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The article discusses a study which focuses on breast cancer patients with micrometastases in sentinel lymph nodes (SLN). The study aims to demonstrate the differences between micrometastatic breast cancers with additional metastatic LN and without LN invasion. The study found micrometastases in SLNs in 30 patients, and the incidence of additional LN invasion in micrometastasic SLNs was 24 percent.

The article presents a study of evaluating the diagnostic value of nipple discharge (ND) cytology and galactography in duct pathology. Different values of sensibility and specificity in detecting duct pathology, potential malignant transforming lesions, positive and negative predicative value, and breast cancer are shown for both cytology and galactography. It mentions the evaluation of performance in predicting nipple discharge.

The article discusses the role of chemotherapy in cancer treatment. It states that chemotherapy can have good results as well as adverse side effects such as toxicity and resistance of tumour cells. It cites the results of research and development of locoregional administration techniques using higher concentrations with fewer side effects. It describes the new local cancer chemotherapy method that can revolutionize the management of tumour using the effective microdialysis procedure.

The authors present a case of endometrial adenocarcinoma after endometrial ablation, emphasizing the importance of close surveillance of these patients, patient selection and education. Even patients with none of the risk factors for endometrial cancer or contraindications to endometrial ablation should be checked carefully.

Objectives: Retrospective evaluation of the clinical behavior, treatment and prognosis in five cases of primary breast lymphoma., Methods: From 1999 to 2003, five patients with primary breast lymphoma were diagnosed in our department., Results: Primary breast lymphoma (PBL) was diagnosed in five patients, whose median age was 63.4 (41-79) years. In four out of five patients, a diagnosis of lymphoma was made after the evaluation of a palpable breast mass measuring 1.5 to 6 cm. All of them were classified as non-Hodgkin's B cell lymphomas and three of five cases were diffuse large cell lymphomas. All patients were submitted to chemotherapy; in only one patient was surgery performed., Conclusions: A relatively high rate of PBL was observed in our department compared with other oncology centers. Beyond its scarce appearance, PBL is very difficult to distinguish from primary breast carcinoma. Histology remains the major diagnostic tool.

We present a case of a 53-year-old woman who developed an endometrioid adenocarcinoma six years after total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), who was on estrogenic-only hormone replacement therapy (HRT).

By means of a questionnaire, sent to the Portuguese hospitals which diagnose and treat most female patients with breast cancer, it was intended to assess the situation regarding the diagnosis of carcinoma in situ and early breast cancer (T1 or T2, N0 or N1), as well as their evolution between 1985 and 2000. The hospital participation rate was 65% and a sample of 865 patients was collected, distributed in the years 1985, 1990, 1995 and 2000. It was found that the presentation form of breast cancer in 1985 was of palpable tumour in 87% of the cases, whereas in 2000 this situation only corresponded to 54% of the patients, being most of the remaining patients diagnosed by imaging without palpable tumour. In 94% of the patients, the first diagnostic investigation was mammography, associated or not to echography, and the second most frequent investigation was fine-needle aspiration biopsy. The time evolution of the tumour size showed an increasingly earlier diagnosis. Invasive tumours not more than 1 cm represented 13.2% in 1985 and 20.3% in 2000. On the other hand, breast cancers more than 2 cm and not more than 5 cm decreased from 67.2% in 1985 to 40% in 2000. When oncology centres and some large university hospitals (Group A) were compared to the other hospitals (Group B), there were no significant differences between the diagnostic methods, although the sequence of diagnostic methods was different in the hospitals in Group A versus those in Group B. It was observed that in more differentiated hospitals the diagnosis was achieved increasingly earlier along the studied periods, and this situation did not occur in the other hospitals.

By means of a questionnaire sent to Portuguese hospitals which diagnose and treat most female patients with breast cancer, it was intended to assess the situation regarding the treatment of carcinoma in situ and early breast cancer (T1 or T2, N0 or N1), as well as their evolution between 1985 and 2000. The hospital participation rate was 65% and a sample of 865 patients was collected, distributed by the years 1985, 1990, 1995 and 2000. It was observed that, in terms of surgery, there was an increase in conservative surgery, which was over 40% in 2000, as well as an increase in the average of excised axillary lymph nodes. Progress in the surgical approach was similar both in cancer centres and in large and university hospitals, when compared with the other surveyed hospitals. Also, no differences between these two hospital groups in disease-free survival and overall survival were found. Postoperative radiotherapy was employed in more than 90% of the patients submitted to conservative surgery and adjuvant chemotherapy was used in 39% of all the patients, while tamoxifen as adjuvant treatment was used in 58% of the patients.

Purpose: The aim of this study was to evaluate the diagnostic ability of ultrasound and color Doppler in axillary lymph node metastases of patients with breast cancer., Material and Methods: A prospective study including 55 patients with primitive, invasive, node negative breast cancer who underwent preoperative axillary ultrasound and color Doppler. Doppler and morphologic ultrasound criteria were applied to the identification of axillary lymph node metastases., Results: The imagery study of all 55 patients identified a total of 141 nodes; 44 were considered to be positive according to established criteria. The histological examination of the axillary dissection revealed a total of 989 nodes; 77 out of 989 presented metastases; all invaded nodes belonged to 21 patients. The previous imagiologic study was positive for axillary lymph node metastases in 15 out of these 21 patients. A sensitivity of 71.4%, a specificity of 71.4%, a negative predictive value of 80.6% and a positive predictive value of 60.0% were achieved., Conclusion: The imagery study of the axillary region through ultrasound and color Doppler might be useful in assessing axillary lymph node metastases in patients with breast cancer.

