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PubMed1990

Radiation-induced brachial plexus neuropathy in breast cancer patients.

The incidence and latency period of radiation-induced brachial plexopathy (RBP) were assessed in 79 breast cancer patients by a neurological follow-up examination at least 60 months (range 67-130 months) after the primary treatment. All patients were treated primarily with simple mastectomy, axillary nodal sampling and radiotherapy (RT). Postoperatively, pre- and postmenopausal patients were randomly allocated chemotherapy or antiestrogen treatment. All patients were recurrence-free at time of examination. Clinically, 35% (25-47%) of the patients had RBP; 19% (11-29%) had definite RBP, i.e. were physically disabled, and 16% (9-26%) had probable RBP. Fifty percent (31-69%) had affection of the entire plexus, 18% (7-36%) of the upper trunk only, and 4% (1-18%) of the lower trunk. In 28% (14-48%) of cases assessment of a definite level was not possible. RBP was more common after radiotherapy and chemotherapy (42%) than after radiotherapy alone (26%) but the difference was not statistically significant (p = 0.10). The incidence of definite RBP was significantly higher in the younger age group (p = 0.02). This could be due to more extensive axillary surgery but also to the fact that chemotherapy was given to most premenopausal patients. In most patients with RBP the symptoms began during or immediately after radiotherapy, and were thus without significant latency. Chemotherapy might enhance the radiation-induced effect on nerve tissue, thus diminishing the latency period. Lymphedema was present in 22% (14-32%), especially in the older patients, and not associated with the development of RBP. In conclusion, the damaging effect of RT on peripheral nerve tissue was documented. Since no successful treatment is available, restricted use of RT to the brachial plexus is warranted, especially when administered concomitantly with cytotoxic therapy.

Adult↗
PubMed2004

Breast metastasis of primary colon cancer.

Metastatic tumors to the breast from colon adenocarcinoma are very rare. They are usually indicative of disseminated disease, and the prognosis is poor. Generally, radical operation should be avoided unless needed for palliation. This case report described a patient with breast metastasis from colon adenocarcinoma treated by simple mastectomy.

Adenocarcinoma↗
PubMed1999

Racial differences in the presentation and surgical management of breast cancer.

BACKGROUND: African American women are seen with more advanced breast cancers, are less likely to be treated with breast-conserving surgery, and generally have poorer prognoses than white women. There are a myriad of potential causes for these phenomena. The purpose of this study was to measure racial differences in the surgical treatment of breast cancer among women with comparable health care access and delivery. METHODS: The Breast Cancer Registry of the Department of Surgery at Henry Ford Hospital was accessed for all patients between January 1, 1990, and December 31, 1997 for whom data on race, tumor characteristics, stage, and treatment specifics were available. Socioeconomic information was collected with use of 1990 census block data. Proportions of women who received each treatment were compared for African Americans and whites with use of the relative risk (RR) and 95% confidence intervals (CI). We used multiple logistic regression to obtain estimates of the relative risk, controlling for potential confounding factors. RESULTS: Of the 1699 patients in the database, 1250 had sufficient information for analysis. A total of 8.7% of African American women were diagnosed with late-stage disease (i.e., stage III or IV) compared with 7.9% of whites. Nevertheless, African American women had a lower frequency of stage I disease (30.5% vs 36.2%) and a higher frequency of stage II disease (36.8% vs 31.4%). Overall and adjusted risk estimates for age, tumor stage, marital status, median income, and type of insurance revealed no substantive or statistically significant differences between African American and white patients. The adjusted RR for local excision was 1.39 (95% CI 0.78 to 2.49), for lumpectomy and axillary dissection RR 0.92 (95% CI 0.66 to 1.29), for simple mastectomy RR 0.84 (95% CI 0.41 to 1.72), and for modified radical mastectomy RR 1.00 (95% CI 0.73 to 1.36). CONCLUSIONS: In this setting of equal access to health care, African American women still have higher frequencies of stage II disease, although the frequencies for late-stage disease are similar. Nevertheless, no surgical differences were found in this population, even after the effects of socioeconomic indicators and stage at diagnosis were controlled for Survival differences between African American and white women are unlikely to be explained by differences in treatment.

Aged↗
PubMed1999

Treatment outcomes for female octogenarians with breast cancer.

