Prikaz slučaja bolesnice s pojavom lokalnog recidiva na prsnom košu pet uzastopnih godina nakon radikalne mastektomije

Breast cancer is most common cancer in women. After surgical treatment and adjuvant therapy, locoregional recurrences do occur in certain number of patients. Herein we report a breast cancer patient who developed isolated chest wall local recurrence 3 years after mastectomy which was reappearing in next fi ve consecutive years. Multimodal treatment which includes surgical excision and adjuvant chemoradiotherapy can achieve a signifi cant degree of palliation when locoregional recurrences are diagnosed. In our case, inclusion of adjuvant treatment did not provide satisfactory local control of disease therefore repetitive surgical excision was the only modality which off ered our patient 7 years of overall survival after fi rst excision of local recurrence.Rak dojke je najčešći rak u žena. Unatoč kirurškom liječenju i adjuvantnoj terapiji, lokalni recidivi se javljaju u određenom broju pacijenata. Prikazan je slučaj bolesnice s pojavama lokalnog recidiva na prsnom košu u razdoblju od pet uzastopnih godina nakon radikalne mastektomije. Koristeći se multimodalnim tretmanom koji uključuje kirurški zahvat i kemoradioterapiju, načelno se postižu dobri rezultati u liječenju lokoregionalnog recidiva. Unatoč danoj terapiji, uzastopne kirurške ekscizije su se pokazale kao jedini modalitet liječenja koji je bolesnici omogućio sedmogodišnje preživljenje nakon pojave prvog lokalnog recidiva

Expression of Genes Responsible for the Repair of Mispaired Bases of the DNA (MLH1) in Invasive Ductal Breast Carcinoma

Breast cancer is a heterogeneous group of diseases determined and distinguished by cellular type, gene expression and clinical signs and symptoms. Identification of histological and biological markers is of great value in predicting the progression of tumor growth and anticipating the expected response to various treatment options. Due to a high degree of cell proliferation in breast tumors and high genetic instability of these tumors, as a consequence of defective DNA repair mechanisms, chemotherapy as a treatment option often renders very successful results. During our scientific research we wanted to determine the involvement of the genetic polymorphisms of DNA mismatch repair system (MLH1 gene) and the subsequent development of breast carcinoma. This study included 108 patients who were surgically treated for inva- sive breast cancer at the Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital »Dubrava«. The expression of the MLH1 gene was determined by immunohistochemical methods. The results showed that 82.9% of tumor cells expressed the MLH1 gene. Analysis of survival rate for patients with invasive ductal breast cancer showed a statistically significant (p=0.043) correlation with the expression of MLH1 genes. The overall five year survival rate of our patients was 78.7%. These results indicate that there is a possible involvement of MLH1 gene in the progression and development of breast cancer

Acetilsalicilna kiselina (ASA) i nesteroidni protuupalni lijekovi (NSAID) u prevenciji tromboze i raka