Breast cysts can be separated into two types: Type I cyst with a lining epithelium which shows apocrine metaplasia, and Type II cyst with an epithelium which is markedly attenuated or absent. The risk of subsequent breast cancer among patients with Type I cysts can be up to 4. The standard treatment is fine needle aspiration, but 20% of the cysts recur. Pharmacological treatment has been tried, which reduces size and volume, but has side-effects and a high recurrence rate post-treatment occurs. The objectives of this prospective study were to sclerose the cyst, induce its regression and prevent or reduce recurrence rate, with the administration of a sclerosing solution (Sclerovein) within the cyst post-aspiration. Fifty-seven patients were followed in the study, 37 with Type I cysts and 20 with Type II cysts. At the end of six months all patients with Type II cysts had no detectable cyst. On the other hand, two patients still had a residual Type I cyst. At the end of three years our recurrence rate appears to be less than 2%, with one patient with a possible recurrence. No significant side-effects were observed. The use of Sclerovein is a simple and safe alternative in the treatment of recurring cysts.

Objective: To investigate the clinical activity and toxicity of a combination chemotherapy consisting of cyclophosphamide (C), adriamycin (A) and cisplatin (P) for patients with primary adenocarcinoma of the Fallopian tube having FIGO stage III-IV disease., Methods: The CAP-regimen consisted of cyclophosphamide 600 mg/m2, adriamycin 45 mg/m2, and cisplatin 50 mg/m2 administered intravenously on day one every 28 days., Results: Twenty-four eligible patients with histologically-confirmed Fallopian tube adenocarcinoma were entered in the trial. Fourteen patients had FIGO stage III, and ten had stage IV disease. The median number of CAP cycles was six. Ten patients had a complete and six had a partial response (response rate: 67%, 95% confidence limits: 45-84%). WHO grade III-IV side-effects included haematological toxicity, nausea/vomiting and alopecia. Furthermore, mild signs of cisplatin-related peripheral neurotoxicity were observed. At a median follow-up of 40 months, nine patients were alive and 15 had died due to malignant disease. The median time to progression was 13 months for all patients. The median overall survival was 24 months and the 1-, 3- and 5-year survival and their 95% confidence limits were 73% (54-92%), 25% (4-46%) and 19% (0-38%), respectively., Conclusion: The present data confirm the therapeutic activity of the CAP-regimen in primary Fallopian tube adenocarcinoma. The response rate is moderate and the toxicity profile is acceptable.

The clinical, transvaginal sonography and colour flow mapping of one patient with placental site trophoblastic tumour is presented. Colour Doppler documented a marked increase in uterine vascularity, characterised by low diastolic flow suggestive of low resistance blood flow, without regression after completion of apparently successful chemotherapy, when negative beta-hCG plasma levels were obtained. Surgical treatment was based upon our experience with colour Doppler assessment of gestational trophoblastic tumours and a review of the literature. This case suggests that TV-CDS, performed serially, is very useful in monitoring patients during chemotherapy and in detecting residual tumour, and should greatly increase the accurancy of diagnosis of PSTT.

At the end of 1991 an enquiry was sent to 40 doctors recognized as experts in Gynaecological Oncology in the E.C. countries to establish the situation of this sub or superspecialty and 32 (80%) answers were received. Inside the E.C. countries only the United Kingdom recognized the subspecialty of Gynaecological Oncology. Concerning the other 11 countries, except Denmark, their experts (invited to answer the questionnaire) consider it is necessary to individualize Gynaecological Oncology as a sub or a superspecialty. Before a training period of 24 or 36 months in Gynaecological Oncology, it is necessary to have the specialty of Obstetrics/Gynaecology. The training period must include 50% or 60% in diagnosis and surgical treatment, 10% in radiotherapy (only theoretical), 10% or 20% in medical oncology (theoretical and practical), 5% or 10% in oncological pathology, basic sciences and general aspects of cancer. Breast diseases, including breast cancer, must be a part of the training in Gynaecological Oncology and at the end of this period an evaluation test must be made. Lastly, the health authorities, of each country, are the best able to recognize the individualization of Gynaecological Oncology.

The possible advantage of adding cisplatin (P) to cyclophosphamide (C) + adriamycin (A) in the management of stages III and IV ovarian cancer of epithelial origin was tested in a trial in which 149 patients were randomized to receive, after initial surgery, either CAP (C = 600 mg/sqm, A = 45 mg/sqm, P = 50 mg/sqm) or CA (C = 600 mg/sqm, A = 45 mg/sqm) every 4 weeks for 6 to 12 cycles, at which time follow-up laparotomoy was to be performed in responding or clinically disease-free patients. Fifteen patients were not included in the final analysis and the remaining 134 patients were considered fully or partially evaluable and are used in analysis of response and survival. The complete and partial response rates were 45.6% in the CAP arm and 45.4% in the CA arm, but the CAP regimen is of special importance in patients with bulky disease. Median survival CAP = 24 m and CA = 24.2 m), time to progression and survival was found not significantly different when CAP and CA were compared. However, more patients in the CA regimen had no macroscopic disease left after surgery than in CAP regimen (11 versus 6) and more patients in the CAP arm dose reductions and schedule delays than in the CA arm (61.1% versus 38.2%).