Scant information is available comparing the treatment outcomes of minor surgery (lumpectomy) versus extensive treatment (radical and simple mastectomy or lumpectomy and radiation) in octogenarians with breast cancer. Medical records of women (ages 80-89) who received treatment for breast cancer from 1984 through 1994 were reviewed. All patients were stage T1 or T2, and none had palpable lymph nodes. The recurrence rate, disease-free interval, and death rate for both groups were compared. Of the 41 patients representing 43 minor surgeries, 12 per cent (5 of 41) of patients developed recurrence, all of which were related to the primary breast tumor. The mean disease-free interval was 28.6 +/- 24.7 months (range, 6-65). Forty-six per cent (18 of 39) of patients died, 10 per cent (4 of 39) from recurrence and metastatic disease from breast cancer and 36 per cent (14 of 39) from other causes. Of those who underwent extensive treatment, 14.6 per cent (7 of 48) of patients experienced recurrence, all related to the primary breast tumor. The mean disease-free interval was 24.0 +/- 21.9 months (range, 2-71). Forty-eight per cent (23 of 48) of patients died, 10 per cent (5 of 48) from recurrence and metastatic disease from breast cancer and 37 per cent (18 of 48) from other causes. None of the differences between the minor surgery versus extensive treatment groups were statistically significant. The recurrence rate, disease-free interval, and death rate from recurrent disease are similar for patients undergoing minor surgery compared with those undergoing extensive treatment.

Aged↗
PubMed1998

Two-step approach for the operation of male breast cancer: report of a case at high risk for surgery.

We report herein the rare case of a 61-year-old man with a history of dissecting aortic aneurysm as well as right breast cancer. He complained of abdominal pain due to a progress of aortic dissection in preparation for the radical operation for breast cancer. Blood pressure was initially controlled and he was administered a simple mastectomy under local anesthesia. One month after the first operation, a radical operation for breast cancer was successfully performed. The tumor was in stage II, and two years after the operation, the patient remained free of recurrent disease. This two-step approach for the operation of male breast cancer may be used as a treatment of breast cancer if a patient is too frail for normal surgery.

Adenocarcinoma↗
PubMedDate not supplied

The value of postlumpectomy mammogram in the management of breast cancer patients presenting with suspiciouis microcalcifications.

PURPOSE: It is recommended that patients with breast cancer who present with mammographically detected microcalcification should undergo postlumpectomy mammogram with magnification views to ensure adequate removal of all clinically demonstrable disease. The value of postlumpectomy mammogram has not been adequately examined in the literature. This report aims to quantify the value of such a study. MATERIALS AND METHODS: Retrospective review identified 90 breast cancer patients referred to our department between 1992 and 1997 who met all of the following criteria: (1) patients were considered for breast conserving management; (2) patients had suspicious microcalcifications on diagnostic mammograms; (3) the mammographic lesions were thought to be removed entirely on postexcision specimen radiographs; (4) surgical excisions were thought to be adequate on the basis of a review of the histologic pathology reports; and (5) postlumpectomy mammograms with magnification views were obtained. Fifty patients had invasive adenocarcinoma and 40 patients had ductal carcinoma in situ. The margins of last resection were clear, close, or focally involved in 70, 13, and seven patients, respectively. Patient records were reviewed to determine whether postlumpectomy mammograms demonstrated residual microcalcifications. RESULTS: Sixteen patients (17%) were found to have residual microcalcifications on postlumpectomy mammograms. Twelve patients underwent either local re-excision (seven patients) or simple mastectomy (five patients). Re-excision was not performed in four patients. Residual malignant cells were found in eight patients (67% of the re-excision group and 9% of the whole group). Six of these patients had their tumors initially resected with clear margins and the remaining two patients had their tumors initially resected with close margins. CONCLUSIONS: Postlumpectomy mammograms with magnification views detected residual clinical disease in a significant proportion of patients. Our result supports the routine use of this test, even when satisfactory postexcision specimen radiographs and adequate lumpectomy resection margins are obtained. This finding is particularly true for patients with ductal carcinoma in situ.

Breast Neoplasms↗
PubMed2000

Chemotherapy extravasation from implanted ports.

