Cancer du sein et obésité, une liaison dangereuse [Breast cancer and obesity, a dangerous relation].

Obesity is associated with different cancers including breast cancer, whose incidence is increased in postmenopausal women. It has an adverse impact on the prognosis of the patients, regardless of their menopausal status. The fact of receiving a systemic adjuvant therapy does not neutralize the prognostic role of obesity. Moderate weight loss after cancer diagnosis could improve the outcome of the patients, while a weight gain during treatment seems without significant effect. Currently available data are still too incomplete to justify systematic programs to lose weight with an oncologic therapeutic aim. However, it is worth to encourage and support our patients to have an optimal diet, physical activity, and to lose weight as promotion of general health.

Traitements antiangiogéniques des cancers métastatiques du côlon et du rectum, du sein et du poumon: bénéfices et risques [Anti-angiogenic therapies for metastatic colorectal, breast and lung cancer: benefits and risks]

Anti-angiogenic therapies have recently enriched the therapeutic armentarium against the most common cancers. Among these, bevacizumab, a monoclonal antibody against vascular endothelial growth factor, is currently used most frequently. While the addition of bevacizumab to chemotherapy improves overall survival in first and second line treatment of metastatic colorectal cancer, its effect in metastatic breast cancer is limited to improvements in tumor response and progression-free-survival. In non-small-cell lung cancer, the positive results of a first American phase III study have not been confirmed by a second European study and are subject to controversies. A summary of the data concerning anti-angiogenic therapies in these three cancers is presented including safety information.

Hormonothérapie dans le cancer du sein: efficacité et effets adverses [Endocrine therapy in breast cancer: efficacy and adverse events].

Endocrine therapy remains a mainstay in the treatment of endocrine-sensitive breast cancer. In the adjuvant setting, 5 years of endocrine therapy significantly reduces recurrence rate and mortality. Tamoxifen is the molecule of choice for premenopausal women, whereas for postmenopausal women aromatase inhibitors are currently part of the standard treatment. Endocrine therapy can induce side effects, which can affect patient's quality of life and lead to premature treatment interruption. Identification and adequately addressing these side effects is fundamental to maintain good treatment compliance and therefore improve breast cancer specific outcome.

Centres du sein: caprice ou nécessité [Breast Centers: whim or necessity?].

In order to prevent disparities in the management of breast cancer having a direct impact on the prognosis of patients, to promote early detection and optimal treatment while considering the quality of life of patients, Breast Centers are being set up in Switzerland on the basis of existing models in Europe. The centers provide also follow-up of patients and are submitted to certification criteria established by the Swiss Society of Senology and the Swiss Cancer League. These criteria include in particular the expertise of specialists based on a sufficient volume of activity and training, compliance with recommendations of clinical practice, integration of supportive care and timeliness of care. The certification process is voluntary. A database enables the regular assessment of the provided care and of the compliance with standards. The aim and the modalities of the creation of the Breast Centers are discussed.

Adenocarcinome au sein d'un adenome pleomorphe de la glande lacrymale. A propos d'un cas. [Adenocarcinoma in a pleomorphic adenoma of the lacrimal gland: a case study]

PURPOSE: To report a patient with an adenocarcinoma in a pleomorphic adenoma of the lacrimal gland. Adenocarcinoma constitutes a distinct group of epithelial malignancies of the lacrimal gland. METHODS: The clinical presentation, workup, surgical approach, and pathological findings were reviewed. RESULTS: A 56-year-old man presented with a 3-month history of a lacrimal fossa mass. This patient presented a painless mass in the upper outer eyelid with significant displacement of the globe. The tumor was localized to the lacrimal gland. Radiological investigations showed a round, well-defined lesion in the fossa of the lacrimal gland. We performed a lateral orbitotomy; en bloc resection was accomplished. The final specimen showed an adenocarcinoma in a pleomorphic adenoma. No recurrences were detected during follow-up. CONCLUSION: Although adenocarcinoma has rarely been reported in association with a pleomorphic adenoma of the lacrimal gland, this combination can exist. If the malignant tumor is limited in the pleomorphic adenoma, the prognosis appears to be better than in cases of local extension. Adjuvant therapy, radiation or others, are not useful.

