosis varies between entities. Immunohistochemistry and molecular analysis can aid in distinguishing between lesions.
Mammography is used to screen for breast cancer in asymptomatic women. The goals are to detect cancer early when it is small and less likely to have spread to lymph nodes, allowing for less morbid treatment with more options. Studies show screening mammography can reduce breast cancer mortality by 20-30% in women aged 40-74 when conducted annually or every 2 years. Abnormal findings may require additional imaging and biopsies.
- Kettering General Hospital Breast Unit went digital between 2010-2012 and implemented tomosynthesis and contrast-enhanced spectral mammography (CESM) to improve cancer detection for women with dense breasts.
- A review of 50 patients who received tomosynthesis found it aided diagnosis in 36 patients (69%), providing extra information in 22 patients and more detailed information in 7 patients.
- A prospective study of 117 CESM exams found it to be as sensitive as MRI in detecting cancer and impacted management for 30% of cancer patients. CESM provided accurate sizing for invasive cancers but was less accurate for lobular cancers and cancers with ductal carcinoma in situ.
Breast cancer is the most common female cancer in the US and the second most common cause of cancer death in women. Risk factors include age, family history, lifestyle factors, and reproductive history. Evaluation of breast complaints requires a thorough history, physical exam including triple assessment with mammography, ultrasound and biopsy. Staging involves assessing tumor size, lymph node involvement and metastasis. Treatment may involve neoadjuvant chemotherapy, surgery such as mastectomy or lumpectomy with radiation, and adjuvant systemic therapy.
This document discusses breast cancer, including its definition, risk factors, types, staging, diagnosis, and treatment. Breast cancer begins in the breast tissue and may start in the ducts or lobes. It is characterized by uncontrolled cell growth. Some key points:
- Invasive ductal carcinoma is the most common type, accounting for around 80% of cases.
- Staging uses the TNM system to classify tumors by size (T), lymph node involvement (N), and metastasis (M).
- Diagnosis involves clinical examination, imaging like mammography, and biopsy.
- Treatment depends on stage but commonly involves surgery, radiation, chemotherapy, hormone therapy, or a combination.
This document discusses the evolution of breast cancer surgery from radical mastectomy to breast-conserving surgery (BCS). It provides an overview of the key factors to consider when determining eligibility for BCS, including tumor characteristics, family history, genetic factors, and patient age/health status. Multiple studies have shown that BCS followed by radiation therapy provides equivalent survival outcomes to mastectomy for appropriately selected early-stage patients. Surgical challenges include achieving negative margins, maintaining cosmesis, and detecting local recurrence after BCS. Patient selection factors and techniques to help guide BCS are discussed.
This document provides information about breast cancer including its epidemiology, risk factors, clinical examination, imaging, biopsy, pathology, staging, histological types, management of early and locally advanced breast cancer, and inflammatory breast cancer. Some key points include:
- Breast cancer is the most common cancer in women with a lifetime risk of 1 in 8.
- Risk factors include family history, late age of first pregnancy, obesity, radiation exposure, and genetic factors like BRCA1/2 mutations.
- Clinical examination involves inspection and palpation of the breasts and lymph nodes. Imaging includes mammography, ultrasound, and MRI.
- Biopsy is used to obtain a definitive diagnosis and can include fine needle aspiration
The document summarizes breast cancer staging systems. It discusses:
- The importance of accurate staging for determining prognosis and treatment.
- The TNM system used worldwide for clinical staging, which classifies tumors by size (T), lymph node involvement (N), and metastases (M).
- Revisions made in the 7th edition of the AJCC Cancer Staging Manual to the TNM classifications for breast cancer, including changes to the definitions of inflammatory carcinoma and microinvasive carcinoma.
- Recommendations for determining tumor size using various imaging modalities and microscopic vs. gross measurements.
- Staging of noninvasive cancers such as DCIS and LCIS.