PURPOSE/OBJECTIVES: To describe the four primary causes of extravasation from implanted ports. DATA SOURCES: Journal articles, textbooks, medical records, depositions, serial photographs, and the authors' personal experiences. DATA SYNTHESIS: Extravasation from ports can occur by four major mechanisms: incomplete needle placement and needle dislodgment, thrombus or fibrin sheath formation, perforation of the superior vena cava, and catheter fracture. The degree of tissue injury can vary but may be severe enough to require that a simple mastectomy be performed to manage chest wall necrosis. CONCLUSIONS: Extravasation is a known risk of chemotherapy administration via implanted ports. Vesicants should be administered only after a blood return has been obtained and the needle inserted into the port septum has been adequately secured. IMPLICATIONS FOR NURSING PRACTICE: Extravasation of vesicant drugs from ports can cause tissue necrosis and may prompt litigation. Risk-management strategies include careful assessment and use of ports, comprehensive patient teaching about the risk of extravasation and measures to decrease the likelihood of needle dislodgment, and development of extravasation-management policies that address port extravasations.

Antineoplastic Agents↗
PubMed1999

The evolving meaning of cancer for long-term survivors of breast cancer.

PURPOSE/OBJECTIVES: To discover the different meanings of cancer for older women who are long-term survivors of breast cancer. DESIGN: Qualitative study using a heuristic approach. SETTING: Large metropolitan area in the Midwestern United States. SAMPLE: A sample of eight women was obtained using network sampling. The women ranged in age from 65-77 years. Length of survival ranged from 5.5-29 years. Five of the women had been treated with a lumpectomy (four with radiation and chemotherapy and one with radiation only). The three other women had been treated with a simple mastectomy, one of whom also was treated with chemotherapy. METHODS: Interviews were conducted in the women's homes. Audiotaped interviews were transcribed and manually coded for patterns and themes. MAIN RESEARCH VARIABLES: Meaning of cancer. FINDINGS: Three meanings of cancer emerged from the data: (a) cancer as sickness and death, (b) cancer as an obstacle, and (c) cancer as transforming. CONCLUSIONS: As the women worked through their cancer experience, their perspectives changed. The meaning of cancer after surviving the disease and its treatment centered around positive, insightful experiences and expansive, renewing interactions with their environment. Further research examining the meaning of cancer is needed to broaden the transferability of the findings to other groups. IMPLICATIONS FOR NURSING PRACTICE: Understanding the meaning of cancer for older women who are long-term breast cancer survivors may enhance nurses' sensitivity to survivors' perspectives. Knowledge of survivors' different meanings of cancer may help to paint a new vision of cancer survivorship comprised of potentially positive, transforming experiences.

Adaptation, Psychological↗
PubMed2000

[Breast angiosarcoma].

OBJECTIVE: To report the case of a female with Mammary Angiosarcoma. SETTING: Breast Unit of Oncology Service from Hospital General de México. CASE REPORT: A 28 year old female patient was noted to have a left painless breast mass with reddish-violaceous macular lesions in the overlaying skin in upper quadrants, which she had initially discovered 2 years previously. The patient described a progressive breast enlargement. Mammography showed dense tissue without focal mass. A contrast-enhanced Magnetic Resonance of left breast was performed, and 10.5 x 8.5 cm enhancing vascular mass with irregular borders that occupied the entire superior portion of the breast was identified, the mass extended to the pectoral fascia but no evidence of muscle invasion. An incisional Biopsy of the breast mass was performed and the biopsy was interpreted as low grade Mammary Angiosarcoma. Left Simple Mastectomy with partial pectoral resection was performed; and final histopathologic result was intermediate grade Mammary Angiosarcoma. Immunohistochemistry was positive for Factor VIII, Anti Ulex Europeaus and CD 31. CONCLUSION: High index suspect is mandatory for an opportune diagnosis and treatment of Angiosarcoma. Magnetic resonance has a potential role in guiding clinical management.

Adult↗
PubMed2001

Treatment and outcome of cystosarcoma phyllodes in Brunei: a 13-year experience.

Cystosarcoma phyllodes is a rare tumour of the breast whose clinical behaviour does not correlate well with histological findings. The optimal treatment of this tumour remains controversial. A retrospective study on the treatment and outcome of women diagnosed with cystosarcoma phyllodes between 1986 and 1998 in Brunei was undertaken. Twenty-seven women were diagnosed over the 13-year study period. Follow-up was complete in 26 cases. The mean age at diagnosis was 35 years. There were 19 (73%) histologically benign lesions, 3 (12%) borderline lesions and 4 (15%) malignant lesions. The mean follow-up period was 37 months. Four patients (16%) had recurrences after surgery (1 benign, 1 borderline and 2 malignant lesions). Mean time to recurrence was 9 months. Breast-conserving surgery with adequate resection margin is advocated in benign and borderline lesions. For malignant lesions, simple mastectomy without routine axillary dissection is recommended. More research is required to determine the role of adjuvant chemotherapy and radiotherapy in the management of malignant cystosarcoma phyllodes [corrected].

