Importancia de las características socio-demográficas y epidemiológicas en el manejo de los tumores de ovario / Importance of the socio-demographic and epidemiological characteristics, in the management of ovary tumors

Objetivo: Describir las principales características socio-demográficas y epidemiológicas, de las pacientes con tumores de ovarios. Métodos: Estudio descriptivo, transversal, con una población de 133 pacientes que acudieron a la consulta de Ginecología Oncológica, del Servicio Oncológico Hospitalario del IVSS, entre julio de 2016 y julio de 2017,con diagnóstico de tumores de ovarios, donde solo 24cumplieron con los criterios de inclusión. Resultados: Mayor procedencia Estado Miranda con 42%. La raza mestiza 46%.El promedio de edad 48,33 años. Menarquia promedio 12,29años. Sexarquia promedio de 19,14 años. Parejas sexuales entre 1-2, 46%. Antecedentes obstétricos: 2,5 gestaciones. Anticonceptivos orales 21%. Dispositivos intrauterinos en 21%.Hábito tabáquico 29%. Síntomas en el 83% (58% aumento de volumen abdominal) con evolución de 4,05 meses. 63%tumores benignos (cistoadenoma mucinoso con 46%), 33%tumores malignos (adenocarcinoma endometroide con 37%)y 4% tumor borderline (atípicamente proliferativo), el tipo(mucinoso). Según la clasificación FIGO estadio 1C y 3C con38% respectivamente. La lateralidad predominante lado derecho(54%). El promedio del tamaño fue de 17,60 cm. Conclusión: Las características socio-demográficas, epidemiológicas y clínico-patológicas, determinan el manejo adecuado de los tumoresde ovarios, por lo que deben ser investigadas a fondo, y deesta manera, ofrecer el mejor tratamiento individualizado a laspacientes(AU)

Objective: To describe the main socio-demographic and epidemiological characteristics of patients with ovarian tumors. Methods: Descriptive, cross-sectional study, with a population of 133 patients who attended the Oncology Gynecology clinic of the Hospital Oncology Service of the IVSS, between July 2016 and July 2017, with diagnosis of ovarian tumors, where only 24 complied with the inclusion criteria. Results: Of the 133 patients who attended the Oncology Gynecology clinic with a diagnosis of ovarian tumors, only 24 patients met the inclusion criteria. Highest origin Miranda State with 42%. The 46% mixed race. The average age 48.33 years. Average menarche 12.29 years. Average sexarchy of 19.14 years. Sexual couples between 1-2, 46%. Obstetric history: 2.5 pregnancies. Oral contraceptives 21%. Intrauterine devices in 21%. Smoking habit 29%. Symptoms in 83% (58% increase in abdominal volume) with evolution of 4.05 months. 63% benign tumors (mucinous cystadenoma with 46%), 33% malignant tumors (endometroid adenocarcinoma with 37%) and 4% borderline (atypically proliferative), the type (mucinous). According to the FIGO stage 1C and 3C classification with 38% respectively. The predominant laterality on the right side (54%). The average size was 17.60 cm. Conclusion: The socio-demographic, epidemiological and clinical-pathological characteristics determine the proper management of ovarian tumors, so they must be thoroughly investigated, and thus offer the best individualized treatment to patients(AU)

Preoperative differentiation of benign and malignant non-epithelial ovarian tumors: clinical features and tumor markers / Diferenciação pré-operatória de tumores ovarianos não epiteliais benignos e malignos: características clínicas e marcadores tumorais

Abstract Objective To evaluate the role of clinical features and preoperativemeasurement of cancer antigen 125 (CA125), human epididymis protein(HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. Methods One hundred and nineteen consecutive women with germ cell, sex cordstromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. Results Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, amongmalignant, fourwere immatureteratomas. Themost common tumors in the sex cordstromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign andmalignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. Conclusion Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant caseswere diagnosed at initial stages with good prognosis. Themeasurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.

