Breast cancer: epidemiology, molecular classification, diagnostic and therapeutic management

Breast cancer is one of the most common types of cancer occurring in the female population. It is estimated that it causes up to 15% of deaths related to oncological diseases. Despite the development of medicine, there are still no effective methods of treating breast cancer, especially in the advanced stage of the disease. Selected, up-to-date details in the field of epidemiology, etiology, and diagnosis of breast cancer are presented in this article. Moreover, the molecular classification and available therapeutic strategies used in patients with breast cancer are described. The most important step in breast cancer prevention is to increase patients' awareness of self-examination and diagnosis. However, in the case of breast cancer therapy, there is a wide range of solutions, but much depends on the molecular subtype of the cancer and the stage of disease advancement. The basic choice if early changes are detected is breast-conserving surgery or mastectomy. To complement the main therapy (i.e. surgery and radiotherapy), adjuvant therapies are used, which include chemotherapy, hormone therapy, and molecularly targeted therapies. Additionally, in the case of triple-negative breast cancer, immunotherapy is used using monoclonal antibodies, which are programmed death receptor 1 inhibitors or blockers of antigen 4 associated with cytotoxic T lymphocytes. Other immunotherapy methods, such as therapy using chimeric T cells and anticancer vaccines, are also of interest in the treatment of patients with triple-negative breast cancer. The worst-prognosis form of breast cancer is a lesion that metastasizes to tissues. In such cases, the recommended systemic treatment includes various methods (molecularly targeted therapy, chemotherapy, hormone therapy) used alone or in combination. A relatively rare situation is the occurrence of breast cancer in the male population. Nevertheless, all disturbing changes should be monitored, as late diagnosis prevents effective therapy, which is based on methods used to treat breast disease in women. Despite many therapeutic strategies currently used in treatment, the death rate among patients with advanced breast cancer is still alarmingly high. The problem is the lack of response to treatment, side effects, and the occurrence of metastases and relapses of the disease

Malignant melanoma: epidemiology, pathogenesis, diagnostics and innovative therapeutic methods

Melanoma is the most common cause of death among people with skin cancer, and its development is most often associated with excessive exposure to ultraviolet radiation and predisposing genetic factors. Early detection of melanoma significantly reduces mortality in both the short and long term. Unfortunately, this cancer has the ability to quickly reach the malignant phase and metastasize to other organs. The typical treatment for melanoma is surgical resection, but over the last few years significant progress has also been made in the field of systemic therapies, which has led to a noticeable improvement in survival in patients with metastases. The article summarizes information about modern therapeutic methods used in patients with melanoma. Drugs belonging to BRAF kinase inhibitors: vemurafenib and dabrafenib are currently the first-line therapy for advanced melanomas with a confirmed BRAF gene mutation. Modern therapeutic strategies that have revolutionized the treatment of melanoma also include immunotherapy. By blocking inhibitory checkpoints of the immune system, it is possible to generate an anti-cancer response alone or in synergy with other types of therapy. These drugs target molecules that are pathologically overexpressed in melanoma, such as PD-1 or CTLA-4. Intralesional agents, such as oncolytic viruses, can also induce immune stimulation to destroy cancer cells. The only drug of this type registered so far for the treatment of melanoma is talimogene laherparepvec, which uses a genetically modified herpes simplex virus type 1. The possibility of individually tailored treatment to the patient is created by CAR-T therapy, which involves collecting tumor-infiltrating T lymphocytes from the patient, modifying them to obtain a receptor that specifically recognizes melanoma cells, and then multiply and introduce it into the patient's body. Recent findings have shown higher success rates with combinations of immunotherapy and chemotherapy, radiotherapy, or targeted molecular therapy. Despite the success of modern systemic therapy, many melanoma patients do not respond to treatment or develop drug resistance, which leads to the constant need to look for new solutions in the fight against this cancer

Mehrsprachige Elemente in Schulbuchaufgaben – Einbindung oder Einbildung?

