INTRODUCTION:breast conserving therapy remains the first choice in breast cancer care for the early stages. Adequate surgical margins are essential to reduce the risk of locoregional recurrence. This study aims to identify risk factors of positive margins and locoregional recurrence.MATERIALS AND METHODS:437 patients who underwent a lumpectomy for invasive breast carcinoma or ductal carcinoma in situ have been included. Age, surgical margins, size, type, grade and number of tumor foci, the presence of ductal carcinoma in situ, lymph node status, expression of hormone receptors and HER-2 gene were assessed as risk factors for positive margins and locoregional recurrence.RESULTS:The disease-free survival is 94 % at 10 years. Patients with positive margins have lower survival (92 %) than those with negative margins (96 %) (p £ 0.05). Lobular and multifocal tumors are at risk of positive margins. Tumors with positive margins, T2, grade III, triple negative and HER-2 positive neoplasms are at risk of locoregional recurrence while the expression of hormone receptors is a protective factor for local recurrence.CONCLUSION:It appears in our study that invasive lobular and multifocal tumors may present positive surgical margins. Studies on pre- operative work-up are needed. Biological factors of the tumor seem to play a fundamental role in the locoregional recurrence or persistence of the tumor.

Vulvo-vaginal infections are frequently encountered by gynecologists and general practitioners. The diagnosis and the recurrence of these affections must lead to a discussion about sexually transmitted disease, notably when trichomonas vaginalis and herpetic infections are found. Even if they do not correspond to classical sexually transmitted diseases, their prevalence is increased by sexual intercourses reports and the number of partners which should also be treated. It is necessary to document the responsible germs, even in case of recurrence as more and more resistance to usual treatments are found together with the appearance of new germs like Candida glabrata.

The use of neoadjuvant systemic therapy (NST) for the primary breast cancer treatment has constantly increased. Initially used to improve breast-conserving surgery (BCS) rate as well as for patients with inflammatory or inoperable locally advanced breast cancer, today, NST is used as a test of chemosensitivity and predictive factor by assessing pathologic complete response. With the increasing use of NST, it is fundamental to establish if NST increases postoperative morbidity.. In our study, the postoperative complications associated with NST were examined. We analyzed the data obtained from patients undergoing treatment for breast cancer in a University Hospital between 2003-2014 in a case-control study. We selected 286 patients attributed to two groups according to the surgery type: Group A, 150 patients undergoing breast conserving surgery with axillary node dissection (75 cases after NST and 75 controls with surgery alone) and group B, 136 patients undergoing mastectomy with axillary node dissection (68 cases after NST and 68 controls). There was no statistically significant difference between both groups in post-operative recovery or the rates of complications: use of antibiotics, re-operation, hematoma, blood transfusion, healing problems, wound infection, lymphocele and lymphoedema. Our study supports the safety of NST and suggests that it is not associated with increased morbidity in the patients undergoing breast surgery as BSC or mastectomy with axillary node dissection.

BACKGROUND:The staging of axillary lymph nodes is critical to the management and prognosis of breast cancer, the most frequent cancer in females. Neoadjuvant therapy and lymph node dissection are recommended when malignant cells invade the lymph nodes. Therefore the pre-operative examination of these lymph nodes is crucial to treatment.METHODS:In this study, we examined the effectiveness of cytology through ultrasound-guided fine needle aspiration (USG-FNA) and ultrasound (US) imaging using an established classification system in correctly identifying lymph node status compared to the final histological results after surgery.RESULTS:Cytology by USG-FNA and US classification were found to be promising methods of axillary lymph node staging.CONCLUSIONS:US and CB offer minimally invasive techniques to pre-operatively examine these lymph nodes in patients with primary breast cancer.

