Surgery RSS feed: Current Issue. Surgery is an authoritative, comprehensive collection of educational reviews that present the current knowledge and practice of surgery Surgery also indicates recent advances that improve the understanding of disease and the safe and effective treatment of patients It comprises concise and systematically updated contributions that are produced over a three-year cycle. Surgery is an excellent didactic tool to help consultant surgeons train their junior staff to become safe and competent surgeons.http://www.surgeryjournal.co.uk/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Surgery0263-9319283March 2010 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.surgeryjournal.co.uk/article/PIIS0263931910000359/abstract?rss=yesContents10.1016/S0263-9319(10)00035-9Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5OFCOFChttp://www.surgeryjournal.co.uk/article/PIIS0263931910000372/abstract?rss=yesEditorial Board10.1016/S0263-9319(10)00037-2Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5iihttp://www.surgeryjournal.co.uk/article/PIIS0263931909002816/abstract?rss=yesAbstract: Breast cancer is the commonest cancer affecting women. A family history of breast cancer increases a woman's lifetime risk of developing the disease. Most of the genetic risk is due to low-risk and moderate-risk susceptibility alleles rather than high-penetrance genes such as BRCA1 and BRCA2. Mutations in these two tumour suppressor genes only account for about 2% of all breast cancers. Female carriers of BRCA gene mutations have a high lifetime risk of developing breast and ovarian cancer and male carriers have an increased risk of prostate and breast cancer.Women with a significant family history of breast cancer should be referred to their local cancer genetics service for a formal cancer genetics risk assessment, discussion of risk management options such as surveillance and risk-reducing surgery and consideration of genetic testing. If a BRCA gene mutation is identified in a family, predictive testing can be offered to unaffected family members to clarify risks and help with risk management decisions.In the future, BRCA mutation carriers are likely to be offered different surgical management and/or first-line chemotherapeutic agents as treatment for cancer and one day chemoprevention agents may also be available.The genetics of breast cancerAlexandra J. Murray10.1016/j.mpsur.2009.11.005Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5Basic science103106http://www.surgeryjournal.co.uk/article/PIIS0263931909002804/abstract?rss=yesAbstract: Cellular pathology is a key component of the breast disease multidisciplinary team, representing the ‘gold standard’ in the diagnosis of breast cancer and providing information key to the determination of prognosis and management. Material may be obtained for pathological examination using fine needle aspiration (cytology) or core biopsy and surgical excision (histopathology). Common benign conditions include fibrocystic change, fibroadenomas, intraduct papillomas and radial scars. Carcinoma is by far the most common malignant tumour and may exist in in situ or invasive forms. The NHS Breast Screening Programme has resulted in the detection of less advanced breast cancers, for example in situ carcinoma and small, low-grade invasive carcinomas. A cellular pathology report for a breast excision specimen should include comments on the factors most pertinent to prognosis and management, such as tumour type, size, grade, and presence of vascular invasion and lymph node metastases. Assessment of adequacy of excision will inform decisions regarding further surgical excision and radiotherapy, while identification of lymph node metastases will prompt consideration for chemotherapy in suitable patients. Cellular pathology can also predict the likelihood of tumour response to hormonal manipulation and newer treatments such as trastuzumab.Breast pathologyAdrian C. Bateman10.1016/j.mpsur.2009.11.004Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5Basic science107113http://www.surgeryjournal.co.uk/article/PIIS0263931909002798/abstract?rss=yesAbstract: This contribution discusses the basic anatomy of the breast.Anatomy of the breastHarold Ellis10.1016/j.mpsur.2009.11.003Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5Basic science114116http://www.surgeryjournal.co.uk/article/PIIS0263931909002993/abstract?rss=yesAbstract: Radiology, along with clinical examination and the pathological results, is a fundamental aspect of the triple assessment of patients with breast disease, particularly those with breast cancer. In addition to long established imaging techniques such as mammography and breast ultrasound in the symptomatic patient, there are now many developing technologies which assist in making and confirming the diagnosis (eg digital tomography, MRI) and in helping the surgeon and oncologist decide on the best treatment plan (eg positron emission tomography).In mammographic screening, small impalpable lesions are identified and assessed. The use of image guided biopsy optimizes preoperative diagnosis in these women. Confirmed screen detected cancers are frequently impalpable and may require preoperative marking by the radiologist (wire localization) to enable the surgeon to identify the lesion in the operating theatre.Sentinel node surgery in the axilla is enhanced by the use of scintimammography allowing identification of the first lymph nodes draining the breast hence minimizing subsequent surgical morbidity.MRI is important in evaluating patients with a high risk of breast cancer due to family history etc., where mammography may be inadequate and also in certain scenarios eg those patients with lobular cancers, as it is more able to accurately size the lesion and inform surgical planning.Imaging techniques in breast cancerGaurav Jyoti Bansal, Kate Gower Thomas10.1016/j.mpsur.2009.12.004Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5Breast117124http://www.surgeryjournal.co.uk/article/PIIS026393190900283X/abstract?rss=yesAbstract: The majority of lesions that occur in the breast are benign. Despite