- Grading of invasive
A 64-year-old female presented with a 4-year history of itching and discharge from an eczematous lesion on her right nipple and areola. On examination, the lesion had scales and mild erythema, and the nipple was retracted. Differential diagnoses included eczema, Paget's disease, psoriasis, and melanoma. Tests were ordered including biopsy of the lesion. A provisional diagnosis of Paget's disease was made pending biopsy results. Prognosis depends on presence of palpable mass, lymph node involvement, and underlying breast cancer, with 5-year survival rates ranging from 32-85% depending on factors present.
1. There is no consensus on what constitutes an adequate margin during breast-conserving surgery, but most studies agree that tumor cells directly at the cut edge of the excised specimen is unacceptable.
2. While clear margins reduce the risk of local recurrence, they do not guarantee complete removal of the disease as 13-25% of cases with clear margins have residual tumor found on re-excision.
3. The risk of local recurrence increases with positive or close margins, and positive margins with invasive disease predict earlier recurrence compared to in situ disease.
4. The type of positive margin, such as multiple positive margins or extensive intraductal component, predicts a higher likelihood of residual tumor found on re-exc
This document discusses the approach to breast pain, masses, and discharge. It begins with the anatomy of the breast and then discusses mastalgia (breast pain), its types (cyclical, non-cyclical), and management approaches. Breast lumps are then covered, including the features that suggest carcinoma and differential diagnoses. Finally, breast discharge is reviewed based on the location and characteristics of the discharge. Key points include that reassurance can be the most effective treatment for mastalgia, fibroadenoma is a common cause of a mobile lump in young women, and duct ectasia typically presents with a creamy discharge from a single duct.
This document discusses various investigations used for breast cancer detection, staging, and treatment. For detection, modalities discussed include mammography, tomosynthesis, xeroradiography, thermography, ultrasound, aspiration, MRI, and mammoscintigraphy. Investigations for staging examine tumor size (T), lymph node involvement (N), and metastasis (M) using techniques like MRI, lymphoscintigraphy, chest x-ray, bone scans, and liver scans. Sentinel node biopsy and lymphoscintigraphy are discussed as investigations used for guiding treatment decisions.
This document discusses various aspects of managing early stage breast cancer, including:
1. It provides an overview of the evolution of surgical approaches from radical to breast conserving surgery and discusses key trials demonstrating equivalent survival with breast conservation plus radiation compared to mastectomy.
2. It discusses the changing approach to axillary staging from axillary dissection to sentinel lymph node biopsy and trials validating the adequacy of sentinel node biopsy alone in certain cases.
3. It addresses locoregional treatment approaches including the appropriate use of radiation after lumpectomy, mastectomy, and with varying nodal involvement based on guidelines.
This document provides an outline and overview of benign breast disorders and diseases. It discusses the anatomy and investigations of the breast, including mammography, ultrasound, MRI, and biopsy techniques. It covers various anatomical anomalies, injuries, and infections that can occur in the breast. It also examines benign breast disease, cysts, nipple disorders, and benign neoplasms. Key points include classifications of benign breast disorders, their presentations, pathological features, and treatment approaches.
Breast biopsy is a medical test involving the removal of cells or tissues that has formed a lump, or a cyst, or is not normal.
http://docturs.com/dd/pg/groups/11280/breast-biopsy/
This document discusses techniques for diagnosing endometriosis, including current and new methods. It provides details on:
1) Primary locations of endometriosis, their prevalence, clinical features, and differential diagnosis according to studies. Common locations include the ovaries and retrocervical region.
2) Four basic sonographic steps for examining patients with suspected deep infiltrating endometriosis, including evaluating transvaginal tenderness and mobility and assessing the "sliding sign".
3) Studies showing substantial agreement between observers using transvaginal sonography to diagnose endometriosis in various pelvic locations, with high accuracy for the rectosigmoid colon.
Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death in women after lung cancer.
According to the American Cancer Society, more than 193,000 cases of breast cancer are diagnosed each year, with an estimated 40,000 deaths.
About 1% of these cancers occur in men.
This includes introduction its classification,etiology,clinical manifestations,diagnostic criteria,management.