Adolescent↗
PubMed1975

[Surgical treatment of breast cancer (author's transl)].

We compared the healing rates of 387 patients with breast cancer, 203 of them had been treated with the extensive operation technique of Halsted, 184 with a simple mastectomy. Both groups had a x-ray treatment after the operation. Our controls 3, 5 and 10 years after the operation showed, that the healing results of the radically operated patients were better. The complication-rate of the radical operations was not more elevated compared with the conservative more ones.

Adult↗
PubMed2002

[Surgical treatment of non-palpable breast tumors].

METHOD: Between 1997 and 2000 the authors performed 110 fine-wire localized breast biopsies in patients with nonpalpable suspicious lesions. RESULTS: 108 target lesions (98.1%) were accurately excised during the initial surgery. Overall, 56 lesions were malignant, among these cases 50 invasive carcinomas and 6 DCIS were found. Breast conservation was achieved in 48 patients (88.5%), simple mastectomy with axillary lymph node sampling was performed in 8 cases. 86% of the invasive malignant lesions belonged to the good prognostic subgroup of the Nottingham Prognostic Index. CONCLUSION: There in an importance of the close cooperation between radiologist, surgeon, pathologist and oncologist in the treatment of nonpalpable preclinical breast carcinomas.

Adult↗
PubMedDate not supplied

[Current data on radiotherapy of breast cancer].

At the Symposium in Teheran two aspects of radiotherapy in mammary cancer came up for discussion: post-operative radiotherapy and the possibilities of conservative treatment, combining tumorectomy ("lumpectomy", "tylectomy ") for stage 1 cases. The place of post-operative irradiation was discussed in relationship to the appearance of local recurrences, metastases and the survival rates available from published data (therapeutic trials and retrospective studies) and in relationship with a population of 206 cases treated at the Gustave Roussy Institute between 1963 and 1966. The possible relationship between post-operative irradiation and immunity were mentioned. With identical wide surgical excision the essential role of post-operative irradiation consists of diminishing in a significant fashion the level of local recurrences. With more restricted surgery of the simple mastectomy type one asks whether irradiation could not replace radical node dissections. It should be reserved for the bad N+ cases. A retrospective study of 44 cases coded T1 NO/N1 MO/PevO treated by tumorectomy and cobalt 60 was compared with 44 matching cases which differed only in their local treatment which consisted of wide surgical excision. The survival actuarial rate at 8 years is 88.6% for the more conservatively treated group compared with 73% for the radical group. In order to provide a quite impartial result a WHO therapeutic trial was begun in 1972.

Adenocarcinoma↗
PubMedDate not supplied

Primary angiosarcoma of the breast: a case report.

Primary angiosarcoma of the breast is a rare entity. The absence of clinical and instrumental features is a fundamental concept in the context of diseases of the breast. Currently, the most extensively used surgical procedure is simple mastectomy with removal of the fascia of the pectoralis major muscle. A 45-year-old woman presenting this lesion is described here, with particular reference to the cytomorphological findings.

Biopsy↗
PubMedDate not supplied

Breast cancer in Queenland fifteen years after treatment.

The incidence of carcinoma of the breast in this Australian series is as high as in most countries of the world, and remains high with increasing age. The mortality rate from cancer is highest in the first three years after treatment of the primary disease, but, even after 10 years, deaths from cancer are nearly as frequent as those from intercurrent disease. At least 25% of patients had advanced disease at initial presentation. A 25% 15-year survival rate is reported in a series of mixed stage at the time of initial treatment, which was by simple mastectomy and radiotherapy in 75% of cases. Large tumours without evidence of axillary metastasis T3N0M0) often had a surprisingly good prognosis. The site of first reappearance of the tumour was local in 30-6% of cases, systemic in 38-4% of cases, and in the opposite breast in 7-6% of cases. It was not possible to classify the remaining 23-4% either because of incomplete information or, more usually, because of synchronous development of local and systemic recurrence. Of patients who developed local recurrence in this group, 83% showed generalized metastatic disease within 10 years of the appearance of the recurrent disease.

Adult↗
PubMed1975

[Surgical manegement of breast cancer].

A survey of common operative methods in carcinoma of the breast is given. The own procedure in localized and generalized stages of the disease is presented. Simple mastectomy plus axillary dissection has according to our experience proven to be the method of choice.

Bone Neoplasms↗