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EN
We report a rare case of metastatic gastric cancer from invasive carcinoma of the breast (BC) as the first symptom of disease-mimicking primary gastric linitis plastica.
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Content available remote Biomarkers in breast cancer
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EN
Breast cancer is one of the most frequently diagnosed cancers among women in the western world. Due to the aggressive behaviour of some specific types and the possibility of an early diagnosis, breast cancer has been constantly studied. Tumour size, histological type, cellular and nuclear characteristics, mitotic index, vascular invasion, hormonal receptors and axillary lymph node status are biomarkers routinely used. However, these parameters are not enough to predict the course of this disease. Molecular biology advances have made it possible to find new markers, which have already been incorporated to the clinical practice. Their ultimate goal is to reduce mortality by identifying women at risk for the development of this disease, help diagnosis, determine prognosis, detect recurrences, monitor and guide treatment, and in particular cancers they are suited for general screening. Tumour markers in breast cancer were ranked in categories reflecting their clinical utility, according to the American College of Pathologists. This article focuses on traditional and new molecular markers stratifying them into categories and emphasizing their relevance in the routine evaluation of patients with breast cancer.
EN
In order to present a reliable picture of hormone-dependent breast cancer treatment in Poland, an on-line survey has been conducted in 19 oncology centres. As a result, data on the treatment of 486 patients have been obtained (405 of them initially presenting with stage I–III of disease advancement, and 81 representing stage IV). It has been concluded that in the majority of cases the treatment in question involves combined therapy, including chemotherapy, hormonal therapy, targeted molecular therapy, radiotherapy, and surgical methods with reference to the group of patients subjected to radical treatment.
EN
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.
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Content available remote Depression and Anxiety Before and After Breast Amputation in Women
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EN
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.
EN
At present, sentinel lymph node biopsy is a standard procedure to assess the advancement of breast cancer and cutaneous melanoma. The aim of the study was to assess the role of the sentinel lymph node biopsy in the treatment of patients with breast cancer in our own material. Material and methods. Analyzed was medical documentation of 258 patients with initially operable breast cancer, qualified for operation with sentinel lymph node biopsy in 2004-2014 in the Department of Surgery of the 4th Military Teaching Hospital. A few hours prior to the planned surgery, radioisotope (technitium-99 sulfur colloid) was applied in the area of tumor or under the areola. 1-2 hours after administering the tracer, the lymphoscintigraphy with the labelling of the sentinel lymph node on the skin was performed. Results. On the basis of the gathered material, obtained were the following parameters: sensitivity – 100%, and specificity – 94.6%. Four cases were false negative (5.5%). Conclusions. 1. Marking the sentinel lymph node in breast cancer, based on the single visualisation method with the use of radioisotope, is a useful and effective technique. 2. The factor influencing the results of the sentinel lymph node biopsy (true positive and negative results and false negative result) was the number of the excised lymph nodes except for the sentinel lymph node. 3. Patients with estrogen receptor expression had often metastases to sentinel lymph node (145 cases – 56%). 4. The false negative rate, i.e. 5.5% in our material, is within the limits of acceptability given in the literature. 5. The sentinel lymph node biopsy performed by the experienced surgical team is a reliable diagnostic tool with a low complication rate.
EN
Introduction The World Health Organization as the main task, set himself to care about the good quality of life in patients after anti¬cancer treatment. Aim The aim of the study is the analysis of specific symptoms in patients after removal of breast cancer with the use of questionnaire QLQ-BR23. Material and methods The study was conducted among 100 patients. The study uses a questionnaire QLQ-C23. Results The discomfort of the patient concerned to taste the food, feel sick/bad, feels pain in the arm or shoulder, swelling of shoulder or arm, difficulty lifting up the arm, swelling of the affected mammary gland responses remained at the average level. Conclusions These problems clearly decreased in the patients satisfaction from life.
PL
Wstęp Światowa Organizacja Zdrowia jako naczelne zadanie stawia sobie dbałość o dobrą jakość życia chorych po leczeniu przeciwnowotworowym . Cel Celem pracy jest analiza specyficznych objawów u pacjentek po usunięciu piersi z powodu raka z wykorzystaniem kwestionariusza QLQ-BR23. Materiał i metody Badania zostały przeprowadzone pośród 100 chorych. W badaniach wykorzystano kwestionariusz QLQ-C23. Wyniki Dyskomfort u pacjentek dotyczył odczuwania smaku potraw, czucia się chorym/niedobrze, odczuwania bólu w ramieniu lub barku, obrzęku ramienia lub ręki, trudności z podnoszeniem ramienia, obrzęku chorej piersi -odpowiedzi utrzymywały się na poziomie średnim. Wnioski Wskazane problemy, niewątpliwie pogarszały u pacjentek satysfakcję z życia.
