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By Sir Hedley Atkins (auth.), Professor Sir Hedley Atkins K.B.E. (eds.)

Sir Hedley Atkins In a piece of writing within the London occasions of November twenty sixth 1973 their clinical correspondent, Dr Tony Smith, mentioned the various tools these days to be had for the remedy of universal ailments. listed here he wrote: "Perhaps the main tricky of the typical stipulations is breast melanoma, the place the variety of substitute deal with­ ments is bigger than most folk believe. After the physician has assessed the dimensions and nature of the expansion, how a ways it has unfold, and the overall well-being of the lady, he has to pick the optimal therapy from a spread that comes with basic elimination of lump, elimination of the breast and elimination of the breast including the underlying muscle and the lymph glands within the shoulder zone. Any of those operations should be mixed with quite a few sorts of X-ray therapy; or the easiest probability should be given by means of treating the tumour with high-voltage X-rays with none operation in any respect. each one of those remedies can provide a whole treatment, and, partly, the alternative is dependent upon the surgeon's ability in assessing the kind of melanoma current and the way some distance it's complex. "The different point within the surgeon's selection, even though, is his choice for one operation instead of one other in accordance with his event and his interpretation of the consequences bought through different surgical teams.

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Prognostic Factors in Brr,ast Cancer. Edited by A. P. M. Forrest and P. B. Kunkler, p. 146. Edinburgh and London: Livingstone 23. Nissen-Meyer, R. (1968). Suppression of ovarian function in primary cancer of the breast. Prognostic Factors in Breast Cancer. Edited by A. P. M. Forrest and P. B. Kunkler, p. 139. Edinburgh and London: Livingstone 24. Patey, D. H. (1960). Prophylactic oophorectomy and adrenalectomy in carcinoma of the breast. Brit. J. Cancer, 14, 457 25. Dao, T. , Nemoto, T. and Chamberlain, A.

If one adds the error uncovered by the above 2 studies, a more likely estimate of axillary node involvement would be 75%; a figure curiously similar to that of the known incurability rate of primary cancer of the breast. Extent The extent of nodal involvement is also related to prognosis. Heavy infiltration of nodes with local fixation (N2) is a grave sign. Conversely the prognosis of patients with "occult" axillary metastases (discovered only on serial section) is better than that of those with overt involvement 61 .

The newer complexes of phosphate and technecium are likely to prove supenor. An alternative method of seeking occult metastatic bone disease is by estimates of urinary hydroxyproline. Increased turnover of the large collagen pool in bone enhances the excretion of this amino-acid: a unique constituent of collagen. Some studies have suggested that its increased secretion may even precede scintiscan evidence of metastatic bone disease 78. Yet considerable variations of excretion have also been reported in patients with bone metastases 79.

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