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| Surgery FAQ Articles |
Take home question to ask yourself: Can you plan your surgery with your doctor in order to avoid trauma to your breast in order to forestall possible spread of cancer cells? |
Articles supporting issues mentioned on Surgery FAQ page
Int J Clin Pract. 2002 Apr;56(3):188-90 Timing of surgery for breast cancer. Fentiman IS. Hedley Atkins Breast Unit, Guy's Hospital, London, UK. Several studies have now shown that premenopausal women with early breast cancer have a significantly better prognosis if their tumours are excised during the luteal phase of the cycle. The 10- year survival for node positive cases undergoing follicular phase surgery was 33% compared with 78% in those having surgery at other times of the menstrual cycle. Further work has shown that there is an improved survival in those with plasma progesterone levels >4 ng/ml(-1), associated with the luteal phase. Luteal phase surgery is also associated with a decreased risk of vascular invasion, implying that the tumour is more cohesive at that time. Similarly, in the heaviest quartile of postmenopausal patients, with the highest endogenous oestrogen levels, there was vascular invasion around tumours in 45% compared with only 11% of the lightest quartile. Changing the hormonal milieu at the time of surgery for breast cancer may have the ability to improve the prognosis for some patients with early breast cancer. OTHER CITATIONS FOR TIMING SURGERY 2: Lemon HM, Rodriguez-Sierra JF. Timing of breast cancer surgery during the luteal menstrual phase may improve prognosis. Nebr Med J. 1996 Mar;81(3):73-8. Corrected and republished in: Nebr Med J. 1996 Apr;81(4):110-5. PMID: 8907825 3: Lemon HM, Rodriguez-Sierra JF. Timing of breast cancer surgery during the luteal menstrual phase may improve prognosis. Nebr Med J. 1996 Apr;81(4):110-5. PMID: 8628449 4: Pujol P, Daures JP, Brouillet JP, Chang S, Rouanet P, Bringer J, Grenier J, Maudelonde T. A prospective prognostic study of the hormonal milieu at the time of surgery in premenopausal breast carcinoma. Cancer. 2001 May 15;91(10):1854-61. PMID: 11346866 5: Cooper LS, Gillett CE, Patel NK, Barnes DM, Fentiman IS. Survival of premenopausal breast carcinoma patients in relation to menstrual cycle timing of surgery and estrogen receptor/progesterone receptor status of the primary tumor. Cancer. 1999 Nov 15;86 (10):2053-8. PMID: 10570431 6: Saad Z, Bramwell V, Duff J, Girotti M, Jory T, Heathcote G, Turnbull I, Garcia B, Stitt L. Timing of surgery in relation to the menstrual cycle in premenopausal women with operable breast cancer. Br J Surg. 1994 Feb;81(2):217-20. PMID: 8156340 7: Badwe RA, Bettelheim R, Millis RR, Gregory W, Richards MA, Fentiman IS. Cyclical tumour variations in premenopausal women with early breast cancer. Eur J Cancer. 1995 Dec;31A(13-14):2181-4. PMID: 8652239 8: Badwe RA, Wang DY, Gregory WM, Fentiman IS, Chaudary MA, Smith P, Richards MA, Rubens RD. Serum progesterone at the time of surgery and survival in women with premenopausal operable breast cancer. Eur J Cancer. 1994;30A(4):445-8. PMID: 8018400 ---------------------------------------------------------- Morphine Cancer Res. 2002 Aug 1;62(15):4491-8. Related Articles, Links Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth. Gupta K, Kshirsagar S, Chang L, Schwartz R, Law PY, Yee D, Hebbel RP. Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA. gupta014@umn.edu Morphine is used to treat pain in several medical conditions including cancer. Here we show that morphine, in a concentration typical of that observed in patients' blood, stimulates human microvascular endothelial cell proliferation and angiogenesis in vitro and in vivo. It does so by activating mitogen-activated protein kinase/extracellular signal-regulated kinase phosphorylation via Gi/Go-coupled G protein receptors and nitric oxide in these microvascular endothelial cells. Other contributing effects of morphine include activation of the survival signal PKB/Akt, inhibition of apoptosis, and promotion of cell cycle progression by increasing cyclin D1. Consistent with these effects, morphine in clinically relevant doses promotes tumor neovascularization in a human breast tumor xenograft model in mice leading to increased tumor progression. These results indicate that clinical use of morphine could potentially be harmful in patients with angiogenesis-dependent cancers. LOCAL ANESTHESIA WITH MASTECTOMY The Breast Journal Volume 11 Issue 2 Page 100 - March 2005 doi:10.1111/j.1075-122X.2005.21536.x Total Mastectomy Under Local Anesthesia: The Tumescent Technique Grant W. Carlson, MD Abstract: The management of breast cancer in elderly women is controversial. Breast cancer in this age group tends to be biologically less aggressive and is highly responsive to hormonal intervention. The risk of dying of other causes often exceeds the risk of cancer recurrence. For these reasons, older patients tend to be treated less aggressively. One large study of elderly women with breast cancer found that half of the patients were undertreated. Four patients (mean age 72 years, range 6195 years) underwent a unilateral total mastectomy for cancer under local anesthesia using the tumescent technique of infiltrating dilute lidocaine with epinephrine (25 ml of 1% lidocaine [250 mg] and 1 ml of 1:1000 epinephrine [1 mg] to 1 L of Ringers lactate) via an infusion pump. Three of the patients had estrogen receptor (ER)-negative tumors and one patient had tumor progression despite switching from tamoxifen to anastrozole. All four patients were class IV as defined by the American Society of Anesthesiology (ASA). There was no morbidity related to the surgery in the form of hematoma, wound infection, or skin flap necrosis. The patients were discharged 14 days after surgery. The anesthesia was adequate in all four cases and there was no deviation from the described technique. The mean operative time was 35 minutes (range 2446 minutes). The tumescent technique is a safe, effective method for performing a total mastectomy in patients who would not be considered candidates for general anesthesia. RECONSTRUCTION COMPLICATION RATE Plast Reconstr Surg. 2003 Aug;112(2):467-76. Infectious complications following breast reconstruction with expanders and implants. Nahabedian MY, Tsangaris T, Momen B, Manson PN. Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. The incidence of infection following breast reconstruction with expanders and implants ranges from 1 to 24 percent. Numerous factors associated with infection have been described; however, a one- variable at time setting and multifactorial analysis have not been performed. The purpose of this study was to analyze a set of factors that may predispose women to infection of the expander or implant. Between 1997 and 2000, a total of 168 implant reconstructions were performed in 130 women at a single institution. The mean age for all women was 48.2 years (range, 25 to 77 years). The factors that were analyzed included axillary lymph node dissection, chemotherapy, radiation therapy, tumor stage, timing of implant insertion, number of sides (unilateral versus bilateral), tobacco use, and presence or absence of diabetes mellitus. Statistical analysis was performed with stepwise logistic regression. Mean time to follow-up for all patients was 29 months (range, 12 to 47 months). Infectious complications occurred in 10 women (7.7 percent) and in 10 expanders or implants (5.9 percent). Infected implants were removed an average of 116 days following insertion (range, 14 to 333 days). Cultured bacteria included Staphylococcus aureus and Serratia marcescens. A significant association (p < 0.04) was detected between implant infection and radiation therapy. The chance for implant infection was 4.88 times greater for implants that were exposed to radiation therapy compared with those that were not. In addition, there was suggestive (p < 0.09) evidence that the chance of implant infection following lymph node dissection was 6.29 times higher than when no lymph nodes were removed. No significant association between implant infection and age, diabetes, tobacco use, tumor stage, timing of implant insertion, or chemotherapy was found. Breast implants following mastectomy in women with early-stage breast cancer: prevalence and impact on survival Gem M Le1 , Cynthia D O'Malley1 , Sally L Glaser1 , Charles F Lynch2 , Janet L Stanford3 , Theresa HM Keegan1 and Dee W West1 1Northern California Cancer Center, Fremont, California, USA 2Iowa Cancer Registry, University of Iowa, Iowa City, Iowa, USA 3Fred Hutchison Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA Breast Cancer Res 2005, 7:R184-R193 Background Few studies have examined the effect of breast implants after mastectomy on long-term survival in breast cancer patients, despite growing public health concern over potential long-term adverse health effects. Methods We analyzed data from the Surveillance, Epidemiology and End Results Breast Implant Surveillance Study conducted in San Francisco–Oakland, in Seattle–Puget Sound, and in Iowa. This population- based, retrospective cohort included women younger than 65 years when diagnosed with early or unstaged first primary breast cancer between 1983 and 1989, treated with mastectomy. The women were followed for a median of 12.4 years (n = 4968). Breast implant usage was validated by medical record review. Cox proportional hazards models were used to estimate hazard rate ratios for survival time until death due to breast cancer or other causes for women with and without breast implants, adjusted for relevant patient and tumor characteristics. Results Twenty percent of cases received postmastectomy breast implants, with silicone gel-filled implants comprising the most common type. Patients with implants were younger and more likely to have in situ disease than patients not receiving implants. Risks of breast cancer mortality (hazard ratio, 0.54; 95% confidence interval, 0.43–0.67) and nonbreast cancer mortality (hazard ratio, 0.59; 95% confidence interval, 0.41–0.85) were lower in patients with implants than in those patients without implants, following adjustment for age and year of diagnosis, race/ethnicity, stage, tumor grade, histology, and radiation therapy. Implant type did not appear to influence long-term survival. Conclusions In a large, population-representative sample, breast implants following mastectomy do not appear to confer any survival disadvantage following early-stage breast cancer in women younger than 65 years old. This website is intended as information only. The editors of this site are not medically-trained. Please consult your licensed health care practitioner before implementing any health strategy. The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician. This site accepts no advertising. The contents of this site are copyrighted 2010 by Breast Cancer Choices, Inc. Contact us with comments or for reprint permission at admin@breastcancerchoices.org Web page updated January 18, 2010. |
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