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1

Aktualne problemy dotyczące postępowania diagnostycznego oraz leczenia operacyjnego chorych na raka piersi – przegląd wybranych zagadnień klinicznych

100%

Nowikiewicz T., Śrutek E., Zegarski W.

Current Gynecologic Oncology

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2015

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vol. 13

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issue 1

11-19

EN

Breast cancer is the most common malignancy in women in Poland and other developed countries. It refers especially to those in peri- and postmenopausal age. Poland is characterized by a dynamic increase in the number of new cases of breast cancer. Namely, in 2010, the number of new diagnosed cases was more than 30% higher than 10 years before. As suggested by epidemiological forecasts for Poland, the trend is expected to be maintained. Surgical treatment is the main prerequisite for a permanent and positive outcome of breast cancer treatment. The percentage of surgeries performed in Poland has increased significantly in recent years from 77% in 2004 to 90% in 2010. The most important prognostic factor affecting longterm treatment outcomes in cancer patients is the clinical grading of the disease. Early detection of breast cancer, preferably at the asymptomatic stage, may significantly determine both the selection of available treatment options and the final treatment outcome. The objective of this study was to discuss current problems related to preoperative diagnostics and surgical treatment of breast cancer patients. Issues concerning mammography screening program were subjected to analysis. The part concerning surgical treatment features new trends regarding procedures of conservative treatment of breast cancer. It is also important to emphasize the necessity of the use of conclusions from the Z0011 trial and personalized oncoplastic surgery techniques in everyday clinical practice.

PL

Rak piersi jest najczęstszym nowotworem złośliwym u kobiet żyjących w Polsce i innych krajach rozwiniętych; dotyczy to zwłaszcza chorych w wieku około- i pomenopauzalnym. W polskiej populacji dynamicznie rośnie liczba nowych przypadków raka piersi: w 2010 roku stwierdzono ponad 30% więcej zachorowań niż 10 lat wcześniej. Według prognoz epidemiologicznych należy spodziewać się utrzymania tej tendencji w naszym kraju. Podstawowy warunek mogący pozwolić na uzyskanie trwałego wyleczenia to zastosowanie leczenia operacyjnego. Odsetek jego wykorzystania w Polsce wyraźnie wzrósł w ostatnich kilkunastu latach – z 77% w roku 2004 do 90% w roku 2010. Najważniejszym czynnikiem mającym wpływ na odległe wyniki leczenia pacjentów z nowotworami złośliwymi jest stopień zaawansowania klinicznego choroby. Wczesne wykrycie raka piersi, optymalnie w stadium bezobjawowym, może w decydujący sposób wpłynąć zarówno na wybór dostępnych metod leczenia, jak i na jego wynik. W pracy omówiono najistotniejsze aktualne problemy diagnostyki przedoperacyjnej i leczenia operacyjnego chorych na raka piersi. Analizie poddano zagadnienia związane z programem wczesnego wykrywania choroby. W części poświęconej leczeniu chirurgicznemu przedstawiono nowe trendy związane z procedurami leczenia oszczędzającego. Podkreślono konieczność wykorzystania w codziennej praktyce klinicznej wniosków z badania Z0011 i technik chirurgii onkoplastycznej.

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Clinical Significance of Van Nuys Prognostic Index As A Qualification Criterion to Sentinel Lymph Node Biopsy in Patients Diagnosed with Ductal Carcinoma in Situ

100%

Nowikiewicz T., Wiśniewska M., Wiśniewski M., Zegarski W.