Resumo Objetivo Avaliar o papel das características clínicas e a medida pré-operatória dos níveis séricos de CA125, HE4, e CEA em mulheres com tumores de ovário não epiteliais benignos e malignos. Métodos Cento e dezenovemulheres consecutivas comtumores ovarianos de células germinativas, do cordão sexual-estroma, e miomas ovarianos foram incluídas neste estudo. Os níveis pré-operatórios dos biomarcadores foram medidos, a cirurgia e a análise histopatológica foram realizadas. Informações sobre tratamento e recorrência da doença foram obtidas dos prontuários médicos das pacientes. Resultados Nossa amostra incluiu 71 mulheres com tumores de células germinativas (64 benignos e 7 malignos), 46 com tumores do cordão sexual-estroma (32 benignos e 14 malignos), e 2 com leiomiomas ovarianos. Entre os tumores benignos de células germinativas, 63 eram teratomas maduros, e, entre os malignos, quatro eram teratomas imaturos. Os tumores mais comuns do grupo do cordão sexual-estroma foram fibromas (benignos) e tumores de células da granulosa (malignos). Os níveis séricos dos biomarcadores não diferiram entre os tumores de ovário não epiteliais benignos e malignos. A cirurgia preservadora de fertilidade foi realizada em 5 (71,4%) mulheres com tumores malignos de células germinativas. Onze (78,6%) mulheres com tumores do cordão sexual-estromamalignos foram tratadas comcirurgia preservadora de fertilidade. Cinco (71,4%)mulheres com células germinativas e apenas 1 (7,1%) com tumor do cordão sexual-estroma foram tratadas com quimioterapia. Uma mulher com tumor de células germinativas recidivou e morreu da doença. Uma mulher com tumor do cordão sexual-estroma recidivou. Conclusão Os tumores de ovário não epiteliais foram benignos namaioria dos casos e os malignos foram diagnosticados em estágios iniciais, com bom prognóstico. A medida dos níveis séricos de CA125, HE4, e CEA não foram úteis no diagnóstico préoperatório desses tumores.

Practical recommendations for the management of benign adnexal masses / Recomendações práticas para o tratamento de massas anexiais benignas

Abstract Objective To performa comprehensive review to provide practical recommendations regarding the diagnosis and treatment of benign adnexal masses, as well as information for appropriate consent, regarding possible loss of the ovarian reserve. Methods A comprehensive review of the literature was performed to identify the most relevant data about this subject. Results In total, 48 studies addressed the necessary aspects of the review, and we described their epidemiology, diagnoses, treatment options with detailed techniques, and perspectives regarding future fertility. Conclusions Adnexal masses are extremely common. The application of diagnosis algorithms is mandatory to exclude malignancy. A great number of cases can bemanaged with surveillance. Surgery, when necessary, should be performed with adequate techniques. However, even in the hands of experienced surgeons, there is a significant decrease in ovarian reserves, especially in cases of endometriomas. There is an evident necessity of studies that focus on the long-term impact on fertility.

Resumo Objetivo Realizar uma revisão abrangente para fornecer recomendações práticas sobre o diagnóstico e tratamento demassas anexiais benignas, bemcomo informações para um consentimento adequado com relação à possível perda da reserva ovariana. Métodos Uma revisão abrangente da literatura foi realizada para identificar os dados mais relevantes sobre o assunto. Resultados No total, 48 estudos abordaram os aspectos necessários da revisão, e descrevemos sua epidemiologia, diagnósticos, opções de tratamento com técnicas detalhadas, e perspectivas sobre fertilidade futura. Conclusões As massas anexiais são extremamente comuns. A aplicação de algoritmos de diagnóstico é obrigatória para excluiramalignidade. A maioria dos casos pode ser manejada conservadoramente. A cirurgia, quando necessária, deve ser realizada com técnicas adequadas. No entanto, mesmo nas mãos de cirurgiões experientes, há diminuição significativa da reserva ovariana, principalmente nos casos de endometriomas. Há uma evidente necessidade de estudos que enfoquemo impacto das massas anexiais benignas na fertilidade em longo prazo.

