28.05.2014

Natural breast cancer treatment options face

ABSTRACT: Sentinel lymph node (SLN) biopsy is a rapidly emerging treatment option for patients with early-stage invasive breast cancer and a clinically negative axilla. Axillary node dissection has long been a mainstay in the treatment of breast cancer: It provides precise staging and prognostication, prevents local recurrence in the axilla, and, in patients with positive nodes, may modestly enhance survival[1]—all important goals in a disease that responds to both local and systemic therapy and has a long natural history. Within the last 2 years, sentinel lymph node (SLN) biopsy (Figure 1) has rapidly emerged as the most exciting development in the surgical treatment of invasive breast cancer since the advent of breast conservation. After a brief description of the history of SLN biopsy, this review will discuss the feasibility and accuracy of the procedure, as well as some of the technical and clinical issues raised by this new technology. Most physicians are familiar with Sappey’s classic studies of the lymphatic anatomy of the chest wall,[2] based on mercurial injection of cadaver specimens. The underlying simplicity of the lymphatic anatomy of the breast was emphasized in subsequent studies using direct lymphangiography.[5,6] As pointed out by Borgstein and Meijer[7] in a recent comprehensive overview of the subject, work by Kett et al[6] in 1970 identified a lymph node (which they called the “Sorgius node”) that received the initial drainage of contrast medium from the breast. The phrase “sentinel node” must be credited to Cabanas,[8] who, in 1977 described cannulation of the dorsal lymphatics of the penis as a means of identifying the first lymph node (“sentinel node”) draining penile carcinoma. In the 1980s, Morton and colleagues independently developed the sentinel node concept as an outgrowth of their work mapping the drainage patterns of cutaneous melanoma with lymphoscintigraphy. The use of SLN biopsy in breast cancer was first reported in 1993 by Krag et al,[11] who employed radiolocalization, and in 1994 by Giuliano et al,[12] who employed blue dye. Since these pioneering reports, 14 groups have published their results with SLN biopsy for breast cancer, validated in all cases by a concurrent axillary node dissection. Regardless of method, SLNs were identified by all of the investigators in a large majority of cases. Sentinel lymph node biopsy yielded an incorrect result in 2% of all patients (for an accuracy of 98%) and 5% of node-positive patients (for a sensitivity of 95%). As shown in Table 1, the SLN was the only site of nodal metastasis in 45% (range, 33% to 67%) of all node-positive cases, strongly supporting the SLN concept. Because the SLN technology is evolving rapidly, variation in technique is widespread, and anecdote rather than controlled observation has been the rule.
Localization of the SLN represents a new challenge for the specialty of nuclear medicine, with requirements quite different from those of solid organ imaging. Interstitial pressure, which must be elevated for lymphatic uptake of particles to occur, is related to both route (intradermal vs intramammary) and volume of injection: Lymphatic uptake of isotope may be greater with either a high-pressure intradermal injection or a high-volume intramammary injection.
One might assume that intramammary injection of isotope, as was done in the studies from America and Holland,[11,14-18,23-25] would most accurately emulate the lymphatic drainage of a breast cancer.
With isotope, as first described by Krag et al,[11] the surgeon uses a handheld gamma probe intraoperatively to find the axillary “hot spot(s)” corresponding to the SLN(s) and removes hot node(s) until the axillary background radiation count falls below a defined threshold level .
Early in the surgeon’s experience, SLN biopsy is best validated by the performance of a backup axillary dissection (as part of a formalized protocol) after removal of the SLN.
In our experience performing more than 800 SLN biopsies at Memorial Sloan-Kettering, we have found that failed SLN localizations diminish but do not altogether disappear with experience; the results of other investigators (Table 1) support this impression. The surgeon’s greatest concern in undertaking SLN biopsy is that the SLN will prove to be falsely negative.
No studies have specifically addressed the relative value of isotope and blue dye in finding the positive SLN.
Thus, an increasing number of investigators performing SLN biopsy for breast cancer have relied on serial sectioning of the SLN, with both H&E and IHC staining of each section.