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Content available remote Acceptance of the illness and the quality of life of patients with breast cancer
80%
EN
Introduction. Breast cancer is the most frequent cancer diagnosed in women. Its treatment is a combined therapy and the sequence and time are established according to the accepted standards in Poland. Consequences posed by this disease include disorder in the physical, mental and social spheres in women. Adapting to cancer is very important for the process of treatment, and the acceptance of the disease is the determinant. Aim. The aim of the study was to determine and compare the degree of acceptance of the illness and the assessment of quality of life among breast cancer patients during cancer treatment. Material and methods. The survey included 85 ill people treated in a conserving way and 94 ill people treated by breast amputation. Patients after the surgical procedure were subjected to adjuvant treatment involving chemotherapy (90 women) and/or endocrine therapy (87 women). The study used standardized questionnaires EORTC (European Organisation for Research and Treatment of Cancer): QLQC-30 and the scale (AIS Approval IIIness Scale). Results. The highest level of acceptance of the disease, so the best ability to adapt to cancer have those women who have undergone radical mastectomy and adjuvant hormone therapy during the treatment. The lowest level of acceptance of the illness, expressed as a negative assessment was observed in women after BCT and during chemotherapy treatment. The use of the EORTC QLQC-30 to assess the overall health and quality of life of patients allowed us to capture statistically significant differences in the percentages stating good health, with the relatively highest negative response rates which were observed in the subgroups treated with chemotherapy and hormone therapy. With regard to the highest quality of life, the percentage of negative responses was observed in subgroups treated with the use of hormone therapy and after mastectomy. Conclusions. Good acceptance of the disease was obtained by women treated for breast cancer who have undergone mastectomy in the course of adjuvant endocrine therapy. The assessment of general health and quality of life was influenced by oncological treatment. Patients during chemotherapy and hormone therapy showed a negative impact of this form of treatment on overall well-being and functioning.Patients after mastectomy and during hormone therapy treatment showed a comparatively lower quality of life compared to a group of patients after BCT and during treatment with chemotherapy
EN
The aim of this study was to use a two-marker assay for the detection of breast cancer cells circulating in patients' blood. We have applied a PCR-based methodology to follow up the possibility of the development of metastatic disease in stage I and II patients who had undergone curative surgery. Since the number of circulating cancer cells in peripheral blood is very low, the technique for their detection needs to be not only highly sensitive, but also very specific. The reverse transcriptase-polymerase chain reaction (RT-PCR) technique may improve the sensitivity of breast cancer cell detection up to only a few cells per one million. The principle of the RT-PCR assay is to amplify a messenger RNA characteristic for breast epithelial cells in a blood sample. Since we do not expect such cells to be circulating in peripheral blood of healthy subjects, detection of the characteristic mRNA should indicate the presence of circulating breast cancer cells. We analyzed the usefulness of three mRNA markers: cytokeratin 19 (CK19), mammaglobin (hMAM) and β subunit of human chorionic gonadotropin (β-hCG) for this test. Blood samples (112) were obtained from 55 patients, in stages I and II, with or without metastasis to regional lymph nodes (N0 or N1). We found that a two-marker assay increases the sensitivity of detection of breast cancer cells in comparison with a single-marker one. Combination of two tumor-specific mRNA markers, hMAM/CK19 or β-hCG/CK19, allowed the detection of circulating breast cancer cells in 65% of N1 patients and 38% of N0 patients. By comparison, the combination hMAM/β-hCG allowed the detection of circulating breast cancer cells in the blood of 68% of N1 patients and 46% of N0 patients. Addition of the third marker did not significantly increase the detection sensitivity.
EN
For dielectric investigations of tissue in the VHF frequency range we propose an open-ended probe separated from the investigated material with non-conducting foil. The influence of the foil on the dielectric response of the probe was studied using reference materials and the model explaining the observed properties was presented and tested. Using the probe we tested the dielectric properties of samples obtained from 113 patients treated surgically against breast cancer. We found that in 94% of investigated cases the dielectric assignment was consistent with the histological one. High efficiency in the differentiation between normal and neoplasm breast tissues and the capacity to satisfy aseptic conditions are promising in intra-operative cancer diagnostics.
EN
Breast cancer is the most common malignancy among women in Poland. Endocrine therapy is the first line of treatment in hormone-receptor-positive advanced breast cancer. Progression during endocrine therapy is unavoidable. Administration of mTOR inhibitor gives a chance of reversing the acquired resistance. This paper presents a case report of a patient with metastatic breast cancer successfully treated with everolimus added to endocrine therapy.