The use of neoadjuvant systemic therapy (NST) for the primary breast cancer treatment has constantly increased. Initially used to improve breast-conserving surgery (BCS) rate as well as for patients with inflammatory or inoperable locally advanced breast cancer, today, NST is used as a test of chemosensitivity and predictive factor by assessing pathologic complete response. With the increasing use of NST, it is fundamental to establish if NST increases postoperative morbidity.. In our study, the postoperative complications associated with NST were examined. We analyzed the data obtained from patients undergoing treatment for breast cancer in a University Hospital between 2003-2014 in a case-control study. We selected 286 patients attributed to two groups according to the surgery type: Group A, 150 patients undergoing breast conserving surgery with axillary node dissection (75 cases after NST and 75 controls with surgery alone) and group B, 136 patients undergoing mastectomy with axillary node dissection (68 cases after NST and 68 controls). There was no statistically significant difference between both groups in post-operative recovery or the rates of complications: use of antibiotics, re-operation, hematoma, blood transfusion, healing problems, wound infection, lymphocele and lymphoedema. Our study supports the safety of NST and suggests that it is not associated with increased morbidity in the patients undergoing breast surgery as BSC or mastectomy with axillary node dissection.

The incidence of cervical cancer has hopefully been dropping down in our industrialized countries since the introduction of both primary and secondary prevention. Nevertheless, it is still lethal in one out of two affected women though the introduction of cytological screening has dramatically reduced the mortality. Progressive diffusion of anti-HPV vaccination, the broadening of the viral types concerned, its association with existing screening measures and finally the introduction of viral detection as a screening tool must optimize the results already obtained.

Introduction: Our hospital has developed a Mobile Oncogeriatric Team (MOT) with the prime help of an oncogeriatric liaison nurse and an interdisciplinary approach to improve the oncologic care pathway of the geriatric patient, his therapeutic support and his follow up.

The presence of adnexal masses during pregnancy is a rare situation but due to a broader use of sonography ; its occurrence is increasing. Their management essentially relies on imagery. We report the case of an 18 weeks-pregnant women presenting bilateral teratomas visualized by RMI. She was successfully treated by laparoscopy. This paper approaches the management of adnexal masses during pregnancy. The epidemiology, possible complications, diagnostic approach and the therapeutic management are discussed.

Introduction: Although many studies describe benefits from the comprehensive assessment of older patients, the lack of geriatricians combined with the increased number of elderly patients revealed the need for screening tools in order to detect cancer patients presenting with geriatric conditions.Objectives: (i) To assess the validity of screening tools to detect patients presenting with geriatric conditions. (ii) To analyze the relative contribution of those tools to detect some characteristics of the geriatric profile and the stage of the tumors.Materials and Methods: Two hundred eleven consecutive elderly patients were screened for the presence of geriatric conditions using the Identification of Senior At Risk score (TSAR) and the G8 score. Comprehensive geriatric assessment for functional, cognitive, mood, and nutritional status, self-perceived fatigue and comorbidities was performed. Oncological assessment included the Kamofsky performance status (KPS) and tumor staging.Results: Both scores detected an average of 80% of frail patients. The PPV and NPV of the scores to detect at least one geriatric condition were respectively 47% and 22% for an ISAR score >= 2 and 76% and 10% for a G8 <15. Area under the ROC curves between ISAR and G8 was not statistically different. In logistic models an TSAR score >= 2 was associated with comorbidity and falls whereas a G8 score <15 was associated with low KPS (<80) and the presence of generalized cancer.Conclusions: High prevalence of geriatric syndromes and comorbidities is associated with positive ISAR and G8 scores but not with the tumor stage. (C) 2012 Elsevier Ltd. All rights reserved.

L’espace enfants/adolescents est un lieu d’accueil à l’hôpital, mis en place en collaboration avec les équipes soignant les patients adultes atteints d’un cancer, pour leurs enfants, adolescents, familles et proches venant leur rendre visite. Ce lieu adapté aux enfants maintient le lien familial. Deux psychologues l’animent et favorisent l’expression des émotions via des médias projectifs : dessin, matériel de bricolage, trousse de docteur, « Playmobil », jeux de société… L’accès est libre tous les mercredis après-midi.

