OBJECTIVE: This study was conducted to determine the difference of hormone receptor status between pre-menopausal and postmenopausal women diagnosed with invasive ductal carcinoma in the local setting. METHODS: This retrospective descriptive study used data gathered from chart review of premenopausal and postmenopausal female patients diagnosed with invasive ductal carcinoma by tissue biopsy and underwent determination of hormone receptor status (estrogen and progesterone receptor) by immunohistochemical staining (ICA) using biopsy samples taken from June 2016 to December 2019 at Cebu Velez General Hospital, Cebu City. The significance of the difference in the hormone receptor status with menopausal status was analyzed using Fisher’s exact test. RESULTS: Comparing the two groups, 25 (60%) of the pre-menopausal women and 37 (73%) of the post-menopausal women were determined as hormone sensitive, while 17 (40%) pre-menopausal women and 14 (27%) post-menopausal women were hormone resistant. The Fisher’s exact test did not detect a statistically significant difference in the hormone receptor status of pre-menopausal and post-menopausal breast cancer patients. CONCLUSION There is no significant difference on the hormonal receptor status among pre-menopausal and post-menopausal women diagnosed with invasive ductal carcinoma. Thus, the need for hormone receptor status determination in these patients should be emphasized to aid in proper diagnosis, prognostication, and treatment planning.

This is a case of a 44- year old female presenting with an 18cm x 17cm soft, movable, non-tender mass at the right axilla extending to the lateral aspect of the right breast. Computerized tomographic scan of the chest revealed a lobulated, multi-septated hypodense mass. The patient underwent excision of the right axillary mass and final histopathology revealed cystic lymphangioma. Adult-onset cystic hygroma of the axilla is a rare case, with less than 10 studies documented in PubMed. Total surgical excision remains to be its primary treatment.
Lymphangioma ; Axilla

The objective of the study was to describe the incorporation of breast cancer screening program in the medical curriculum of a medical school and determine its feasibility in finding breast cancer.

METHODS: From school year 2011 - 2012, a 3-hour module that assesses third year medical students' proficiency in clinical breast examination (CBE) was incorporated into the pre-clinical clerkship program at the Cebu Institute of Medicine. The students who have satisfactorily completed the module were invited to participate in the Breast Cancer Control Outreach Program (BCAcop). Pertinent data included: number of participating consultants and students,number of patients seen as well as their demographic and clinical profile, breast cancer cases found.

RESULTS: Four BCAcop were conducted and 6 consultants supervised the medical students in the CBE modules and BCAcop. Seventy seven medical students passed the CBE module and participated in BCAcop. A total of 254 patients with age range of 8 to 80 (mean32 years) attended the lay forum while 246 patients (96.9%) consulted at the on-site breast clinic. Among those examined, 146 patients (59.3%) had essentially normal breasts. Fibrocystic change was the most frequent diagnosis with 49 patients (19.9%), followed by fibroadenoma with 34 patients (13.8%). Six patients (2.4%) were suspected to have breast cancer. Four patients (66.7%) proceeded to have a biopsy and were confirmed. Two patients availed of treatment.

CONCLUSION: Incorporating breast cancer screening program in the medical school curriculum encourages medical students to participate in breast cancer control outreaches where their basic knowledge and skills on clinical breast exam are reinforced with actual patient contact. Furthermore, women with breast cancer are found and offered treatment through this program.

OBJECTIVE: To describe common practices in pain assessment and control of surgery patients at Cebu Velez General Hospital (CVGH).

METHODS: Records of adult patients admitted to the Department of Surgery within January to June 2014 were reviewed. Data collected were method of pain monitoring, pain scores and analgesics given on admission, operation done, pain within and beyond 24 hours postoperatively, analgesics given 24 hours post-operatively, and upon discharge.

RESULTS: A total of 176 operations were included in this survey.Fifty one percent of the operations were under general surgery. Pain monitoring was done by the surgical clerks. Not one chart had pain monitoring documented in the vital signs monitoring sheets. Thirty two percent had no pain assessment on admission. Among those with pain assessment on admission, 60.5% suffered from significant pain. Tramadol was the most frequent parenteral analgesics given at 80% on admission as well as postoperatively and upon discharge.Tramadol+paracetamol combination was the most prescribed oral analgesics post-operatively. Within 24 hours after surgery, 40.9% of patients had no recorded pain assessments. Half of those patients assessed suffered from significant pain while still in the hospital.Beyond 24 hours post-op, 47.7% had no documented pain assessment. Almost a third of the patients assessed for pain had significant pain.

CONCLUSION: Postoperative pain assessment and control have been poorly addressed among surgical patients from admission to discharge. Tramadol was the most commonly utilized analgesic whether parenteral, oral, monotherapy or in combination with a nonopioid analgesic.

OBJECTIVE: To evaluate the quality of life (QoL) after palliative surgery of patients with advanced breast or gastrointestinal malignancies

METHODS: Quality of Life (QoL) of 32 patients with advanced breast or gastrointestinal cancer (Stage IIIB up to Stage IV) was evaluated before surgery (baseline), then 7 and 30 days after surgery using the Medical Outcomes Study Short form (SF-36v2? Questionnaire).Statistical significance of the difference in outcomes was tested using the two-tailed T-test at 95% CI.

RESULTS: Preoperatively, the patients scored poorly (scores below the average mean of 50) in all 8 subscales of the SF-36v2?. Seven days after a palliative surgery, patients showed significant improvement in all subscales except Vitality and Social Functioning.The patients experienced statistically significant changes in quality of life subscale scores on Physical Functioning, Role-Physical, Bodily Pain, General Health, Role Emotional, and Mental Health after surgery. A significant change in all subscales occurred 30 days after surgery compared to the baseline and 7 days post-op.