A trend towards a reduced risk of thrombosis and cancer has been observed among people taking acetylsalicylic acid (ASA) or any of nonsteroidal anti-inflammatory drugs (NSAID). ASA is the active substance in both German Aspirin and Croatian Andol. The key action of these drugs is that they block cyclooxygenase (COX) enzymes catalyzing the conversion of arachidonic acid (ADA) to prostaglandins (PG) and thromboxanes (TXA). ADA metabolites are associated with inflammatory process, thrombosis, carcinogenesis and tumor growth. Increased expression of COX-2 has been observed in both inflammations and tumors including: head and neck tumors, tumors of the upper aerodigestive tract, oropharyngeal leukoplakia, premalignant oral lesions, pancreatic, esophageal, gastric and skin cancer, melanoma, prostate, urinary bladder, lung, ovarian and cervical cancer, lymphoma, leukemia, breast cancer, colon cancer, etc. ASA and NSAID act preventively at the COX level and reduce the occurrence and growth of tumors, enhancing the radio- and chemotherapy effect on tumor. Besides at the COX level, ASA/NSAID also show antitumor activity at other levels acting as inhibitors of: aromatase gene, transforming growth factor- (TGF-), platelet-derived growth factor (PDGF), insulin-like growth factor (IGF), activator protein-1 (AP-1), serine kinase IKK-, nuclear factor kappa B (NF-B), urokinase-type plasminogen activator (PA), mitogen-activated protein p38 (p38 MAP) activation, etc. In addition, ASA/NSAIDs are efficient in other diseases including: infections, rheumatism, diabetes mellitus, blood vessel diseases, hypertension, eclampsia, Alzheimer’s disease, etc. To reduce the occurrence of cancer, the World Health Organisation promotes decreased body mass, increased physical activity and plant-based diet, which contains fewer calories, abounds in cellulose fibers, vitamins and ASA. Exceeding the recommended dose of ASA may cause serious side effects. On the other hand, 5-aminosalicylic acid (5-ASA), shown to successfully treat gastrointestinal inflammations (GIT) and reduce risk of tumor occurrence causes less adverse side effects. Nitric oxide-donating aspirin (NO-ASA) and nitric oxide donating NSAID (NO-NSAID) do not cause damage to the gastrointestinal mucosa, and they are very successful in the treatment of inflammation and prevention of intestinal and other cancers. Under medical supervision, low doses of ASA / NSAID are recommended to be taken daily for cancer prevention, then after cancer surgery and during chemotherapy and radiotherapy to reduce the risk of cancer recurrence and thrombosis.Uočen je smanjen rizik pojave tromboze i raka u ljudi koji su rabili acetilsalicilnu kiselinu (ASA) ili neke druge lijekove iz skupine nesteroidnih protuupalnih lijekova (NSAID). ASA je aktivni sastojak njemačkog Aspirina i hrvatskog Andola. Ključ djelovanja tih lijekova je blokada enzima ciklooksigenaze (COX) koji sudjeluju u razgradnji arahidonske kiseline (ADA) na prostaglandine (PG) i tromboksane (TXA). Metaboliti ADA povezani su s upalom; trombozom; karcinogenezom i rastom tumora. Pojačana ekspresija COX-2 uočena je u upalama i tumorima kao što su: tumori glave i vrata; gornjeg aerodigestivnog trakta; orofaringelane leukoplakije; premaligne oralne lezije; karcinom pankreasa; ezofagusa; želuca; raka kože; melanoma; prostate; mjehura; pluća; jajnika; vrata maternice; limfoma; leukemije; dojke; crijeva; itd. ASA i NSAID djeluju preventivno na razini COX-a i smanjuju pojavu i rast tumora; te pojačavaju učinak zračenja i kemoterapije na tumor. Osim na razini COX-a; ASA/NSAID djeluju antitumorski i na drugim razinama; kao što su inhibicije: aromatase gena; transformirajućeg faktora rasta _ (TGF-_); faktora rasta iz trombocita (PDGF); insulinu sličnog faktora rasta (IGF); aktivatora proteina-1 (AP-1); serine kinaza IKK-_; nuklearni faktor kappa B (NF-_B); urokinazni aktivator plasminogena (_PA); aktivacija mitogenom aktiviranog proteina p38 (p38 MAP); itd. Koristan je učinak ASA/NSAID i u drugim bolestima kao što su: infekcije; reuma; diabetes mellitus; krvožilne bolesti; hipertenzija; eklampsija; Alzheimerova bolest; itd. Radi smanjenja pojavnosti karcinoma Svjetska zdravstvena organizacija propagira manju tjelesnu masu; veću fizičku aktivnost i biljnu prehranu koja je manje kalorična; bogata celuloznim vlaknima; vitaminima i ASA. Zbog neželjenih nuspojava; prekoračenje dozvoljenih doza ASA može biti opasno. Manje neželjenih posljedica ima 5-aminosalicilna kiselina (5-ASA) koja uspješno liječi upale probavnog trakta (GIT) i smanjuje rizik pojave tumora. NO-ASA i NSAID (NO-NSAID); ne oštećuju sluznicu probavnog trakta. Vrlo su uspješni u liječenju upale i prevenciji raka crijeva i ostalih rakova. Uz liječničku kontrolu ASA / NSAID se preporučaju svakodnevno u malim dozama za prevenciju raka; te poslije operacije raka; u tijeku liječenja raka kemoterapijom i radioterapijom za smanjenje rizika recidiva i tromboze

Hipoksija u bolesnika sa solidnim tumorima

Anemia is the main cause of hypoxia in tumor patients. Hemoglobin (Hb) at concentration of 150 g/L, 100% saturated, carries about 200 mL O2/L blood, while Hb 75 g/L carries about 100 mL O2/L. Under normal conditions, O2 extraction ratio (O2ER) is 0.25, meaning that Hb 150 g/L releases 50 mL O2/L in tissues, and Hb 75 g/L releases 25 mL O2/L (hypoxia). In healthy persons, compensatory mechanisms may increase O2ER to the borderline value of 0.50. In tumor patients, Hb concentration should be carefully monitored as their compensatory mechanisms for O2 delivery to cells are disordered. Under anaerobic conditions (without O2), from 1 mol glucose only 5% of necessary energy is released, requiring anemia correction in tumor patients. Hypoxia promotes malignant tumor progression and reduces the sensitivity of tumor cells to radio- and chemotherapy. Despite the fact that some patients survived surgery with Hb 50 g/L, and that, for economic benefits, the aim is to lower a transfusion trigger or erythropoietin Hb < 80 g/L, the verified borderlines of Hb 100 g/L and hematocrit 0.300 are still considered to be safe. It has been known that patients with higher Hb concentration respond better to surgery, chemotherapy and radiotherapy, having a better quality of life and longer survival time.Anemija je glavni uzrok hipoksije u tumorskih bolesnika.Hemoglobin (Hb) u koncentraciji od 150 g/L, zasićen 100%, prenosi oko 200 mL O2/L krvi, dok Hb 75 g/L prenosi oko 100 mL O2/L. U normalnim uvjetima O2 ekstrakcija u tkiva (O2ER) je 0.25, što znači da Hb 150 g/L ostavlja tkivu 50 mL O2/L, a Hb 75 g/L ostavlja 25 mL O2/L - hipoksija. U zdravih osoba kompenzatornim mehanizmima O2ER se može povisiti do graničnih 0.50. U tumorskih bolesnika vrlo je važno paziti na Hb koncentraciju, jer su kompenzatorni mehanizmi dovoda O2 u stanicu poremećeni. U anaerobnim uvjetima (bez O2) iz 1 mola glukoze osloba|a se samo 5% potrebne energije, stoga je jako važna korekcija anemije u tumorskih bolesnika. Hipoksija potiče malignu progresiju tumora i smanjuje osjetljivost tumora na radiokemoterapiju. Iako su neki ljudi preživljeli operacije s Hb 50 g/L, iako se iz ekonomskih razloga „trigger“ transfuzije ili eritropoietina nastoji spustiti na Hb < 80 g/L, još uvijek se provjerenom granicom smatra Hb 100 g/L i hematokrit 0.300. Zna se da ljudi s višom koncentracjom Hb povoljnije reagiraju na operaciju, kemoterapiju i radioterapiju, da imaju bolju kvalitetu života i duže preživljenje

