Author: Rodrigo Arrangoiz MS, MD, FACS, FSSO

#Arrangoiz #BreastCancer #BreastSurgeon #CancerSurgeon #SurgicalOncologist

• Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:
  • Es experto en el manejo del cáncer de mama.

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

👉A BRCA gene mutation is the most commonly identified clinically actionable result of any gene test.

👉A family history of a combination of early-onset gastric cancer and infiltrating lobular carcinoma of the breast should raise concern for hereditary diffuse gastric cancer syndrome.

👉This syndrome is caused by a mutation in the CDH1 (E-cadherin) gene.

👉Lifetime risk for signet cell diffuse gastric cancer is estimated at 70% and infiltrating lobular carcinoma at 40%.

👉Prophylactic gastrectomy is recommended for CDH1 mutation carriers with a family history of diffuse gastric cancer.

👉CDH1-mutated families with multiple (and often bilateral) infiltrating lobular cancers, but no gastric cancers, are increasingly recognized.

👉Enhanced surveillance with breast magnetic resonance imaging is recommended for women with CDH1 mutations.

REFERENCES

1. Corso G, Figueiredo J, Biffi R, et al. E-cadherin germline mutation carriers: clinical management and genetic implications. Cancer Metastasis Rev. 2014;33:1081-1094.
2. Kurian AW, Hare EE, Mills MA, et al. Clinical evaluation of a multiple-gene sequencing panel for hereditary cancer risk assessment. J Clin Oncol. 2014;32:2001-2009.
3. Daly M, Pilarski R, Axilbund, et al. Genetic/familial high-risk assessment: breast and ovarian, version 2.2015. J Natl Compr Canc Netw. 2016;14:153-162.
4. Petridis C, Shinomiya I, Kohut K, et al. Germline CDH1 mutations in bilateral lobular carcinoma in situ. Br J Cancer. 2014;110:1053-1057.
5. Pharoah PD, Guilford P, Caldas C, et al. Incidence of gastric cancer and breast cancer in CDH1 (E-cadherin) mutation carriers from hereditary diffuse gastric cancer families. Gastroenterology. 2001;121:1348-1353.
6. Tung N, Battelli C, Allen B, et al. Frequency of mutations in individuals with breast cancer referred for BRCA1 and BRCA2 testing using next-generation sequencing with a 25-gene panel. Cancer. 2015;121:25-33.

#Arrangoiz #BreastCancer #BreastSurgeon #CancerSurgeon

👉Cowden syndrome is caused by mutation in the PTEN gene.

👉It is one of the few breast cancer predisposition syndromes with a clinically recognizable phenotype. (Peutz-Jeghers syndrome is another.)

👉Clinical features include extreme macrocephaly (head circumference >60 cm), multiple facial tricholemmomas (small skin-colored papules) and a family history of thyroid cancer before age 20 years or endometrial cancer before age 30 years.

👉It is a very rare syndrome, with only six cases identified among 2079 recently reported multigene panel tests.

👉It is clinically important, however, because the lifetime breast cancer risk may be as high as 85% and affected individuals have a very high risk of endometrial and thyroid cancer as well as a moderately increased risk of colorectal cancer and melanoma.

👉Current American Cancer Society guidelines support enhanced surveillance with annual mammogram and magnetic resonance imaging for women with PTEN mutations, though the timing of when this should begin is vague.

👉Data by Riegert-Johnson et al. suggest screening should commence around age 35 years as this is the time that the risk of breast cancer starts to increase.

👉Even after a cancer diagnosis, individuals with Cowden syndrome remain at increased risk of a variety of second primary cancers, especially breast, thyroid, and endometrial.

REFERENCES

1. LaDuca H, Stuenkel AJ, Dolinsky JS, et al. Utilization of multigene panels in hereditary cancer predisposition testing: analysis of more than 2,000 patients. Genet Med. 2014;16:830-837.
2. Ngeow J, Stanuch K, Mester JL, et al. Second malignant neoplasms in patients with Cowden syndrome with underlying germline PTEN mutations. J Clin Oncol. 2014;32:1818-1824.
3. Riegert-Johnson DL, Gleeson FC, Roberts M, et al. Cancer and Lhermitte-Duclos disease are common in Cowden syndrome patients. Hered Cancer Clin Pract. 2010;8:6.
4. Tan MH, Mester JL, Ngeow J, et al. Lifetime cancer risks in individuals with germline PTEN mutations. Clin Cancer Res. 2012;18:400-407.