Polish Journal of Surgery

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2015

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vol. 86

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issue 10

479-485

EN

Diagnose of ductal carcinoma in situ (DCIS) requires, at least in a part of cases, assessment of auxiliary lymph nodes. The aim of the study was to analyze clinical value of Van Nuys Prognostic Index (VNPI) as the important criterion for qualification of DCIS patients to sentinel lymph node biopsy (SLNB). Material and methods. Analysis included patients diagnosed with DCIS and qualified to SLNB, operated in years 2004-2013. We performed a statistical analysis to assess correlation between VNPI value and positive pathological verification of excised sentinel lymph node (SLN). The influence of other clinical factors on presence of metastases in SLN was also determined. Results. 3,6% of DCIS patients were diagnosed with metastases in SLN. Metastases were diagnosed in 6.7% patients with VNPI > 10 points vs 3.4% in patients with VNPI < 10 points. In 75% of patients with metastatic SLN the value of VNPI was at least 10 points. In premenopausal patients metastases in SLN were diagnosed in 8.1% of cases vs 1.4% in postmenopausal patients. In patients diagnosed with cancer of the other breast metastases in SLN were found in 6.3% of cases vs 3.2% in one-sided cancer. Patients with multifocal cancer were over twice as often diagnosed with metastases in SLN (5% vs 2%). There was no correlation found between VNPI value and positive pathological verification of SLN. No differences between prevalence of SLN metastases depending on selected clinical features were found. Conclusions. Recommendation of VNPI as the criterion of qualification to SLNB starting with 10 points could be more favourable in patients with DCIS. Deciding on SLNB in DCIS patients, we should also take into consideration other clinical features.

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Problems concerning patients’ qualification for surgical procedures allowing for evaluation of the condition of axillary fossa lymph nodes in the radical treatment of breast cancer

100%

Nowikiewicz T., Śrutek E., Zegarski W.

Polish Journal of Surgery

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2015

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vol. 87

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issue 6

290-294

EN

The presence of metastases in the lymph nodes of the axillary fossa is the most important prognostic factor in patients with breast cancer. The surgical treatment option required for evaluation of the condition of the axillary lymph nodes depends on the results of a preoperative physical examination of the patients. The aim of the study was to evaluate the correctness of breast cancer patients’ qualification to surgical procedures allowing for evaluation of the condition of the axillary lymph nodes. Material and methods. A retrospective analysis of a group of 963 patients with a diagnosed malignancy of the breast, treated surgically in the period from 01 Jan 2011 to 29 Feb 2012. Depending on the result of evaluation of the axillary lymph node clinical condition, the patients underwent sentinel lymph node biopsy or elective axillary lymphadenectomy. Results. In 27.4% of patients subjected to excision of the sentinel lymph node, metastatic lesions were found in the lymph nodes removed during the procedure. In most cases (98.1%) that concerned the lymph nodes of the lower part of the axilla. In 17.4% of patients, metastases were located also in the middle or upper part (9%). In the group of patients primarily qualified to lymphadenectomy, the metastatic lesions in the axillary lymph nodes were diagnosed in 67.2% of patients. They were most commonly located in the lower part of the axillary fossa (in 96.7% of cases), and in 68.8% of patients in the middle or upper part (35.8%). Conclusions. Biopsy of the sentinel lymph node in patients with clinically advanced breast cancer is an effective and safe method of evaluation of the condition of the axillary fossa lymph nodes. A high rate of false positive results concerning the clinical stage of the disease requires changing the rules of patients’ qualification to elective axillary lymphadenectomy.

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Evaluation of the effects of mammography screening program on cancer progression and implemented treatment in patients with breast cancer

100%

Nowikiewicz T., Zegarski W., Piątkowska M., Klag M.

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vol. 85

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issue 4

204-209

EN

The primary goal of mammography screening is to decrease mortality in patients with breast cancer. The aim of the study was evaluation of the screening program results on course of implemented therapy and its results in breast carcinoma patients. Material and methods. Evidence includes data on the group of 1818 patients with breast cancer that were subject to surgical treatment at the Clinic of Breast Cancer and Reconstructive Surgery of the Oncology Center in Bydgoszcz (558 patients hospitalized from January 2006 to December 2006 and 1260 patients treated from January 2011 to June 2012). Analysis included type of diagnostic procedure implemented before surgical treatment, as well as grade of cancer progression, results of pathology tests done on specimens and type of surgical procedure. Additionally, the screening group (tumor diagnosed based on screening mammography) and symptomatic group (cancer diagnosed otherwise that within the screening program) were identified. Results. In 2006, in 28.4% of patients included in the study, primary tumor was discover in screening process (vs 61.5% in 2011-2012). In the first period, 35.7% of changes did not exceed 2 cm - cT1 (vs 48.3% in 2011-2012), while the percentage of cT4 was 9.9% (vs 4.7% in 2011-2012). In 2006, 30.8% of patients were treated in the grade I of clinical progression (vs 44.2% in 2011-2012), 53.4% in the grade II, 14% in grade III and 0.2% in grade IV (vs 45.7%, 9.7%, and 0.4%, respectively). In 45.5% (2006) and 39.9% (in 2011-2012) of patients, metastases were found in axillary lymph nodes. Differences were similar both in screening and symptomatic group. In 2006, in 12.4% of surgical patients breast conserving therapy (BCT) was implemented (vs 49.8% in 2011-2012). In the screening group, it was applied in 15.2% of patients (in 2006) and in 63% (in 2011- 2012), while in symptomatic group the percentages were 11.8% and 41%, respectively. Conclusions. In both periods of analysis, significant differences were observed as to implementation of breast cancer screening program, as well as to grade of clinical and pathological progression of the cancer. Observable increase of screening tests allowed for significantly more frequent implementation of breast conserving surgical procedures.

