BALKAN MCO 2011 - R. Popescu and J. Zgajnar - Multidisciplinarity in oncology
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This document summarizes a case of screen-detected breast cancer that was managed through a multidisciplinary approach at the Janez Žgajnar Institute of Oncology Ljubljana. A 51-year-old woman underwent mammography screening where microcalcifications were discovered in her right breast. After a consensus conference and biopsy confirming high-grade ductal carcinoma in situ, a preoperative conference recommended a mastectomy and sentinel node biopsy with possible reconstruction. A reconstruction meeting proposed an immediate autologous free flap. Final pathology found invasive ductal carcinoma along with the DCIS, and postoperatively it was determined that completion axillary dissection was needed. The case was presented to the breast cancer tumor board.
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This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
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This document discusses selective axillary dissection in carcinoma of the breast. It notes that tumor size and axillary lymph node status are important prognostic factors, and that axillary lymph node dissection is an important staging procedure. However, total axillary dissection can cause morbidity. The concept of sentinel node biopsy is explored as a way to select patients who need full axillary dissection versus those who do not by examining the first lymph node(s) that receive metastatic cells from the primary tumor. Studies demonstrating the predictive value and accuracy of sentinel node biopsy in determining axillary node status are summarized.
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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
Basic principles surgical oncology.pptx ...
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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.
Management of axilla in breast cancer : Recent updates
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A surgical oncologist is a surgeon with additional training in treating cancer patients using a multidisciplinary approach including surgery, radiation, chemotherapy, and other disciplines. The key goals of cancer surgery are to remove the cancerous tissue through procedures like curative resection, debulking, or palliative surgery. Accurate staging of the cancer is also important for surgeons to plan the appropriate treatment and evaluate outcomes.
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This study examined predictors of contralateral breast cancer in unilateral breast cancer patients undergoing contralateral prophylactic mastectomy (CPM). The study analyzed 542 patients who underwent CPM at one cancer center between 2000-2007. Univariate analysis found that younger age, Gail risk score >1.67%, ipsilateral invasive lobular histology, additional ipsilateral moderate-high risk pathology, and multicentric ipsilateral tumor predicted higher risk of contralateral breast cancer. However, multivariate analysis identified only younger age and ipsilateral invasive lobular histology as independent predictors of contralateral breast cancer. The study aimed to help identify which unilateral breast cancer patients might most benefit from CPM.
BALKAN MCO 2011 - J. Zgajnar and M. Margaritoni - Surgery (SLNB, management o...
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This document summarizes guidelines and techniques for surgery of nonpalpable breast lesions detected by screening. Key points discussed include:
- Localization techniques like radioguided seed placement or wire localization are necessary to accurately excise nonpalpable lesions.
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1) The document discusses management of breast cancer, including diagnosis, staging, treatment options, and controversial issues.
2) It provides statistics on breast cancer incidence worldwide and in Egypt, noting it is one of the most common cancers in Egyptian females.
3) Projections estimate the number of breast cancer cases in Egypt could double from 2025 to 2050 as the population grows, posing greater challenges for cancer control efforts.
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This document discusses the role and history of surgical oncology. It outlines how surgery has evolved from open procedures to minimally invasive and robotic techniques. Key developments include the transition to laparoscopic surgery and increased use of intraoperative navigation and genomic testing. The roles of the surgical oncologist include prevention, diagnosis through biopsy techniques, definitive and palliative treatment, and rehabilitation. Challenges include identifying curable patients and balancing treatment efficacy with quality of life. The field continues to advance through multidisciplinary care, research, and education.
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This document discusses treatment of diffuse large B-cell lymphoma (DLBCL). It notes that DLBCL is a heterogeneous disease with genetic subgroups that have different prognoses and responses to treatment. The addition of the antibody rituximab to chemotherapy improves outcomes for DLBCL compared to chemotherapy alone. Strategies discussed to improve outcomes include increasing chemotherapy dose intensity and the potential role of the drug bortezomib for the activated B-cell subtype.
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This document discusses treatment of diffuse large B-cell lymphoma (DLBCL). It notes that DLBCL is a heterogeneous disease with genetic subgroups that have different prognoses and responses to treatment. The addition of the antibody rituximab to chemotherapy like CHOP has improved outcomes for DLBCL compared to chemotherapy alone in the post-rituximab era. Strategies to further improve outcomes include targeting specific genetic subgroups like the activated B-cell subtype using drugs like bortezomib that inhibit pathways like NF-kB.
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- Ovarian cancer is the ninth most common cancer in women and the fifth leading cause of cancer death in women. Risk factors include age over 60, obesity, talcum powder use, fertility drugs, genetic predispositions like BRCA mutations.
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This document summarizes key information about ovarian cancer, including epidemiology, staging, treatment milestones, prognostic factors, and recent clinical trials. It notes that the median age of diagnosis is 63 years and discusses improvements in 5-year survival over time. New developments discussed include the role of surgery, chemotherapy regimens, targeted therapies like bevacizumab, and trials in recurrent settings.
