Tata Memorial Centre Evidence Based Management of Breast cancer.

ABSTRACT: The incidence of breast cancer is increasing rapidly in urban India due to the changing lifestyle and exposure to risk factors. Diagnosis at an advanced stage and in younger women are the most concerning issues of breast cancer in India. Lack of awareness and social taboos related to cancer diagnosis make women feel hesitant to seek timely medical advice. As almost half of women develop breast cancer at an age younger than 50 years, breast cancer diagnosis poses a huge financial burden on the household and impacts the entire family. Moreover, inaccessibility, unaffordability, and high out-of-pocket expenditure make this situation grimmer. Women find it difficult to get quality cancer care closer to their homes and end up traveling long distances for seeking treatment. Significant differences in the cancer epidemiology compared to the west make the adoption of western breast cancer management guidelines challenging for Indian women. In this article, we intend to provide a comprehensive review of the management of breast cancer from diagnosis to treatment for both early and advanced stages from the perspective of low-middle-income countries. Starting with a brief introduction to epidemiology and guidelines for diagnostic modalities (imaging and pathology), treatment has been discussed for early breast cancer (EBC), locally advanced, and MBC. In-depth information on loco-regional and systemic therapy has been provided focusing on standard treatment protocols as well as scenarios where treatment can be de-escalated or escalated.

Isolated Mesenteric Injury causing Ileal Devascularisation with Uterine Perforation following Termination of Pregnancy; A Case Report and Literature Review.

Surgical abortion is one of the leading causes of maternal mortality, constituting up to 20% of maternal deaths. Uterine perforation is a rare complication, accounting for4% of all the abortion related complications. Intestinal injury with uterine perforation following termination of pregnancy is even rare and is a potentially fatal complication with mortality of up to 10%. A 27-year-old G3P2L2 woman with 12 weeks of gestation referred to our hospital in hemorrhagic shock with a suspicion of uterine perforation following dilatation and curettage for termination of pregnancy. Patient underwent emergency laparotomy. She was found to have uterine perforation with mesenteric and ileal injuries intraoperatively. Perforation closure with ileoileal resection and anastomosis was done. Postoperatively the patient recovered completely. Prompt reporting/recognition of uterine perforation, preoperative resuscitation and early intervention are the most important steps in the management of patients with intestinal injury. Trauma surgeon should never hesitate or delay in considering an Emergency Laparotomy/laparoscopy in cases of suspected intestinal injury with uterine perforation. Emergency exploration decreases the morbidity and mortality to a great extent in patients with intestinal injury.