Surgical Oncology

Editorial Board/Aims and Scope

2012-06-01

Prognosis of malignant sacrococcygeal germ cell tumours according to their natural history and surgical management

2012-03-29

Abstract: Introduction: Malignant sacrococcygeal (SC) germ cell tumours (GCT) may be diagnosed as primary pelvic tumour or malignant recurrence of foetal SC teratoma (FSCT) operated during the neonatal period. In order to evaluate the difference between these two populations, the authors report their experience with SC-GCT registered in the French TGM 95 protocol.Population and methods: The protocol comprised risk-adapted-chemotherapy (CT) followed by surgery. Standard risk (SR: localized tumour completely resected) had no adjuvant therapy. Intermediate-Risk (IR: localized tumour, incomplete or no initial surgery with αFP<15,000 ng/ml) received Vinblastine–Bleomycin–Cisplatin regimen; while High-Risk (HR: αFP > 15,000 ng/ml and/or metastases) received Etoposide–Ifosfamide–Cisplatin.Results: Fifty-seven patients with SC-GCT, aged 0–80 months (median 16), were registered between 1995 and 2005. Nineteen patients had secondary SC-GCT after FSCT. All patients received CT: 17 IR and 1 SR after reevolution; 39 HR (25 with metastases). 51 patients underwent delayed surgery, which was incomplete in 8 patients.Evolution: Seventy-two percent of the secondary SC-GCT had systematic biological follow-up. αFP increasing was the first presenting sign in 80% of the cases. Patients with secondary SC-GCT had a lower median αFP level at diagnosis, were less frequently classified as HR and received less CT. The two groups with secondary vs. primary SC-GCT had a statistically similar favourable outcome (Overall Survival: 93.8% vs. 86.2%; Event-Free Survival: 89.2 vs. 78.2%; p > 0.34 and >0.32), respectively, but with less burden of therapy.Conclusions: SC-GCT has a good overall prognosis provided complete surgery is achieved and CT is administered to IR and HR patients. SC-GCT in patients followed by αFP after treatment for FSCT had less tumour extension than newly-diagnosed patients, probably because of earlier detection of the disease.

Quality of life, functional ability and physical activity after different surgical interventions for bone cancer of the leg: A systematic review

2011-10-17

Abstract: Purpose: To systematically review published studies comparing Quality of Life (QoL), functional ability and/or physical activity between different surgical interventions due to a malignant bone tumour of the leg.Methods: A systematic literature search, covering the years 2000–2010 was performed using the PubMed, Embase, Web of science and Cochrane databases. Studies were included if they described and statistically compared QoL, functional ability and/or physical activity of at least two surgical interventions for lower extremity bone cancer. In addition, the methodological quality of the selected studies was evaluated by using a 24-point scale. Where appropriate, a qualitative analysis or meta-analysis was performed.Results: The search strategy resulted in a list of 246 citations. Based on titles and abstracts 50 full-text articles were selected, of which 13 articles describing 12 studies, were finally included. Overall, the methodological quality of the studies was moderate. Studies were heterogeneous with respect to their categorisation of surgical interventions, average age of patients and average duration of follow-up. Overall, results regarding differences between ablative and limb-sparing surgery varied largely. Meta-analysis was considered to be not appropriate due to clinical heterogeneity, methodological differences and flaws.Conclusion: Twelve studies comparing the outcomes of QoL, functional ability and physical activity between limb-sparing and ablative surgery groups were identified, with an overall moderate methodological quality. Their largely varying outcomes suggest that no general conclusions on the advantage of either limb-sparing or ablative surgery in patients with malignant bone tumours of the lower extremity can be drawn.