#Arrangoiz #BreastSurgeon

• Peutz-Jeghers syndrome is a clinical diagnosis and most patients with the syndrome rarely undergo genetic testing:
  • Instead they are managed clinically
• Affected individuals are recognized by:
  • Pigmented mucocutaneous lesions

• • Hamartomatous gastrointestinal polyps
• STK11 mutations are very rare in hereditary breast cancer families:
  • But de novo mutations can occur:
    • So some patients with Peutz-Jeghers syndrome will have no family history of breast cancer
    • Lifetime cancer risk is estimated at 67% to 85%:
      • With the greatest risk attributable to:
        • Gastrointestinal cancer
        • Pancreatic cancer
    • Lifetime breast cancer risk is estimated at 24% to 32%:
      • Which meets enhanced surveillance guidelines:
        • Breast self-examination:
          • Begin at 18 years of age:
            • Once a month
        • Clinical breast exam:
          • Begin at 18 years of age:
            • Every six months once the diagnosis is made
        • Breast MRI of digital mammography:
          • Begin at 25 years of age:
            • Once a year
  • STK11 is part of a protein complex that senses energy levels in the cell:
    • Enforcing quiescence when energy is scarce:
      • It is not involved in DNA double strand break repair

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

• El entrenamiento y el volumen del cirujano son factores críticos para obtener el mejor resultado con las menores complicaciones en la cirugía de tiroides.
•  

• Ashok Shaha MD, FACS cirujano de cabeza y cuello de Memorial Sloan Kettering Cancer Center experto en tiroides durante su plática inaugural de la American Head and Neck Society nos habla de quien debe estar realizando cirugía de tiroides.

  https://www.youtube.com/watch?v=dVHc6HZdn70

👉Rodrigo Arrangoiz MS, MD, FACS cirujano de tumores de cabeza y cuello / cirujanos de tiroides y cirugía endocrina de Sociedad Quirúrgica S.C. cumple con los requisitos determinados por el Dr. Saha para realizar cirugía de tiroides.

Su entrenamiento fue el siguiente:

• Cirugia general y gastrointestinal: • Michigan State University: • 2004 al 2010• Cirugia oncológica / tumores de cabeza y cuello / cirugia endocrina: • Fox Chase Cancer Center (Filadelfia): • 2010 al 2012• Maestria en ciencias (Clinical research for healthprofessionals): • Drexel University (Filadelfia): • 2010 al 2012• Cirugia de tumores de cabeza y cuello / cirugiaendocrina • IFHNOS / Memorial Sloan Kettering Cancer Center: • 2014 al 2016

http://www.sociedadquirurgica.comhttp://www.hiperparatiroidismo.info

http://www.cirugiatiroides.com

#Arrangoiz#CirugiadeTumoresdeCabezayCuello#CirugiaEndocrina#CirugiaOncologica#HeadandNeckSurgery#EndocrineSurgery

• According to the 5th edition of the ACR BI-RADS® Atlas, visual estimation of breast fibroglandular composition should be defined by one of the following four descriptions:
  • Almost entirely fatty
  • Scattered areas of fibroglandular density
  • Heterogeneously dense
  • Extremely dense

👉The U.S. population distribution of breast density is as follows:

• 10% almost entirely fatty
• 40% scattered areas of fibroglandular density
• 40% heterogeneously dense
• 10% extremely dense

👉Women with heterogeneously dense or extremely dense breasts are considered to have “dense breasts.”

👉Sensitivity of mammography decreases as breast density increases.

👉Increased breast density not only has a masking effect which may obscure masses, but also serves as an independent risk factor for breast cancer.

👉It has been reported that the increased risk may be as much as 4- to 6-fold.

👉Estimates this high are obtained when comparing women with dense breasts to those with fatty replaced breasts.

👉Since only 10% of women have fatty replaced breasts, it makes more sense to make the comparison with women of average breast density.

👉The relative risk for cancer in women with heterogeneously dense breasts compared with the average woman is approximately 1.2, and the relative risk for cancer in women with extremely dense breasts compared with the average woman is approximately 2.1.

👉In general, breast density decreases with increasing age and increasing body mass index, so it is not the absolute density that is a risk factor, but the difference in the observed and expected density—the so called “residual density.”

👉Several states have recently passed legislation requiring women with dense breasts to be specifically informed of their breast density.

👉Women are informed of the limitations of mammography in dense breasts and are instructed to discuss further management with their physicians.

👉An informed decision regarding potential use of supplemental screening options, in addition to mammography, should be discussed, factoring in elements such as overall breast cancer risk as well as the positives and negatives of additional screening.

👉Despite a lack of consensus, algorithms for screening women with dense breasts are available and often emphasize breast cancer risk.

👉Women with heterogeneously dense breasts (or extremely dense breasts) with no additional risk factors require only annual mammography.

👉The decision to pursue additional imaging in patients with elevated risk should supplement but never entirely replace mammography.

👉Biannual screening mammography is not considered appropriate, and there is no indication for thermography.

👉Use of screening ultrasound or MRI are appropriate for women at increased risk, but the benefit remains to be determined in women of average risk for breast cancer.

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

👉A portacath or “port” provides intravenous access to a large vein in the body to deliver chemotherapy, blood products, antibiotics, and IV fluids.

👉Large veins are better for rapid infusion of high volumes or because some drugs, like cancer chemotherapies, can cause severe irritation if delivered to the smaller veins of the arms or legs or could lead to a chemical burn if they were to leak into surrounding tissues.

👉The portal refers to a reservoir implanted under the skin, usually in the upper chest below the collarbone.

👉To access the port, a narrow needle with is inserted into the port where the bump is, either with or without numbing the skin beforehand.

👉Click bio link for complete patient information about portacaths! https://ja.ma/32a0LfK

#Arrangoiz #Teacher #CancerSurgeon #Cancer #FightCancer #SurgicalOncologist

#Arrangoiz #Teacher #Surgeon