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80%
PL
Rak piersi jest najczęstszym nowotworem złośliwym u kobiet zarówno w Polsce jak i na świecie. Nowotwór spośród wszystkich chorób, odbierany jest przez kobiety jako bardzo silne przeżycie traumatyczne. Celem niniejszej pracy była ocena stopnia akceptacji choroby nowotworowej przez kobiety po mastektomii. Badaniu poddano 54 pacjentki po mastektomii, średnia wieku 57,2 lat. W badaniach posłużono się ankietą składającą się z pytań dotyczących danych demograficznych i skali AIS. W momencie rozpoznania 92,59% kobiet nie zaakceptowało choroby. W chwili obecnej u 75,93% stwierdzono akceptację raka piersi. Badane czują się zarówno potrzebne (42,59%) jak i niezależne od innych (31,48%). Ponad połowa pacjentek (53,70%) nie odczuwa, że jest ciężarem dla innych, a 44,44% uważa się za pełnowartościowe kobiety. Za samowystarczalne uważa się 27,78% ogółu badanych kobiet. Niski poziom akceptacji miało 10/54 kobiet. Wysoki poziom akceptacji zaobserwowano u co drugiej ankietowanej. Na poziom akceptacji nie wpływał wiek, miejsce zamieszkania i stopień wykształcenia badanych. Upływający czas od zabiegu operacyjnego miał wyraźny wpływ na akceptację choroby (p < 0,001). Wysoki poziom akceptacji miały kobiety, które pogodziły się z chorobą do 2 lat po operacji.
EN
Aim. Breast cancer is the most common malignancy in women, both in Poland and worldwide. Unlike other diseases, cancer is perceived by women as a very severe trauma. The aim of this study was to assess the degree of cancer acceptance among women after mastectomy. Material and method. The study involved 54 patients after mastectomy, the mean age of 57.2 years. The study used a questionnaire consisting of questions and AIS scale. Results. At diagnosis, 92.59% of women did not accept the disease and at the moment of the study 75.93% did. Tested women felt both needed (42.59%) and independent from others (31.48%). More than a half of patients (53.70%) did not feel a burden to others and 44.44% considered themselves high-value women. 27.78% of the whole group stated they were self-sufficient. The low level of acceptance was observed in 10 out of 54 women. A half of women declared high level of acceptance. Age, place of residence and education of respondents did not influence the level of acceptance. The time from the surgery had a clear impact on the acceptance of the disease (p < 0.001). Conclusion. Very good level of acceptance was observed in women who got used to the fact they had cancer up to 2 years after surgery.
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80%
EN
Oncoplastic and reconstructive techniques are essential tools in the armamentarium of contemporary breast surgeons. The aim of the study was to identify oncoplastic reconstructive patterns in breast cancer centers across Poland. A questionnaire of 18 questions was sent by email to the members of the Polish Society of Surgical Oncology and the Polish Society of Plastic, Reconstructive and Esthetic Surgery via their dedicated websites. The numbers of breast cancer patients operated on in each center ranged from 120 to 904 per year. Breast-conserving surgery (BCS) predominated in all but one center (range 50-70%). Immediate breast reconstructions (IBR) accounted for 6-42% of procedures, The most frequent type of IBR was either a two-stage expander followed by a permanent implant or one-stage implant- based with or without synthetic mesh. The most frequent type of delayed breast reconstruction (DBR) was a two-stage expander followed by implant-based reconstruction. None of the surveyed cancer centers performed free flap reconstruction. Deep inferior epigastric perforator (DIEP) flaps were performed in the plastic surgery department. Reconstructions based on pedicled flaps were performed in cancer centers. Acellular dermal matrices (ADM) and fat transfer were used in selected centers. In the clinical scenario of adjuvant radiotherapy, delayed breast reconstruction was favored. The full range of oncoplastic BCS was performed. Patient-reported outcome measures (PROM) and complications were assessed. Our findings can act as a platform for further improvement in skills, certification, data collection and audit, including patient reported expectation measures. There is also an urgent need to address pan-European inconsistencies in procedural reimbursement.
EN
The authors describe a case of adverse reaction after administration of Patent Blue C dye, consisting of the allergic reaction, mainly limited to skin. In addition to presenting this case is a brief overview of the allergic reaction observed in connection with the use of Patent Blue V dye, which is commonly used in Poland to identify the sentinel lymph node.
