java barcode reader source code CARCINOMA OF THE MALE BREAST in Objective-C

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CARCINOMA OF THE MALE BREAST
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A painless lump beneath the areola in a man usually over 50 years of age Nipple discharge, retraction, or ulceration may be present Generally poorer prognosis than in women
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Data are insufficient to determine whether interruption of pregnancy improves the prognosis of patients who are identified to have potentially curable breast cancer and who receive definitive treatment during pregnancy Theoretically, the increasingly high levels of estrogen produced by the placenta as the pregnancy progresses could be detrimental to the patient with occult metastases of hormone-sensitive breast cancer Moreover, occult metastases are present in most patients with positive axillary nodes, and treatment by adjuvant chemotherapy could be potentially harmful to the fetus early in gestation, although chemotherapy may be given to pregnant women later Under these circumstances, interruption of early pregnancy seems reasonable, with progressively less rationale for the procedure as term approaches The decision is affected by many factors, including the patient s desire to have the baby and the prognosis especially when axillary nodes are involved Equally important is the advice regarding future pregnancy (or abortion in case of pregnancy) to be given to women of child-bearing age who have had definitive treatment for breast cancer It is assumed that pregnancy will be harmful if occult metastases are present, though this has not
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Breast cancer in men is a rare disease; the incidence is only about 1% of that in women The average age at occurrence is about 60 somewhat older than the most common presenting age in women There may be an increased incidence of breast cancer in men with prostate cancer As in women, hormonal influences are probably related to the development of male breast cancer There is a high incidence of both breast cancer and gynecomastia in Bantu men, theoretically owing to failure of estrogen inactivation by a liver damaged by associated liver disease It is important to note that first-degree relatives of men with breast cancer are considered to be at high risk This risk should be taken into account when discussing options with the patient and family In addition, BRCA2 mutations are common in men with breast cancer Men with breast cancer, especially with a history of prostate cancer, should receive genetic counseling The prognosis, even in stage I cases, is worse in men than in women Blood-borne metastases are commonly present when the male patient appears for initial treatment These metastases may be latent and may not become manifest for many years
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A painless lump, occasionally associated with nipple discharge, retraction, erosion, or ulceration, is the primary complaint Examination usually shows a hard, ill-defined, nontender mass beneath the nipple or areola Gynecomastia not uncommonly precedes or accompanies breast cancer in men Nipple discharge is an uncommon presentation for breast cancer in men but is an ominous finding associated with carcinoma in nearly 75% of cases Breast cancer staging is the same in men as in women Gynecomastia and metastatic cancer from another site (eg, prostate) must be considered in the differential diagnosis Benign tumors are rare, and biopsy should be performed on all males with a defined breast mass
Treatment
Treatment consists of modified radical mastectomy in operable patients, who should be chosen by the same criteria as women with the disease Breast conserving therapy is rarely performed Irradiation is the first step in treating localized metastases in the skin, lymph nodes, or skeleton that are causing symptoms Examination of the cancer for hormone receptor proteins is of value in predicting response to endocrine ablation Men commonly have ER-positive tumors Adjuvant chemotherapy is used for the same indications as in breast cancer in women Because breast cancer in men is frequently a disseminated disease, endocrine therapy is of considerable importance in its management Tamoxifen is the main drug for management of advanced breast cancer in men Tamoxifen (20 mg orally daily) should be the initial treatment There is little experience with AIs though they should be effective Castration in advanced breast cancer is a successful measure and more beneficial than the same procedure in women but is rarely used Objective evidence of regression may be seen in 60 70% of men with hormonal therapy for metastatic disease approximately twice the proportion in women The average duration of tumor growth remission is about 30 months, and life is prolonged Bone is the most frequent site of metastases
from breast cancer in men (as in women), and hormonal therapy relieves bone pain in most patients so treated The longer the interval between mastectomy and recurrence, the longer the remission following treatment is likely As in women, there is correlation between ERs of the tumor and the likelihood of remission following hormonal therapy AIs should replace adrenalectomy in men as it has in women Corticosteroid therapy alone has been considered to be efficacious but probably has no value when compared with major endocrine ablation Either tamoxifen or AIs may be primary or secondary hormonal manipulation Estrogen therapy 5 mg of diethylstilbestrol three times daily orally may be effective hormonal manipulation after others have been successful and failed, just as in women Androgen therapy may exacerbate bone pain Chemotherapy should be administered for the same indications and using the same dosage schedules as for women with metastatic disease or for adjuvant treatment
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