Locally advanced breast cancer refers to large primary breast tumors (greater than 5 cm) with lymph node involvement or skin/chest wall fixation. Neoadjuvant chemotherapy is often used to shrink large tumors to operable sizes and increase the rate of breast conservation. Studies have found neoadjuvant chemotherapy achieves clinical response rates of 60-90% and pathological complete response rates of 10-30%. Common regimens include anthracycline-based chemotherapy like AC or FEC. Neoadjuvant chemotherapy is indicated for locally advanced, inoperable breast cancer and inflammatory breast cancer and can improve breast conservation rates in early-stage disease. While it effectively downstages tumors, surgery is still needed for local tumor control
This document provides guidelines for the clinical management of adnexal masses. It discusses how adnexal masses are a common problem that can be either benign or malignant. The goal is to differentiate between masses that are likely benign versus those that may be cancer. Various imaging modalities, physical exams, models, and serum markers can help determine if a mass is probably benign, uncertain, or likely malignant to guide appropriate management, which may include surgery.
Acs0304 Surgical Management Of Melanoma And Other Skin Cancersmedbookonline
This document discusses the evaluation and management of malignant skin lesions. It recommends that any clinically suspicious lesion undergo biopsy, with excisional biopsy preferred for small lesions and incisional biopsy for large lesions. For confirmed malignancies, further excision with appropriate margins is usually necessary. It then focuses on the two most common types of skin cancer: basal cell carcinoma and squamous cell carcinoma. For basal cell carcinoma, complete surgical excision with a 4mm margin is the main treatment. For squamous cell carcinoma, surgical margins of 6-10mm are recommended depending on risk factors, with lymph node assessment important for high-risk lesions.
Mammography is used to screen for breast cancer in asymptomatic women. The goals are to detect cancer early when it is small and less likely to have spread to lymph nodes, allowing for less morbid treatment with more options. Studies show screening mammography can reduce breast cancer mortality by 20-30% in women aged 40-74 when conducted annually or every 2 years. Abnormal findings may require additional imaging and biopsies.
- Kettering General Hospital Breast Unit went digital between 2010-2012 and implemented tomosynthesis and contrast-enhanced spectral mammography (CESM) to improve cancer detection for women with dense breasts.
- A review of 50 patients who received tomosynthesis found it aided diagnosis in 36 patients (69%), providing extra information in 22 patients and more detailed information in 7 patients.
- A prospective study of 117 CESM exams found it to be as sensitive as MRI in detecting cancer and impacted management for 30% of cancer patients. CESM provided accurate sizing for invasive cancers but was less accurate for lobular cancers and cancers with ductal carcinoma in situ.
Breast cancer is the most common female cancer in the US and the second most common cause of cancer death in women. Risk factors include age, family history, lifestyle factors, and reproductive history. Evaluation of breast complaints requires a thorough history, physical exam including triple assessment with mammography, ultrasound and biopsy. Staging involves assessing tumor size, lymph node involvement and metastasis. Treatment may involve neoadjuvant chemotherapy, surgery such as mastectomy or lumpectomy with radiation, and adjuvant systemic therapy.
This document discusses breast cancer, including its definition, risk factors, types, staging, diagnosis, and treatment. Breast cancer begins in the breast tissue and may start in the ducts or lobes. It is characterized by uncontrolled cell growth. Some key points:
- Invasive ductal carcinoma is the most common type, accounting for around 80% of cases.
- Staging uses the TNM system to classify tumors by size (T), lymph node involvement (N), and metastasis (M).
- Diagnosis involves clinical examination, imaging like mammography, and biopsy.
- Treatment depends on stage but commonly involves surgery, radiation, chemotherapy, hormone therapy, or a combination.