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Current guidelines on the diagnosis and management of lobular carcinoma in situ

100%

Śrutek E., Nowikiewicz T., Zegarski W.

Current Gynecologic Oncology

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2017

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vol. 15

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issue 1

87-90

EN

Lobular carcinoma in situ of the breast is classified as non-invasive malignant tumor of the breast. Its diagnosis is a marker for an increased risk of developing other histological types of breast cancer. Lobular carcinoma in situ is usually asymptomatic, with no characteristic radiological features. The diagnosis is often accidental while diagnosing lesions found on screening mammography. The most important clinical issue associated with the diagnosis of lobular carcinoma in situ is the possible risk of concurrent breast cancer of another histological type. According to the current standards of managing patients with lobular carcinoma in situ of the breast, surgical biopsy of the mass is most commonly recommended. Specific principles of therapy depend on the circumstances surrounding the diagnostic process. The complete diagnosis requires histopathological study of tissue specimens from paraffin blocks. It is necessary to determine the histological subtype of the identified tumor as different subtypes present significant differences as to the course of the disease (classic lobular carcinoma in situ, pleomorphic, florid or comedo with necrosis ones). Contrary to the classic lobular carcinoma in situ, other subtypes are characterized by significantly higher risk of coexisting infiltrating breast cancer. In such cases, it is necessary to perform surgical excision of the tumor. Diagnosis of LCIS does not require surgical treatment (possible active surveillance of the patient).

PL

Rak zrazikowy gruczołu piersiowego in situ należy do postaci nieinwazyjnych nowotworów złośliwych o tej lokalizacji narządowej. Jego zdiagnozowanie jest markerem zwiększonego ryzyka rozwoju w przyszłości innych typów histologicznych raka piersi. Zrazikowy rak piersi in situ to najczęściej guz bezobjawowy, nieposiadający charakterystycznych cech radiologicznych. Do jego wykrycia dochodzi zwykle przypadkowo, w trakcie diagnostyki zmian uwidocznionych podczas skriningu mammograficznego. Najbardziej istotnym problemem klinicznym związanym ze zdiagnozowaniem tego nowotworu jest ryzyko współistnienia zmiany z innym rodzajem histologicznym raka piersi. Zgodnie z aktualnymi standardami leczenia chorych ze zrazikowym rakiem piersi in situ zalecana jest najczęściej biopsja chirurgiczna zmiany. Szczegółowe zasady postępowania terapeutycznego zależą od okoliczności zdiagnozowania guza. Rozpoznanie choroby wymaga oceny histopatologicznej preparatów tkankowych, pochodzących z bloków parafinowych. Niezbędne jest określenie podtypu histologicznego wykrytej zmiany, które wykazują znaczne różnice dotyczące przebiegu choroby (postać klasyczna, podtyp pleomorficzny, podtyp w stadium rozkwitu bądź podtyp comedo z martwicą). W odróżnieniu do typu klasycznego zrazikowego raka piersi in situ, pozostałe postaci cechuje istotnie wyższe ryzyko współistnienia form raka naciekającego piersi. W przypadku ich stwierdzenia konieczne jest operacyjne wycięcie zmiany. Wykrycie postaci klasycznej raka zrazikowego gruczołu piersiowego in situ nie wiąże się z taką koniecznością (możliwość aktywnego nadzoru chorych).