Individuals at high-risk for pancreatic cancer development: Management options and the role of surgery

2012-01-16

Abstract: Pancreatic cancer (PC) is a highly lethal disease. Despite advances regarding the safety and long-term results of pancreatectomies, early diagnosis remains the only hope for cure. This necessitates the implementation of an intensive screening program (based mainly on modern imaging), which – given the incidence of PC – is not cost effective for the general population. However, this screening program is recommended for individuals at high-risk for PC development. Indications for screening include the following three clinical settings: hereditary cancer predisposition syndromes associated with PC, hereditary pancreatitis and familial pancreatic cancer syndrome. The aim of this strategy is to identify pre-invasive (precursor) lesions, which are curable. Surgery is recommended in the presence of recognizable lesion on imaging lesions. Partial (anatomic) pancreatectomy – depending on the location of the suspicious lesion – is the most widely accepted type of surgical intervention in this setting; occasionally, however, total pancreatectomy may be required, in carefully selected patients. Despite that experience still remains limited, there is evidence that this aggressive strategy allows early detection of neoplastic lesions, thereby improving the effectiveness of surgery and prognosis.

Management of recurrent cervical cancer: A review of the literature

M. Peiretti, I. Zapardiel, V. Zanagnolo, F. Landoni, C.P. Morrow, A. Maggioni — 2012-01-16

Abstract: Objective: The aim of this narrative review is to update the current knowledge on the treatment of recurrent cervical cancer based on a literature review.Material and methods: A web based search in Medline and CancerLit databases has been carried out on recurrent cervical cancer management and treatment. All relevant information has been collected and analyzed, prioritizing randomized clinical trials.Results: Cervical cancer still represents a significant problem for public health with an annual incidence of about half a million new cases worldwide. Percentages of pelvic recurrences fluctuate from 10% to 74% depending on different risk factors. Accordingly to the literature, it is suggested that chemoradiation treatment (containing cisplatin and/or taxanes) could represent the treatment of choice for locoregional recurrences of cervical cancer after radical surgery. Pelvic exenteration is usually indicated for selected cases of central recurrence of cervical cancer after primary or adjuvant radiation and chemotherapy with bladder and/or rectum infiltration neither extended to the pelvic side walls nor showing any signs of extrapelvic spread of disease. Laterally extended endopelvic resection (LEER) for the treatment of those patients with a locally advanced disease or with a recurrence affecting the pelvic wall has been described.Conclusions: The treatment of recurrences of cervical carcinoma consists of surgery, and of radiation and chemotherapy, or the combination of different modalities taking into consideration the type of primary therapy, the site of recurrence, the disease-free interval, the patient symptoms, performance status, and the degree to which any given treatment might be beneficial.

Does post-mastectomy radiotherapy represent a contraindication to skin-sparing mastectomy and immediate reconstruction: An update

K. Lambert, K. Mokbel — 2012-02-01

Abstract: The use of skin-sparing mastectomy (SSM) to facilitate breast reconstruction is increasing due to a wide acceptance of improved cosmetic outcomes and evidence of equivalence in oncologic outcomes. The rates of patients undergoing mastectomy for whom post-mastectomy radiotherapy (PMRT) will be recommended is increasing as evidence of decreased loco-regional recurrence and increased survival mounts.PMRT may adversely effect complication rates and cosmetic outcomes for patients undergoing immediate breast reconstruction and PMRT – although the evidence for this is methodologically flawed.This article summarises the above evidence and highlights a reconstructive algorithm that may be used to mitigate the possible deleterious effects of PMRT on results.

Application of propensity score model to examine the prognostic significance of lymph node number as a care quality indicator

Yun-Jau Chang, Li-Ju Chen, Yao-Jen Chang, Kuo-Piao Chung, Mei-Shu Lai — 2012-01-06

Abstract: Purpose: There is a controversy about whether lymph node yield can be used as a proxy of quality care for patient with colorectal cancer. We aim to use propensity score models to investigate the association between lymph node number and long-term survival for colorectal cancer patients.Materials and methods: Taiwan Cancer Database was employed to review all patients with newly diagnosed colorectal cancer from 2003 to 2005. Exclusion criteria included those patients with stage IV disease or without information of lymph node. Propensity score models (examined lymph node >12 or <12 as dependent variable) were applied to group of patients with Stage II or Stage III disease and primary end point was 5-year survival (and mortality). We also report results of Stage I–III for comparison.Results: We identified 15,731 newly diagnosed colorectal cancers during study period, among which a total of 10,517 colorectal cancer patients treated at 32 hospitals fulfilled the inclusion criteria. Pathology reports of about 63 % (6658/10517) patients revealed lymph node retrieval >12. After propensity score matching, there were 2888, 1079, 1094 pairs recruited for Stage I–III, Stage II and Stage III, respectively. According to analysis of these matched pairs, the 5-year risk adjusted overall mortality were lower for lymph node examined ≥12 than <12 among Stage II (24.3% vs. 31.1%, p=0.012) and Stage I–III (20.8% vs. 23.6%, p=0.003), but insignificant for Stage III (40.2% vs. 45.6%, p=0.073). Similar situation happened with regard to disease-free and disease-specific mortality.Conclusion: For patients with colorectal cancer undergoing colorectal surgery, the quality metric of lymph node is associated with significantly better 5-year survival except for Stage III disease.

