A rectal metastasis of an unknown lobular breast carcinoma and its management.

Breast cancer is the most common cancer in women but gastro- intestinal metastases of breast cancer are rare. They can occur years after the diagnosis or at the diagnosis of breast cancer. We report the case of a patient complaining of dyschesia, tenesmus and anal incontinence leading to the discovery of a rectal metastasis of an unknown breast neoplasia. Given the oligo-metastatic condition, multidisciplinary and aggressive management was the chosen therapy.

Effect of cavity margin shavings to ensure completeness of excision on local recurrence rates following breast conserving surgery.

AIMS: The presence of residual disease at the excision margin after breast conserving surgery is the most important risk factor for local recurrence. One method for assessing tumour margin involvement is to take shavings from the wall of the resulting cavity following wide excision of the lesion. METHODS: We have reviewed our experience of shaving the margin of the cavity as our method to ensure completeness of excision. RESULTS: Of 351 patients treated with breast conservation 61 patients had residual disease in the cavity margin biopsies. Younger age, axillary lymph node status, multi-focal tumours and high grade tumours were significantly correlated with margin involvement. In patients who had clear margins eight patients (2.8%) had developed a local recurrence at follow-up of 55 months (25-89 months). CONCLUSIONS: In our hands the use of cavity margin shavings allows us to achieve an acceptable rate of local control.

The role of lymph node sampling and radiotherapy in the management of the axilla in early breast cancer.

Management of the axilla in early breast cancer is an issue of ongoing debate. We reviewed our experience in 312 patients who underwent axillary lymph node sampling between 1994 and 1998, of whom 81 patients (24%) had axillary lymph node metastasis. There have been two axillary recurrences, one associated with local recurrence to the breast and one presenting with distant metastasis. There were no patients with isolated axillary disease as their only site of recurrence and no axillary failures in the node-positive group treated with axillary sampling and radiotherapy. Axillary lymph node sampling effectively stages the axilla. This can safely be followed by radiotherapy to the axilla in case of lymph node metastasis. Axillary lymph node sampling forms a sound basis to develop new techniques, such as sentinel lymph node biopsy currently investigated by ongoing trials.