This document discusses the evolution of breast cancer surgery from radical mastectomy to breast-conserving surgery (BCS). It provides an overview of the key factors to consider when determining eligibility for BCS, including tumor characteristics, family history, genetic factors, and patient age/health status. Multiple studies have shown that BCS followed by radiation therapy provides equivalent survival outcomes to mastectomy for appropriately selected early-stage patients. Surgical challenges include achieving negative margins, maintaining cosmesis, and detecting local recurrence after BCS. Patient selection factors and techniques to help guide BCS are discussed.
This document provides information about breast cancer including its epidemiology, risk factors, clinical examination, imaging, biopsy, pathology, staging, histological types, management of early and locally advanced breast cancer, and inflammatory breast cancer. Some key points include:
- Breast cancer is the most common cancer in women with a lifetime risk of 1 in 8.
- Risk factors include family history, late age of first pregnancy, obesity, radiation exposure, and genetic factors like BRCA1/2 mutations.
- Clinical examination involves inspection and palpation of the breasts and lymph nodes. Imaging includes mammography, ultrasound, and MRI.
- Biopsy is used to obtain a definitive diagnosis and can include fine needle aspiration
The document summarizes breast cancer staging systems. It discusses:
- The importance of accurate staging for determining prognosis and treatment.
- The TNM system used worldwide for clinical staging, which classifies tumors by size (T), lymph node involvement (N), and metastases (M).
- Revisions made in the 7th edition of the AJCC Cancer Staging Manual to the TNM classifications for breast cancer, including changes to the definitions of inflammatory carcinoma and microinvasive carcinoma.
- Recommendations for determining tumor size using various imaging modalities and microscopic vs. gross measurements.
- Staging of noninvasive cancers such as DCIS and LCIS.
- Grading of invasive
A 64-year-old female presented with a 4-year history of itching and discharge from an eczematous lesion on her right nipple and areola. On examination, the lesion had scales and mild erythema, and the nipple was retracted. Differential diagnoses included eczema, Paget's disease, psoriasis, and melanoma. Tests were ordered including biopsy of the lesion. A provisional diagnosis of Paget's disease was made pending biopsy results. Prognosis depends on presence of palpable mass, lymph node involvement, and underlying breast cancer, with 5-year survival rates ranging from 32-85% depending on factors present.
1. There is no consensus on what constitutes an adequate margin during breast-conserving surgery, but most studies agree that tumor cells directly at the cut edge of the excised specimen is unacceptable.
2. While clear margins reduce the risk of local recurrence, they do not guarantee complete removal of the disease as 13-25% of cases with clear margins have residual tumor found on re-excision.
3. The risk of local recurrence increases with positive or close margins, and positive margins with invasive disease predict earlier recurrence compared to in situ disease.
4. The type of positive margin, such as multiple positive margins or extensive intraductal component, predicts a higher likelihood of residual tumor found on re-exc
This document discusses the approach to breast pain, masses, and discharge. It begins with the anatomy of the breast and then discusses mastalgia (breast pain), its types (cyclical, non-cyclical), and management approaches. Breast lumps are then covered, including the features that suggest carcinoma and differential diagnoses. Finally, breast discharge is reviewed based on the location and characteristics of the discharge. Key points include that reassurance can be the most effective treatment for mastalgia, fibroadenoma is a common cause of a mobile lump in young women, and duct ectasia typically presents with a creamy discharge from a single duct.
This document discusses various investigations used for breast cancer detection, staging, and treatment. For detection, modalities discussed include mammography, tomosynthesis, xeroradiography, thermography, ultrasound, aspiration, MRI, and mammoscintigraphy. Investigations for staging examine tumor size (T), lymph node involvement (N), and metastasis (M) using techniques like MRI, lymphoscintigraphy, chest x-ray, bone scans, and liver scans. Sentinel node biopsy and lymphoscintigraphy are discussed as investigations used for guiding treatment decisions.
This document discusses various aspects of managing early stage breast cancer, including:
1. It provides an overview of the evolution of surgical approaches from radical to breast conserving surgery and discusses key trials demonstrating equivalent survival with breast conservation plus radiation compared to mastectomy.
2. It discusses the changing approach to axillary staging from axillary dissection to sentinel lymph node biopsy and trials validating the adequacy of sentinel node biopsy alone in certain cases.