CONCLUSIONS: While patients with advanced malignancy experienced problems with quality of life preoperatively, they improved postoperatively but not to the level of a normal person.

Background: This study was conducted to determine the factors which may affect the incidence and recurrence of breast cancer in patients treated at the Vicente Sotto Memorial Medical Center (VSMMC). Methods: Utilizing hospital records, a case-control study was done on all breast cancer patients, treated at the VSMMC from January 200 to December 2007, comparing those who developed recurrence and those who did not. Results and Conclusions: Of the total of 404 patients treated at VSMMC during this period, only 370 patients (91.6%) with complete records were retrieved and included in the study. Overall recurrence rate was 17.8%. Age, parity, menopausal status nor family history of breast cancer, tumor characteristics, nor adjuvant therapy compliance, were the same for the two groups. More patients without recurrence underwent hormonal therapy (P=0.113). Those patients with recurrent breast cancer more often had positive lymph nodes (P=0.007). Key words: recurrent breast cancer
NOT IDENTIFIED

Objectives: To determine if ultrasound can increase the accuracy of fine needle aspiration biopsy in confirming malignancy in clinically malignant breast masses. Methods: Clinically malignant breast masses underwent ultrasound, fine needle aspiration biopsy/cytology, and tissue biopsy. Accuracy of each test and in combination were calculated using histopathology as gold standard. Results: The accuracy of ultrasound alone was only 67.5% sensitivity of 90.0%, specificity of 33.3%, positive predictive value of 67.2% and negative predictive value of 68.8%, while FNAB alone has an accuracy of 89.2%, sensitivity of 90.0%, specificity of 87.9%, postive predictive value of 91.8%, and negative predictive value of 85.3%. With concordant findings in ultrasound and FNAB, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value are 94.3%, 97.6%, 81.8%, 95.3%, and 90%, respectively. Conclusion: With concordant findings in ultrasound and FNAB, accuracy in confirming malignancy is 94.3%. Key words: breast cancer, breast ultrasonography, fine needle aspiration biopsy/cytology
NOT IDENTIFIED

Objectives: To determine the accuracy of SLNB using methylene blue dye. Methods: Breast cancer patients consulting at the VSMMC Breast Center with biopsy proven adenocarcinoma of the breast, a Tis, T1, T2 or T3 primary breast tumor and clinically negative ipsilateral axilla by palpation and ultrasound, were included in the study. The subjects underwent either modified radical mastectomy or breast conservation theraphy. Subareolar injection of 5 ml 1% methylene blue dye 5 minutes prior to sentinel lymph node biopsy. Three blue staining axillary lymph nodes were taken and sent to pathology for frozen section evaluation and after surgery, H & E staining. A completion axillary lymph node dissection was done in all patients. Accuracy of SLNB using methylene blue was calculated using final histopathology results as gold standard. Results: Twent patients were included in this study. SLNB in this group had an accuracy, sensitivity, specificity, PPV, and NPV of 95.0% 83.3%, 100%, 100%, and 93.3%, respectively. The false negative rate is 6.7%. On the average, the SLN's were identified in 14 minutes. Conclusion: Sentinel lymph node dissection with methylene blue has an accuracy of 95% in the VSMMC Breast Center. Key words: sentinel lymph node biopsy, methylene blue dye, breast cancer
Human ; Female ; SENTINEL LYMPH NODE BIOPSY

Objective: To determine if early discharge after mastectomy is a safe alternative to the standard duration of postoperative hospital confinement. Methods: This is a review of breast cancer patients who were discharged early after mastectomy consulting at the breast center at the Vicente Sotto Memorial Medical Center from May 2007-May 2010. The following variables were recorded: date of surgery, date of discharge, presence of surgical site morbidities such as infection, dehiscence, necrosis and significant pain, date of 1st drain removal, date of 2nd drain removal, presence of seroma, application of elastic bandage. Results: Of the 60 patients: 43 (71.7%) were from CVGH Breast Specialty Clinic and 17 (28.3%) from VSMMC Breast Clinic. There were 9 patients (15%) who developed surgical site morbidities, namely: infection -3 (5.0%), minimal partial wound dehiscence -4 (6.7%), superficial skin necrosis -2 (3.3%). No patient complained of significant pain on follow-up. The first drain was removed within a mean of 6 days. The second drain was removed a mean of 7 days. Fifteen patients (25%) developed seroma. There was no readmission due to morbidities. Conclusion: Early discharge after mastectomy is a safe alternative to the standard duration of postoperative hospital confinement. Key words: mastectomy, postoperative pain
Human ; MASTECTOMY ; PAIN, POSTOPERATIVE

OBJECTIVE: To determine the effectiveness of a nurse navigator in facilitating the management of patients diagnosed with breast cancer.

METHODS: A retrospective study was conducted reviewing all patients seen at the Vicente Sotto Memorial Medical Center (VSMMC) Breast Center from November 20, 2009  to May 28, 2010. The management of patients utilizing a nurse navigator was compared with the management of those without a nurse navigator. With the expectation that patients clinically diagnosed with breast cancer should have the biopsy results within 2 weeks, operated on within another 2 weeks (if cancer is confirmed by the biopsy), or receive initial treatment within 1 month of initial consultation, duration of clinical courses were analyzed and compared statistically.

RESULTS AND CONCLUSIONS: Nineteen patients who were managed with a nurse navigator were compared with 21 patients without a navigator. The mean duration of the clinical courses (from clinical diagnosis to initial intervention) of both groups was not statistically different. However, there were less patients with delayed initial intervention in the group with a nurse navigator (P = 0.0284). Only 1 patient in each group had their initial intervention within 1 month from initial consultation. The most common cause for delays were financial problems at 39% of delayed cases.