Reverse transcriptase–polymerase chain reaction (RT-PCR) technology has the exciting potential to identify metastases even smaller than those found by IHC, but thus far has proven to be problematic in the study of SLNs from breast cancer patients. In addition, the level of expression at which a result is defined as positive or negative is somewhat arbitrary and allows considerable latitude in the interpretation of results. Tinea versicolor problem is a skin infection that is caused due to the infection of fungus on the skin. Apple cider vinegar is also not anti inflammatory in nature but also prevents the skin infection very effectively. Aloe vera gel provides relief from the skin discolouration problem and also prevents the redness on the skin. Tea tree oil is a very effective remedy to treat the problem of tinea versicolor completely. Turmeric is very beneficial for the health of the skin and the use of it provides relief from the skin discolouration and damage.
Garlic is anti fungal in nature and thus it is a very useful remedy to treat tinea versicolor infection. Coconut oil is used in getting relief from the problem of tinea versicolor very effectively. By using lavender one can get effective relief from all the symptoms of the problem and also the rich properties of lavender oil are very useful in treating the skin infection. Blepharitis can be classified into two forms, posterior blepharitis which causes inflammation inside the eyelids, and anterior blepharitis which causes inflammation near the base of the eyelids.
Individuals suffering from the condition would need to clean their eyes at regular intervals throughout the day to prevent the formation of crust on the eyelids.
Standing under a hot shower is known to be effective in treating both forms of blepharitis. Applying a drop or two of tea tree oil on the inflamed eyelids can effectively treat blepharitis and its symptoms. Applying some baby shampoo over the inflamed eyelids can effectively treat blepharitis in individuals. A few drops of castor oil added to the inflamed eyelids can effectively bring down the swelling, itching, irritation, burning sensation and pain associated with blepharitis.The best time to follow this remedy would be at night when a cotton bud can be used to gently apply the oil all over the eyelids and lashes. Placing a few slices of grated potato over the inflamed eyelids can effectively reduce the swelling caused by blepharitis, and provide immense relief from the pain and itching caused by the condition. Coconut oil is often recommended as a very effective home remedy for blepharitis, and is considered instrumental in reducing the pain and irritation caused by the condition.A cotton bud needs to be soaked in coconut oil and then placed directly above the inflamed eyelids for about 20 minutes.
In some cases, blepharitis can be caused due the presence of lice in the hair, eyebrows and eyelashes. Opting for over the counter NAC (N-Acetyl Cysteine) supplements can help treat blepharitis and its symptoms effectively.
Indicated for the adjuvant treatment of postmenopausal women with hormone receptor positive early breast cancer.


In the era of mammographic detection, SLN biopsy has the potential to eliminate axillary dissection for the enlarging cohort of breast cancer patients who are node-negative.
To date, no procedure has proven as effective as axillary lymph node dissection in accomplishing these goals.
It has the potential to identify those patients most likely to be helped by axillary dissection (ie, those with positive nodes) and to spare node-negative patients, who cannot benefit, from the morbidity of an operation. It will also attempt to answer a key question: Where will SLN biopsy ultimately fit into the treatment algorithm for breast cancer in the 21st century? The lymphatics of the chest wall and breast converge into a few main trunks, which, in turn, drain into relatively few nodes low in the axilla. He noted that the sentinel node was frequently the only positive node, and proposed that if the sentinel node were negative, a deep inguinal node dissection might be avoided. Their classic 1992 study[9] described the intradermal injection of blue dye into the melanoma site and the identification of a “blue node” in the regional nodal basin. In the study by Krag et al, isotope identified the SLN in 82% of 22 cases, with 100% accuracy.
Of the 14 groups, 7 used isotope localization,[13-19] 3 used blue dye,[20-22] and 4 used a combination of both methods.[23-26] Table 1 summarizes the results of all 1,564 reported cases.
The 66% success rate for blue dye in the initial 1994 report of Giuliano et al[12] may simply reflect the developmental stage of a new procedure; in this group’s more recent experience,[20] blue dye successfully identified the SLN in 93% of cases. Although nearly half of the series (7 of 16) reported an accuracy of 100%, these comprise only 23% of the total number of cases. Nevertheless, all of those who perform SLN biopsy would agree that it is a multidisciplinary procedure requiring close collaboration among nuclear medicine (for institutions using radiolocalization), surgery, and pathology. The behavior of injected radiocolloids is largely a function of particle size and interstitial pressure. Interestingly, in the two series from Milan,[13,16] lymphatic mapping based on a subdermal injection of isotope over the tumor site was equally successful and accurate in predicting axillary node status. It identifies anomalous patterns of lymphatic drainage, which, in turn, directly alter the surgical approach. Each failed localization will result in an axillary dissection that might not otherwise have been necessary. With blue dye, as described by Giuliano et al,[12] the surgeon identifies blue lymphatic vessels exiting the tail of the breast and traces them to a blue-stained SLN in the axilla, removing all blue nodes. The learning curve for this procedure varies from institution to institutions and surgeon to surgeon.