Aufgaben nehmen eine zentrale Rolle bei der Gestaltung von Lehr-Lern-Prozessen ein und ihre Passung für die Schüler*innen kann erhöht werden, indem sie an das Vorwissen und die Vorerfahrungen der Lernenden anknüpfen. Hierzu zählen der Kultusministerkonferenz (KMK 2013) zufolge mehrsprachige Kompetenzen (also die Fähigkeit eines Menschen, mehr als eine Einzelsprache zur Kommunikation zu nutzen), über die spätestens mit Einsetzen des Fremdsprachenunterrichts alle Schüler*innen verfügen. Die Einbindung von Mehrsprachigkeit in Schulbuchaufgaben bietet deshalb ein großes Potenzial, um über eine erhöhte Passung Lernprozesse verbessern zu können. Der vorliegende Beitrag stellt Ergebnisse einer empirischen Studie vor, die den Fragen nachgeht, a) inwiefern mehrsprachige Elemente in Schulbuchaufgaben aus Sachfächern der Sekundarstufe I aktuell eingebunden werden, b) wie diese Einbindungen mehrsprachigkeitsdidaktisch ausgestaltet sind und c) welches kognitive Aktivierungslevel sie aufweisen. Der Beitragstitel referiert mit der Nachfrage Einbindung oder Einbildung? auf das diesbezügliche Weiterentwicklungspotenzial von Schulbuchaufgaben, das bei der Untersuchung festgestellt wird. Der Beitrag schließt mit einer Diskussion, durch welche mehrsprachigkeitsdidaktischen Schärfungen die Nutzung der Lernangebote gestärkt und damit der individuelle Lernerfolg weiter erhöht werden könnte

Mnogie nowotwory pierwotne u kobiet nosicielek mutacji genu BRCA1 – dwa przypadki kliniczne

Mutations of BRCA1 and BRCA2 genes account for the majority of hereditary breast and ovarian cancers. So far, risk-reducing salpingo-oophorectomy has been the most effective strategy for gynecological cancer prevention in susceptibility gene mutation carriers. It does not prevent, however, from the occurrence of primary peritoneal cancer. We present two clinical cases of patients with the BRCA1 gene mutation. Both patients had a family history of cancer and both were presenting with metachronic malignances. The first patient, whose mother suffered from breast and ovarian cancer, was diagnosed with left breast cancer in 2004. The patient was 44 years old at diagnosis. Genetic testing revealed the BRCA1 gene mutation. A breast conserving therapy (BCT) was conducted, followed by chemotherapy, radiotherapy and immunotherapy with trastuzumab due to HER2 overexpression. Due to BRCA1 mutation, in November 2005, prophylactic hysterectomy with appendages was performed. Histological examination revealed bilateral ovarian cancer (adenocarcinoma G3) with metastasis to the paraaortal lymph node. The patient received six cycles of chemotherapy: paclitaxel and carboplatin. Ovarian cancer relapsed 3 years later. After that the patient received 5 lines of chemotherapy and finally died due to disease progression in September 2011. The second patient, a 49-year-old woman, was diagnosed with breast cancer in July 2003 and subsequently treated with neoadjuvant chemotherapy, breast conserving surgery and radiotherapy. Genetic testing was also performed and revealed the BRCA1 gene mutation. A year earlier the patient had undergone hysterectomy with appendages due to uterine myomas. Three of her five sisters suffered from breast and ovarian cancer. The patient’s father died of colorectal cancer. The patient remained under surveillance. Because of the increasing level of Ca-125 (since October 2004), PET-CT was performed and revealed a tumor lesion of the peritoneum. Histological examination from the biopsy confirmed primary peritoneal cancer (papillary serous adenocarcinoma – primary peritoneal carcinoma). Reexamination of the tissues from hysterectomy with appendages was also performed and revealed an adenocarcinoma in the right ovary. Pathologic examination excluded metastasis of a breast cancer. Pathomorphology of the ovarian lesion was also different than in the lesions of the peritoneum. Thus, three different tumor types (breast, ovarian and peritoneal cancer) coexisted independently. The patient received chemotherapy: paclitaxel and cisplatin. Later on, due to disease progression she was treated with five consecutive chemotherapy regimens and hormonal therapy. The patient died in January 2008. These case illustrate that genetic diagnosis may be critical for the overall treatment plan.Za większość przypadków dziedzicznego raka piersi i jajnika odpowiadają mutacje genów BRCA. Obecnie najskuteczniejszą metodą prewencji raka jajnika jest obustronne usunięcie przydatków, niegwarantujące jednak zahamowania rozwoju pierwotnego raka otrzewnej. Przedstawiono przypadki dwóch chorych, z dodatnim wywiadem rodzinnym, mutacją genu BRCA1, u których stwierdzono nowotwory metachroniczne. U pierwszej chorej, której matka chorowała na nowotwór piersi i jajnika, w 2004 r. rozpoznano raka piersi lewej. Zastosowano operację oszczędzającą, uzupełniającą chemioterapię, radioterapię oraz immunoterapię trastuzumabem z uwagi na nadekspresję HER2. Ze względu na mutację genu BRCA1 u chorej wykonano operację profilaktycznego usunięcia macicy z przydatkami. Badanie histopatologiczne wykazało ognisko gruczolakoraka w obu jajnikach oraz w węźle chłonnym paraaortalnym. Zastosowano VI cykli chemioterapii: paklitaksel i karboplatyna. Nawrót raka jajnika stwierdzono trzy lata później. Chora otrzymała kolejnych V linii chemioterapii i zmarła w sierpniu 2011 r. z powodu progresji choroby. Druga chora, 49-letnia, leczona od lipca 2003 r. z powodu raka piersi prawej – neoadjuwantowa chemioterapia, BCT, radioterapia. U chorej stwierdzono mutację genu BRCA1. Rok wcześniej usunięto macicę z przydatkami z powodu mięśniaków. Trzy z pięciu sióstr kobiety chorowały na raka piersi i jajnika. Ojciec chorej zmarł z powodu raka jelita grubego. Chora pozostawała pod ścisłą kontrolą. Z powodu narastającego stężenia markera Ca-125 (od października 2004 r.) wykonano PET-TK, stwierdzając nowotworowe zajęcie otrzewnej. Badanie histopatologiczne materiału biopsyjnego wykazało gruczolakoraka otrzewnej, a ponowna ocena materiału z operacji usunięcia macicy z przydatkami, ognisko gruczolakoraka w jajniku prawym. Histopatolog wykluczył przerzut raka piersi i jednoznacznie określił odmienność morfologii zmian w otrzewnej od zmiany w jajniku. U chorej rozpoznano trzy niezależne nowotwory. Zastosowano chemioterapię: cisplatyna i paklitaksel. Następnie, z powodu progresji choroby, zastosowano V kolejnych linii chemioterapii oraz hormonoterapię. Chora zmarła w styczniu 2008 r

