Vexed surgeons, perplexed patients, and breast cancers which may not be cancer

Article Abstract:

The current widespread use of mammography has created some confusion and controversy regarding the optimal treatment of certain noninvasive breast cancers. Previously, only palpable tumors were being detected and treated. Now, smaller tumors are being diagnosed, and the appropriate course of action is far from clear. The diagnosis of ductal carcinoma or lobular carcinoma in situ is becoming far more common; in situ refers to the fact that the tumor cells have not yet migrated beyond their original basement membrane boundaries. The treatment options include observation, wide area excision with or without radiotherapy, and total mastectomy. The incidence of invasive cancer after local excision of ductal carcinoma in situ is from 4 to 15 percent. The degree to which radiotherapy might reduce this rate is uncertain. Some consider total mastectomy the treatment of choice, but even with this approach, recurrence and death are not necessarily prevented. Patients with ductal or lobular carcinoma in situ are at high risk for the development of cancer in the other breast, and although prophylactic breast removal is popular with neither physicians nor patients, it is, somewhat paradoxically, more prevalent in the treatment of disease which has not yet spread to surrounding tissue. In the absence of detailed factual data, the patient should be told what is known about the relative benefits and disadvantages of each approach, and these options should be evaluated in light of the patient's own priorities and preferences. The patient might also be encouraged to participate in the National Surgical Adjuvant Breast and Bowel Project, and it is hoped that as this study progresses, solid data will permit more objective decision-making about the treatment of breast cancers in situ. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Statistics, Carcinoma in situ, Mastectomy, Carcinoma, Ductal, Ductal carcinoma

---

Surgical palliation for recurrent rectal cancers ulcerating in the perineum

Article Abstract:

The local progression of rectal cancer imposes a horrible condition on the patient. The tumors may ulcerate through the perineum, which is the floor of the pelvis. Such ulceration causes excruciating pain and often the foul odor of decaying flesh. Attempts to palliate the discomfort with chemo- or radiotherapy meet with limited success of short duration. In such cases, death comes as a relief to all concerned. In an effort to mitigate somewhat this awful condition, a pilot study was initiated to investigate the use of surgery to relieve the symptoms of ulcerating rectal cancers. Seven patients, all of whom were in pain and had exhausted all other modes of treatment, were treated surgically. All patients had been expected to remain in the hospital until their death. The massive removal of cancerous tissue along with at least two centimeter healthy margins from the pelvic region had the desired effect. All seven patients were able to return home, and three returned to work. In no case was smell a problem, which had discouraged the family from assuming care of the patient, and the pain was controlled with relatively small amounts of analgesics. Six patients died within 2 to 24 months after surgery; one remains alive 13 months after surgery. The surgical debridement provided a measure of dignity and freedom from pain in a situation which otherwise would have meant six months of excruciating deterioration in a hospital ward. (Consumer Summary produced by Reliance Medical Information, Inc.)

Colorectal cancer, Surgery

---

The control of breast cancer: a World Health Organization perspective

Article Abstract:

Although research is continuing on the treatment of breast cancer, the greatest decrease in deaths from breast cancer is likely to be achieved by using standard therapy at earlier stages of the disease. The World Health Organization estimates that more than half of the breast cancer patients in the world would gain prolonged life through programs of greater public awareness and early detection. Prevention may be a possibility; Japanese women have a rate of breast cancer one fifth that of American women; when Japanese women move to the US, the incidence approaches the American rate. Although dietary fat has been thought to be associated with increased incidence of breast cancer, numerous studies have failed to find a link. Studies have shown that in countries where adequate treatment facilities exist, but where public awareness is low, educational programs and breast self-examination can make a significant difference. The mortality from breast cancer is still increasing in most countries of the world, but enough knowledge is now available to make a positive change. The three factors which must be brought together by health care programs are public education, early detection, and locally available treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Social policy, Health education, World Health Organization

Similar abstracts:

• Abstracts: For nurses and patients, it's a matter of life and death. The nurse who shattered the glass ceiling. 800 million pounds sterling: the government's incentive to end NHS reliance on agency nurses
• Abstracts: Efficacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases
• Abstracts: The role of second-look surgery in the management of advanced germ cell malignancies. Peripheral primitive neuroectodermal tumor (peripheral neuroepithelioma) in children: a review of the St. Jude experience and controversies in diagnosis and management
• Abstracts: Adjuvant systemic therapy. Progress in the treatment of early breast cancer. The breast biopsy
• Abstracts: The epidemiology of Pseudomonas aeruginosa in oncology patients in a general hospital. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.