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  • ISSN: 2373-9436
    Volume 4, Issue 1
    Review Article
    Susan B. Kesmodel* and John A. Olson
    Endocrine therapy is one of the mainstays of treatment for patients with hormone receptor-positive breast cancer. While this has primarily been used in the adjuvant setting, the use of neo adjuvant endocrine therapy has increased in recent years as we have developed a better understanding of breast cancer tumor biology and breast cancer subtypes. Neoadjuvant endocrine therapy is a well-tolerated treatment that can increase eligibility for breast conserving surgery in patients with hormone receptor-positive breast cancer and response to therapy allows for risk stratification of patients to guide adjuvant therapy. In addition, neoadjuvant endocrine therapy provides an outstanding platform to examine mechanisms of endocrine resistance and to optimize endocrine therapies that are currently being used to treat patients with breast cancer. Multiple ongoing clinical trials are evaluating the use of neoadjuvant endocrine therapy, alone, or in combination with other targeted agents, to better understand endocrine resistance and to identify new treatment strategies that may improve outcomes in breast cancer patients.
    Thao N.D. Pham and Debra A. Tonetti*
    Breast cancer remains the most common cancer in women worldwide and the second most common cancer among women in the U.S. The optimal treatment for patients is based on the expression of the estrogen receptor a (ER), progesterone receptor (PR) and HER2 as assessed by immunohistochemical methods. Patients with tumors that express ER are treated with endocrine therapy including tamoxifen or aromatase inhibitors administered in the adjuvant or neo-adjuvant setting. Unfortunately a significant percentage of patients experience endocrine resistance and disease recurrence. Such targeted therapies do not exist for patients with triple negative breast cancer (TNBC), who are currently principally treated with cytotoxic chemotherapy. Endocrine resistance in patients of ER+ subtype and the aggressive nature of TNBC subtype continue to be significant roadblocks to successful therapeutic management. Protein kinase C alpha (PKCa) is a serine-threonine kinase implicated in numerous physiological and pathological processes, including breast cancer. PKCa participates in a number of oncogenic pathways, making it a very attractive target for breast cancer therapy. Many of these pathways are functionally relevant in both ER+ and TNBC patients. In addition, in ER+ patients, expression of PKCa is a promising biomarker for poor response to endocrine therapy. This review will summarize the current understanding of PKCa in both ER+ and TNBC subtypes.
    Mandic Aljosa*, Djurdjevic Srdjan, Stojanovic Sanja and Kacanski Mocko Mihaela
    Introduction: During the last three decades fertility preservation are established as a new treatment modality for young patients with early cervical cancer using different surgical approaches and techniques such as vaginal or abdominal simple or radical trachelectomy, total laparoscopic or robotic trachelectomy even large conisation with laparoscopic lympadenectomy. A further goal for gynecological oncology is to try to consider fertility-preserving approach in these patients with bulky cervical cancer not compromising the oncology outcome.
    A case report: A 25-year-old patient with cervical adenocarcinoma, FIGO stage IB2, was diagnosed with tumor size more than 40 mm. Preoperative magnetic resonance (MR) was performed and patient received neoadjuvant chemotherapy protocol, Cisplatinum/Doxorubicin, three cycle in 10 days interval followed abdominal radical trachelectomy with pelvic and paraaortic lymphadenectomy. All findings on the follow-up visit after 24 months showed no sign of disease recurrence and patient's menstrual cycles were regular.
    Until know small case control studies point on acceptable approach with neoadjuvant chemotherapy followed conservative fertility spare surgery in young patients with bulky cervical tumor who respond well on chemotherapy but we still need more evaluation and data in these group of patients.
    Case Report
    Matthew Sills, Sarah Norton*, Robert Landers and Gerrard O'Donoghue
    Background: Malignant melanoma of the areola of the breast is rare. Only a few cases have been reported in the literature. Diagnostic dilemmas may occur due to the location of these malignant lesions.
    Case: A pigmented lesion of the left nipple in a young female patient that was increasing in size, with an associated colour change is described. A preoperative ultrasound was performed and the lesion was excised. Initial histology showed it to be an infiltrating malignant melanoma in a pre-existing naevus. The tumour was in vertical growth phase, filling the papillary dermis and extending into the superficial reticular dermis (Clarke's level IV) to a depth of 1.4mm. It was noted that the exact depth of tumour was difficult to measure due to the presence of the associated naevus. In-situ tumour cells involved the radial margin at initial resection. The mitotic rate was 1/mm2.
    Post-operatively, CT TAP and CT brain were performed which were negative for metastatic disease. A bone scan showed abnormal sternomanubrial activity. For this reason, a PET scan was performed which was negative for metastases. Following Breast and supra-regional Dermatopathology MDM discussion the patient underwent a non-nipple sparing WLE and SLNM. Final histology demonstrated no further disease in re-excision specimen and lymph nodes were reported as having dark carbon-like pigment within them with no malignancy seen. The carbon-like pigment was consistent with an ipsilateral tattoo on the patients' hand.
    Conclusion: Malignant melanoma of the breast is a rare but important differential diagnosis for pigmented lesions. The clinical presentation includes a change in size, pigmentation, ulceration and bleeding in a pre-existing naevus. Once diagnosed, prognosis depends on tumour size, Clarke's level, Breslow Thickness, location, ulceration and metastases. SLNB with lymphoscintigraphic mapping is a minimally invasive procedure and is a useful tool for predicting survival and prognosis in these patients.
    Mini Review
    Agustina D.R. Nurcahyanti*
    This short review is a glance at information about cervix cancer, mainly the situation in Indonesia. Research-based studies, current chemotherapy and possible future chemotherapy, including the mechanisms of action, for cervix cancer will be briefly discussed. The main purpose of this short review is to provide, in short form, information on how far the incidence of cervix cancer is currently emerging and why new treatment needs to be continuously developed, mainly from natural product-based cytotoxic drugs. This can serve as a warning, then hopefully leading to an improvement in cervix cancer treatment and also prevention, especially in developing countries such as those in South-East Asia, where the development of socioeconomic and education has steadily risen and remains impressive to sustain cancer control program.
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