Perioperative immunonutrition for gastrointestinal cancer: A systematic review of randomized controlled trials

Yan Zhang, Yuanhui Gu, Tiankang Guo, Yiping Li, Hui Cai — 2012-02-10

Abstract: Background: To improve the clinical outcome, immunonutrition (IN) was usually used in the patients undergoing elective gastrointestinal caner surgery. However, its effectiveness remains uncertain.Methods: Randomized controlled trials (RCTs) published between 1995 and 2011 were identified and extracted by two reviewers independently from electronic databases, including PubMed, EMBASE, and Cochrane Library. The quality of included trials was assessed according to the handbook for Cochrane reviewer (V5.0.1). Statistical analysis was carried out with RevMan software.Results: Nineteen RCTs involving a total of 2331 patients were included in our meta-analysis. The results showed perioperative IN significantly reduced length of hospital stay (WMD, −2.62; 95% CI, −3.26 to −1.97; P < 0.01) and morbidity of postoperative infectious complication (RR, 0.44; 95% CI, 0.32 to 0.60; P < 0.01) compared with standard diet. Moreover, perioperative IN also significantly decreased morbidity of postoperative non-infectious complication in comparison with standard diet (RR, 0.72; 95% CI, 0.54 to 0.97; P = 0.03).Conclusion: Perioperative IN is effective and safe to reduce postoperative infection, non-infection complication and length of hospital stay.

Adenocarcinoma arising from a gastric duplication cyst

Jinfeng Zheng, Hongbiao Jing — 2012-03-29

Abstract: Malignant transformation in a gastric duplication cyst (GDC) is extremely rare, with only eight reported cases to date. An additional case of an adenocarcinoma arising from a GDC in a 25-year-old male is reported here. Ultrasonography and computed tomography (CT) scans detected a well-defined cyst arising from the greater curvature of the stomach. The patient was submitted to en-bloc resection of the mass with total gastrectomy and regional lymphadenectomy. At the time of laparotomy, the unilocular cyst was full of a thick substance and had no association with the gastric lumen. Microscopic examination revealed that the cystic mass had a well-formed cyst wall with an inner mucosal lining, submucosal layer, muscularis propria, and outer serosal layer. The inner cyst was lined by gastric mucosa. A mediated differentiated adenocarcinoma was found in the duplication cyst, which had invaded the serosa of the cyst wall and the gastric muscular wall. To our knowledge, this is the youngest and only asymptomatic patient in whom neoplastic GDC changes have been reported.

Nomograms can predict non-sentinel node status in sentinel node-positive breast cancer, but are they still relevant?

Hiram S. Cody — 2012-01-30

Since the pioneering reports of Krag (1993) and Giuliano (1994) , sentinel lymph node (SLN) biopsy for breast cancer has become standard care at many institutions worldwide, and the role of axillary dissection (ALND) is diminishing. For patients with negative SLN, it is clear (based on the results of 69 observational studies and 5 randomized trials ) that ALND is not required; although the SLN are falsely negative in about 5% of node-positive patients, axillary local recurrence after a negative SLN biopsy is rare (0.3%) and long-term survival is unaffected . For patients with positive SLN, the algorithm is evolving from a policy of routine completion ALND (still considered standard care at many centers) to a more selective approach. This makes sense: completion ALND is negative in about 70% of all SLN-positive patients (or about 90% of those with low-volume metastases) detected only by immunohistochemical (IHC) stains , and axillary local recurrence in selected SLN-positive patients treated without ALND is rare (1%) . Can we predict in advance which SLN-positive patients do not require ALND?

