[The internist and ovarian cancer]. / El médico clínico y el cáncer de ovario.

For the purpose of evaluating the role and participation of the internist in the diagnosis of Epithelial Ovarian Cancer (EOC), 81 medical records belonging to patients with EOC, were analyzed. The mean age of the patients was 63.5 years old (SD 12.33). Of these patients 21% were asked about their personal and familiar oncology history during their first office visit. Thirteen patients (16%) were asymptomatic in the first consultation. The more frequent symptoms were pain and abdominal distention. During this first examination, 46 patients (56.8%) presented some evident physical sign, and EOC was suspected in 35 patients (P = 0.00000004): the most frequent sign was an abdominopelvic mass in 34 patients (74%). Forty-six patients with EOC (56.8%) consulted an internist and twenty-four patients (29.6%) a gynecologist at first evaluation, without significant differences in diagnostic suspicion. Internists did not perform an abdomino-pelvic palpation. Gynecologists performed the abdomino-pelvic palpation in 74 patients, and 58 (78.4%) were found to be abnormal. The mean age of patients examined by internists was 68.2 years old, that is ten years older than the patients examined by gynecologists (P = 0.0007) and 70% were in Stages III and IV (P = 0.02). Gynecologists examined 9 asymptomatic patients (P = 0.0003) and 42% in Stages III and IV. The more frequent reasons for consultation to internists were abdominal pain (23 patients) and distention (17 patients). On the other hand metrorrhagia (9 patients) was the most common reason to consult a gynecologist. In conclusion, internists were frequent receptors of women with ovarian cancer at the first consultation. Their patients were older and with a more advanced disease stage. The interrogation concerning the oncology history was insufficient and the gastrointestinal symptoms were the most frequent cause for consulting an internist. The presence of some physical signs was associated with more diagnostic suspicion. The gynecologists examined more asymptomatic patients.

[Immunohistochemical characteristics of mammary carcinomas with estrogen-negative and progesterone-positive receptors]. / Características de los carcinomas de mama receptores de estrógenos negativos y receptores de progesterona positivos determinados por inmunohistoquímica.

In a series of 256 mammary carcinomas, 22 (8.5%) were positive for progesterone receptors (PR) and negative for estrogen receptors (ER). These cases seem to belong to a distinctive group with a biologic behavior not well understood. In order to contribute to a better understanding of such tumors, their association with different pathologic and immunohistochemical factors were compared with those of the rest of the tumors of the series. The results were that favorable factors such as smaller size, negative axillary lymph nodes and low histologic and nuclear grades were decreasingly associated with tumors that were ER+ PR+; ER+ PR-; ER- PR+; and ER- PR-. In relation to immunohistochemical features, tumors that were ER+ PR+; ER+ PR- and ER- PR+ behaved in a similar way, whereas ER- PR- tumors were different from the rest because fewer expressed bcl-2 (p = 0.0000) and had a greater expression for p53 (p = 0.009) and MIB-1/Ki-67 (p = 0.05). No significant differences were found between the four populations in recurrence rate or metastases, nor overall survival. In conclusion, these findings show that tumors that are ER- PR+ might have biological characteristics somewhere in between ER+ PR+ and ER- PR+.

[Tamoxifen as the primary treatment for breast cancer in elderly patients]. / Tamoxifeno como tratamiento primario del cáncer de mama en pacientes de edad avanzada.