We advocate the combined use of isotope and blue dye for SLN biopsy (Figure 2): Although 80% of SLNs were found by both isotope and dye, 10% were found by isotope alone, and 10% by blue dye alone. However, our experience suggests that while most positive SLNs will be found by both isotope and blue dye, a small fraction (perhaps 10%) will be found by either isotope or blue dye alone.
The IHC technique uses antibodies to cytokeratin and, thus, identifies epithelial cells that are presumed to represent metastases from the breast (Figure 3).
First, since breast cancer has no unique marker (such as tyrosinase for melanoma), the analysis must depend on nonspecific epithelial cell products. Consumption of yogurt helps in improving the digestion and immunity of the body and prevents the infection. Not only this, Indian lilac is also very useful in relieving the symptoms of the problem like itching and inflammation. By the application of apple cider vinegar on your body you can get relief from the problems like itching. The oil is rich in anti inflammatory properties that relieve the skin from the symptoms of the problems. The rich anti inflammatory nature is also very effective in treating the problem of itching and inflammation on the skin caused due to the problem. Lemon has useful exfoliating properties that remove the skin symptoms like itching and inflammation. It has rich anti inflammatory properties and provides relief from the symptoms of the problem and also the anti fungal nature prevent the infection very effectively.
The condition usually arises when the oil glands located at the base of the eyelashes malfunction. Both cases, however, can be effectively treated at home with the help of certain home remedies. The best way to clean the eyes would be to use a warm towel to gently rub the inflamed eyelids.Doing so would effectively remove the crust formed on the lashes, and oil residues and scaly patches near the eyelids as well. Individuals with the condition would need to stand under a hot shower with his eyes closed (face turned upwards). A few drops of the oil can be applied to the eyes as well before bedtime in order to prevent the formation of crust. Placing potato slices on the eyelids can also get rid of the infection behind blepharitis (and it symptoms).Individuals with blepharitis can opt to grate a fresh potato and apply the pieces on the eyelids for about 20 minutes.
The remedy needs to be followed at regular intervals throughout the day (maybe 3-4 times every day) in order to prevent the symptoms from flaring up again.
In these cases, it is considered wise to get rid of the lice before treating the condition and its symptoms. These supplements contain an amino acid called cysteine which would stimulate the increased production of an antioxidant enzyme called glutathione in the body.
Using radioisotope, blue dye, or both methods, experienced surgeons can successfully localize SLNs in more than 90% of cases. Nevertheless, axillary dissection is a major operation, requires general anesthesia, and produces long-term morbidity in a small, but significant, minority of patients. Undoubtedly, sentinel lymph node biopsy will rapidly become a standard treatment option for all patients with early-stage breast cancer and will replace axillary dissection for many of these patients.
These studies formed the anatomic basis of the complete axillary dissection incorporated into radical mastectomy by Halsted in the 1890s.[3] The internal mammary nodes represent an alternative route of lymphatic drainage, but, as shown in the work of Turner-Warwick[4] and others, receive only a small fraction of the lymphatic flow of the breast. Among 237 node basins studied (with a standard node dissection performed in all cases), SLNs were identified in 82% of patients.
In the report of Giuliano et al, blue dye identified the SLN in 65% of 173 cases, with 96% accuracy.


Overall, radioisotope localization appears to find the SLN more frequently than does blue dye, and the combination of isotope plus dye appears to be superior to isotope localization alone in these pilot studies. No diagnostic test is perfect, and the accuracy of SLN biopsy is probably slightly less than 100%. This examination is probably less useful on a routine basis in breast cancer, where the primary focus is the axilla. Debate centers on which method is best to accomplish this objective: isotope, blue dye, or both? At present, it is impossible to specify exactly how many procedures should be done with validation before SLN biopsy can be performed as a “stand-alone” procedure.