OncoReview
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2015
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tom 5
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nr 3
A103-108
EN
Breast cancer is the most common female cancer in the world and in Poland. The improvement of diagnostic and therapeutic methods has led to patients’ longer life expectancy. It has also made breast cancer a chronic disease, increasing the risk of late side effects of oncological therapy. More cardiovascular diseases are diagnose in patients over 65 with an oncological history than in those without it and therefore much effort must be made to maximise effectiveness of the therapy with as few side effects as possible. The article presents two breast cancer patients treated with big doses of liposomal doxorubicin with a good response and almost no side effects.
EN
Mitochondria are cell energetic centers where ATP is produced. They also play a very important role in the PDT as intracellular sites of photosensitizer localization. Photosensitizers gathering in mitochondria (like porphyrin derivatives used in this work) are more effective in tumor cell destruction. Moreover, it was assumed that di-amino acid substituents attached to porphyrin ring will strengthen the effectivity of interaction with membrane receptors of examined cells. MTT assay was performed to investigate the influence of PP(Arg)2 and PP(Ala)2(Arg)2-based PDT on breast cancer cell viability for 24 h, 48 h and 120 h after cell irradiation. Then the influence of PP(Ala)2(Arg)2- and PP(Arg)2-mediated PDT on early mitochondrial apoptosis induction via measurements of the transmembrane mitochondrial potential changes was examined. Results showed that lower energy doses and maximal nontoxic photosensitizer doses of PP(Ala)2(Arg)2 and PP(Arg)2 applied in PDT can imply apoptotic cell death. It was confirmed that modification of the protoporphyrin IX by attaching two alanine substituents raised the efficiency of photodynamic therapy.
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80%
EN
Ultrasound is used for breast cancer detection as a technique complementary to mammography, the standard screening method. Current practice is based on reflectivity images obtained with conventional instruments by an operator who positions the ultrasonic transducer by hand over the patient’s body. It is a non-ionizing radiation, pain-free and not expensive technique that provides a higher contrast than mammography to discriminate among fluid-filled cysts and solid masses, especially for dense breast tissue. However, results are quite dependent on the operator’s skills, images are difficult to reproduce, and state-of-the-art instruments have a limited resolution and contrast to show micro-calcifications and to discriminate between lesions and the surrounding tissue. In spite of their advantages, these factors have precluded the use of ultrasound for screening. This work approaches the ultrasound-based early detection of breast cancer with a different concept. A ring array with many elements to cover 360. around a hanging breast allows obtaining repeatable and operator-independent coronal slice images. Such an arrangement is well suited for multi-modal imaging that includes reflectivity, compounded, tomography, and phase coherence images for increased specificity in breast cancer detection. Preliminary work carried out with a mechanical emulation of the ring array and a standard breast phantom shows a high resolution and contrast, with an artifact-free capability provided by phase coherence processing.
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Content available remote Nuclei segmentation for computer-aided diagnosis of breast cancer
80%
EN
Breast cancer is the most common cancer among women. The effectiveness of treatment depends on early detection of the disease. Computer-aided diagnosis plays an increasingly important role in this field. Particularly, digital pathology has recently become of interest to a growing number of scientists. This work reports on advances in computer-aided breast cancer diagnosis based on the analysis of cytological images of fine needle biopsies. The task at hand is to classify those as either benign or malignant. We propose a robust segmentation procedure giving satisfactory nuclei separation even when they are densely clustered in the image. Firstly, we determine centers of the nuclei using conditional erosion. The erosion is performed on a binary mask obtained with the use of adaptive thresholding in grayscale and clustering in a color space. Then, we use the multi-label fast marching algorithm initialized with the centers to obtain the final segmentation. A set of 84 features extracted from the nuclei is used in the classification by three different classifiers. The approach was tested on 450 microscopic images of fine needle biopsies obtained from patients of the Regional Hospital in Zielona Góra, Poland. The classification accuracy presented in this paper reaches 100%, which shows that a medical decision support system based on our method would provide accurate diagnostic information.
EN
Breast cancer is the most frequently diagnosed female cancer in Poland (over 17,500 women). Anthracyclines have become one of the most important drugs in breast cancer systemic treatment. In the treatment of metastatic disease combination chemotherapy with doxorubicin provides the objective response rate of 60–85%, and the median time of progression-free survival is about 12 months. Non-pegylated liposomal doxorubicin (NPLD) in combination with cyclophosphamide is associated with a lower risk of cardiotoxicity, higher efficacy and more favourable toxicity profile as compared with conventional anthracycline regimes. Two cases of females patients treated with NPLD described in this article demonstrate the importance of the choice of chemotherapy, professional monitoring, early detection and treatment of adverse effects. Non-pegylated liposomal doxorubicin ordained in systemic treatment of stage IV breast cancer prolongs survival and enhances the quality of life. It is a reasonable option for palliative therapy.
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