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Open access

Jan Morawiec, Adam Dziki, Zbigniew Morawiec and Agnieszka Kołacińska

Abstract

The aim of the study was to analyze clinicopathological features in breast cancer patients with local recurrence (LR).

Material and methods. A retrospective analysis of database of breast cancer patients operated on in the Department of Surgical Oncology in Łódź from 2 January 2009 to 30 June 2013, identified 1080 women with primary breast cancer and 11 patients with LR.

Results. LR rate was 0.23% per year. True recurrence (TR) occurred more frequently in patients with luminal B molecular subtype, in HER-2 positive and in triple-negative subgroups. In one patient with luminal -A subtype new primary (triple negative) occurred. TR were noted predominantly in patients with axillary lymph nodes metastases and with luminal B subtype who did not receive adjuvant chemotherapy but were given only endocrine therapy. LR were observed more frequently in patients who did not receive adjuvant radiotherapy or this treatment was delayed. Minimal surgical margins in postoperative specimens measured by pathologist were 4-25 mm, mean 9.5 mm.

Conclusions. The LR rate in patients operated on breast cancer in the Department of Surgical Oncology between 2009 and 2013 was low. TR was diagnosed in patients with non- luminal A breast cancer despite wide surgical margins, especially if the patients did not receive optimal adjuvant systemic treatment or radiotherapy was delayed or omitted. Complete cancer excision followed by an immediate implementation of optimal adjuvant treatment seems to be crucial especially in patients with poor tumor biology.

Open access

Beata Szutowicz-Wydra, Jacek Wydra, Wiesław J. Kruszewski, Maciej Ciesielski, Mariusz Szajewski, Jakub Walczak and Rita Hansdorfer-Korzon

Abstract

Breast cancer often requires combined oncologic treatments, the base of which is surgery. Quality of life (QoL) after each surgical procedure may influence the process of decision making among women, who qualify for multiple oncological strategies. Our knowledge about QoL in breast cancer patients is derived from comparative studies. Results may differ, depending on country, culture, and societal relations.

The aim of the study was to investigate the quality of life of Polish patients treated with breast-conserving therapy (BCT) or mastectomy with breast reconstruction.

Material and methods. The study involved women who underwent surgery for breast cancer in the Department of Surgical Oncology of the Gdynia Oncology Center from September 2010 to November 2013. Eighty-two breast reconstructions (in 79 patients) and 226 BCT procedures were performed. QoL was measured with the use of EORTC QLQ-C30 and QLQ-BR23 questionnaires.

Results. Global QoL was high in both groups and did not differ significantly. Body image was slightly better after BCT than after mastectomy with breast reconstruction, but sexual QoL was lower. Future perspective was quite low in both groups. Disease symptoms were not bothering.

Conclusions. The global QoL among Polish breast cancer patients treated with BCT or mastectomy with breast reconstruction is high and does not differ between groups. There is a need for anxiety and disease-related fear prophylaxis and for the improvement of sex life of breast cancer survivors.

Open access

Krzysztof Kozak, Rafal Wojcik, Maciej Czerwonka, Slawomir Mandziuk and Barbara Madej-Czerwonka

Abstract

Breast cancer is the most common cancer among Polish women [1], thus, the problem of surgical treatment of breasts, especially with regard to conserving and/or reconstruction surgery, is extensively discussed. Currently, in Poland, efforts are made to increase the number of oncologic and reconstructive breast centers which offer specialized treatment of this cancer, the so-called ‘Breast Units’ [1]. This paper analyzes methods of reconstructions, discusses the techniques used in particular types of surgeries and additionally informs the reader of the oncological aspects of the procedures. Based on literature, statistical data of breast reconstructions from Poland and the world are presented. Moreover, complications and psychological aspects of mammary gland surgery are dealt with, and the aesthetic effects of breast reconstructions are discussed. To support of our findings, we also present selected clinical cases from the oncological and reconstructive point of view.

Open access

Andrzej Nowicki, Anna Szwed and Ryszard Laskowski

Depression and Anxiety Before and After Breast Amputation in Women

Breast cancer is the most frequent malignancy in women. The diagnosis of neoplastic disease produces or deepens anxiety and depression in a patient.

The aim of the study was to assess the influence of surgery and socio-demographic factors on the level of anxiety and depression in women suffering from breast cancer.

Material and methods. 50 women (30-71 years old, mean age 54.7 years) with breast cancer were enrolled into the study. They were assessed two times - before and after surgery. To evaluate the level of depression BECK scale was used. It consists of 21 points that determine the level of depression. HAD scale containing seven descriptions of a patient's status was used to assess the level of anxiety.

Results. Most of patients (17(34%) women had vocational education. More than half of the analyzed women were free of depression both before and after surgery, 50 % and 60% respectively. 2% of all women had extremely deep depression preoperatively. A normal and high level of anxiety before surgery was felt by 21 (42%) and 21 (42%) women respectively.

