Pregnancy-associated breast cancer has an incidence of about 1 in 3,000 pregnancies. Diagnosis can be difficult and delayed due to physiological changes during pregnancy. Breast ultrasound is the standard method for evaluating breast masses during pregnancy, while mammography plays a limited role. Treatment requires a multidisciplinary approach and depends on cancer stage and pregnancy trimester. Prognosis does not seem to differ from non-pregnant patients, and breastfeeding after treatment is generally encouraged when safe.
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.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
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.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
obstetric and gynaecological management with breast cancer .pptxWafaa Benjamin
Obstetric & Gynaecological Management with Breast Cancer
Breast cancer is the most common cancer in females worldwide. It increasingly affects women through their reproductive age. The prognosis of breast cancer is improving, with 5-year survival 80% ( >50years(. As a result, obstetrician and gynaecologists are nowadays facing more women who are:
◦ Diagnosed with breast cancer during pregnancy
◦ Coming for Pre-pregnancy counselling following breast cancer treatment
◦ Asking for fertility preservation with breast cancer
◦ Having a Genetic predisposition to breast cancer
On this presentation I am going to address those problems in clinical case scenarios in line with latest evidences.
According to Dr. Vo Dang Hung, Director of TMMC Healthcare's Oncology Center. Breast Cancer is the most popular cancer among women. Know your risks and get frequent Breast Cancer Screenings to protect yourself.
From Queens Library's expert-led panel, Cancer Awareness: What You Need to Know, featuring professionals from New York Hospital Queens, North Shore LIJ, the American Cancer Society, and the Leukemia and Lymphoma Society
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Breast cancer is a malignancy originating from breast tissue. This chapter
distinguishes between early stages, which are potentially curable, and
metastatic breast cancer (MBC), which is usually incurable.
Primary small cell breast carcinoma represents less than 1% of breast cancers. Due to its rarity, there are no uniformly accepted guidelines for treatment. Its prognosis is varied being generally regarded as worse than that of most breast cancers and it poses unique diagnostic challenges. We present a case of primary small cell breast cancer, rationale for our management strategies with reference to the published literature to serve as a guide to the management of this rare cancer of the breast.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Pregnancy associated breast cancer
1.
2. Summary
[Pregnancy associated breast cancer]
168
SSuummaarryy
Pregnancy-associated breast cancer (PABC) is defined as any breast carcinoma diagnosed during pregnancy or during the first postpartum year. Breast cancer is one of the most frequently diagnosed malignancies during pregnancy with an incidence of one in 3000 pregnancies.
The diagnosis is difficult and often delayed resulting in later stage presentation due to pregnancy related physiological changes. History taking should stress on risk factors and family history. About 48% of women with an early-onset of breast cancer have a positive family history and 9% were associated with BRCA 1 or BRCA 2 mutations.
Most women diagnosed with pregnancy-associated breast cancer will present with a painless mass in the breast. Palpation cannot discriminate malignant from benign lumps.
Breast ultrasound has a high sensitivity and specificity for the diagnosis of PABC. It can distinguish between cystic and solid breast lesions. It is the standard method for the evaluation of a palpable breast mass during pregnancy.
With adequate abdominal shielding, a mammography presents little risk to the fetus throughout the pregnancy. However, mammography is often less useful than ultrasound in PABC with a significantly higher false-negative. The main role of mammo-
3. Summary
[Pregnancy associated breast cancer]
169
graphy is to exclude diffuse malignant-type micro-calcifications which would preclude breast-conserving surgery. Digital mammography is more accurate in detecting breast cancer in women aged under 50 years.
MRI may be used in pregnant women if other non-ionising forms of diagnostic imaging are inadequate or if the examination provides important information that would otherwise require exposure to ionizing radiation, but MRI is not recommended during the first trimester because the developing embryo is susceptible to injury from various physical agents.
A core needle biopsy is the technique of choice for histological examination. Fine Needle aspiration cytology (FNAC) may be misleading and should not be performed during pregnancy. The pathologist must be made aware of the pregnancy to avoid misdiagnosis of hyperproliferative changes of the breast during gestation.