Tendências de Incidência e Mortalidade por Câncer de Ovário nos Países da América Latina / Trends in Incidence and Mortality by Ovarian Cancer in Latin American Countries / Tendencias de Incidencia y Mortalidad por Cáncer de Ovario en Países de América Latina

Introdução: O câncer de ovário é o sétimo mais comum e a nona causa de morte por câncer em mulheres, no mundo. Na América Latina, o câncer é a segunda causa de morte, e as projeções indicam um provável crescimento no número de mortes entre os anos 2012 e 2035. Objetivo: Analisar as tendências de incidência e mortalidade para o câncer de ovário em países da América Latina. Método:Estudo ecológico de série temporal, com dados de incidência extraídos da Agência Internacional para Pesquisa do Câncer de 1990 a 2012, e dados de mortalidade obtidos de 17 países da Organização Mundial da Saúde de 1995 a 2013. A tendência de incidência foi analisada pela regressão Joinpoint. A variação percentual média anual (AAPC) e o intervalo de confiança de 95% foram calculados para incidência e mortalidade. Resultados: As maiores taxas de incidência para o câncer de ovário foram observadas em Cali (Colômbia) e Goiânia (Brasil) na faixa etária acima de 60 anos. Houve tendência de estabilidade na maioria dos países, exceto em Goiânia (Brasil), na faixa etária de 60-74 anos, que apresentou tendência de aumento (AAPC: 3,4%; IC 95%: 0,3; 6,6). A maior taxa de mortalidade por câncer de ovário ocorreu no Uruguai para a faixa etária de 60-74 anos e a menor, em Belize e Guatemala, para a faixa etária de 0-39 anos. Conclusão: A incidência do câncer de ovário na América Latina apresentou estabilidade na maioria dos países. Em alguns, como o Brasil, observou-se aumento nas tendências de mortalidade.

Introducción: el cáncer de ovario es el más común y la novena causa de muerte por cáncer en mujeres de todo el mundo. En América Latina, el cáncer es la segunda causa principal de muerte y las proyecciones se consideran un número probable de muertes entre los años 2012 y 2035. Objetivo: Analizar las tendencias de mortalidad y mortalidad por cáncer de ovario en los países latinoamericanos. Método: Estudio de series de tiempo ecológicas, con datos extraídos por la Agencia Internacional de Investigación sobre el Cáncer, de 1990 a 2012 y datos con mortalidad de 17 países de la Organización Mundial de la Salud, de 1995 a 2013. Se analizó una tendencia de incidencia mediante la regresión de Joinpoint. El cambio porcentual anual medio (AAPC) y el intervalo de confianza del 95% se calcularon para la incidencia y la mortalidad. Resultados: Las tasas de incidencia más altas de cáncer de ovario se observaron en Cali (Colombia) y Goiânia (Brasil) en el grupo de edad de más de 60 años. Hubo una tendencia hacia la estabilidad en la mayoría de los países, excepto en Goiânia (Brasil), en el grupo de edad de 60-74 años, con una tendencia creciente (AAPC: 3,4%; IC 95%: 0,3; 6,6). Las tasas de mortalidad más altas debidas al cáncer de ovario no ocurrieron en Uruguay para el grupo de edad de 60-74 años y las más bajas en Belice y Guatemala, para el grupo de edad de 0-39 años. Conclusión: La incidencia del cáncer de ovario en América Latina se ha mantenido estable en la mayoría de los países. En algunos, como Brasil, las tendencias de mortalidad pueden aumentar.

