Meme Kanseri Tani ve Tedavisinde Multidisipliner Guncel Yaklasimlar

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Necati ÖZEN
Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Genel Cerrahi ABD, Samsun
Article Language: TR
Değerli Meslektaşlarım;

Kadınlarda küresel kanser insidansı incelendiğinde en sık görülen kanser, meme kanseridir. 2018 yılında yeni tanı alan meme kanserli kadın sayısı 2.088.849'dur. Kadın kanserleri içinde meme kanseri oranı %25,4 olarak verilmekte; diğer bir deyimle her 4 kadın kanserinin bir tanesi meme kanseri olmaktadır. 2018 yılı verilerine göre kadınlarda kansere bağlı ölümler incelendiğinde meme kanseri %15.0 ile birinci sıradadır. Bunu akciğer kanseri %13,8 ile ve kolerektal kanserler %9,5 ile izlemektedir.

Meme kanserinin tarihi seyrine baktığımızda M.Ö. 460'da Hipokrat'ın meme kanserlerini tanımladığını, daha sonraki yıllarda Galen'in meme kanserlerini sistemik bir hastalık olarak belirlediğini görmekteyiz. 19. yüzyıla kadar çeşitli yöntemlerle tedavi edilmeye çalışılan meme kanserini New Yorklu cerrah Dr. Sir William Halsted 1882 yılında 'Halsted Radical Mastectomy' adıyla 1970'lere kadar uygulanan şekliyle tanımlamıştır. Bu dönemde meme kanseri Halsted Hipoteziyle 'loko-rejyonel hastalık' olarak kabul edilmiştir.

Dr. Umberto Veronesi ve Dr. Bernard Fisher aynı yıllarda meme kanserinin 'sistemik hastalık' teorisini benimsemiş ve meme koruyucu cerrahinin öncülüğünü yapmışlardır. 1970-1990 döneminde bu cerrahların yanı sıra Dr. Gianni Bonadonna adjuvan kemoterapinin öncülüğünü yapmıştır.

Dr. Armando Giuliano 1994 yılında 'isosulfan blue dye' kullanarak gerçekleştirdiği Sentinel Lenf Nodu Biyopsisini meme cerrahisinde aksiller diseksiyon yerine cerrahi dünyasına sunmuştur. 2000'li yıllarda uygun vakalarda MKC'ye olanak sağlamak için (downstaging) ve aksillanın daha düşük morbidite ile değerlendirme ve tedavisi için neoadjuvan kemoterapi kullanılmaya başlanmıştır.

Günümüzde meme kanseri ile ilgili araştırmalar sayesinde bu sistemik hastalığın aynı zamanda heterojen bir hastalık olduğu anlaşılmıştır. Moleküler sınıflamayı sağlayan östrojen ve progesteron reseptörleri ve HER2 durumunun bilinmesi ve genetik mutasyon testleri (BRCA1, BRCA2) sayesinde 'kişiye özel tedavi' kavramı ortaya çıkmıştır. TNM ile meme kanseri evrelemesinde sadece tümör çapı, lenf nodu durumu ve uzak metastaz değil; tümör grade, ER, PR, HER2 durumu ve Oncotype DX skoru da evreleme değerlendirmelerine girmeye başlamıştır.

Bu sistemik heterojen hastalığın tanı ve tedavisi konusunda sevk ve idaresi multidisipliner olarak ve meme konseyleri kurularak yapılmalıdır. Meme kanseri tanı, tedavi ve takibinde baş döndürücü bir hızla ortaya çıkan gelişmeler kafalarda birçok soru oluşturmaktadır. Bu kitapta okuyacağınız konular meme kanseri ile ilgili birçok soruyu cevaplamaya çalışacak ve bizleri günümüzdeki gelişmelerle buluşturacaktır.

'Türkiye Klinikleri'nin meme kanserine ayırdığı bu kitabında Editör olarak görevlendirilme şansını bana veren Türkiye Klinikleri ailesine minnet ve şükranlarımı sunuyorum. Kitabın hazırlanmasında emeği bulunan tüm meslektaşlarıma seçkin yazarlıkları ve deneyimleriyle katkıda bulundukları için teşekkür ediyorum.

Prof. Dr. Necati ÖZEN
Editör
Dear Colleagues;

When the global cancer incidence in women is examined, the most common cancer is breast cancer. Number of newly diagnosed women breast cancer patients in 2018 is 2,088,849. Breast cancer rate in female cancer patients was reported as 25.4%, in other words, and it has been stated that one in 4 female cancer patients has breast cancer. According to 2018 data, breast cancer ranks first with a rate of 15.0% when cancer-related deaths in women are examined. Following this, lung cancer is followed by 13.8% and colorectal cancers with 9.5%.

When we look at the historical course of breast cancer, we see that in 460 BC Hippocrates defined breast cancers, and in later years Galen identified breast cancers as a systemic disease.

Breast cancer, which was tried to be treated with various methods until the 19th century, was explained by New York surgeon Dr. Sir William Halsted defined it as 'Halsted Radical Mastectomy' in 1882, as applied until the 1970s.

In the same years, Dr. Umberto Veronesi and Dr. Bernard Fisher pioneered breast conserving surgery by adopting the 'systemic disease' theory of breast cancer. In addition to these surgeons between 1970 and 1990, Dr Gianni Bonadonna also pioneered adjuvant chemotherapy.

Dr Armando Giuliano presented in 1994 the Sentinel Lymph Node Biopsy, which he performed using 'isosulfan blue dye', to the surgical world in breast surgery instead of axillary dissection. In the 2000s, neoadjuvant chemotherapy was started to be used for both downstaging and evaluation and treatment of axilla with lower morbidity in appropriate cases.

Today, thanks to researches on breast cancer, it has been understood that this systemic disease is also a heterogeneous disease. Thanks to the knowledge of the estrogen and progesterone receptors that provide molecular classification and HER2 status and genetic mutation tests (BRCA1, BRCA2), the concept of 'personalized treatment' has emerged. Thus, in breast cancer staging with TNM, not only tumor diameter, lymph node status and distant metastasis, but also tumor grade, ER, PR, HER2 status and Oncotype DX score have begun to be included in staging evaluations.

The management and administration about the diagnosis and treatment of this systemic heterogeneous disease should be done multidisciplinary by establishing breast councils. On the other hand, the rapid developments in the diagnosis, treatment and follow-up of breast cancer raise many questions.

With the topics you will read in this book, it is tried to answer many questions about breast cancer and it is aimed to present the recent developments.

I am grateful and thankful to Türkiye Klinikleri family for giving me the chance to be the Editor in this book of Türkiye Klinikleri that is devoted to breast cancer. I would like to thank all my colleagues who contributed to the preparation of this book for their distinguished authorship and experience.

Prof. Dr. Necati ÖZEN
Editor

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