Breast conservation therapy: severe breast fibrosis after radiation therapy in patients with collagen vascular disease

Article Abstract:

Early screening programs have resulted in more cases of breast cancer being diagnosed in the early stages when breast-conserving surgery is possible. Generally, the cosmetic results are excellent. However, there are a minority of cases in which severe fibrosis develops in response to the radiation therapy that is usually given after surgery for breast cancer. This abnormal development of connective tissue seriously affects the appearance of the breast and may be very painful. Case histories have been previously reported in which severe fibrosis occurred in women with diseases such as lupus erythematosus and scleroderma at the time of treatment. Two further cases have now been observed in which the radiation therapy resulted in severe fibrosis. One patient had scleroderma and other had rheumatoid arthritis. Lupus erythematosus, scleroderma, and rheumatoid arthritis are examples of diseases that are collectively referred to as collagen vascular diseases. The causes of these disease are not known, but the features include inflammation of collagen (an important connective tissue protein) and the blood vessels. These disease are considered to result from autoimmune processes in which the immune system malfunctions and attacks the body's own tissues. This common feature of the patients affected by breast fibrosis in response to radiation therapy suggests a possible mechanism. Radiation therapy induces some tissue damage, which may damage some of the connective tissue. Recovery might be normal in most people, but in women with collagen vascular disease, the fragments of damaged connective tissue may trigger an autoimmune response. Unfortunately, a vicious cycle may result in which the autoimmune response causes further tissue damage which exacerbates the autoimmune response. On the basis of case histories, it is not possible to determine what the risk of breast fibrosis might be for women with collagen vascular disease. Further study may reveal, however, that breast conserving surgery may not be appropriate for these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Case studies, Complications and side effects, Breast cancer, Rheumatoid arthritis, Radiotherapy, Scleroderma (Disease), Collagen diseases

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Has there been any improvement in the staging of gastric cancer?: findings from the German Gastric Center TNM Study Group

Article Abstract:

For convenience of description, patient evaluation, and data collection, tumors are usually classified according to stage. In general, stage I tumors are restricted to their original location, and higher stages represent cancer invasion of local tissue, spread to lymph nodes, and metastatic spread to distant parts of the body. The TNM system (Tumor, Nodal involvement, and distant Metastases) of assigning stages to various tumors has become something of a standard, although differences exist regarding variations in definitions among different countries and the inclusion of new data, such as that from modern imaging techniques. To determine if the TNM system meets current needs for the evaluation and prognosis of cases of stomach cancer, the records of 1,420 patients were reviewed. The results indicate that the TNM system is very useful, and that splitting stages I and III into A and B stages, i.e., IA, IB, IIIA, and IIIB, allows better estimates of disease prognosis. The prognostic value of TNM stages could be improved if the system included the factor of residual tumor after surgery, such as the R classification of the American Joint Committee on Cancer. Although purists feel that the inclusion of such a factor, which represents the result of a treatment, is not in keeping with the principle of tumor staging, it is clear that the inclusion of this factor in TNM staging would result in more accurate prognoses of cases of stomach cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Identification and classification, Tumor staging, Cancer staging, Tumors, Stomach cancer

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