Introduction: Ovarian cancer is the seventh most common and the ninth cause of death by cancer in women worldwide. In Latin America, cancer is the second cause of death and projections indicate a probable growth of the number of deaths between 2012 and 2035. Objective: To analyze the trends of incidence and mortality by ovarian cancer in Latin American countries. Method: Ecological time series study, with incidence data extracted from the International Agency for Research on Cancer, from 1990 to 2012 and mortality data from 17 countries of the World Health Organization, from 1995 to 2013. An incidence trend was analyzed by the Joinpoint regression. The average annual percentage change (AAPC) and the 95% confidence interval were calculated for incidence and mortality. Results: The highest incidence rates of ovarian cancer were observed in Cali (Colombia) and Goiânia (Brazil) in the age group older than 60 years. There was a tendency towards stability in most countries, except in Goiânia (Brazil), in the age group from 60-74 years old, with an increasing trend (AAPC: 3.4%; 95% CI: 0.3; 6.6). The highest rate of mortality by ovarian cancer occurred in Uruguay for the age group of 60-74 years and the lowest, in Belize and Guatemala, for the age group of 0-39 years. Conclusion: The incidence of ovarian cancer in Latin America has remained stable in most countries. In some, as Brazil, increase of mortality rates was observed.

Epidemiologia de cáncer de ovario colombia 2009- 2016 / Epidemiology of ovarian cancer colombia 2009- 2016

Resumen Introducción el cáncer es una de las enfermedades más temidas por la humanidad y el tumor maligno de ovario no es la excepción. Se caracteriza por su alta agresividad y por presentar síntomas inespecíficos, además de no contar, hasta el momento, con pruebas de tamizaje que permitan una detección precoz, convirtiéndose en uno de los cánceres femeninos con alta mortalidad ocupando el séptimo lugar a nivel mundial. Objetivo Medir la prevalencia, mortalidad y la letalidad asociadas al cáncer de ovario entre 2009 a 2016 en la población colombiana. Método se realizó un estudio descriptivo, transversal, ecológico. A partir de una base de datos en el RIPS de SISPRO y DANE se seleccionaron las mujeres con diagnóstico de tumor maligno de ovario. Resultados se hallaron 36.798 mujeres con diagnóstico de cáncer de ovario, la edad media fue de 63 años con una prevalencia de 31,66 por 100.000 mujeres, en los departamentos de Antioquia, Santander, y Bogotá. Se estimó una tasa de mortalidad de 3,9 por 100.000 mujeres, predominio en educación básica primaria, y régimen de seguridad social contributivo. La letalidad fue de 15,75%. Conclusiones En Colombia la prevalencia, mortalidad y letalidad entre 2009 a 2016 presentó una tendencia al incremento, predominio en casadas, bajo nivel educativo y menor acceso a los servicios de salud. En virtud de lo anteriormente expuesto, se abre la posibilidad de establecer prioridades sanitarias, diseño de futuras estrategias en prevención de la enfermedad en salud pública, detención precoz y con la consecuente disminución de la mortalidad.

Ovarian sertoli-leydig cell tumors: epidemiological, clinical and prognostic factors / Tumores de células de Sertoli-Leydig ovarianos: fatores epidemiológicos, clínicos e prognósticos