A total of 21 elderly patients with breast carcinoma without evidence of systemic dissemination received tamoxifen (20 mg daily) as primary treatment. Of these 57% had a potentially operable tumor (stages I:2, IIa:6, IIb:2, IIIa:2) with a high operative risk that contraindicated the surgery and 43% had a locally advanced tumor unfit for primary radiotherapy, chemotherapy, or surgery. The mean age was 81.3 +/- 5.7 years (range 70-91). Diagnosis was made by fine-needle aspiration cytology in 16 patients and by incision biopsy in 5 of them. The median follow-up was 11.5 months (range 3-54). In 67% there was a clinical objective response (RC: 14%, RP: 53%), and 33% had disease stabilization. There was no evidence of systemic dissemination during the follow-up. Two patients who had achieved a partial response with a duration of 11 and 54 months, respectively, had a loco regional progress. One of them responded to a second hormonal treatment. Of the patients, 81% are still alive, and 14% died of other causes. One patient was lost during the follow-up. These preliminary results show a high loco regional response to tamoxifen. A higher number of patients and a longer time of follow-up are needed to establish the habitual use of tamoxifen as primary treatment of breast carcinoma in elderly patients.

[The immunohistochemical determination of hormonal receptors in breast cancer. A retrospective study in 322 cases]. / Determinación inmunohistoquímica de receptores hormonales en cáncer de mama. Estudio retrospectivo en 322 casos.

A study of 322 patients with infiltrating ductal carcinoma of the breast, followed from 6 to 20 years, is presented. Pathological characteristics including immunohistochemical determinations of estrogen and progesterone receptors are shown, as well as interrelations of the different factors between themselves and with the follow up. Results showed significant relations between positive estrogen receptors and low nuclear grade (p < 0.001), histological low grade (p = 0.06) and positive progesterone receptors (p = 0.001). In addition, progesterone receptors were associated with stage I (p = 0.02); tumors with less than 2 cm in diameter (p = 0.01); low nuclear grade (p < 0.001) and positive estrogen receptors (p < 0.001). The univariate Cox regression analysis of prognostic factors revealed an association between positive lymph nodes and high nuclear grade with a more frequent tumoral recurrence. On the other hand, overall survival was significantly affected by cases in stage II, positive lymph nodes, tumors with diameter greater than 2 cm, and high nuclear grade. Stepwise Cox regression analysis showed that a high nuclear grade, positive lymph nodes and absence of estrogen receptor, were associated with a higher risk for recurrence and that tumor size and the state of lymph nodes were predictive for overall survival. This paper demonstrates that histochemical determination of hormonal receptors is useful because together with other known prognostic factors it contributes to a better management of patients with breast carcinoma.

Determinación inmunohistoquímica de receptores hormonales en cáncer de mama. Estudio retrospectivo en 322 casos. / [The immunohistochemical determination of hormonal receptors in breast cancer. A retrospective study in 322 cases]

A study of 322 patients with infiltrating ductal carcinoma of the breast, followed from 6 to 20 years, is presented. Pathological characteristics including immunohistochemical determinations of estrogen and progesterone receptors are shown, as well as interrelations of the different factors between themselves and with the follow up. Results showed significant relations between positive estrogen receptors and low nuclear grade (p < 0.001), histological low grade (p = 0.06) and positive progesterone receptors (p = 0.001). In addition, progesterone receptors were associated with stage I (p = 0.02); tumors with less than 2 cm in diameter (p = 0.01); low nuclear grade (p < 0.001) and positive estrogen receptors (p < 0.001). The univariate Cox regression analysis of prognostic factors revealed an association between positive lymph nodes and high nuclear grade with a more frequent tumoral recurrence. On the other hand, overall survival was significantly affected by cases in stage II, positive lymph nodes, tumors with diameter greater than 2 cm, and high nuclear grade. Stepwise Cox regression analysis showed that a high nuclear grade, positive lymph nodes and absence of estrogen receptor, were associated with a higher risk for recurrence and that tumor size and the state of lymph nodes were predictive for overall survival. This paper demonstrates that histochemical determination of hormonal receptors is useful because together with other known prognostic factors it contributes to a better management of patients with breast carcinoma.

