Surgical oncology
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Increasing numbers of women are using hormone replacement therapy (HRT) in their 50s and 60s. Oestrogen alone or oestrogen and progestogen combined given in this age group increase breast density and this has the effect of reducing both the sensitivity and specificity of breast screening in HRT users. HRT significantly increases the risk of developing breast cancer with combinations of oestrogen and progestogens increasing the risk to a greater degree than oestrogen alone. ⋯ Prospective randomised trials are underway but are unlikely to include sufficient numbers to exclude a small adverse influence of HRT on breast cancer mortality. Tibolone, a gonadomemetic agent which has been used to control menopausal symptoms, appears to have less direct effects on the breast and is being evaluated as an alternative to oestrogen in breast cancer survivors who develop significant menopausal symptoms resistant to non-hormonal therapies. There is clear evidence that HRT causes breast cancer and the challenge for the physician is to control the menopausal symptoms using HRT or alternatives while at the same time limiting the risks associated with this treatment.
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Review Comparative Study
Sentinel node in the era of neoadjuvant therapy and locally advanced breast cancer.
The most important determinant of prognosis for patients with breast cancer is the status of the axillary lymph nodes. Axillary lymph node dissection (ALND) has been performed for over a century to stage the cancer, achieve regional control, and perhaps improve survival. In accordance with tradition, ALND has been performed on all patients with the diagnosis of invasive breast cancer. ⋯ While numerous methodological issues are being raised, the utility of LM and SNB identification continues to expand. In the current review we assess the application of this technique to locally advanced breast cancer (LABC) and neoadjuvant chemotherapy. What role does SNB play in locally advanced disease? Is LM and SNB accurate for patients with advanced disease? What influence do axillary metastases have on further treatment? What is the role of SNB in the planning for neoadjuvant patients? The skillful management of patients with breast cancer lies in the delicate balance between maximizing the efficacy of treatment and minimizing its morbidity and failure.
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The conventional and accepted treatment for curative resection of colon cancer is laparotomy with hemicolectomy for right or left sided lesions. The technique of colon resection through an open laparotomy incision is well known. Over the past several years, laparoscopically assisted colectomy has been developed and studied, following the explosion of laparoscopic technology from the cholecystectomy experience and with acquisition of advanced general laparoscopic techniques. ⋯ The laparoscopic approach has been shown to be technically and oncologically feasible with equivalent lymph node harvest from mesenteric lymphadenectomy and achieves adequate proximal and distal margins of colonic resection. Despite initial early anecdotal reports of port site cancer recurrence in laparoscopically assisted colectomy, port site recurrence is rare and its incidence is similar to incisional recurrences in conventional open colectomy. Recent prospective comparative studies have demonstrated equivalent patient survival and equivalent local or distant colon cancer recurrences for open versus laparoscopic curative resection of colon cancer.