Abstract Objective To describe a series of cases of ovarian Sertoli-Leydig cell tumors (SLCTs). Methods Retrospective review of 12 cases of SLCT treated at the Hospital do Câncer de Barretos, Barretos, state of São Paulo, Brazil, between October 2009 and August 2017. Results The median age of the patients was 31 years old (15-71 years old). A total of 9 patients (75.0%) presented symptoms: 8 (66.7%) presented with abdominal pain, 5 (41.7%) presented with abdominal enlargement, 2 (16.7%) presentedwith virilizing signs, 2 (16.7%) presented with abnormal uterine bleeding, 1 (8.3%) presented with dyspareunia, and 1 (8.3%) presented with weight loss. The median preoperative lactate dehydrogenase (LDH) was 504.5 U/L (138-569 U/L), alpha-fetoprotein (AFP) was 2.0 ng/ml (1.1-11.3 ng/ml), human chorionic gonadotropin (β-hCG) was 0.6 mUI/ml (0.0-2.3 mUI/ml), carcinoembryonic antigen (CEA) was 0.9 ng/ml (0.7-3.4 ng/ml), and cancer antigen 125 (CA-125) was 26.0 U/ml (19.1-147.0 U/ml). All of the tumors were unilateral and surgically treated. Lymphadenectomy was performed in 3 (25.0%) patients, but none of the three patients submitted to lymphadenectomy presented lymph node involvement. In the anatomopathological exam, 1 (8.3%) tumor was well-differentiated, 8 (66.7%) were moderately differentiated, and 3 (25.0%) were poorly differentiated. A total of 5 (55.6%) tumors were solid-cystic, 2 (22.2%) were purely cystic, 1 (11.1%) was cystic with vegetations, and 1 (11.1%) was purely solid, but for 3 patients this information was not available. The median lesion size was 14.2 cm (3.2-23.5 cm). All of the tumors were at stage IA of the 2014 classification of the International Federation ofGynecology andObstetrics (FIGO). A total of 2 (16.7%) patients received adjuvant treatment; 1 of themunderwent 3 cycles of paclitaxel and carboplatin every 21days, and the other underwent 4 cycles of ifosfamide, cisplatin and etoposide every 21 days. None of all of the patients had recurrence, and one death related to complications after surgical staging occurred. Conclusion Abdominal pain was the most frequent presentation. There was no ultrasonographic pattern. All of the SLCTs were at stage IA, and most of them were moderately differentiated. Relapses did not occur, but one death related to the surgical staging occurred.

Resumo Objetivo Descrever uma série de casos de tumores de células de Sertoli-Leydig (TCSLs) ovarianos. Métodos Revisão retrospectiva de 12 casos de TCSL tratados no Hospital de Câncer de Barretos entre outubro de 2009 e agosto de 2017. Resultados A mediana de idade foi 31 anos (15-71 anos). Um total de 9 pacientes (75,0%) apresentaram sintomas: 8 (66,7%) apresentaram dor abdominal, 5 (41,7%) apresentaram aumento abdominal, 2 (16,7%) apresentaram virilização, 2 (16,7%) apresentaram sangramento uterino anormal, 1 (8,3%) apresentou dispareunia, e 1 (8,3%) apresentou emagrecimento. A mediana de desidrogenase láctica (DHL) foi 504,5 U/L (138-569 U/L), alfafetoproteína (AFP) foi 2,0 ng/ml (1,1-11,3 ng/ml), gonadotrofina coriônica humana (β-hCG) foi 0,6 mUI/ml (0,0-2,3 mUI/ml), antígeno carcinoembrionário (CEA) foi 0,9 ng/ml (0,7-3,4) ng/ml, e antígeno cancerígeno 125 (CA-125) foi 26,0 U/ml (19,1-147,0 U/ml), todos pré-operatórios. Todos os tumores foram unilaterais e tratados cirurgicamente. Realizou-se linfadenectomia em 3 (25,0%) pacientes, por em, nenhuma das tr^es apresentou acometimento linfonodal. No exame anatomopatológico, 1 tumor (8,3%) era bem diferenciado, 8 (66,7%) eram moderadamente diferenciados, e 3 (25,0%) eram pouco diferenciados. Um total de 5 (55,6%) tumores eram sólido-císticos, 2 (22,2%) eram puramente císticos, 1 (11,1%) era cístico com vegetações, e 1 (11,1%) era puramente sólido, mas para 3 pacientes estas informações não estavam disponíveis. A mediana da dimensão da lesão foi 14,2 cm (3,2-23,5 cm). Todos os tumores eram estádio IA de acordo com a classificação de 2014 da Federação Internacional de Ginecologia e Obstetrícia (FIGO, na sigla em inglês). Duas (16,7%) pacientes receberam adjuvância; uma realizou 3 ciclos de paclitaxel e carboplatina a cada 21 dias, e a outra 4 ciclos de ifosfamida, cisplatina e etoposide a cada 21 dias. Dentre todas as pacientes, nenhuma apresentou recidiva e houve um óbito relacionado a complicações após estadiamento cirúrgico. Conclusão Dor abdominal foi a apresentação mais frequente. Todos os TCSLs eram estádio IA e a maioria era moderadamente diferenciada. Não ocorreram recidivas, mas ocorreu um óbito relacionado ao estadiamento cirúrgico.