Tamoxifeno como tratamiento primario del cáncer de mama en pacientes de edad avanzada. / [Tamoxifen as the primary treatment for breast cancer in elderly patients]

A total of 21 elderly patients with breast carcinoma without evidence of systemic dissemination received tamoxifen (20 mg daily) as primary treatment. Of these 57

had a potentially operable tumor (stages I:2, IIa:6, IIb:2, IIIa:2) with a high operative risk that contraindicated the surgery and 43

had a locally advanced tumor unfit for primary radiotherapy, chemotherapy, or surgery. The mean age was 81.3 +/- 5.7 years (range 70-91). Diagnosis was made by fine-needle aspiration cytology in 16 patients and by incision biopsy in 5 of them. The median follow-up was 11.5 months (range 3-54). In 67

there was a clinical objective response (RC: 14

, RP: 53

), and 33

had disease stabilization. There was no evidence of systemic dissemination during the follow-up. Two patients who had achieved a partial response with a duration of 11 and 54 months, respectively, had a loco regional progress. One of them responded to a second hormonal treatment. Of the patients, 81

are still alive, and 14

died of other causes. One patient was lost during the follow-up. These preliminary results show a high loco regional response to tamoxifen. A higher number of patients and a longer time of follow-up are needed to establish the habitual use of tamoxifen as primary treatment of breast carcinoma in elderly patients.

Determinación inmunohistoquímica de receptores hormonales en cáncer de mama. Estudio retrospectivo en 322 casos. / [The immunohistochemical determination of hormonal receptors in breast cancer. A retrospective study in 322 cases]

A study of 322 patients with infiltrating ductal carcinoma of the breast, followed from 6 to 20 years, is presented. Pathological characteristics including immunohistochemical determinations of estrogen and progesterone receptors are shown, as well as interrelations of the different factors between themselves and with the follow up. Results showed significant relations between positive estrogen receptors and low nuclear grade (p < 0.001), histological low grade (p = 0.06) and positive progesterone receptors (p = 0.001). In addition, progesterone receptors were associated with stage I (p = 0.02); tumors with less than 2 cm in diameter (p = 0.01); low nuclear grade (p < 0.001) and positive estrogen receptors (p < 0.001). The univariate Cox regression analysis of prognostic factors revealed an association between positive lymph nodes and high nuclear grade with a more frequent tumoral recurrence. On the other hand, overall survival was significantly affected by cases in stage II, positive lymph nodes, tumors with diameter greater than 2 cm, and high nuclear grade. Stepwise Cox regression analysis showed that a high nuclear grade, positive lymph nodes and absence of estrogen receptor, were associated with a higher risk for recurrence and that tumor size and the state of lymph nodes were predictive for overall survival. This paper demonstrates that histochemical determination of hormonal receptors is useful because together with other known prognostic factors it contributes to a better management of patients with breast carcinoma.

Tamoxifeno como tratamiento primario del cáncer de mama en pacientes de edad avanzada. / [Tamoxifen as the primary treatment for breast cancer in elderly patients]

A total of 21 elderly patients with breast carcinoma without evidence of systemic dissemination received tamoxifen (20 mg daily) as primary treatment. Of these 57

had a potentially operable tumor (stages I:2, IIa:6, IIb:2, IIIa:2) with a high operative risk that contraindicated the surgery and 43

had a locally advanced tumor unfit for primary radiotherapy, chemotherapy, or surgery. The mean age was 81.3 +/- 5.7 years (range 70-91). Diagnosis was made by fine-needle aspiration cytology in 16 patients and by incision biopsy in 5 of them. The median follow-up was 11.5 months (range 3-54). In 67

there was a clinical objective response (RC: 14

, RP: 53

), and 33

had disease stabilization. There was no evidence of systemic dissemination during the follow-up. Two patients who had achieved a partial response with a duration of 11 and 54 months, respectively, had a loco regional progress. One of them responded to a second hormonal treatment. Of the patients, 81

are still alive, and 14

died of other causes. One patient was lost during the follow-up. These preliminary results show a high loco regional response to tamoxifen. A higher number of patients and a longer time of follow-up are needed to establish the habitual use of tamoxifen as primary treatment of breast carcinoma in elderly patients.