Association of insularity and body condition to cloacal bacteria prevalence in a small shorebird

Do islands harbour less diverse disease communities than mainland? The island biogeography theory predicts more diverse communities on mainland than on islands due to more niches, more diverse habitats and availability of greater range of hosts. We compared bacteria prevalences ofCampylobacter,ChlamydiaandSalmonellain cloacal samples of a small shorebird, the Kentish plover (Charadrius alexandrinus) between two island populations of Macaronesia and two mainland locations in the Iberian Peninsula. Bacteria were found in all populations but, contrary to the expectations, prevalences did not differ between islands and mainland. Females had higher prevalences than males forSalmonellaand when three bacteria genera were pooled together. Bacteria infection was unrelated to bird's body condition but females from mainland were heavier than males and birds from mainland were heavier than those from islands. Abiotic variables consistent throughout breeding sites, like high salinity that is known to inhibit bacteria growth, could explain the lack of differences in the bacteria prevalence between areas. We argue about the possible drivers and implications of sex differences in bacteria prevalence in Kentish plovers

Teacher Professionalization for Language Support in Heterogeneous Learning Groups with Digital Media: Ein Seminarkonzept an der Universität zu Köln

Sprachliche sowie mediale Kompetenzen stellen in modernen Gesellschaften notwendige Voraussetzungen für Wissensaneignung und Partizipation am sozialen Leben dar. Inklusionsorientierte Bildungssysteme von Einwanderungsländern wie der Bundesrepublik Deutschland stehen aktuell vor der Aufgabe, ihren Schüler_innen sprachliche und digitale Kompetenzen zu vermitteln, die diese Kinder und Jugendlichen in die Lage versetzen, an schulischen Bildungsprozessen erfolgreich teilzunehmen, aber auch autonomes Lernen eigenverantwortlich zu organisieren. In diesem Beitrag möchten wir ein Seminarkonzept vorstellen, das ein Team aus Sprach- und Mediendidaktiker_innen der Universität zu Köln entwickelte und umsetzte, um die o.g. Herausforderungen zu adressieren. Die vorgestellte Lehrveranstaltung war an die Durchführung einer Ferienschule für neu zugewanderte Schüler_innen gebunden und setzte die für die aktuellen Bachelor- und Masterstudiengänge als zentral geltende Theorie-Praxis-Kopplung konsequent um. Im Rahmen des Seminars erhielten Lehramtsstudierende die Möglichkeit, Schüler_innen mit heterogenen Voraussetzungen sprachlich und medial zu fördern und somit ihr zuvor erworbenes theoretisches Wissen in der Praxis zu erproben und es anschließend zu reflektieren.In modern society, linguistic as well as digital media skills are necessary prerequisites for knowledge acquisition and social participation. Inclusion-oriented educational systems of countries with high levels of immigration – such as the German education system – are currently facing the task of providing students with linguistic and digital media skills in order to enable them to successfully participate in educational processes and facilitate independent learning. To address these challenges language and media didactics experts of the University of Cologne developed a seminar concept and implemented it in a program that prepared teaching students for teaching newly immigrated students in a summer school. The course focused on the close linking of theory and practice – a central component of recent courses at BA- and MA-level. As part of the seminar, teaching students were given the opportunity to teach language and media skills to newly immigrated students with different competence levels whilst being mentored by lecturers and tutors. It was thought that this would allow the teaching students to apply their theoretical knowledge in practice and help them to reflect on it