Management of patient with breast carcinoma diagnosed during pregnancy.

OBJECTIVE: To present actual complex review of diagnosis and treatment of breast cancer during pregnancy, demonstrated on particular case report. DESIGN: Case report and review article. SETTING: University Hospital Královské Vinohrady, Prague Department of Obstetrics and Gynaecology, Department of Radiotherapy and Oncology. CASE REPORT: Patient with breast cancer diagnosed in early pregnancy, her oncological treatment. Circumstantial finding was endometriosis of rectovaginal septum and dehiscence of uterotomy after C-section. DISCUSSION: On this case we demonstrate importance of all early diagnosis, prompt examination management and early therapy onset already during the pregnancy. CONCLUSION: Breast cancer therapy results are equal in pregnant and non-pregnant women, when we compare patients of same age, with same stage and same biological characteristics of tumor. The obstacle during pregnancy is often late diagnosis, which causes bigger size of tumor and more extensive affection of lymphatics in time of therapy onset.

[Clinical and Functional Importance of Selected CASP8 and CASP9 Polymorphisms in Breast Carcinoma]. / Klinický a funkcní význam vybraných polymorfizmu CASP8 a CASP9 u karcinomu prsu.

BACKGROUND: Caspase-8 and caspase-9 (encoded by CASP8 and CASP9) are executive caspases of programmed cell death (apoptosis). Dysregulation of apoptosis plays an important role in cancer development, progression, and resistance to anticancer therapy. The goal of this work was to evaluate potential associations between polymorphisms in CASP8 and CASP9, previously linked to breast cancer risk, and the transcript levels of these genes (including their alternative anti-apoptotic variants) in tumor tissues and the clinical characteristics of the patients. MATERIAL AND METHODS: Sanger sequencing, high resolution melting (HRM) analysis, and allelic discrimination were used to identify polymorphisms in DNA samples isolated from tumor tissues and peripheral blood lymphocytes of 60 breast carcinoma patients. Total transcript levels of CASP8 and CASP9, and levels of alternative splicing variants CASP8L and CASP9B, were quantified by real-time PCR in tumor tissues. Clinically interesting associations were validated in DNA from lymphocytes of 615 breast carcinoma patients. RESULTS: A haplotype in CASP9 composed of three polymorphisms rs4645978-rs2020903-rs4646034 was significantly associated with CASP9 expression in tumors, with the expression of the progesterone receptor and ERBB2, and with the TNBC subtype of breast carcinoma in the validation study. The associations between the rs3834129 polymorphism in CASP8 and stage of disease, rs6435074 with grade, expression of estrogen receptor and ERBB2, and rs6723097 with ERBB2 expression have not yet been validated. However, rs6723097 was associated with disease-free survival in patients treated with hormonal therapy. CONCLUSION: This study reveals a previously unknown and presumably functional (in silico) association between a haplotype in CASP9 and molecular and clinical phenotypes of breast carcinoma. The potential clinical utility of this association for prognostication of breast carcinoma should be evaluated by independent studies.Key words: breast carcinoma - caspases - polymorphisms - functional - clinical - importanceThis work was supported by grant of the CU Grant Agency No. 1444313, and grant of the Internal Grant Agency of the Czech Ministry of Health No. 15-25618A.The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 3. 3. 2016Accepted: 26. 10. 2016.

Screening of Psychological Distress 4.5 Years after Diagnosis in Breast Cancer Patients Compared to Healthy Population.

BACKGROUND: Survival rate of breast cancer patients has improved significantly in recent years. Cancer diagnosis represents a great psychological distress for patients which may not stem solely from the disease itself. Patients may experience higher distress even several years after treatment. PATIENTS AND METHODS: The study was carried out at the Department of Obstetrics and Gynecology and Department of Internal Medicine, Haematology and Oncology, Faculty Hospital Brno. Results of 85 patients at 4.5 years after diagnosis of breast cancer compared to 72 healthy controls are presented in this paper. The data were collected in the form of semi-structured interviews, from the patients medical records and by Symp-tom Check List-90. RESULTS: The overall rate of psychological distress (GSI) 4.5 years after breast cancer dia-gnosis does not differ significantly (p = 0.703) from the healthy population. Also, we did not find any statistically significant relationship between the observed factors and the level of psychological distress in breast cancer patients. CONCLUSION: Screening investigation showed no difference in the psychological distress in breast cancer patients 4.5 years following diagnosis, compared with the healthy population.

Change in Quality of Life Measured over Time in Czech Women with Breast Cancer.