3. It addresses locoregional treatment approaches including the appropriate use of radiation after lumpectomy, mastectomy, and with varying nodal involvement based on guidelines.
This document provides an outline and overview of benign breast disorders and diseases. It discusses the anatomy and investigations of the breast, including mammography, ultrasound, MRI, and biopsy techniques. It covers various anatomical anomalies, injuries, and infections that can occur in the breast. It also examines benign breast disease, cysts, nipple disorders, and benign neoplasms. Key points include classifications of benign breast disorders, their presentations, pathological features, and treatment approaches.
Breast biopsy is a medical test involving the removal of cells or tissues that has formed a lump, or a cyst, or is not normal.
http://docturs.com/dd/pg/groups/11280/breast-biopsy/
This document discusses techniques for diagnosing endometriosis, including current and new methods. It provides details on:
1) Primary locations of endometriosis, their prevalence, clinical features, and differential diagnosis according to studies. Common locations include the ovaries and retrocervical region.
2) Four basic sonographic steps for examining patients with suspected deep infiltrating endometriosis, including evaluating transvaginal tenderness and mobility and assessing the "sliding sign".
3) Studies showing substantial agreement between observers using transvaginal sonography to diagnose endometriosis in various pelvic locations, with high accuracy for the rectosigmoid colon.
Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death in women after lung cancer.
According to the American Cancer Society, more than 193,000 cases of breast cancer are diagnosed each year, with an estimated 40,000 deaths.
About 1% of these cancers occur in men.
This includes introduction its classification,etiology,clinical manifestations,diagnostic criteria,management.
Locally advanced breast cancer refers to large primary breast tumors (greater than 5 cm) with lymph node involvement or skin/chest wall fixation. Neoadjuvant chemotherapy is often used to shrink large tumors to operable sizes and increase the rate of breast conservation. Studies have found neoadjuvant chemotherapy achieves clinical response rates of 60-90% and pathological complete response rates of 10-30%. Common regimens include anthracycline-based chemotherapy like AC or FEC. Neoadjuvant chemotherapy is indicated for locally advanced, inoperable breast cancer and inflammatory breast cancer and can improve breast conservation rates in early-stage disease. While it effectively downstages tumors, surgery is still needed for local tumor control
This document provides guidelines for the clinical management of adnexal masses. It discusses how adnexal masses are a common problem that can be either benign or malignant. The goal is to differentiate between masses that are likely benign versus those that may be cancer. Various imaging modalities, physical exams, models, and serum markers can help determine if a mass is probably benign, uncertain, or likely malignant to guide appropriate management, which may include surgery.
Acs0304 Surgical Management Of Melanoma And Other Skin Cancersmedbookonline
This document discusses the evaluation and management of malignant skin lesions. It recommends that any clinically suspicious lesion undergo biopsy, with excisional biopsy preferred for small lesions and incisional biopsy for large lesions. For confirmed malignancies, further excision with appropriate margins is usually necessary. It then focuses on the two most common types of skin cancer: basal cell carcinoma and squamous cell carcinoma. For basal cell carcinoma, complete surgical excision with a 4mm margin is the main treatment. For squamous cell carcinoma, surgical margins of 6-10mm are recommended depending on risk factors, with lymph node assessment important for high-risk lesions.
This document provides information on diagnosing and treating breast cancer. It discusses evaluating a patient's history and performing a physical exam. Investigation may involve fine needle aspiration biopsy or core needle biopsy to obtain samples. Breast imaging with mammography, ultrasound or MRI can further evaluate abnormalities. Staging helps determine how far cancer has spread. Surgical options include breast-conserving surgery by removing the tumor with radiation, or mastectomy by removing the entire breast. The goal is to completely remove the cancer while maximizing cosmetic results.