Chirurgie du cancer du sein [Breast cancer surgery].

Breast conserving surgery followed by radiation therapy is the treatment of choice for early breast cancer. For patients who choice or need a mastectomy, breast reconstruction provides an acceptable alternative. Breast cancer surgery has been evolving through minimally invasive approaches. Sentinel node biopsy has already remplaced axillary lymph node dissection in the evaluation of the axilla. Local ablation of the tumor may be a valuable alternative to surgery in the future.

Intégrer le genre dans la formation médicale prégraduée: peut-on transférer l'expérience néerlandaise sur sol suisse ? Etude exploratoire menée au sein de l'École de médecine de l'Université de Lausanne (FBM/UNIL) pour l'année académique 2009-2010

[Table des matières] Résumé. Zusammenfassung. 1. Introduction. 2. Intégrer le genre dans les études de médecine : la " Success Story " néerlandaise. 2.1 En amont du projet national de 2002-2005. 2.1.1 L'étude pilote menée à l'Université Radboud à la fin des années 1990. 2.2 Integrating Gender into the Core Curriculum: le déroulement du projet national (2002-2005). 3. Enseignement prégradué en médecine à Lausanne: quelle place pour le genre ? Etat des lieux pour l'année académique 2009-2010. 3.1 Inventaire: quelques fleurs dans le désert ? 3.2 La situation lausannoise à l'aune des exigences du projet néerlandais. 3.3 L'organisation de l'enseignement à l'École de médecine de Lausanne suite à la réforme des années 2000. 3.4 Le développement des études genre à l'Université de Lausanne et en Suisse: quel impact sur la médecine ? 4. Inclure le genre dans les études prégraduées de médecine : le cadre au niveau suisse. 4.1 Quelles possibilités de soutien au niveau des instruments nationaux de pilotage de la formation médicale prégraduée ? 5. Quelles possibilités de transfert ? Des questions pour l'avenir. 5.1 Comment transférer l'expérience néerlandaise? 5.2 Quelles activités pourraient être entreprises au niveau national ? 6. Annexes.

Place du pathologiste dans la prise en charge néoadjuvante des cancers du sein [Neoadjuvant treatment of breast cancer: implications for the pathologist].

These past few years, neoadjuvant strategy has taken an increasing place in the management of breast cancer patients. This strategy is mainly indicated to obtain a tumour bulk regression allowing a breast conserving surgery in patients that otherwise would have undergone mastectomy. Of note, development of new chemotherapy agents and targeted therapies has critically helped in the progress of neoadjuvant strategy as it is currently associated with better pathological response rates. In this context, the pathologist is at the crossroad of this multidisciplinary process. First, he provides on the initial core needle biopsy the tumour pathological characteristics that are critical for the choice of treatment strategy, i.e. histological type, histological grade, proliferative activity (mitotic count and Ki67/MIB1 index labeling), hormone receptor status (oestrogen receptor and progesterone receptor) and HER2 status. Secondly, the pathologist evaluates the pathological response and the status of surgical margins with regards to the residual tumour on the surgical specimen after neoadjuvant treatment. These parameters are important for the management of the patient, since it has been shown that complete pathological response is associated with improved disease free survival. Several grading systems are used to assess the pathological response in breast and axillary lymph nodes. The most frequently used in France are currently the systems described by Sataloff et al. and Chevallier et al. In this review, we detail the different steps involving the pathologist in neoadjuvant setting, with special regards to the quality process and future perspectives such as emerging predictive biomarkers.

Cancer du sein: radiothérapie et signalisation oestrogénique [Breast cancer: radiotherapy and estrogen signaling].

Hormone receptors are expressed in more than 75% of breast cancer. Therefore, two prescription modalities of endocrine therapy could be proposed: either sequential or concomitant to breast cancer irradiation. If combined to radiotherapy, is endocrine therapy a radiosensitizer? Does endocrine therapy enhance the risk factor of radio-induced toxicity? Here, we will distinguish the interaction of ionizing radiation combined with therapies targeting oestrogen receptor (REα) from the interaction of ionizing radiation with oestrogen. This review aims at making clear all these items.