Topical fluorouracil is often used for superfi cial lesions This medication

Topical fluorouracil is often used for superfi cial

This preview shows page 407 - 409 out of 540 pages.

Topical fluorouracil is often used for superfi- cial lesions. This medication produces marked local irritation or inflammation in the involved tissue but no systemic effects. Microscopically controlled surgical excision carefully removes recurrent lesions until a tu- mor-free plane is achieved. After removal of large lesions, skin grafting may be required. Irradiation is used if the tumor location re- quires it. It’s also preferred for elderly or debili- tated patients who might not tolerate surgery. Chemosurgery may be necessary for persis- tent or recurrent lesions. It consists of periodic applications of a fixative paste (such as zinc chloride) and subsequent removal of fixed pathologic tissue. Treatment continues until tu- mor removal is complete. Cryotherapy, using liquid nitrogen, freezes the cells and kills them. Battling illness Treating basal cell carcinoma Numerous risk factors for breast cancer have been identified, but the exact cause remains unknown.
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Other significant risk factors have been identified. These in- clude: a family history of breast cancer radiation exposure being a premenopausal woman older than age 45 • obesity • age recent use of hormonal contraceptives early onset of menses or late menopause nulligravida (never pregnant) first pregnancy after age 30 high-fat diet colon, endometrial, or ovarian cancer postmenopausal progestin and estrogen therapy alcohol use (one or more alcoholic beverages per day) benign breast disease. About one-half of all breast cancers develop in the upper outer quadrant. (See Breast quadrants .) Understanding classification Breast cancer is generally classified by the tissue of origin and the location of the lesion: Lobular cancer develops within the lobes. Ductal cancer, the most common form, develops within the ducts. Less than 1% of breast cancers originate in the nonepithelial connective tissue. Inflammatory cancer (rare) grows rapidly and causes the over- lying skin to become edematous, inflamed, and indurated. 398 CANCER Breast quadrants This illustration shows the quadrants of the right breast and the Tail of Spence. The upper outer quadrant is the most common site of breast cancer. Axillary tail of Spence Upper outer quadrant Upper inner quadrant Lower outer quadrant Lower inner quadrant Susceptibility to breast cancer Patients with BRCA1 and BRCA2 account for ap- proximately 5% of all breast cancer cases. General screening of the population for these genes isn’t recommend- ed. However, screening women with a strong family history of breast cancer is recommended when genetic counseling is available. Recent studies sug- gest that prophylactic re- moval of the breasts in BRCA1 and BRCA2 carri- ers greatly decreases the risk of breast cancer in these individuals. Re- cent studies also show that removing the ovaries and fallopian tubes in premenopausal BRCA1 and BRCA2 carri- ers reduces the risk of breast cancer.
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