Multicentre validation of different predictive tools of non-sentinel lymph node involvement in breast cancer

2011-12-26

Abstract: Sentinel lymph node (SN) biopsy offers the possibility of selective axillary treatment for breast cancer patients, but there are only limited means for the selective treatment of SN-positive patients. Eight predictive models assessing the risk of non-SN involvement in patients with SN metastasis were tested in a multi-institutional setting. Data of 200 consecutive patients with metastatic SNs and axillary lymph node dissection from each of the 5 participating centres were entered into the selected non-SN metastasis predictive tools. There were significant differences between centres in the distribution of most parameters used in the predictive models, including tumour size, type, grade, oestrogen receptor positivity, rate of lymphovascular invasion, proportion of micrometastatic cases and the presence of extracapsular extension of SN metastasis. There were also significant differences in the proportion of cases classified as having low risk of non-SN metastasis. Despite these differences, there were practically no such differences in the sensitivities, specificities and false reassurance rates of the predictive tools. Each predictive tool used in clinical practice for patient and physician decision on further axillary treatment of SN-positive patients may require individual institutional validation; such validation may reveal different predictive tools to be the best in different institutions.

Immunotherapy for treating metastatic colorectal cancer

Shahe Boghossian, Stuart Robinson, Alexei Von Delwig, Derek Manas, Steve White — 2011-10-17

Abstract: Background: Colorectal cancer remains one of the leading causes of death in the world. Surgery still remains the mainstay of treatment for primary and metastatic colorectal cancer. Immunotherapy used as an adjunct to surgery can play an important role in controlling the spread of tumour.Methods: The online databases PubMed, Medline, Scirus and Medscape Oncology were used to identify articles of relevance. Keywords included; “Immunotherapy”, “Cellular Immunotherapy”, “Metastatic Colorectal Cancer”, “Monoclonal Antibody” “Tumour Vaccines” and “Adoptive Cell Therapy”. The databases search was from the period of June 1995 until May 2010 inclusive.Results: Our understanding of tumour immunology has allowed the development of some successful therapies. Immunotherapy through the use of monoclonal antibodies is an effective adjunct to chemotherapy for metastatic colorectal cancer. Other modalities that are in the stages of development are cellular and conjugated vaccines. However, these vaccines are being experimented in advanced stages of colorectal tumours.Conclusion: Colorectal cancer vaccines are being developed for advanced stages of colorectal tumour. However, their use as an early adjunct could potentially limit the spread of tumour or even result in cure. Further trials are required to ensure the safety and efficacy of cellular vaccines against colorectal tumours to allow their use on patients early in their disease presentation.

Intrahepatic radiofrequency ablation versus electrochemical treatment in vivo

2011-10-17

Abstract: Background: Radiofrequency ablation (RFA) and electrochemical treatment (ECT) are two methods of local liver tumour ablation. The objective of this study was to compare these methods when applied in proximity to vessels in vivo.Methods: In a total of ten laparotomised pigs, we used ECT (Group A, four animals) and RFA (Group B, four animals) to create four areas of ablation per animal under ultrasound guidance within 10 mm of a vessel. Group C consisted of two control animals. Chemical laboratory tests were performed immediately before and after each procedure and on days 1, 3 and 7 after surgery. Following the last tests, the livers were harvested for morphological evaluation.Results: The mean duration of surgery was 5 h 40 min in Group A (ECT), 2 h 47 min in Group B (RFA), and 2 h 30 min in Group C (control animals). After ECT, the harvested livers showed a mean volume of necrosis of 1.84 cm3 ± 0.88 at the anode and 2.59 cm3 ± 1.06 at the cathode. The presence of vessels did not influence the formation of necrotic zones. Ablation time was 67 min when a charge of 200 coulombs was delivered. We measured pH values of 1.2 (range: 0.9–1.7) at the anode and 11.7 (range: 11.0–12.1) at the cathode. In one of the 16 RFA ablations (6%), the target temperature was not reached and the procedure was discontinued. After 14 of 16 RFA procedures (88%), morphological analysis showed incomplete ablation in perivascular sites. Both ECT and RFA were associated with a reversible increase in monocyte, C-reactive protein (CRP) and aspartate aminotransferase (AST) levels. There was no significant increase in interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α) and IL-6.Conclusion: In the majority of cases, intrahepatic RFA in vivo leads to incomplete necrosis in proximity to vessels and the presence of histologically intact perivascular cells. Without a reduction in liver perfusion, the central application of RFA should be considered problematic. ECT is a safe alternative. It is not associated with a heat sink effect but has the disadvantage of long treatment times.