BACKGROUND: This study examined the impact of breast cancer on quality of life (QOL) of Czech women by comparing the QOL of breast cancer patients with that of age-matched healthy controls. METHODS: The sample consisted of 74 breast cancer patients who filled in self-assessment questionnaires retrospectively before treatment and at the time of the study. In addition, 73 healthy controls completed the same battery of questionnaires. QOL was assessed using the Rand 36-Item Health Survey, the Life Satisfaction Questionnaire, and the Czech research version of Functional Assessment of Breast Cancer Therapy. The Wilcoxon paired test and Mann-Whitney U test were used for data analysis. RESULTS: A statistically significant decline in QOL in breast cancer patients was found for the following components: Physical Functioning (p = 0.021), Role Functioning-Physical (p < 0.001), Bodily Pain (p = 0.001), General Health (p = 0.031), Role Functioning-Emotional (p = 0.023), and Physical Well-being (p = 0.001). The only significant increase over time was observed in Social/Family Well-being (p = 0.024). For most of the components, patients showed a statistically significant lower QOL than that of healthy controls. A recent diagnosis, advanced disease stage, more comorbidities, a higher BMI, and other sociodemographic characteristics were associated with a higher incidence of a lower QOL over time. CONCLUSION: Perceived QOL decreased over time in breast cancer patients mainly in components such as physical and emotional functioning, bodily pain, and general health, with several risk factors strongly influencing this change. The QOL of patients was lower than that of the non-cancer population, indicating that subsequent care should be improved to minimize the adverse effects that breast cancer has on QOL.

Predicting Vitality Change in Older Breast Cancer Survivors after Primary Treatment--an Approach Based on Using Time-related Difference of Pro-inflammatory Marker C-reactive Protein.

BACKROUND: We aimed to determine prognosis of vitality change and functional status of breast cancer survivors after primary oncological treatment using time-related differences of elevated levels of highly sensitive proinflammatory C-reactive protein (CRP). PATIENTS AND METHODS: The test group consisted of 46 elderly breast cancer survivors (median age was 65 years) who completed Vitality Scale of Short Form 36 (SF-36) after completing treatment and another retrospectively at diagnosis. Data on tumor-related factors, treatment, and outcomes were obtained retrospectively from medical records, and linear regression analysis was performed. CRP was followed at diagnosis and one year after primary treatment. Within the scope of this study, clinically important difference in the Vitality Scale was set at five points of change. RESULTS: Results showed a statistically significant relationship between CRP change and vitality component of SF-36 change (rs = - 0.350, p = 0.023) in which a decrease in CRP inversely correlated with the quality of life component. The overall change was 1.078 of the vitality scale score (approximately 1 point) for each 1 unit decrease of CRP (1 mg/ L). Association of CRP levels (before and after treatment, its difference between these time points) with age, number of comorbidities and stage of the disease was analyzed and no statistically significant relationship was found in our study. CONCLUSION: Preliminary results suggested time-related differences in elevated CRP levels as a potentially suitable predictor for change in vitality status for long term, chronic condition for older breast cancer survivors. We suggest the interpretation schema including an understanding that CRP change of 5 mg/ L and more should be considered a potential risk factor for subsequent negative clinical outcomes.

[Psychoneuroimmunology in context of comprehensive breast cancer treatment]. / Aplikace poznatku psychoneuroimunologie v kontextu komplexní onkologické lécby karcinomu prsu.

BACKGROUND: Numerous studies have proven a relationship between stress and cancer progression or recurrence, and on the other hand, positive effects of psychological and social support and interventions on cancer patients quality of life. PURPOSE: This review article aims to provide an overview of recent studies that dealt with effects of psychosocial interventions on health and psychological state of breast cancer patients, from cellular and immune response over coping skills to overall survival. CONCLUSION: Both short- and long-term studies have proven positive effects of psychosocial interventions on levels of stress hormones, cellular (immune) response and general patients quality of life. On the other hand, findings on overall survival are contradictory and cannot provide unambiguous conclusions.

[Diagnosis of minimal breast cancers]. / Diagnostika minimálních karcinomu prsní zlázy.