Homologous recombination deficiency in ovarian cancer: a review of its epidemiology and management

Ovarian cancer patients with homologous recombination deficiencies exhibit specific clinical behaviors, and improved responses to treatments, such as platinum-based chemotherapy and poly (ADP-ribose) polymerase (PARP) inhibitors, have been observed. Germline mutations in the BRCA 1/2 genes are the most well-known mechanisms of homologous recombination deficiency. However, other mechanisms, such as germline and somatic mutations in other homologous recombination genes and epigenetic modifications, have also been implicated in homologous recombination deficiency. The epidemiology and implications of these other mechanisms need to be better understood to improve the treatment strategies for these patients. Furthermore, an evaluation of various diagnostic tests to investigate homologous recombination deficiency is essential. Comprehension of the role of homologous recombination deficiency in ovarian cancer also allows the development of therapeutic combinations that can improve the efficacy of treatment. In this review, we discuss the epidemiology and management of homologous recombination deficiency in ovarian cancer patients.

Câncer de ovário / Ovarian cancer

Objetivos: O câncer de ovário (CO) apresenta grande impacto na taxa de mortalidade por neoplasias ginecológicas no mundo. No Brasil, apresenta incidência estimada de 5,95 casos para cada 100.000 mulheres. Esta revisão tem por objetivo reunir as principais informações sobre a neoplasia maligna ovariana, abordando pontos de interesse na prática médica e trazendo atualizações sobre o tema. Métodos: Foi realizada uma revisão do CO utilizando bases de dados PubMed, MedLine, Lilacs e o Portal de Periódico Capes, das quais foram selecionados artigos dos últimos 5 anos, com foco em atualizações sobre diagnóstico, tratamento e aspectos gerais da doença. Resultados: Foram reunidas as últimas evidências sobre epidemiologia, investigação, diagnóstico, fatores de risco incluindo rastreamento genético, tratamento pré e pós operatório e seguimento após o tratamento do CO. Conclusões: Esta revisão esclarece os pontos base da doença, auxilia no manejo e no acompanhamento das pacientes afetadas por esta patologia.

Aims: Ovarian cancer (CO) has a great impact on the mortality rate due to gynecological neoplasias in the world. In Brazil, it has an estimated incidence of 5.95 cases per 100,000 women. This review aims to gather the main information about ovarian malignancy, addressing points of interest in medical practice and bringing updates on the subject. Methods: A review of the CO was made using the data base PubMed, MedLine, Lilacs and Capes Periodical Portals, of which articles of the last 5 years were selected, focusing on updates on diagnosis, treatment and general aspects of the disease. Results: The latest evidence on epidemiology, research, diagnosis, risk factors including genetic screening, pre and postoperative treatment and follow-up after CO treatment were collected. Conclusions: This review clarifies the basics of the disease, helps in the management and follow-up of the patients affected by this pathology.

