Bianca Gibelli

Timing of breast cancer surgery in relation to the menstrual cycle: an update of developments

It is well-established that hormones have multiple effects on breast cancer. Some, but not all studies indicate that the phase of the menstrual cycle (and hence hormonal status) at the time of breast surgery may influence survival. In this paper we review the literature in this area, explore how it is possible that such an association may occur, and note that randomised studies which unambiguously determined the phase of the cycle at the time of the operation are lacking. We go on to describe an ongoing self-randomised trial designed to address this problem and present preliminary results which show that only about 75% of the women ovulated during the cycle in which the operation took place, and that the established prognostic factor Ki-67 varied with the phase of the cycle in women who ovulated. It is too early to assess the significance of this finding.

Surgical management of thyroid cancer.

Thyroid cancer is the most common endocrine neoplasm; however, it only accounts for less than 1% of all human malignances. Thyroid cancers are divided into well differentiated and non-well differentiated cancers, according to their histology and behavior. The surgical management options of well-differentiated thyroid cancer include total or near-total thyroidectomy, subtotal thyroidectomy and lobectomy plus isthmusectomy. The extent of surgery for thyroid cancer continues to be an area of controversy. Complications associated with thyroid surgery are directly proportional to the extent of thyroidectomy and inversely proportional to the experience of the operating surgeon. They occur less frequently with good surgical technique and better understanding of surgical anatomy, and include wound healing and infections (seroma, hematoma and wound infection), nerve injury, hypoparathyroidism, hypothyroidism, postoperative hemorrhage and respiratory obstruction.

Predictive Markers of Response to Everolimus and Sunitinib in Neuroendocrine Tumors

Neuroendocrine tumors (NETs) represent a large and heterogeneous group of malignancies with various biological and clinical characteristics, depending on the site of origin and the grade of tumor proliferation. In NETs, as in other cancer types, molecularly targeted therapies have radically changed the therapeutic landscape. Recently two targeted agents, the mammalian target of rapamycin inhibitor everolimus and the tyrosine kinase inhibitor sunitinib, have both demonstrated significantly prolonged progression free survival in patients with advanced pancreatic NETs. Despite these important therapeutic developments, there are still significant limitations to the use of these agents due to the lack of accurate biomarkers for predicting tumor response and efficacy of therapy. In this review, we provide an overview of the current clinical data for the evaluation of predictive factors of response to/efficacy of everolimus and sunitinib in advanced pancreatic NETs. Surrogate indicators discussed include circulating and tissue markers, as well as non-invasive imaging techniques.

Role of hemithyroidectomy in differentiated thyroid cancer.

Purpose of reviewThe incidence of differentiated thyroid cancer (DTC), especially among small tumors, is increasing worldwide, despite the fact that the mortality rate from thyroid cancer remains stable. Total thyroidectomy with or without radioiodine therapy is actually the standard treatment. In the last 2 decades, several studies have shown that lobectomy could be an alternative to total thyroidectomy in low-risk DTC without compromising overall survival. The aim of this article was to assess the role of conservative surgery (hemithyroidectomy) in DTC reviewing the literature data. Recent findingsRecent advances in diagnostic techniques allow treatment to be tailored to patients’ needs. The latest consensus guidelines suggest that patients with high-risk tumors should undergo total thyroidectomy, whereas patients with small, low-risk, node-negative DTC may be candidates for conservative surgery. Careful risk evaluation and stratification makes it possible to individualize treatment, avoid overtreatment and guarantee a good long-term prognosis with low recurrence risk. Excellent prognosis of DTC would require large sample sizes and long-term follow-up for prospective trials comparing the outcomes of total thyroidectomy vs. lobectomy; however, there are several remarkable retrospective studies. SummaryBased on current clinical data, a conservative surgery might be appropriate for patients with low-risk DTC.

Right pelvic mass in a patient with a radically resected carcinoid of the appendix

A 22-year-old male patient with a radiologically detected right pelvic mass presented without any symptoms. Two years before he underwent appendectomy due to acute appendicitis elsewhere, and a carcinoid was incidentally diagnosed. Our revised histological report confirmed a conventional carcinoid of the appendix, excluding a goblet cell carcinoid (adenocarcinoid). The tumour infiltrated the whole wall thickness without serosal invasion; margins were negative; the macroscopic size of the tumour had been omitted in the original pathology report. Immunohistochemical chromogranin-A, neuron specific enolase, and synaptophysin were positive. Follow-up was negative over the two subsequent …

New therapeutic approaches in head and neck oncology. Can surgeons do more

Once surgeons were considered as magicians with golden hands able to cure terrible diseases, or as quacks, perhaps with a particular skill in cutting and sewing. Today their role is much more realistically defined and in addition to the cutting and sewing, they are intimately involved in therapeutic decision making. This is particularly the case in head and neck oncology. We shall illustrate this by describing our experience with some new therapeutic approaches to the treatment of head and neck malignancies.