Obesity and Cancer—Opportunities to Break the Link

Obesity is a major global health problem with a rising worldwide burden. In addition to its association with several diseases, obesity is associated with increased incidence and worse prognosis for many malignances. Many possible mechanisms that contribute to the obesity-cancer link have been proposed, but key pathways likely include steroid hormone signaling, altered gut microbiota, insulin and insulin growth factor interactions, levels of circulating adipokines, and local and systemic inflammation. By understanding these mechanisms and their interactions, we may be able to intervene to improve the public health burden imposed by obesity. Equally critical to the development of targeted intervention strategies is the identification of accurate biomarkers to better detect populations that are more or less likely to benefit from specific interventions.     

New Developments in Assessing Risk of Local Recurrence in Patients with Ductal Carcinoma In Situ after Lumpectomy and Breast Radiation

Ductal carcinoma in situ of the breast comprises nearly 25 % of all diagnoses of breast cancer. The current paradigm for management of DCIS consists of breast-conserving surgery followed by post-operative radiotherapy. The goal of the treatment of DCIS is to reduce the risk of local recurrence (and invasive local recurrence) to prevent the detrimental psychological impact of recurrence and minimize the need for additional treatment. A number of clinical, pathological, and molecular variables have been identified as predictive markers of recurrence and can be used to help risk stratify women with this diagnosis. We present here a review of current markers of recurrence, risk prediction tools, and future directions.     

Oncoplastic Breast Surgery: What,When and for Whom?

Oncoplastic surgery is integral to all breast cancer surgeries. The use of an aesthetic approach to breast conservation or mastectomy greatly enhances the range of options that can be offered to women with breast cancer and facilitates better outomes from it. It should be the standard of care. However, a structured approach to selecting appropriate techniques is essential, and although many operative procedures are reported, this article sets out to describe a set of principles and an algorithm by which the what, when and for whom for oncoplastic surgery can be defined.     

Aromatase Inhibitor-Associated Arthralgia: How Big Is the Problem and What Can Be Done?

Aromatase inhibitor-induced arthralgia (AIA) remains a significant clinical dilemma for breast cancer survivors and their oncologists. Approximately half of women who take aromatase inhibitors (AIs) experience joint pain which often affects daily functioning and quality of life. Effects can be so severe that many women stop taking the AI; nonetheless, we know very little about what causes AIA, or how to effectively treat it. This article briefly describes the syndrome of AIA and then discusses several potential management strategies for this frequent clinical quandary.     

UK guidelines for the management of bone sarcomas

This document is an update of the British Sarcoma Group guidelines published in 2010. The aim is to provide a reference standard for the clinical care of patients in the UK with bone sarcomas. Recent recommendations by the European Society of Medical Oncology, The National Comprehensive Cancer Network and The National Institute for Health and Care Excellence have been incorporated, and the literature since 2010 reviewed. The standards represent a consensus amongst British Sarcoma Group members in 2015. It is acknowledged that these guidelines will need further updates as care evolves. The key recommendations are that bone pain or a palpable mass should always lead to further investigation and that patients with clinico-radiological findings suggestive of a primary bone tumour at any site in the skeleton should be referred to a specialist centre and managed by a fully accredited bone sarcoma multidisciplinary team. Treatment recommendations are provided for the major tumour types and for localised, metastatic and recurrent disease. Follow up schedules are suggested.