Caracterización de las pacientes con cáncer de ovario. Hospital Gineco-Obstétrico "Ramón González Coro" 2001-2013 / Characterization of patients with ovarian cancer. Gyneco-obstetric Hospital "Ramón González Coro" 2001-2013

Introducción: actualmente en Cuba y en todo el mundo, el cáncer de ovario representa la octava causa más importante de neoplasias malignas en la mujer, pero es la cuarta causa relacionada con la mortalidad. Objetivo: identificar el comportamiento por tipos histológicos y por tratamientos del cáncer de ovario. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo, de pacientes con cáncer de ovario, atendidas en el Hospital "Ramón González Coro", La Habana. En el período comprendido entre enero de 2001 a julio de 2013. Las unidades de análisis fueron las historias clínicas de las 98 pacientes que se estudiaron. Resultados: se observó que 69,3 % tenían entre 31 y 60 años de edad. La edad promedio del grupo completo fue 48,2 años, la mitad de las pacientes no refirieron antecedentes patológicos. La paridad promedio fue 1,3. En 3,1 % tenían antecedentes de una neoplasia maligna confirmada y tratada, 14,3 % poseían antecedentes familiares maternos de neoplasia maligna; siendo el motivo de consulta más frecuente el "dolor en bajo vientre" (40,8 %). No hubo asociación significativa entre los estadios (FIGO) y el tipo de cáncer. Conclusiones: los resultados obtenidos se comportan, en general, de acuerdo a patrones epidemiológicos reportados internacionalmente, aunque la frecuencia de cáncer epitelial fue menor que la referida en la literatura consultada. La mayoría de los cánceres estudiados estaban en estadios I y III (AU).

Background: currently in Cuba and around the world, the ovarian cancer represents the eighth most important cause of malignant neoplasia in women, but it is the fourth cause related with mortality. Objective: identifying behavior by histological types and by ovarian cancer treatment. Materials and methods: a descriptive, retrospective study was carried out in patients with ovarian cancer attended in the Hospital "Ramón González Coro", Havana, in the period between January 2001 and July 2013. The analysis units were the clinical records of the 98 studied patients. Outcomes: it was observed that 69.3 % were aged 31-60 years. The average age of the entire group was 48.2 years; half of the patients did not refer pathological antecedents. The average parity was 1.3. 3.1 % had antecedents of confirmed and treated malignant neoplasia; 14.3 % had maternal antecedents of malignant neoplasia, being the most frequent motive of consultation "pain in the low womb" (40.8 %). There was not significant association between the stages (FIGO) and the cancer type. Conclusions: the obtained results behave, in general, according to the epidemiological patterns internationally reported, though the frequency of the epithelial cancer was lower than the one referred in the consulted literature. Most of the studied cancers were in stages I and III (AU).

Epidemiological overview, advances in diagnosis, prevention, treatment and management of epithelial ovarian cancer in Mexico / Panorama epidemiológico, avances diagnósticos, prevención, tratamiento y manejo de cáncer ovárico epitelial en México

Abstract The epithelial ovarian cancer (EOC) has been underdiagnosed because it does not have a specific clinical presentation, and the signs and symptoms are similar to the irritable bowel syndrome and pelvic inflammatory disease. EOC is less common than breast and cervical cancer, but it is more lethal. On the whole, EOC has an early dissemination to peritoneal cavity, which delays a timely diagnosis and increases the rate of advanced diagnosed disease. The diagnosis usually surprises the women and the primary care physician. Therefore, it is necessary to count on prevention and early diagnosis programs. EOC has 80% response to surgical treatment, but nearly 70% of the patients may relapse in five years. The objectives of this document are presenting a summary of the EOC epidemiology and comment about advancements in prevention, diagnosis, and treatment of this cancer. That will raise awareness about the importance of this disease.

Resumen El cáncer ovárico epitelial (COE) ha sido subdiagnosticado debido a que no tiene presentación clínica específica y a que los signos y síntomas son similares al síndrome de colon irritable y a la enfermedad inflamatoria pélvica. Es menos común que el cáncer de mama o el cervicouterino, pero es más letal. En general, tiene diseminación temprana a cavidad peritoneal, lo cual retrasa un pronóstico oportuno e incrementa la tasa de diagnóstico de enfermedad avanzada. Usualmente, el diagnóstico sorprende a la mujer y al médico de primer contacto. Entonces, es necesario contar con programas de prevención y diagnóstico temprano. El COE tiene 80% de respuesta quirúrgica, pero cerca de 70% de las pacientes puede recaer en cinco años. Los objetivos de este documento son presentar un resumen de la epidemiología del COE y comentar los avances en prevención, diagnóstico y tratamiento de este cáncer. Esto despertará la conciencia acerca de la importancia de esta enfermedad.