Peritoneal surface malignancies and regional treatment: A review of the literature

2011-10-17

Abstract: Recent studies have lead to a renewed interest in cytoreductive surgery and intraperitoneal chemotherapy as a regional treatment modality for patients with peritoneal surface malignancies. There have been multiple phase III randomized trials that have shown a survival advantage with intraperitoneal chemotherapy in certain patients. More well designed phase III studies are needed to further define which groups of patients may benefit from cytoreductive surgery and intraperitoneal chemotherapy.

Exploring the role of resection of extrahepatic metastases from hepatocellular carcinoma

Terence C. Chua, David L. Morris — 2011-10-17

Abstract: The role of hepatic resection, taking into consideration the functional status of the liver, for localized hepatocellular carcinoma (HCC) is an established curative treatment. In advance disease, a variety of interventional-based liver-directed therapies and more recently systemic therapy with sorafenib are available to treat unresectable tumors. Extrahepatic Metastasis (EHM) of HCC may occur at initial diagnosis or during recurrence following treatment. This may occur with or without concurrent intrahepatic disease. We reviewed the published works on surgical metastasectomy for common sites of EHM of HCC metastases. It appears from the studies reported in the literature that from selected cases reported, long-term survival may be achieved from resecting metastasis at sites of the abdominal lymph node, adrenal gland, lung, and peritoneum. The encouraging results presented demonstrate that highly selected fit patients may be suitable candidates for these radical curative pursuits. It is likely that indications for resection of EHM HCC may benefit patients with limited isolated metastasis, who have a preserved liver function, and whose primary tumor has been adequately controlled. A registry study to pull the results of case reports and institutional experiences may be useful in cumulating evidence of this practice.

Co-expression of stem cell genes CD133 and CD44 in colorectal cancers with early liver metastasis

Xiaodong Huang, Yu Sheng, Ming Guan — 2011-10-17

Abstract: Purpose: To investigate the expression status and clinical implications of stem cell genes CD133 and CD44 in the colorectal cancers with early liver metastasis.Materials and methods: The differential genes of early liver metastases in colorectal cancer were detected by RT2 Profiler™ PCR Array. The expression and the relationship of stem cell gene CD133 and CD44 were analyzed by immunofluorescent tests.Results: CD133 and CD44 were significantly higher co-expressed in colorectal cancer with early liver metastases compared to those without early liver metastases, and the content of CD133 and CD44 proteins decreased following growth of the transplanted tumors. Of the 80 cases without early liver metastases, 12 were observed CD133 and CD44 proteins co-expression, while 36 of the 40 cases with early liver metastases were found CD133 and CD44 proteins co-expression (15% vs. 90%, P < 0.05). Survival analysis revealed CD133 and CD44 proteins co-expression was associated with poorest prognosis (57.14% vs. 87.41%, X2 = 48.49, P = 0.001). After Cox regression, age, Duck’s stage, lymph node metastasis, and CD133 and CD44 proteins co-expression were shown to be the independent prognostic factors of colorectal cancers.Conclusions: CD133 and CD44 proteins were highly co-expressed in colorectal cancer with early liver metastases, and may be a potential biomarker for the early liver metastases.Highlights: ► CD133 and CD44 were co-expressed in colorectal cancer with early liver metastases. ► CD133 and CD44 proteins co-expression were shown to be the independent prognostic factors of colorectal cancers. ► CD133 and CD44 proteins may be a potential biomarker for the early liver metastases.