A high level of anxiety was found in 15 patients (30%) postoperatively. The level of depression after surgery decreased in 32 women and psychological status was deteriorated in 9 patients according to BECK scale. The level of anxiety after surgery decreased in 30 patients and deteriorated in 8 cases according to HAD scale. The intensity of anxiety decreased after surgical treatment. The most intensive increase in depression was observed in women with secondary education (51 points) before surgery and 35 points in women with vocational education after surgery. The highest level of anxiety before surgical treatment was found in women with secondary as well as vocational education (21 points). Whereas the highest level of anxiety after surgery was observed in patients with secondary education. (21 points). The hardest depression was observed in working patients (51 points) preoperatively and they still had the hardest depression (35 points) postoperatively, too. The level of anxiety was highest in working women both preoperatively and postoperatively (21 points). The most intensive depression before surgery was observed in women at middle social status (35 points) and this tendency was observed also after surgery. The level of anxiety before surgery was the highest in women with good and middle social status (21 points). After surgery it was the highest in patients with middle social status (21 points). The most intensive depression before surgical treatment was found in patients between 51 and 60 years old (51 points). The hardest depression after surgery was observed in women between 41 and 50 years old (35 points). The highest level of anxiety was felt by patients between 41 and 50 and between 51 and 60 years old (21 points) preoperatively and in women between 51 and 60 years old (21 points) postoperatively.

Conclusions. The intensity of depression and anxiety in women with breast cancer decreased significantly after mastectomy. Patients with university education had lower levels of anxiety and depression both before and after surgery. Working women with average social status had the highest levels of anxiety and depression both before and after surgical treatment. The age of a patient did not influence significantly on the levels of anxiety and depression both before and after surgery.

Open access

Rasha Hamdy Hamed, Khalid Salim, Abdullah Alzahrani and Shereef Elsamany

Abstract

Purpose

Adjuvant trastuzumab is currently an internationally standard for the treatment of localised breast cancer that over express HER2 with the most adverse effect being cardiotoxicity. We conducted this study to evaluate the cardiac safety of trastuzumab in clinical practice.

Methods

This study is a retrospective observational single institutional study conducted in the Oncology Center of King Abdulla Medical City (KAMC), Makkah, Saudi Arabia, from June 2011 to January 2014. We evaluated the incidence of cardio toxicity and associated risk factors during adjuvant trastuzumab treatment.

Results

Of 57 patients, 20 patients (35%) exhibited cardiotoxicity. About 14% of patients had drop of left ventricular ejection fraction (LVEF) below 50%, whilst 10% and 15% drop of LVEF below their baseline levels were found in 30% and 5% of patients, respectively. About 98.3% of our patients have completed treatment, of whom 21% had a provisional interruption because of a fall in LVEF. A definitive trastuzumab discontinuation has been made in 1.75% of cases because of a nonregressive reduction in LVEF. Analysis of risk factors related to trastuzumab cardio toxicity found that patients older than 40 years were more likely to develop cardio toxicity compared to those younger than 40 years. This difference was statistically significant (p = 0.042).

Conclusion

In our study, the cardiac safety seems comparable with the literature data. Trastuzumab-related cardiotoxicity is manifested by an asymptomatic decrease in the LVEF and less commonly by clinical heart failure. Most instances are transient, asymptomatic and reversible.

Open access

Agnieszka Karpińska, Krzysztof Safranow, Józef Kładny and Violetta Sulżyc-Bielicka

Abstract

The achieve pathologic complete response is proven to be the most important parameter of prognosis. Thereports evaluating the impact of obesity on the obtained pathologic response to chemotherapy are unequal.

The aim of the study was to evaluate in locally advanced breast cancer patients, treated with AT(doxorubicin plus docetaxel) neoadjuvant chemotherapy: 1. The relationship of obesity with obtaining pathological response. 2. The relationship of obesity and free of disease recurrence survival (DFS) and overall survival (OS) associated with the tumour.

Material and methods. A retrospective study was carried out in a group of 105 patients with locally advanced breast cancer, treated with AT neoadjuvant chemotherapy and then treated with radical surgery. Two variants of pathological response have been adopted: a pCR (T0N0) and pCR1 (TisN0, TxN1, T1N0, T1N1, T0N1). The relationship of obesity with pathological response and survival was investigated.

Results. In univariate analysis the pCR1 was obtained with its arising from the borderline of statistical significance with lower incidence of obesity. In pCR1 multivariate analysis, negative pCR1 relationship with obesity was on the borderline of the statistical significance. The multivariate analysis showed a significant negative association OS with obesity (p=0.047) and positive with the occurrence of menopause (p = 0.029).

Conclusions. In patients with locally advanced breast cancer treated with AT neoadjuvant chemotherapy. 1. Obesity seems to be an independent and unfavourable predictor of the lack of obtaining pCR1 pathological response 2. In the multivariate analysis, the obesity was a significant independent factor related to shorter OS.