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Ocena jakości życia kobiet leczonych metodą BCT z procedurą węzła wartowniczego z powodu raka piersi

88%

Głowacka I., Zegarski W., Hagner W., Nowacka K., Nowikiewicz T.

Polskie Forum Psychologiczne

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2015

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vol. XX

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issue 2

261-272

EN

Summary. Introduction: Breast cancer is the most common tumor among women in Poland. About 5000 women die every year because of breast cancer. The purpose of research was to determine the influence of BCT with sentinel lymph node biopsy on the change in quality of life in patients undergoing this procedure. Materials and methods: The study involved 50 women (median age – 50.2 years) undergoing BCT with sentinel lymph node biopsy for breast cancer in the Department of Breast Cancer and Reconstructive Surgery, Centre for Oncology, Bydgoszcz, Poland. The assessment was carried out in patients in clinical stages I and II. Standard QLQ-C30 and QLQ-BR23 questionnaires were used. The same participants filled in the QLQ-C30 and QLQ-BR23 questionnaires before (Group A1) and six weeks after the procedure (Group A2). Results: Quality of life measured with the use of EORTC QLQ-C30 and EORTC-BR 23 scales was higher in women before the procedure with respect to role functioning and global quality of life assessment (p < 0.05). There was an improvement in emotional functioning, feeling sick and unwell, and mental functioning after the procedure (p < 0.05). No statistically significant differences were noted in physical functioning, cognitive functioning, social functioning, or sexual functioning before and after the procedure (p > 0.05).

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Recommendations of Association of Polish Surgeons and Polish Society of Oncological Surgery Gastrointestinal Fistulae in Patients Treated for Malignancy - Diagnostics and Treatment

64%

Szawłowski A., Pertkiewicz M., Drews M., Dziki A., Krasnodębski I., Kulig J., Lampe P., Stojcev Z., Wallner G., Zegarski W.

Polish Journal of Surgery

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2008

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vol. 80

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issue 12

694-711

EN

Postoperative gastrointestinal fistulae occur more often in patients undergoing surgical treatment for oncological reasons than non-oncological reasons. Fistula is associated with a number of serious sequelae and complications: fluid and electrolyte abnormalities, acid-base abnormalities, local and systemic infection and progressive cachexia that increase morbidity, treatment duration and mortality. Development of fistula additionally delays or prevents specific treatment in oncology. For a patient, a fistula is associated with both physical and mental suffering resulting from concern over further therapy.Although the introduction of advanced surgical techniques, intensive postoperative care, total parenteral nutrition and modern enteral nutrition, resulted in decreased postoperative mortality, however the number of patients with gastrointestinal fistulae hospitalized in the departments of surgery is not decreasing. This may result from the fact that many patients still present for treatment in the advanced phase of their malignancy (clinical stage III/IV according to International Union Against Cancer - UICC) and consequently in worse general status, which poses a high risk of postoperative complications and requires more extensive procedures in progressively older patients. Thus gastrointestinal fistulae still remain a serious clinical problem. Main components of treatment of fistulae include: adequate draining, fighting of infections, artificial nutrition and drugs that decrease gastrointestinal secretion (e.g. somatostatin) that are intended to create conditions for spontaneous fistula healing. Some cases may require an early or late surgical intervention.

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Zasady stosowania dootrzewnowej chemioterapii w hipertermii (HIPEC) w leczeniu nowotworów złośliwych powierzchni otrzewnej w połączeniu z zabiegami cytoredukcyjnymi: zalecenia krajowe

52%

Rutkowski P., Śpiewankiewicz B., Herman K., Jastrzębski T., Kładny J., Kojs Z., Krzakowski M., Polkowski W., Wyrwicz L., Wysocki P., Zdzienicki M., Zegarski W.