Deux vaccins anti-HPV arriveront prochainement sur le marche en Belgique. Diriges contre la proteine L1 de certains types de Papilloma virus, ils visent la prevention contre le cancer du col et contre certaines lesions precancereuses. Il est connu depuis plus d'une decennie que l'infection par certains types d'HPV est un prealable a la majorite des cancers du col uterin. Des evidences epidemiologiques et de biologie moleculaire etayent ce fait. C'est pourquoi des vaccins diriges contre les proteines de capside de ces virus ont ete developpees. Deux de ces vaccins sont actuellement sur le point d'etre enregistres en Belgique. Cervarix® (GSK) est un vaccin dirige contre les HPV 16 et 18, qui sont associes a 70 % des cancers du col dans le monde. Gardasil® (Sanofi Pasteur MSD) propose une vaccination contre les proteines L1 de l'HPV 16 et 18, mais egalement contre les HPV 6 et 11 qui sont associes a des lesions benignes de la sphere ano-genitale (condylomes). Les resultats obtenus jusqu'a present sont tres prometteurs en termes d'efficacite preventive des infections persistantes et des dysplasies cervicales. Deux apports recents meritent d'etre notes: d'une part, la prevention offerte par Cervarix® se maintient pendant au moins 4,5 ans, d'autre part, la vaccination par Gardasil® de patientes deja infectees par un des types viraux (16, 18, 6,11) se revele efficace a 100 % en prevention des maladies causees par les types restants. Il est donc vraisemblable que la prevention du cancer du col par vaccination anti-HPV concernera bientot non seulement les patientes naives de tout contact avec HPV mais aussi les patientes ayant deja rencontre ces virus.

Two anti-HPV vaccine will soon be registered on the Belgian market. Providing immunity against the L1 protein of several oncogenic types of Papilloma virus, they aim at protecting against cervical cancer and several precancerous lesions. It has been known for years that oncogenic HPV infection of the uterine cervix is a prerequisite to the development of cervical cancer. This is supported by epidemiological has well as biological observations. That is why vaccines against capsid protein of these viruses had been developed. Two of these vaccines are about to be registered in Belgium. Cervarix (GSK) is directed against HPV 16 and 18 which are associated to ca 70% of the cervical cancers in the world. Gardasil (Sanofi Pasteur MSD) propose a vaccination against L1 protein of HPV 16 and 18, but also against HPV 6 and 11 which are responsible of benign lesions of the ano genital area (condylomas). The results obtained so far are very promising considering their preventive efficacy on persistant infections and cervical dysplasias. Two recent publications must be discussed: first, the protection offered by Cervarix is maintained for 4.5 years at least, second, vaccination by Gardasil of patients already infected by one of the HPV types (16, 18, 6, 11) provides a 100% efficacy in preventing diseases caused by the remaining types. It is therefore probable that HPV vaccination will not only concerns naive patients from any contact with HPV but also patients having already be in contact with these viruses.

Cervical cancer incidence and mortality are falling off since the introduction of pap smear in the early 60's. In Belgium, however, there is no controlled screening politics. Oncogenic papillomaviruses are implicated in cervical cancer. Their identification is possible on thin layer technique, which allows the clinician to adapt his follow-up whether they are present or not, notably in case of borderline or low grade lesions. Cervical cancer is progressing slowly, the peak incidence happening more or less ten years after first lesions. Therefore, screening starting age, frequency and ending age are still debated. In Belgium, it is still not organised and may miss the most exposed populations. Furthermore, screening frequency is decreasing rapidly after age of 50 even though there is another incidence peak of cervical cancer at the age of 70. Pap smears' evolution in Belgium is unsure since there will be soon HPV vaccines available. But these will not be active against all oncogenic types and though they will be given to young girls before their first sexual experiences, the rest of the female population will require pap smear for a few years.