Mandibular conservation in oral cancer

Latha P. Rao, Mridula Shukla, Vinay Sharma, Manoj Pandey — 2011-10-17

Abstract: Surgery is one of the established modes of initial definitive treatment for a majority of oral cancers. Invasion of bony or cartilaginous structures by advanced upper aero-digestive tract cancer has been considered an indication for primary surgery on the basis of historic experience of poor responsiveness to radiation therapy . The mandible is a key structure both in the pathology of intra-oral tumours and their surgical management. It bars easy surgical access to the oral cavity, yet maintaining its integrity is vital for function and cosmesis. Management of tumours that involve or abut the mandible requires specific understanding of the pattern of spread and routes of tumour invasion into the mandible. This facilitates the employment of mandibular sparing approaches like marginal mandibulectomy and mandibulotomy, as opposed to segmental or hemimandibulectomy which causes severe functional problems, as the mandibular continuity is lost. Accurate preoperative assessment that combines clinical examination and imaging along with the understanding of the pattern of spread and routes of invasion is essential in deciding the appropriate level and extent of mandibular resection in oral squamous cell carcinoma. Studies have shown that local control rates achieved with marginal mandibulectomy are comparable with that of segmental mandibulectomy. In carefully selected patients, marginal mandibulectomy is an oncologically safe procedure to achieve good local control and provides a better quality of life. This article aims to review the mechanism of spread, evaluation and prognosis of mandibular invasion, various techniques and role of mandibular conservation in oral squamous cell carcinoma.

Treatment strategy for early gastric cancer

J. Wang, J.-C. Yu, W.-M. Kang, Z.-Q. Ma — 2011-10-17

Abstract: Gastric cancer ranks the second leading cause of cancer-specific mortality worldwide. With a poor prognosis, 5-year survival rate of gastric cancer is less than 20%–25% in the USA, Europe, and China . However, early gastric cancer(EGC) offers an excellent (over 90%) chance of cure based on surgical resection . As the increasing detection of EGC, more treatment options have been developed both curatively and minimally invasively to maintain a good quality of life(QOL). One of the advanced therapeutic techniques is endoscopic dissection. Improvements in surgical treatment include minimizing lymph node dissection, reconstruction methods, laparoscopy-assisted surgery, and sentinel node navigation surgery(SNNS) . With technological advances, even Natural Orifice Transluminal Endoscopy Surgery (NOTES) and robotic surgery are expected to represent the next revolution . However, there still remains much dispute among these treatments, which arouses further clinical trials to verify. Update of the treatments, controversial indications, prognosis and current strategies for EGC are discussed in this review.

Survivin expression and targeting in breast cancer

Kumkum Jha, Mridula Shukla, Manoj Pandey — 2011-10-17

Abstract: Introduction: Survivin a multifunctional protein that controls cell division, inhibition of apoptosis and promotion of angiogenesis. It is expressed in most human neoplasm, but is absent in normal and differentiated tissues. The purpose of this article is to overview the expression of survivin, effect of its expression in response to treatment, correlation with other markers and newer advancement in targeting survivin.Methods: A detailed search of Medline was carried out using the following search strategy: “((survivin) OR ((apoptosis) AND (inhibitor OR inhibitors))) AND ((breast) AND (neoplasm OR neoplasms OR tumor OR tumor OR cancer OR carcinoma))”. Abstract of all articles thus identified were reviewed to identify the relevant studies, full articles of studies thus identified were then obtained and reviewed. All relevant data was extracted and tabulated.Results: Survivin expression by Immunohistochemistry was identified in 65.3% (55.2–90.0%) of the breast cancer patients among the identified studies while survivin mRNA by RT-PCR was identified in 93.6% (90–97%). Survivin expression has been reported to be associated with over expression of HER 2, vascular endothelial growth factor (VEGF), urokinase plasminogen activator (uPA)/PAI-1.Conclusion: Survivin is over expressed in majority of breast cancers. The over expression of survivin is found to correlate with HER 2 and EGFR expression. Survivin expression has been found to confer resistance to chemotherapy and radiation. Targeting survivin in experimental models improves survival. More studies are needed on the role of survivin in multi drug resistance (MDR) in the presence of Pgp/uPA/PAI-1 and the impact of survivin over expression in triple negative breast cancer.