Open access

Ronalds Mačuks, Ludmila Eņgele, Inta Nuķe, Agnese Sudraba and Simona Doniņa

Comparative Analysis of Insulin-like Growth Factor I and Tumour-associated Antigens in Cancer Patients at the Time of Diagnosis

Insulin-like growth factor-1 (IGF-1) is a polypeptide hormone with structure similar to insulin. Many experimental data support the suggestion that risk of cancer is higher among persons with raised concentration of IGF-1 and some studies support the role of IGF-1 as a biomarker of increased risk of development of colorectal (CRC) and breast cancer (BC). We have determined IGF-1, CA19-9, CEA, CA72-4 for colorectal, CA15-3 and CEA for breast cancer to clarify utility of IGF-1 as a biomarker of cancer presence at the time of diagnosis. In total, 42 men and 52 women with CRC and 139 women with BC were examined. The cut-off level for IGF-1 concentration in serum was established from results of apparently healthy 27 men and 130 women. An IGF-1 and tumour-associated antigens were detected by chemiluminescence's method using analyser Immulite 2000 (Siemens). Elevated level of IGF-1 was detected in 42.8% of men and 30.7% of women with colorectal cancer. The highest detection rates for CRC using a two biomarker combination were for men as well as for women (57.1% and 57.6%). IGF-1 showed higher detection rates between women with breast cancer in postmenopause vs. women at premenopausal age (33.6% vs. 27.7%). IGF-1 can be used as an additional biomarker for selected colorectal and breast cancer patient groups.

Open access

Piotr Pluta, Piotr Smolewski, Agnieszka Pluta, Barbara Cebula-Obrzut, Agnieszka Wierzbowska, Dariusz Nejc, Tadeusz Robak, Radzisław Kordek, Leszek Gottwald, Janusz Piekarski and Arkadiusz Jeziorski

Significance of Bax Expression in Breast Cancer Patients

Bax protein, the proapoptotic member of Bcl-2 protein family, plays the key role in apoptosis pathway.

The aim of the study was to assess the expression of Bax protein in breast cancer cells.

Material and methods. Sixty-two breast cancer patients were included in the study. The control group encompassed 11 fibroadenoma patients. Single cells were isolated from defrosted samples and prepared for flow cytometry measurement.

Results. Median expression of Bax protein in study group was 7.9% (range: 0-49.4%) and was significantly lower than in control (median expression 15.8%; range 4.9-30.9%; p=0.034). Expression of Bax correlated with expression of p53 and caspase-3 proteins (p<0,01, rank Spearman test). In patients under 70 years old and with positive estrogen receptors status the expression of Bax protein was significantly higher (p=0.03 and p=0.01 respectively).

Conclusions. Lower expression of Bax protein in breast cancer cells may suggest the potential way of apoptosis avoidance of tumor cells. Correlations among Bax protein, p53 and caspase-3 are likely associated with active apoptotic mechanism in breast cancer cells expressing Bax protein. Further investigation with long time follow-up should be performed to establish the prognostic role of Bax protein expression in breast cancer patients.

Open access

O. Munteanu, A. Dumitru, O. Bodean, L. Arsene, D. Voicu, E. Bratilă, C. Mehedinţu, M. Sajin and M.M. Cîrstoiu

Abstract

From breast malignant tumors, bone is the most frequent site of metastasis. Bone metastases from breast cancer are correlated with pathological fractures, spinal cord compression and other skeletal-related events as well as bone pain and hypercalcemia. These lead to impaired mobility, decreased quality of life, and overall decrease in survival. Clarification of mechanisms regulating bone metastasis has advanced greatly in the last years and this has translated into plentiful unused therapeutic options. Greater understanding of the pathophysiology of bone metastases has led to the detection and clinical efficiency of bone-targeted agents. This review summarizes the key evidence for current clinical practice and future directions.

Open access

Patrycja Groszek, Bolesław Samoliński and Edyta Krzych-Fałta

Abstract

Introduction. Cancer and its treatment can cause serious mental and physical disorders that greatly limit the autonomy and independence of patients and reduce their quality of life. Mastectomy violates woman‘s image both in their self-assessment and in their public reception. Among the consequences after mastectomy, there are problems in the physical sphere, which reduce everyday activities, there also appear problems with the mental state associated with the reduction of the sense of feminity.

Aim. The aim of the study was to identify health concerns of women after mastectomy.

Material and methods. The study included 40 randomly selected women after mastectomy aged over 20. The research tool used in the study was the original survey, consisting of 28 questions. The questions were designed in order to gather information about the health concerns of women after mastectomy. The analysis was performed using Statistica software.

Results. The disease changed for worse lives in 55% of women after mastectomy; 35% reported no impact and 10% of respondents admitted that the disease changed their lives for the better. The number of 22.5% of interviewees complained of frequently occurring low mood, depression and sadness, while 52.5% have experienced these emotions sometimes. Approximately 90% of respondents have been using a breast prosthesis after mastectomy. As many as 72.5% of women reported decrease in physical fitness after surgery, while 27.5% did not experience any change.

Conclusions. The mastectomy procedure has a negative impact on physical and emotional state of women.