Approach to Breast Cancer Treatment in Elderly Patients

Old age should be carefully evaluated before the treatment of all kinds of diseases, not only chronologically but also in functional terms. Regardless of the stage of breast cancer, it is known that older patients benefit from standard treatments as much as younger patients to the extent that they are represented in clinical trials, but we also know that toxicity is augmented in this age group. The elderly patient group is a very heterogeneous group within itself, and it is important to separate the healthier, more fit elderly group who will benefit from standard treatments from the group that can only receive standard treatment with some rehabilitation. In addition, it is one of the most important duties of the clinician to identify patients who cannot tolerate both standard and modified treatments before initiation of the cancer treatment. Today, although there are several Comprehensive Geriatric Evaluation tools which are developed for aiding the clinician for making treatment decisions, most of the elderly patients are not properly evaluated in the busy day to day clinical practice. As an alternative,parameters such as patients daily work, social enviorment, prescirbed medicines for other comorbidities, and the potential side effects of the recommended treatment should be carefully reviewed. The validity of the treatment decisions taken at the start of the treatment should be re-evaluated at each visit and if necessary, modifications should be made to maximize benefit with the least toxicity

Transthoracic fine-needle aspiration cytology of non-invasive, low-grade urothelial carcinoma with lung metastasis: A case report with review of the literature

Radiological analyses in a 61-year-old patient being followed since 2005 for low-grade, non-invasive urothelial carcinoma (UC) (Ta) revealed a 5-cm pleural-based mass in the lower lobe of the right lung for which a subsequent transthoracic fine-needle aspiration cytology was performed. Upon observing the carcinoma cells consistent with UC metastasis, systemic chemotherapy was commenced. The patient underwent a metastatectomy based on the thoracic computerized tomography scan performed on the 4 th month of treatment, which revealed notable regression. The resected tumor was morphologically similar to cells seen in the transthoracic fine-needle aspiration and was immunohistochemically positive for p63, uroplakin, thrombomodulin, CK7 and CK20 at varying degrees but was negative for TTF-1. We report a case of metastatic UC of the lung in a patient who had had a low-grade superficial UC of the urinary bladder and we discuss the cytopathological features of this rare entity in light of the literature