Short term recurrence and survival rate of breast cancer patients post surgical treatment; north borneo experience.

Introduction: Breast cancer is the most common cancer among women and one of the major causes of mortality and morbidity worldwide. The aim of this study is to determine two-year cumulative recurrence rates and survival rates and their influential factors among women with breast cancer after surgical treatment. Methods: The breast cancer registry with focus on patient's outcome after treatment was retrospectively review for relevant data. The study was started on 2019. All breast cancer patients who underwent surgical procedure between 2016 and 2019 were identified and recruited in this study and was follow up for two year. We performed Kaplan Meier method to determine 2-year recurrence rates and survival rates and compared unadjusted survival statistics using Log-rank test between baseline variables and outcomes. Result: From 2016 to 2019, a total of 482 breast cancer patients underwent surgical procedure. The overall observed 2-year recurrence rate among breast cancer patients after surgical treatment was 11.8% (95%CI:8.5,16.4) while for the survival rate was 94.8% (95% CI:91.8,96.7). Log rank test showed that lymph node involvement (p < 0.001) and high lymph node ratio (p < 0.001) were associated with higher cumulative recurrence rates. Meanwhile, stage 4 breast cancer (p = 0.001), higher grade tumour (p = 0.011), larger tumour size (>5 cm) (P = 0.005) and type of tumour (p = 0.018) were demonstrated to have lower survival rates. Conclusion: Recurrence rate were significant predictor among patient with lymph node involvement and higher lymph node ratio, while stages of tumour, tumour grade, size of tumour and type of tumour were all highly significant predictor for survival rate. Therefore, the aim for early diagnosis and management of breast cancer is crucial in improving the treatment outcome.

A rare case of breast squamous cell carcinoma and literature review.

Introduction: Breast Squamous Cell Carcinoma (SCC) is quite a rare tumour that the features portray squamous cell differentiation. Presentation of case: We report a case of a 56-year-old female presented left breast lump that had been increasing in size for a 7 months duration associated with nipple retraction for one week. Ultrasound breast was done and revealed a large mixed echo density mass lesion in the left breast at 12 o'clock, 2cm from the nipple and measuring 4.2 × 3.4cm along with an enlarged node in the left axilla with thickened cortex and as for Mammogram revealed suspicious left breast lesion with enlarged axillary nodes, BIRADS 5. Histopathology from the left breast showed Invasive carcinoma with squamous differentiation, B5b, ER: negative, PR: Positive, Her2: Negative, CK5/6: Positive. Then a staging CECT Thorax, Abdomen and Pelvis was done which showed enhancing mass lesion seen at the left breast (4.1 × 4.3cm) with areas of necrosis within and multiple enlarged left axillary nodes seen with no local infiltration to the muscle or skin as well as no distant metastases. Patient underwent Neoadjuvant chemotherapy for 6 cycles and completed them. Discussion: This case highlights the crucial need of early detection along with the obstacles faced in reaching an early diagnosis tagged with the lack of guideline to manage this patient. Conclusion: In the management of Breast Squamous Cell Carcinoma, the standard treatment would be to go for mastectomy with axillary clearance. However, the prognosis usually depends on the tumour size and the advance age of the patient as described in this article.

The role of debridement in wound bed preparation in chronic wound: A narrative review.

OBJECTIVE: To provide an overview of the types of wound debridement and update the available scientific consensus on the effect of wound debridement. METHODS: The articles were searched through CINAHL, PubMed, Cochrane Library, and Medline database for relevant articles on all types of wound debridement. Articles included were all systematic review on the effectiveness of wound debridement-related outcome, published within the year 2017 until Aug 2021, in English. RESULTS: A total of seven scientific articles had been selected for review out of 318 screened. The authors reviewed a total of 318 titles and abstracts related to wound debridement effectiveness. Seven articles that were selected were narratively reviewed by two authors. The findings of the review were organized into autolytic, enzymatic, sharp, surgical, biological, and mechanical debridement methods and includes the advantages and disadvantages of each. The author further explored on the role of wound debridement according to wound bed preparation model. Articles were synthesized and organized based on the authors, year, total studies included in the systematic review, study range of year, total sample, debridement method, wound types, and findings. CONCLUSION: Maggot debridement therapy showed a consistent finding in terms of effectiveness in debriding chronic wounds. The newer debridement method includes hydro-surgery, low-frequency ultrasonic and enzymatic collagenase debridement were getting more attention due to faster wound bed preparation and less painful. However, these newer method of debridements showed inconclusive findings and the patient safety was not clearly defined. A higher level of review is warranted in the future study.

A case of rectal cancers in teenager: A conundrum of genetics and clinical medicine.

INTRODUCTION: Signet cell carcinoma (SRCC)of the rectum is a rare subtype of the rectum cancer which accounts for only 0.8% of colorectal cancer in adolescents and young adults (AYAs) which spread aggressively to other organs and peritoneum. CASE PRESENTATION: We present a case of 15-year-old boy from rural area, presented with chronic diarrhea and per rectal bleeding for 3 months. The diagnosis was determined by colonoscope which revealed a fungating mass identified at 10cm from anal verge. Histological examination confirmed diagnosis of signet ring cell adenocarcinoma. CT scan of the abdomen showed thickening involving the recto-sigmoid colon and rectal mass, without evidence of distant metastatic disease. The patient's carcinoembryonic antigen level was within the normal range. He underwent a colostomy and was subjected to neoadjuvant CCRT and surgery. DISCUSSION: This CASE highlights the importance and challenges in achieving early diagnosis and surgical intervention of signet-ring cell carcinoma in adolescents, as most cases are detected at an advanced stage coupled with the scarcity of information on these rarer subtypes which leads to a poor prognosis. CONCLUSION: In managing Signet cell carcinoma of the colorectal, physician have to know that it has a poor prognosis in patients of any age. However, in young teenagers delayed diagnosis and treatment option are narrowed to palliative management. Genetic profiling of family members and similar environment population may be a key to early detection.