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Nearly 500,000 new cases of cervical cancer occur worldwide each year, with the majority in developing countries. Infection with HPV is responsible for virtually all cervical cancer cases. Screening includes Pap smears and HPV testing, while vaccination may prevent up to 70% of cases but is not widely available due to cost. Diagnosis is through biopsy and histopathological examination, while staging uses the FIGO system based on tumor size and spread. Treatment depends on stage but commonly includes surgery such as hysterectomy with or without radiation or chemotherapy.V. Kesic - Cervical cancer - State of the art
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T. Cufer - Breast cancer - State of the art for advanced breast cancer
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N. El Saghir - Breast cancer - State of the art for early breast cancer
1) Breast cancer is heterogeneous with different subtypes defined by receptor status and gene expression profiles. The subtypes have different biological behaviors and clinical outcomes.
2) Accurate diagnosis requires biopsy (FNA or core) followed by receptor testing before treatment decisions. Surgery options include breast conserving therapy or mastectomy with/without reconstruction.
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The document discusses guidelines for screening, diagnosis, staging, adjuvant therapy, advanced disease treatment, and follow-up for colorectal cancer from both the ESMO and NCCN perspectives. It provides recommendations for screening the general and high-risk populations. It also outlines the diagnostic and staging workup, including endoscopy, biopsy, imaging, and surgical staging. Guidelines are presented for adjuvant therapy based on cancer stage. Recommendations are provided for managing both synchronous and metachronous metastatic disease, as well as rectal cancer treatment.G. Pentheroudakis - Colorectal cancer - State of the art
1) A trial found that adding bevacizumab to chemotherapy for stage III colon cancer extended disease-free survival compared to chemotherapy alone, delaying cancer relapse but not preventing it completely.
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3) The interpretation is that relapses were delayed by bevacizumab treatment but then occurred at a steady rate later on, similar to the chemotherapy alone group.
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This document provides an overview of squamous cell carcinoma of the head and neck (SCCHN), including its anatomical sites, incidence and mortality rates, risk factors, staging guidelines, and treatment approaches. It discusses the roles of surgery, radiation therapy, chemotherapy, concurrent chemoradiation, and targeted therapies like cetuximab in managing localized and advanced SCCHN. Concurrent chemoradiation is now standard for improving local control and organ preservation compared to radiation alone. The addition of cetuximab to radiation was shown to improve locoregional control and overall survival.J.B. Vermorken - Head and neck - State of the art
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2) Adjuvant chemotherapy in resected early-stage non-small cell lung cancer (NSCC) improves survival compared to surgery alone, though benefits vary by stage. Platinum-based regimens like cisplatin and vinorelbine are commonly used.
3) For locally advanced unresectable NSCLC, concurrent chemoradiotherapy is superior to sequential chemotherapy and radiotherapy, improving median and 5-year survival.
ABC1 - O. Pagani - State-of-the-art HT treatment in ER+ disease
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2) The FIRST trial found that fulvestrant 500 mg had significantly longer time to progression compared to anastrozole as first-line therapy for postmenopausal women.
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BALKAN MCO 2011 - R. Popescu and J. Zgajnar - Multidisciplinarity in oncology
- 1. Janez Žgajnar Institute of Oncology Ljubljana
- 9. Institute of Oncology Ljubljana
- 15. Basics of Surgical Oncology
- 20. Sentinel node biopsy limfoscintigraphy
- 21. Sentinel node biopsy surgery
- 33. Tearing the rectosacral ligament
- 34. Pelvic nerves and dissection plane Righ hypograstric n. Left hypograstric n. R.J. Heald (modified)
- 35. Correct and incorrect plane of dissection Correct plane Incorrect plane
- 42. Case report of a screen detected breast cancer
- 44. Breast cancer in Slovenia by stage and period Register raka za Slovenijo
- 45. 24.848 15.192 14.623 6.252 16.098 Σ = 64.683 8.688 32.103 9.122 42.005 16.056 I. II. III. Target population (50- 69): 255.624 Average cumulative incidence rate 1998 – 2002 4,68-5,37 5,38-6,06 6,06-6,74 6,75-7,42 7,43-8,11 5.954 Σ = 91.655 Σ = 99.286
- 46. SIEMENS - NOVATION HOLOGIC - SELENIA Mobile units
- 47. Screening workflow and timing P T T T P P S Č S S Č Č P P P Double reading CONSENSUS Invitation to further assessment ASSESSMENT PREOPERATIVE MDC MEETING The patient is informed 15%-20% 5%-7% 1%-2%
- 54. High grade DCIS
- 55. High grade DCIS
- 58. Free flaps : DIEP msTRAM SIEA continues to dominate as the workhorse for (autologous tissue) breast reconstruction.