Current Gynecologic Oncology

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2014

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vol. 12

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issue 2

86-97

EN

The management of peritoneal surface malignancy is a significant clinical problem in oncology. It was demonstrated that the combination of complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) may lead to long-term control of the disease or improved survival in selected patients. The aim of this paper was to present the optimal indications and technical guidelines for performing HIPEC in Poland. The application of this method requires experience of a multidisciplinary team of physicians (gynecologic oncologist, surgeon and clinical oncologist), availability of diagnostic and therapeutic resources (intensive care unit) as well as a dedicated perfusion system. A crucial aspect for obtaining optimal treatment outcomes is the selection of patients. Such a selection takes place both at the beginning of treatment and intraoperatively. The initial selection of patients qualified for HIPEC includes ruling out extraperitoneal spread of cancer and metastases to the liver (single resectable liver metastases in patients with colorectal carcinoma are not contraindications) and lungs. According to current international guidelines, the HIPEC procedure is a standard treatment in patients with ovarian carcinoma that metastasizes to the peritoneum, in colorectal cancer, when PCI <20 and in patients with peritoneal mesothelioma or pseudomyxoma peritonei as well as in patients with gastric cancer.

PL

Leczenie nowotworów złośliwych powierzchni otrzewnej stanowi istotny problem w onkologii. Wykazano, że skojarzenie maksymalnej cytoredukcji chirurgicznej z dootrzewnową chemioterapią w hipertermii (hyperthermic intraperitoneal chemotherapy, HIPEC) może prowadzić do długotrwałej kontroli choroby lub wydłużenia przeżyć u odpowiednio wybranych chorych. Celem niniejszego opracowania są zalecenia dla optymalnego zakresu wskazań i sposobu prowadzenia HIPEC w Polsce. Zastosowanie tej metody wymaga doświadczenia wielospecjalistycznego zespołu lekarskiego (ginekolog onkolog, chirurg, onkolog kliniczny), a także zaplecza diagnostycznego i leczniczego (oddziału intensywnej opieki medycznej) oraz dedykowanego systemu do perfuzji. Kluczową kwestią dla uzyskania optymalnego wyniku leczenia jest odpowiedni dobór chorych. Dobór ten następuje zarówno na etapie planowania leczenia, jak i śródoperacyjnie. Wstępna selekcja pacjentów kwalifikowanych do leczenia z wykorzystaniem HIPEC obejmuje wykluczenie pozaotrzewnowych przerzutów nowotworu oraz przerzutów do wątroby (pojedyncze resekcyjne przerzuty do wątroby u chorych na raka jelita grubego nie są przeciwwskazaniem) i płuc. Zgodnie z istniejącymi zaleceniami międzynarodowymi procedura HIPEC jest standardowo stosowana u chorych z przerzutami do otrzewnej raka jajnika, raka jelita grubego, gdy PCI <20 oraz u chorych na międzybłoniaka lub śluzaka rzekomego otrzewnej i wybranych chorych na raka żołądka.

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Polish Consensus Statement On The Protective Stoma

40%

Szczepkowski M., Banasiewicz T., Krokowicz P., Dziki A., Wallner G., Drews M., Herman R., Lorenc Z., Richter P., Bielecki K., Tarnowski W., Kruszewski J., Kładny J., Głuszek S., Zegarski W., Kielan W., Paśnik K., Jackowski M., Wyleżoł M., Stojcev Z., Przywózka A.

Polish Journal of Surgery

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2015

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vol. 86

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issue 8

391-404

Refine search results

Aktualne problemy dotyczące postępowania diagnostycznego oraz leczenia operacyjnego chorych na raka piersi – przegląd wybranych zagadnień klinicznych

Clinical Significance of Van Nuys Prognostic Index As A Qualification Criterion to Sentinel Lymph Node Biopsy in Patients Diagnosed with Ductal Carcinoma in Situ

Problems concerning patients’ qualification for surgical procedures allowing for evaluation of the condition of axillary fossa lymph nodes in the radical treatment of breast cancer

Evaluation of the effects of mammography screening program on cancer progression and implemented treatment in patients with breast cancer

Current guidelines on the diagnosis and management of lobular carcinoma in situ

Ocena jakości życia kobiet leczonych metodą BCT z procedurą węzła wartowniczego z powodu raka piersi

Recommendations of Association of Polish Surgeons and Polish Society of Oncological Surgery Gastrointestinal Fistulae in Patients Treated for Malignancy - Diagnostics and Treatment

Zasady stosowania dootrzewnowej chemioterapii w hipertermii (HIPEC) w leczeniu nowotworów złośliwych powierzchni otrzewnej w połączeniu z zabiegami cytoredukcyjnymi: zalecenia krajowe

Polish Consensus Statement On The Protective Stoma