DESIGN: This is a retrospective study evaluating the minimum detection cancers in the group of women mammographically examined in our department. The study covers the period from 1. 1. 2012 to 31. 12. 2012. Interestingly we introduced several interesting case studies. OBJECTIVE: 1. Confirmation upward trend in the number of minimal breast cancers, stage T1. 2. The need for multidisciplinary cooperation for quick minimal surgical intervention and effective cancer treatment. SETTING: Department of Radiology, Department of Gynecology and Obstetrics, Third Faculty of Medicine Charles University, Faculty Hospital KV, Prague. METHODS: The methodology is based on a retrospective evaluation of the number of participants, regardless of age, that come for examination the workplace Breast Radiologists in 2012. Of all the tests are then evaluated the number and types of histological proven cancer, focusing on cancer detection stage T1 and other solutions from surgery after cancer treatment. RESULTS: In 2012 it was made in 6700 FNKV screening mammography, of this number, 45 were confirmed malignant tumors in asymptomatic women. In 2012 it was simultaneously performed 2276 diagnostic mammography in women with clinically palpable resistance, and malignant tumors was confirmed in 122 women. Overall, mammographically and ultrasonographically examined 10 146 women for the year 2012. Of the 167 women with histologically confirmed malignant tumor. Brest carcinoma, stage T1, was diagnosed in 34% of patients and 66% of patients were malignant bearing greater than 10mm. The most common histological type of breast cancer in our department during the period from 1. 1. 2012 to 31. 12. 2012 was invasive ductal carcinoma (DIC) and in 82% of invasive lobular carcinoma (LIC) was diagnosed in 10%, mixed DIC and LIC in 4% and other cancers represented 4%. CONCLUSION: The diagnosis mode, core cut biopsy with histological conclusion, preoperative marking bearings in the presence of the surgeon, assessment resection, definitive histology, mammary team, cancer treatment, subsequent postoperative control at one workplace, is in terms of the patient not only effective, individualized and complex, but also cost effective.

[Cooperation between mammologist and radiodiagnostic in the management of mammary leasions in the University Hospital Kralovské Vinohrady]. / Spolupráce mamologa a radiodiagnostika pri managementu mamárních lézí ve FNKV.

Epidemiological datas describing up to date status of diagnostics and oncological parameters (incidence, mortality, prevalence, total number of pacients with breast cancer) are given in the article. Further changes are comented in this field after start of mammografic screening programme in our country in the year 2002. Authors evaluated possibilities of clinical diagnostics performed by mammologist in his ambulance and possibilities and types of invasive and noninvasive (immaging) diagnostic methods performed by radiodiagnostic according mammologist indication. Management of benign and malignant leasions detected and treated in the mammological centre of the University Hospital Královské Vinohrady are mentioned.

[Fixed combinations in the treatment of hypertension]. / Fixní kombinace v lécbe hypertenze.

We present an overview of current opinions on combination therapy and the role of fixed combinations in the treatment of hypertension as per the ESH/ESC and CSH guidelines of 2007 and the revised European guidelines of 2009. A renin-angiotensin system blocker (ACE-I or sartan) combined with a calcium channel blocker is the most frequently recommended combination, followed by renin-angiotensin system blocker and a diuretic and a calcium channel blocker and a diuretic. A fixed combination of a calcium channel blocker and a beta-blocker has now been also recommended. Higher patient compliance and thus better control of hypertension is the main advantage of fixed combinations. We present an overview of fixed combinations registered in the Czech Republic until May 2012.

[Reproductive functions in women after cancer therapy]. / Reprodukcní funkce u onkologických pacientek.

Improvement in early diagnostics and treatment options led to an increase in the number of young oncological patients in reproductive age. These young oncological patietns have life-long consequences of treatment, such as infertility, early menopause and sexual dysfunctions. There is the possibility of maintening fertility by assisted reproduction methods. So far, ovarian stimulation followed by ICSI and cryopreservation of embryos seem to be the most successful method. Unfortunately, this method is suitable only for patients with a stable partner where there is no risk of delay because of necessary stimulation of ovulation. For patients without a partner, it is possible to freeze stimulated oocytes. Cryopreservation of immature oocytes followed by in vitro maturation seems to be a very promising method. Freezing ovarial tissues followed by transplantation is at this point only an experimental procedure. The authors present their experience with in vitro maturation of oocytes of 28 women with pregnancy rate 14.3%. Twenty-seven cases of infertility with a high risk of ovarial hyperstimulation syndrome and one case of breast cancer patient before chemotherapy were chosen for IVM.

[Changes in lipid profiles in women after surgical castration during the fertile age]. / Zmeny lipidového profilu u zen po chirurgické kastraci ve fertilním veku.

OBJECTIVE: The main known risk factors for coronary heart disease in women, other than age, which is the most important risk factor of all, are cigarette smoking, raised blood pressure, obesity, diabetes and premature menopause, especially after ovarectomy. DESIGN: Retrospective clinical study. SETTING: Medical building, Prague 7, Department of Obstetrics and Gynecology 3rd Medical Faculty Charles University and Faculty Hospital Vinohrady, Prague 10. METHODS: In 1995 and 1996 we investigated plasma lipid levels and bone density in 75 women, 3 to 5 years after ovarectomy without HRT (group A). The results were compared with a control group (group B) of women of the same age and BMI. This group of women had normal menstruation periods. We investigated age, body mass index, bone density, total cholesterol, HDL and LDL cholesterol, ateroghenic index and triglycerides. RESULTS: When we compared groups A and B, there was a better result in all serum lipid levels in group B, but not significantly. In group A was more women with patological level of HDL-cholesterol. In group A there was a significantly lower level of bone density than in group B and there was an increase in the number of patients with osteoporosis in this group. CONCLUSIONS: Castration in premenopause had no influence in mean levels of parameters of lipid metabolism, but bone density significantly decreased after castration in this period.

