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In Belgium, breast cancer is the most frequent women's cancer accounting for to 35.3 % of the cases. In 2013, 10,778 newly diagnosed breast cancers have been reported in Belgium. Breast cancer has a relatively good prognosis with a 5 year overall survival of 88 %. Survival will be different regarding the subtype and stage at diagnosis. The review of the literature and the guidelines from ESMO and ASCO regarding the follow-up of patients with early breast cancer will be used as references. International guidelines recommend clinical visits (frequencies depending of the subtypes of breast cancer) with an annual mammography associated with an echography. MRI Imaging should be performed in " at risk " patients. A more extensive exploration should be proceede when a relapse is suspected during follow up. Indeed, studies have shown that intensive follow- up with several additional exams detect more recurrences without any impact on overall survival and lead to anxiety. The follow-up of patients treated for breast cancer has several objectives : - Detect a local recurrence or a second tumor ; - Diagnosis of a distant relapse ; - Detect side effects of treatment ; - Psycho-social impact of the disease and improve the quality of life.En Belgique, le cancer du sein est le cancer le plus fréquent chez la femme (35,3 % des cas). En 2013, 10.778 nouveaux cancers du sein ont été répertoriés. Son pronostic est relativement bon, avec des taux de survie à cinq ans de 88 %. Il sera différent en fonction du type de cancer du sein et de son stade. La revue de la littérature et les recommandations actuelles de l’ESMO (European Society of Medical Oncology) et de l’ASCO (American Society of Clinical Oncology) concernant le suivi des patientes traitées pour un cancer du sein, seront prises comme références. Les recommandations internationales se limitent à des consultations cliniques (dont la fréquence peut varier selon les types de cancer du sein) associées à une mammographie de même qu’à une échographie mammaire annuelle tandis qu’une résonance magnétique nucléaire sera également réalisée chez les patientes à risque. Un bilan est à réaliser dans le cadre du suivi uniquement si une rechute est suspectée. En effet, de nombreuses études ont montré que la surveillance dite intensive est responsable certes de la découverte d’un plus grand nombre de rechutes, mais également d’une angoisse accrue chez les patientes et n’a pas d’impact favorable sur la survie sans progression ou sur la survie globale. La surveillance des patientes ayant été traitées pour un cancer du sein vise plusieurs objectifs : - Rechercher une récidive locale ou une deuxième tumeur ; - Diagnostiquer une récidive à distance ; - Détecter les possibles complications secondaires aux traitements adjuvants administrés ; - Évaluer le retentissement psycho-social de la maladie et améliorer la qualité de vie des patientes.

Concomitant chemoradiation is the "new gold standard" for dealing with locally advanced cervical carcinoma, but what about surgery? We don't know yet to what extent surgery is necessary and how radical it must be when it is performed. In this study, we present the analysis of the results obtained in patients treated by concomitant chemoradiation followed by radical surgery.Twenty-two patients, median age 49 years, with I(b) - III(a) cervical tumors were enrolled to be treated by concomitant chemoradiation followed by radical surgery. The chemoradiation protocol included external radiotherapy to the pelvis: 45 Gy; Cisplatin 40 mg/m(2) in continuous intravenous infusion once a week (5 weeks) followed by brachytherapy one week later. Surgery was performed 4 to 6 weeks later and consisted in radical hysterectomy with pelvic lymphadenectomy.20/22 patients underwent surgery after chemoradiation because of a diagnosis of lung metastases in one and presence of a nonresectable metastasis for the other. A complete pathological response was demonstrated in 12/20 patients (60%), a microscopic residual tumor in 7 patients (35%), and residual disease1cm in 1 patient (5%).This study showed a particularly high rate of pathologic responses (T(0)+T(mic): 95%) and of local control. We don't know yet if surgery is a real necessity or if it could be less extended after concomitant chemoradiation.

Determination of axillary lymph node status is crucial in diagnosis of early breast cancer. However thanks to an early diagnosis, an increasing number of axillary lymph node dissections are free of disease. This raises questions about the need for this procedure. The study aim was to report an experience with lymphadenectomy and sentinel node mapping in patients with T0-T1 carcinoma of the breast.Between November 1997 and December 1999, 84 consecutive women (T0-T1 N0 according to the 1987 UICC classification) with recently diagnosed breast cancer, were included in this study for identification of the sentinel lymph node (SLN). The SLN was removed and submitted for histological examination. All patients underwent axillary dissection; nodes from levels I and II (Berg's classification) were excised and submitted to histological examination.The average tumor diameter was 12.7 mm (range, 3 to 25 mm). The lymphatic mapping technique was obtained after injection of the isotope into the breast around the tumor in 53/84 patients: the sentinel lymph node was the only positive node in 10 patients and it was positive in 5 patients with other axillary nodes. In 15/84 patients, an intradermal injection of blue dye was used; two sentinel nodes were positive and one falsely negative. In 16/84 patients, an interdermal injection of blue dye was used to make up for. In this study, the sentinel node was positive in three patients and falsely negative in one patient. The discrepancy was due to an important involvement of an axillary area excluded from the lymphatic channels. 22/84 patients (26%) had a metastatic spread to the axillary nodes. 30/84 patients had also an isotopic captation in another lymph node group (internal mammary).This study confirms that lymphatic mapping is technically possible in the patients with T0-T1 breast cancer and that the histological characteristics of the sentinel node probably reflect the histological characteristics of the rest of the axillary lymph nodes, but do not provide any information about the other lymph node sites.