this they are a major cause of concern of anxiety and morbidity to patients. It is important to recognize symptoms and signs, to exclude malignancy and manage appropriately. Breast lumps, nipple discharge, mastalgia, breast infection and gynaecomastia will be reviewed.Management of benign diseases of the breastRhiannon Foulkes, Christopher A. Gateley10.1016/j.mpsur.2009.11.007Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5Breast125129http://www.surgeryjournal.co.uk/article/PIIS0263931909002774/abstract?rss=yesAbstract: Breast cancer is the commonest cancer in the United Kingdom. Its incidence is increasing and although mortality from the disease is decreasing it still accounts for over 10,000 deaths a year. All women referred with breast symptoms should undergo triple assessment with clinical examination, radiological imaging and a biopsy of any abnormality found. The treatment of patients with breast cancer should be multidisciplinary and all patients should be discussed and treatment plans formulated at regular multidisciplinary meetings. Patients with breast cancer are usually treated surgically and may have a range of surgical options open to them, although for the majority this will involve breast-conserving surgery or mastectomy. A lymph node staging procedure is also performed for invasive cancers to guide the use of adjuvant therapy and achieve loco-regional disease control. Unless there is preoperative evidence of involved axillary lymph nodes this should take the form of a sentinel lymph node biopsy. Throughout the course of treatment, patients should have access to dedicated breast care nurses to help explain treatment options further, answer questions, and allay any fears they may have.Management of breast cancer: basic principlesGary Osborn, Eifion Vaughan-Williams10.1016/j.mpsur.2009.11.001Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5Breast130134http://www.surgeryjournal.co.uk/article/PIIS0263931909002828/abstract?rss=yesAbstract: Despite important advances in medical treatment, surgery remains a fundamental part of the primary management of breast cancer. Surgeons have a significant input into the therapeutic planning of treatment under the aegis of the multidisciplinary team.Breast cancer management has seen an evolution from the radical extirpation of the previous century, involving loss of the breast, skin and underlying muscle, to current practice, which aims for local excision of the tumour whilst preserving much of the breast. Advancements in the techniques of sentinel node biopsy have reduced formal extensive axillary staging surgery to a minimally invasive procedure.Breast reconstruction has become more common and today's surgeons and patients have a wide range of both alloplastic and autologous techniques from which to choose. Plastic surgery techniques have recently been used at the time of onco-logical tumour excision to allow wider resection margins and improved aesthetic outcomes, thus allowing more women to safely avoid a mastectomy. This article provides a résumé of the current state-of-the art surgical techniques in breast cancer.Surgical techniques in breast cancerMiles G. Berry, Kelvin F. Gomez10.1016/j.mpsur.2009.11.006Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5Breast135139http://www.surgeryjournal.co.uk/article/PIIS0263931909002786/abstract?rss=yesAbstract: Adjuvant therapy for breast cancer aims to reduce the risk of recurrence and improve survival following primary surgical treatment. There have been major new developments in all aspects of treatment over recent years contributing to the consistent fall in breast cancer mortality. Systemic adjuvant therapies such as chemotherapy, hormonal therapy and biological therapy (trastuzumab) reduce the risk of the patient developing distant metastases and improve survival. Radiotherapy is given to reduce the risk of local recurrence. The choice of adjuvant therapies is complex and each patient is discussed in a multidisciplinary meeting. Treatment is individualized and takes into account the biological characteristics of the cancer and patient-related factors, such as age and other co-morbidities.Adjuvant treatment for breast cancerHelen Passant, Annabel Borley10.1016/j.mpsur.2009.11.002Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5Breast140143http://www.surgeryjournal.co.uk/article/PIIS0263931909002981/abstract?rss=yesAbstract: Breast cancer is a major health problem worldwide with over one million new cases diagnosed each year. The aim of treatment is to achieve good loco-regional control, provide appropriate adjuvant therapy and treat potential micro-metastasis. Good loco-regional control is essential to minimize local recurrence rates with histological clear margin being the most important factor. Several prognostic factors can be used to guide suitable adjuvant therapy. The most important is hormone sensitivity and the use of hormone manipulation has improved both recurrence rates and overall survival. Early detection with breast screening and better treatment options have improved outcome, but still 35–40% of patients will eventually present with metastatic disease. Metastatic disease is incurable, but several therapies have been shown to maintain a good quality of life whilst prolonging survival. A multidisciplinary team approach is essential to obtain the diagnosis and plan the appropriate treatment. The diagnosis of metastatic disease brings distress to patients and their relatives and support should be available from palliative care teams.Metastatic disease of the breast and local recurrence of breast cancerEleri L. Davies, Helen M. Sweetland10.1016/j.mpsur.2009.12.003Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5Breast144147http://www.surgeryjournal.co.uk/article/PIIS026393190900297X/abstract?rss=yesFor questions 1–4, select the statements which are true and which are false. The correct answers are given below. When considering breast pathology:Test yourself: MCQ and extended matchingMichael G. Wyatt10.1016/j.mpsur.2009.12.002Surgery 28, 3 (2010)2010-03-01Surgery2010-03-01283S0263-9319(10)X0003-5Test yourself148149