[Granulosa cell tumor--clinical group and literature review]. / Nádor z bunek granulózy--klinický soubor a literární prehled.

OBJECTIVE: To present a review of literature and to analyse a clinical retrospective series of patients with granulosa cell tumor. DESIGN: Retrospective study and review. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Prague, Czech Republic. METHODS: Retrospective analysis of age, stage, surgery, radiotherapy and chemotherapy, survival curve, number of recurrences and time to recurrence. Literature and information database (Medline 1997-1999) review. RESULTS: In a group of 43 patients the median of age was 53.5 years. 83.7% of cases were in a stage I. There were two duplicate tumors in a series. Conservative surgery was performed in 9/43 cases, 5 of them were reoperated on. The most frequent chemotherapy regimens were platinum-cyclophoshamide and BEP (bleomycin, etoposide, platinum). The 5-year overall survival was 86% and specific survival 90.7%. There were 3/43 recurrences, median time to recurrence was 22 months. CONCLUSION: A good prognosis of a patient with granulosa cell tumor requires a precise histopathologic examination, an adequate surgery and a comprehensive clinical analysis of a case to evaluate an indication of adjuvant therapy. Concentration of patients in oncogynaecological centres is advisable. A careful follow-up because of a risk of late recurrences is necessary.

[Immunoscintigraphy in the diagnosis of ovarian carcinoma]. / Imunoscintigrafie v diagnostice ovariálního karcinomu.

The authors define the place of immunoscintigraphy (IS), a diagnostic method which differs qualitatively from the usual examination methods (US-ultrasonography, CT-computed tomography) in the management of ovarian cancer when monitoring the response to therapy and for detection of subclinical manifestations of the disease. The author explains the principle of the method which involves a highly specific antigen-antibody reaction. Possibilities to influence the accuracy of the examination and results of a clinical perspective study are submitted the objective of which was to test the possible use of this diagnostic method under our conditions. In a group of 66 women (with an established diagnosis of ovarian cancer or a newly detected ovarian tumour) 76 IS examinations were made and the finding was confirmed by biopsy. The results of the histological examination were also a criterion of the accuracy of IS and CT examinations resp. The material for biopsy was obtained on operation, second look operation, by fine needle biopsy or on necropsy. The authors evaluate 65 IS examinations. The accuracy of the examination was evaluated as very satisfactory (84%), the sensitivity 89%, specificity 79%, there was a minimal number of falsely positive findings (9.2%) and falsely negative ones (6.2%). An analysis of possible reasons of failure of IS examinations is made. The authors evaluate the contribution of IS and its place among diagnostic methods in the treatment and follow up of women with ovarian cancer.

[Monitoring of malignant gynecologic tumors using the immune response to lactate dehydrogenase virus antigens]. / Monitorování gynekologických maligních nádoru imunitní odpovedí na LDH virový antigen.

The cell mediated immunity was examined by the leukocyte adherence inhibition (LAI) test in 21 patients with CIN III and 146 patients with invasive gynaecologic malignancies before treatment and at 3-month intervals. Our own LDV antigen and organ specific antigens were used. The test was highly specific (95.1%) in comparison with a control group of healthy blood donors. The sensitivity of the test was lower (64.7-86.8%). There was no correlation with the development of disease (remission or relapse). The test in a two-year investigation does not seem suitable for monitoring of disease. Depending the nature of LDV infection, only a longer investigation extending over more years would enable further conclusions.

[The status of children and family relations after successful in vitro fertilization and embryo transfer]. / Stav detí a rodinných vztahu po úspesném pokusu o in vitro fertilizaci a embryotransfer.

Using a retrospective questionnaire method, the authors evaluated the neuropsychologic status of 20 IVF children and the family relationships. The status of the children is favourable and in certain activities (composition of sentences) the children were better than their peers. According to the authors this is due to the increased care of mature parents after the arrival of the long expected child. The authors confirmed on their own material that the birth of an IVF child has a far reaching positive biological, psychological and social impact on both parents and training of their children. If the family environment was influenced by long lasting treatment of sterility, the arrival of an IVF child normalizes the situation.