Most PABC are invasive ductal carcinomas. A common finding is a high frequency of estrogen-receptor (ER)-negative tumors and patholo-gical lymph node involvement. Some recent studies suggest that HER-2/Neu overexpression and epidermal growth factor receptors to be higher in PABC compared to breast cancer without pregnancy.
Staging in PABC is done according to the usual TNM system of breast cancer. Suspected pulmonary metastases can be
4. Summary
[Pregnancy associated breast cancer]
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investigated by chest X-ray with proper using of abdominal shielding, liver ultrasound is the preferred technique to detect liver metastases. Bone scan for searching for bone metastasis is only recommended in cases of uncertain MRI findings, or when MRI is unavailable.
Before medical management physician should be aware of the psychological issue of this especial case of breast cancer. Cancer during pregnancy puts the mother in a difficult situation. Also, for the medical team it is a complex setting, because two individuals are involved: the mother and her unborn child. This require a more a different ways of dealing with our patient than the traditional ones
Good communicating skills are necessary for breaking the bad news. This requires a skilled staff in communication, transparency, shared decision making and avoiding uncertainties. The patient is more satisfied when she is more capable of understanding investigations, prognosis, risks and treatment options. It was believed that by telling the true diagnosis of cancer, doctors would cause additional harm to the patient. Now this way of handling information completely changed. However the information should be given in pieces at several different appointments.
The therapeutic approach to breast cancer during pregnancy requires the participation of a multidisciplinary team. The
5. Summary
[Pregnancy associated breast cancer]
171
protocol of treatment of breast cancer in pregnant women should be as close as possible to that offered to non-pregnant women. Treatment should be individualised, taking into account the age of pregnancy at diagnosis, the patient’s preferences and stage of the disease. Treatment plan according to the stage of pregnancy can be summerized as follow:
In the 1st trimester, if no indication for termination of pregnancy, mastectomy is done with axillary staging, adjuvant chemotherapy is startred in the 2nd trimester. raditherapy and hormonal treatement if indicated should start only after delivery.
In the 2nd or 3rd trimesterS: mastectomy or conservative surgery cab be done with axillary staging. adjuvant chemotherapy should be started after surgery but adjuvant radiotherapy or hormonal treatement cab be delivered only after delivery. Neoadjuvant chemotherapy cab be considered in some cases during pregnancy only starting from the second trimester.
Survival of pregnant patients with breast cancer is not increased by termination of the pregnancy, even if the cancer has spread. Termination of PABC is only valid if pregnancy itself is an obstacle to drastic treatment, is associated with unacceptable risks for the health of mother and fetus or is thought to be morally unacceptable in the presence of incurable maternal cancer.
6. Summary
[Pregnancy associated breast cancer]
172
Surgery and anaesthesia are safe during pregnancy if physiologic alterations are considere. Except in the first trimester, pregnancy does not change the indications of the type of surgery, conservative or radical. Breast conservation performed during the first trimester is probably associated with an excessively long delay in postoperative radiotherapy. Conservative surgery at the end of second and third trimester can be proposed and radiotherapy is delayed until after childbirth.
Patients with PABC are excluded from the randomized studies on SLNB. But when the tumor is diagnosed at an early stage, a considerable proportion of patients have node-negative disease and might therefore benefit from SLNB. Because of this controversy,one trial supported the the safety of SLNB in pregnant patients with breast cancer, when performed with a low- dose lymphoscintigraphic technique.
Radiotherapy is contraindicated in pregnancy especially in the second and third trimesters. It should be postponed until after delivery. But in a Patient diagnosed in the first trimester and need to presesrve her breast, then there is the question of giving postoperative radiotherapy before delivery only in 1st or early 2nd trimester, or delaying it until later. Here, the decision should be taken after a thorough discussion of available data between the patient, her family and the multidisciplinary team, taking into account the potential benefits and risks of this treatment.