The role of oncoplastic therapeutic mammoplasty in breast cancer surgery- A review

O.C. Iwuchukwu, J.R. Harvey, M. Dordea, A.C. Critchley, P.J. Drew — 2011-10-17

Abstract: Background: Reduction mammoplasty is an established technique for symptom relief in women with breast hypertrophy. Therapeutic mammoplasty and radiotherapy may allow cancers to be surgically treated whilst maintaining oncological safety and improving cosmetic outcome. This article aims to review the evidence upon which therapeutic mammoplasty is based and to outline an approach for surgical planning and selection.Methods: A systematic PubMed and Medline literature search was carried out. All abstracts were studied and papers that dealt primarily with breast conservation using plastic surgery techniques were reviewed.Results and conclusion: Therapeutic mammoplasty is a useful procedure for breast conserving cancer surgery in women with large breasts, conferring a good cosmetic and functional outcome. This article proposes that breast surgeons experienced in oncological surgery can safely resect tumours from all aspects of the breast with a minimal number of variations in standard mammoplasty technique.

The evolving role of axillary lymph node dissection in the modern era of breast cancer management

J.M. Barry, W.P. Weber, V. Sacchini — 2011-10-17

Abstract: The standard of practice in breast cancer surgery is that all patients with a positive sentinel node mandate an axillary lymph node dissection (ALND). Recently, this dogma has been challenged by a trial from ACOSOG (American College Of Surgeons Oncology Group) (Trial Z0011) which demonstrated that patients (without clinically/radiologically apparent axillary metastases) undergoing breast conserving surgery (i.e lumpectomy followed by whole breast radiotherapy) with positive sentinel nodes failed to derive any significant benefit by having an axillary lymph node dissection (ALND) . The logical progression from this study is to question the validity of performing routine axillary lymph node dissections on all patients with positive sentinel lymph nodes (SLN). In addition to the Z0011 trial, there is emerging data that additional patients exist who fail to derive any benefit from axillary surgery. The aim of this article is to discuss the potential subpopulations of patients that may avoid unnecessary ALND in the modern era of breast cancer management.

The art of conversation through serious illness

Chris Bebb — 2011-10-17

Although this book relates to professional health carers, in the main it is written with particular reference for family and friends who are supporting loved ones during the diagnosis, treatment and palliative phases of a life threatening and life changing illness, including cancer.

HPV and other infectious agents in cancer

Paolo Giorgi Rossi — 2011-10-17

In this book the authors report some results of a monumental literature revision lead by the National Infectious Agents Committee working under the umbrella of the Primary Prevention Action Group, sponsored by the Canadian Partnership Against cancer and the Canadian Cancer Society though the National Cancer Institute of Canada.

Children with cancer

Heather Mc Dowell — 2011-10-17

Jean Bracken whose daughter was diagnosed with malignancy in 1977 subsequently wrote the 1st edition of this book in 1986. The author acknowledges that much has changed since that time, but the present edition is an update on knowledge, in regard to genetic implications and epidemiology along with most recent advances in the various modes of treatment. The 1st part of the book gives an overall view of what cancer is and an update on possible causes and genetic factors running in families. It is unfortunate that on two occasions the phrase “contract cancer” is used giving readers the impression that this is a contagious condition. The main bulk of the book is systematic chapters on all the tissue subtypes of malignancy found within childhood and continuing into early adulthood. Thereafter, a substantial proportion of this book deals with problems particularly relevant to North America, where the author originates, e.g. giving advice on dealing with insurance and healthcare pathways within the North American health care system. Thus, a large part of the book is irrelevant to European readers. At the end of each chapter there is a bibliography, but again this is very biased towards North American literature.

Storying Later Life: Issues, Investigations, and Interventions in Narrative Gerontology

Riccardo A. Audisio, Matilde M. Audisio — 2011-10-17

It was a surprise to receive this book intended for reviewing on our cancer Journal which focuses mainly on surgical treatments. Due to this, I was not able to assign this text to any members of our accomplished panel of surgical experts, and therefore decided to attempt reviewing this myself. Furthermore, I have approached and included Matilde in order to expand my critical mass on this subject. Consequently, please accept our apologies for our simple words and assumptions as we are certainly not experts in narrative or social gerontology, psychology or mental care.