This editorial discusses guidelines for managing adnexal masses and determining when to observe, intervene, or refer to a specialist. It summarizes a study finding that complex or solid adnexal masses with a CA-125 over 35 units/mL have a high risk of ovarian cancer. For postmenopausal women over 50 with these characteristics, referral to a gynecologic oncologist is recommended. However, in younger women, functional cysts are more common and the cancer risk is lower, so observation may be preferable. Simple cysts under 10 cm can usually be monitored regardless of age if CA-125 is normal. Overall, careful assessment of adnexal masses is important to guide management and surgical planning.
1) Abdominal masses can have a wide range of clinical importance, from benign to life-threatening, so careful evaluation is needed.
2) A thorough history, physical exam, and diagnostic studies are used to establish a diagnosis and appropriate treatment plan.
3) Diagnostic studies include lab tests, imaging like ultrasound and CT, and minimally invasive techniques like biopsy to determine the nature and origin of masses.
Adrenal Mass in Pregnancy: Diagnostic Approach and DilemmasApollo Hospitals
An adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, incidentally found during radiologic examination for other reasons.
1. Such “adrenal incidentalomas” are increasingly recognised in clinical practice.
2. This is attributed to routine use of sophisticated and sensitive imaging techniques, with a reported prevalence of 4.4%.
3. Incidental findings of such masses pose dilemmas in evaluation and management, as current recommendations based on expert opinion.
4. Are open to debate in terms of cost and clinical
benefits. The uncertainties in management multiply with
such adrenal incidentalomas in the context of pregnancy.
We report a rare case of a large adrenal incidentaloma
complicating second trimester of pregnancy. This case
outlines the huge decisional dilemmas, both for the patient
and healthcare provider.
This document provides information about breast cancer including its definition, anatomy, risk factors, etiological factors, pathophysiology, clinical manifestations, stages, diagnostic tests, treatment, management, and nursing care. It discusses how breast cancer begins in the ductal or lobular cells and can spread through the lymphatic system and bloodstream. Risk factors include family history, obesity, lack of breastfeeding. Treatment may involve surgery, radiation, chemotherapy, hormone therapy and pain management. Nursing care focuses on education, managing anxiety and pain, and promoting healthy coping.
Endometrial cancer arises from the uterine lining and is the most common gynecologic cancer in the US. There are two subtypes - a low-risk subtype associated with increased estrogen exposure, and a high-risk subtype not associated with estrogen. Symptoms include abnormal uterine bleeding. Diagnosis involves endometrial biopsy or D&C to obtain tissue samples. Treatment depends on staging and may involve surgery, radiation therapy, and adjuvant therapies depending on risk factors.
Breast disorder & Mastectomy -a7med mo7ameda7med mo7amed
The document discusses breast disorders and mastectomy. It defines mastectomy as the surgical removal of all or part of the breast tissue. There are different types of mastectomies that remove varying amounts of breast tissue. Risk factors for breast cancer are discussed, as well as signs and symptoms. Diagnostic tests for breast cancer include mammography, MRI, and biopsy. Treatment options include surgery, chemotherapy, radiation, and adjuvant therapies. Nursing care involves managing pain, promoting positive body image, and providing education and support before and after surgery.
Fertility And Pregnancy Outcome In Cancer PatientsMamdouh Sabry
Better life of Cancer patients during childhood and age reproductive period regarding fertility, fertility preservation and pregnancy outcome is the main concern.concentrating upon different safe diagnostic modalities, management and outcome.
This document provides information on diagnosing breast cancer. It describes the anatomy of the breast, signs of cancerous growth, and various diagnostic techniques including breast self-examination, mammography, ultrasound, MRI, sentinel lymph node dissection, tumor markers, and biopsy methods. Survival rates vary by clinical stage of cancer. Biomarkers like ER, HER2, Ki67 are also discussed.