7. Summary
[Pregnancy associated breast cancer]
173
Administration of chemotherapy during the first trimester is contraindicated and should be postponed. During the second and third trimester, chemotherapy can be administered relatively safely. Different chemotherapy regimens have been used for the treatment of PABC. Anthracyclines-based regimens are the most widely used is breast cancer treatment and has been shown to be associated with favorable safety profile when administered during pregnancy.
In the advanced/metastatic setting, anthracycline-based regimens remain the best choice as well. For patients who are not good candidates for anthracycline-based regimens, single agent taxane (paclitaxel or docetaxel) would be a preferred option. Weekly administration of paclitaxel has been shown to be associated with higher efficacy and better tolerability compared to the 3-weekly schedule.
Chemotherapy should not be given after 34-35 weeks of gestation as spontaneous delivery can occur before bone marrow recovery. The delay of delivery for 2-3 weeks after chemotherapy also allows for fetal drug excretion via the placenta. Chemotherapy may start again at 10 days postpartum.
Hormonal treatment, if indicated, should be started after delivery and after completion of chemotherapy.
Safety profile of trastuzumab during pregnancy is unclear. Trastuzumab was associated with increase in oligohydramnios
8. Summary
[Pregnancy associated breast cancer]
174
risk which is known to significantly increase the risk of premature delivery, fetal morbidity and mortality, However, the risk appeared to be much lower in those exposed to trastuzumab for one trimester or less.
Biphophonates have an increase risk of fetal skeletal anomalies secondary to in-utero exposure and can also affect uterine contraction. It is better to administer biphophonates following delivery whenever possible.
Obstetric role in patient with PABC is necessary. Prenatal care should be performed as in a high-risk obstetric unit. Before every cycle of cytotoxic treatment, an evaluation of fetal morphology, growth and wellbeing must be carried out by ultrasound screening. The time of delivery should be balanced according to the need of breast cancer treatment and the maturation of the fetus. Vaginal birth holds a lower risk of maternal morbidity compared with caesarean section.
The prognosis of pregnant women does not seem to differ from that of non-pregnant patients of the same age and stage of disease. It is possible that the worse prognosis initially attributed to pregnant women was due to a more advanced stage at diagnosis or a less standardized therapy
A common question asked by a pregnant lady still under or had finished treatment of a breast cancer is about the feasabilty to breastfeed her baby. Suppression of lactation does not improve
9. Summary
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prognosis. Breast cancer survivors who become pregnant should be encouraged to breastfeed. A history of breast surgery and radiation may affect milk supply. Mothers who have undergone mastectomy but no radiation to the remaining breast can often develop a full supply for one infant. There should be a time interval of 14 days or more from the last chemotherapy session to start of breastfeeding to allow drug clearance from breast milk. If chemotherapy is restarted, breastfeeding must cease. Women taking tamoxifen should not breastfeed. Some researchers believe that breastfeeding after breast cancer will have a protective effect on the contralateral breast.
Another very common question is the probability of subsequent pregnancy after breast cancer treatment. Amenorrhea is a common problem following adjuvant chemotherapy given to premenopausal women with breast cancer. Chemotherapy can be detrimental to ovarian competence, devastating a woman's future fertility potential by damaging oocytes. The extent of damage is dependent on medication, drug dosage, and patient age.
For women at significant risk of future infertility, several strategies have been explored for fertility preservation including: Embryo and oocyte cryopreservation, Gonadotropin releasing- hormone (GnRH) agonist for ovarian protection and ovarian cortex cryopreservation.
10. Summary
[Pregnancy associated breast cancer]
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The question that might mind both the oncologist and the obstetrician more than the patient is the influence of subsequent pregnancy on recurrence and distant metastasis and on survival as general. Estrogens play a well known role in breast carcinogenesis and are dramatically increased during pregnancy. However, recent reports from the literature are reassuring.
Patients are generally advised to wait at least two years after diagnosis before becoming pregnant, because of the higher rate of recurrence of breast cancer in the first years after the diagnosis.