The pregnancy-associated breast cancer seems to have become increasingly common with a high frequency of advanced breast cancer with axillary node metastases and so associated with poor prognosis.This review examines the diagnosis, prognosis, and management of cancer during pregnancy; both in terms of the cancer's effect on the pregnancy, and the pregnancy's effect on the cancer.Diagnostic procedures (breast sonography) and excisional biopsies are necessary to reduce the delay of several months or more after discovery of a mass and before treatment. No histological difference, between patients with pregnancy-associated breast cancer and patients with non-pregnancy-associated breast cancer, was diagnosed.The treatment is linked to the effects of adjuvant therapy on the fetus.

Hepatocellular adenoma resection and focal nodular hyperplasia supervision are widely recognized as the best management when these benign liver tumors are diagnosed. Differential diagnosis is thus mandatory.Twenty-nine patients with a presumed benign liver tumor were retrospectively analyzed.Histopathological analysis of these resected liver tumors demonstrated hepatocellular adenoma in 16 patients and focal nodular hyperplasia in 13. One hepatocellular carcinoma was disclosed into a hepatocellular adenoma and 2 hepatocellular adenoma showed foci of liver-cell dysplasia. Seven patients with hepatocellular adenoma (43%) had evidence of intratumoral hemorrhage, among which 3 patients were admitted with intraperitoneal tumoral rupture. Computed tomography, performed in 26 patients, was the most reliable examination to characterize these presumed benign liver tumors. Magnetic resonance imaging concerned only 5 patients but 3 hepatocellular adenoma and 1 focal nodular hyperplasia were diagnosed. The indications of focal nodular hyperplasia surgical resection were chronic pain (4 pts), hepatocellular adenoma diagnosis (4 pts), undeterminate liver mass (2 pts), a liver mass of unknown origin in patients with a neoplastic history (3 pts). A diagnosis of focal nodular hyperplasia assumed by the imaging work-up was always histologically confirmed. All the patients underwent hepatic resection with no mortality.This report underlines the risk of hemorrhage or malignant transformation of hepatocellular adenoma that justifies a safety surgical resection. An imaging work-up in favor of focal nodular hyperplasia allows radiological observation.

From 1974 till 1993, 9 patients have been treated in our Hospital for a breast cancer. Compared with the amount of women breast cancers treated, actually near 300 per year, this 0.3% figure seems small, and is lower than that found in the literature (1%). The therapeutic attitude is the same as that proposed for women. The follow-up varied from 9 to 120 months with a mean of 57. Five patients are actually still living without recurrence. One patient presented a local recurrence, one was lost sight off and two died from their cancer. Despite the fact that it was a small group of patients we can say that the symptoms, the clinical staging, the proposed treatments and the survival rate are the same as found in the literature.

Diaphragmatic rupture occurs in 25% of the thoracic and abdominal blunt injuries. It may be discovered immediately or sometimes several months or even years after the trauma. The diagnosis can be made easily on the basis of a standard chest X-ray. Barium swallow examination, computerized tomography Scan and especially Magnetic resonance imaging can be helpful for differential diagnosis. Surgical treatment is always necessary.

Between 1988 and 1991, at the Jules Bordet Institute in Brussels, 11 patients were submitted to a surgical treatment due to an uterus cervix central recurrence. The majority were of the epidermoid type. The primary stage of the lesion at the moment of diagnosis varied from stage Ib to stage IIIb lesions. Six of the eleven patients were not submitted to an adequate initial treatment. These recurrences appeared between the 4th and the 264th month after the initial treatment. The treatments, which were determined according to the site of recurrence, consisted of: an anterior pelvic exenteration for four patients, a total exenteration for one patient, for two of them a total hysterectomy with bilateral salpingo-oophorectomy and partial cystectomy, a cervix amputation for another one and finally, for the last three ones, a laparotomy with debulking or derivation colostomy. The mortality during and after the operation was nil but there were several short term complications. After a minimal 19 months follow-up we could see that three patients survived, one was generalized and seven died. Due to the scarce number of patients and pathological disparity of them, the authors reviewed the literature concerning this problem, in order to determine some guidelines for similar cases. In spite of its consequences, surgery seems to be the only valid solution to propose to these patients, not only to give them a chance to survive but also to improve their life quality.