Biopsija limfnoga čvora „čuvara“ kod raka dojke; iskustvo stečeno u Klinici za tumore, Zagreb, Hrvatska

The study was aimed at analyzing metastatic involvement in sentinel lymph node in patients with primary breast cancer. The study includes 51 female patients undergoing surgery for primary breast cancer at the University Hospital for Tumors, Zagreb, Croatia. Prior to the standard surgical procedure, sentinel lymph node biopsy was performed and patohistologically and immunohistochemically analyzed. Sentinel lymph node biopsy was done in 51 patients meeting the indication criteria for the procedure. In 39 (76.47%) biopsy samples immunohistochemical results were negative (no signs of metastases), in 11 (21.57%) the result was positive, and in 1 (1.96%) patient the sentinel lymph node was not located using the gamma probe following the preoperative lymphoscintigraphy. Recently, a new phase in conserving surgery for breast cancer has started. Considering the presence of the so-called skip metastases in 2% of the cases, the idea of conserving surgery for axillary lymph nodes occurred, and thus the sentinel node surgery has been developed. In simple terms, in case the sentinel lymph node is negative, other axillary lymph nodes should not be removed; if the node is positive, a classic axillary dissection, i.e. the removal of axillary lymph nodes should be done.U radu je analizirana metastatska zahvaćenost limfnoga čvora „čuvara“ u bolesnica s primarnim rakom dojke. Analizirana je 51 bolesnica s primarnim rakom dojke operirana u Klinici za tumore, Zagreb, Hrvatska u razdoblju.Prije standardnog kirurškog zahvata, učinjena je biopsija čimfnog čvora „čuvara“, a potom su uzorci analizirani patohistološki i imunohistokemijski. Biopsija limfnog čvora „stražara“ je učinjena u 51 bolesnice koje su zadovoljavale indikaciju za navedeni postupak. U 39 (76,47%) uzoraka biopsije imunohistokemijska obrada dala negativan rezultat (nema znakova metastaza), u 11 (21,57%) uzoraka je nalaz pozitivan, a u jedne (1,96%) bolesnice limfni čvor „stražar\u27\u27 nije lociran gama-kamerom nakon preoperacijske limfoscintigrafije U zadnje vrijeme teži se poštednim zahvatima u postupcima operacije raka dojke. Znajući da je postojanje tzv. „skip metastaza” negdje oko 2 %, pojavljuje se ideja o poštednoj operaciji aksilarnih limfnih čvorova. Tako je stvorena kirurgija „sentinel” limfnog čvora (limfnog čvora „stražara“). Pojednostavljeno, ako je „sentinel” limfni čvor negativan, ne bi trebalo uklanjati druge limfne čvorove u pazuhu, a ako je pozitivan, činila bi se i dalje klasična disekcija aksile s uklanjanjem aksilarnih limfnih čvorova

Značenje tumorskog markera Ca 15-3

In the postoperative course of breast tumor treatment, along with regular ultrasound and radiological assessments, measurements of tumor marker CA 15-3 levels are also used. The levels of tumor marker CA15-3 are of particular significance in the follow-up of patients with metastatic breast cancer. In this paper, the correlation between the tumor mass and the level of tumor marker CA l5-3 is confirmed (1,2).U postoperativnom tijeku uz redovitu ultrazvučnu te radiolo{ku obradu pacijentice, koriste se i vrijednosti tumorskog markera CA 15-3. Vrijednosti tumorskog markera CA 15-3 osobito su važne u praćenju bolesnica s metastatskim karcinomom dojke. I u ovom radu potvr|ena je korelacija izme|u tumorske mase i razine tumorskog markera CA l5-3 (1,2)