Our experience suggests that about half of all falsely negative SLN biopsies will occur within the first 10 cases performed by each surgeon. Although others have achieved excellent results with a single modality (Table 1), the reliability of SLN biopsy in our hands would have been undermined by reliance on a single localization technique. Reanalysis of the “negative” SLNs in these 10 patients (with serial sections and IHC stains) demonstrated that 80% were, in fact, positive. Although no authors have reported the occurrence of a “falsely positive” SLN in breast cancer, benign rests of epithelial cells (typically melanocytes) in the subcapsular area of a lymph node may occasionally be mistaken for metastasis; we have encountered 1 such case in our first 600 SLN biopsies. As a result, there is no way to be certain that the amplified gene product obtained was expressed specifically by a tumor cell within the node.
Main factors that cause the infection to occur are improper hygiene, humidity, weak immunity etc.
Not only this, you can also get relief from the symptoms of the problem by applying fresh yogurt on your skin to get relief. Boil some leaves of Indian lilac in water and soak your body in water to treat the problem effectively.
It is therefore advisable to follow the application of apple cider vinegar on the skin regularly to treat tinea versicolor completely. Not only this, the oil is also rich in anti microbial nature and thus eliminates the organisms responsible for the skin infection.
You can also apply garlic oil directly on the skin to get relief from the skin symptoms caused due to the problem. Fill bath water and then add baking soda in it and soak your body to infuse the solution to get relief from the problem. Not only this, lemon is also acidic in nature and thus prevents the growth of fungus on the skin. The inner layers of the eyelids can also be cleansed by gently pulling back the eyelids and placing a warm towel in these areas for about 20 minutes. The warmth of the water would melt and wash away the crust formed on the lashes.It would also reduce the inflammation caused in the eyes. It would cause a stinging sensation for some time, but would effectively reduce the itching, irritation and swelling afterwards. A solution can be prepared by mixing a drop of baby shampoo in boiling water, and letting the resultant solution steep for about 30 minutes.A clean cotton bud can be inserted into the warm solution and then carefully rubbed against the eyelids (at the base of the eyelashes) to reduce the inflammation and remove the crust.
Following this remedy at least 2-3 times a day can effectively eradicate the infection and bring down the symptoms of the condition within a few days.
And that’s where petroleum jelly can be considered extremely useful. Applying some petroleum jelly on the eye lashes and along the base of the eyelids would suffocate the lice and kill them. The enzyme in turn, would help to loosen secretions, including the crusty secretions formed at the base of the eyelashes.Getting rid of these secretions would remove the blockages in the oil glands present in the eyelashes. Particles between 5 to 10 nm in size rapidly enter the lymphatics but spread into numerous nodes. Management of the 14% of patients who demonstrate internal mammary drainage[25] is a new, unresolved problem. Therefore you should apply aloe vera gel on the affected parts of the skin to get the benefits.
Rinsing the eyes with lukewarm water afterwards would wash away the dead lice.This can be followed by treating blepharitis using any of the remedies mentioned above. And that would in turn, effectively treat blepharitis and its symptoms (including pain and inflammation). Sentinel lymph node biopsy reliably predicts axillary node status in 98% of all patients and 95% of those who are node-positive. Sentinel lymph node localization depends on a small fraction of the injected isotope dose (perhaps 1%) migrating consistently to relatively few regional nodes, and optimal particle size is probably between 10 and 200 nm. The problems leads to the discolouration of the skin and invites symptoms like peeling skin, itching, scaling, skin flakes, redness etc. Following this remedy at least once every day can effectively treat blepharitis and prevent it from recurring as well (in case it is caused by lice infestation).
The operation is best learned under a formalized protocol in which a backup axillary dissection is performed to validate the technique during the surgeon’s early experience. It is very important to treat the problem with time in order to prevent the infection to spread to other parts of the body and here are the useful home remedies that provide effective relief and can treat the problem completely. Enhanced pathologic analysis, including serial sections and immunohistochemical (IHC) staining, is an essential element of the procedure. In experienced hands, SLN biopsy has less morbidity and greater accuracy than conventional axillary dissection. Required fields are marked *Name * Email * Website Comment Notify me of follow-up comments by email. BendoMD assumes no responsibility for the consequences of not presenting yourself to the doctor has on your health.



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