This document discusses breast procedures used to diagnose, stage, and treat breast disease. It covers breast ultrasonography, which can evaluate palpable or mammographically indeterminate breast lesions and guide biopsies. Ductal lavage is described as an investigational method to retrieve breast duct epithelial cells for analysis via a catheter inserted into the duct. Ductoscopy is mentioned as an emerging endoscopic technique to directly visualize the mammary duct lining and biopsy system, currently being evaluated for evaluating nipple discharge, high-risk patients, and determining intraductal disease extent in breast cancer patients. Core needle biopsy is highlighted as the standard minimally invasive biopsy technique replacing excisional biopsy for diagnosis due to being less invasive, costly and exp
Asccp management guidelines august 2014 ppt. Dr. Sharda Jain /Dr Jyoti Agarw...Lifecare Centre
Updated Consensus
American society of Colpscopy & cervical pathology
Guidelines 2014for Managing forAbnormal Cervical Cancer Screening Test and Cancer Precursors
Dr. Sharda Jain /Dr Jyoti Agarwal / dr. Jyoti Bhasker
This case study describes a 37-year-old female patient who presented with a breast mass. Diagnostic tests performed included a mammogram, biopsy, and right modified radical mastectomy which revealed invasive ductal carcinoma. The management plan for this patient includes neoadjuvant chemotherapy, followed by surgical therapy such as modified radical mastectomy and adjuvant radiation therapy. Adjuvant chemotherapy or hormone therapy may also be recommended depending on risk factors. Regular follow-up exams are important to monitor for potential recurrence.
This document discusses various topics related to breast cancer risk assessment and management, including:
1. It describes several risk assessment tools used to evaluate a patient's risk of developing breast cancer based on factors like family history, age, biopsy history, and genetic factors.
2. It discusses various imaging modalities used in breast cancer screening and diagnosis, such as mammography, MRI, and molecular breast imaging.
3. It provides an overview of surgical options for breast cancer, including lumpectomy techniques, mastectomy approaches, and the use of breast-conserving therapy when possible.
asmi gyn.pptx about ovarian cancer gynaecologyAsmitajha12
Ovarian cancer accounts for 3-4% of cancers in women and is the fourth most common cause of cancer death. Family history and genetic factors significantly increase risk. Symptoms are often vague until late stages when the cancer has spread. Diagnosis involves imaging tests and cancer antigen (CA125) blood levels. Most cancers are diagnosed at late stages. Treatment involves surgery to remove the ovaries and other organs, followed by chemotherapy. Despite aggressive treatment, survival rates remain low due to late stage diagnosis. Screening high-risk women aims to detect cancers earlier when treatment is most effective.
This document provides an overview of benign and malignant breast pathology, including:
1. It outlines the differences between symptomatic and screen-detected breast disease, and describes various types of benign breast disease like cysts, duct ectasia, and fibroadenomas.
2. It discusses risk factors for breast malignancy and the process of non-operative diagnosis using triple assessment and multidisciplinary review meetings.
3. The document covers types of breast cancer treatment and classifications like in situ versus invasive carcinoma, and explains prognostic indicators in invasive carcinoma like tumor grade and lymph node status.
Breast cancer screening guidelines recommend biennial mammography for women aged 50-74 in well-resourced settings, as it can reduce breast cancer mortality by around 16% compared to no screening. For limited-resource settings, the guidelines conditionally recommend clinical breast examination as a low-cost alternative. Screening intervals of less than 24 months show no added benefit over longer intervals. Shared decision making around risks of false positives and overdiagnosis is important. Early diagnosis through awareness and symptom screening is prioritized where most women present at late stages due to weak health systems.
Staging and investigation of cervix and uterusAtulGupta369
This document summarizes staging and investigations for cancers of the cervix and uterus. It discusses the epidemiology, risk factors, clinical presentation, screening, diagnosis and imaging for cervical cancer. Screening includes Pap smears, colposcopy and biopsy. Imaging includes pelvic MRI, cystoscopy and CXR/CT for staging. Similarly for endometrial cancer, it discusses epidemiology, risk factors, clinical presentation of abnormal bleeding, and diagnostic tools including endometrial biopsy and D&C. Imaging includes ultrasound, CT and MRI to assess myometrial invasion and metastatic workup includes chest imaging for staging.
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.