Incidence of epithelial ovarian cancer according to histologic subtypes in Korea, 1999 to 2012 / 부인종양

OBJECTIVE: To investigate trends in the incidence of epithelial ovarian cancer (EOC), according to histologic subtypes, in Korean women between 1999 and 2012. METHODS: Data from the Korea Central Cancer Registry recorded between 1999 and 2012 were evaluated. The incidences of EOC histologic subtypes were counted. Age-standardized incidence rates (ASRs) and annual percentage changes (APCs) in incidence rates were calculated. Patient data were divided into three groups based on age (59 years), and age-specific incidence rates were compared. RESULTS: Overall, the incidence of EOC has increased. Annual EOC cases increased from 922 in 1999 to 1,775 in 2012. In 1999, the ASR was 3.52 per 100,000 and increased to 4.79 per 100,000 in 2012 (APC, 2.53%; p<0.001). The ASRs in 2012 and APCs between 1999 and 2012 for the four major histologic subtypes were as follows (in order of incidence): serous carcinoma (ASR, 2.32 per 100,000; APC, 4.34%; p<0.001), mucinous carcinoma (ASR, 0.73 per 100,000; APC, -1.05%; p=0.131), endometrioid carcinoma (ASR, 0.51 per 100,000; APC, 1.48%; p=0.032), and clear cell carcinoma (ASR, 0.50 per 100,000; APC, 8.13%; p<0.001). In the sub-analyses based on age, clear cell carcinoma was confirmed as the histologic subtype whose incidence had increased the most since 1999. CONCLUSION: The incidence of EOC is increasing in Korea. Among the histologic subtypes, the incidence of clear cell carcinoma has increased markedly across all age groups since 1999.

Outcomes of carotid artery stenting at a high-volume Brazilian interventional neuroradiology center

OBJECTIVES: Carotid artery stenting is an emerging revascularization alternative to carotid endarterectomy. However, guidelines have recommended carotid artery stenting only if the rate of periprocedural stroke or death is < 6% among symptomatic patients and < 3% among asymptomatic patients. The aim of this study is to evaluate and compare clinical outcomes of symptomatic and asymptomatic patients who had undergone carotid artery stenting as a first-intention treatment. METHOD: A retrospective analysis of patients who underwent carotid artery stenting by our interventional neuroradiology team was conducted. Patients were divided into two groups: symptomatic and asymptomatic patients. The primary endpoints were ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage and major adverse cardiac and cerebrovascular events at 30 days. The secondary endpoints included ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage, ipsilateral transient ischemic attack and major adverse cardiac and cerebrovascular events between the 1- and 12-month follow-ups. RESULTS: A total of 200 consecutive patients were evaluated. The primary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral stroke (2.4% vs. 2.7%, p = 1.00), ipsilateral parenchymal hemorrhage (0.8% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (4.7% vs. 2.7%, p = 0.71). The secondary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral ischemic stroke (0.0% vs. 0.0%), ipsilateral parenchymal hemorrhage (0.0% vs. 0.0%), ipsilateral TIA (0.0% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (11.2% vs. 4.1%, p = 0.11). CONCLUSIONS: In this retrospective study, carotid artery stenting was similarly safe and effective when performed as a first-intention treatment in both symptomatic and asymptomatic patients. The ...

Quality of life and sexuality comparison between sexually active ovarian cancer survivors and healthy women / 부인종양

OBJECTIVE: compare quality of life (QoL) and sexual functioning between sexually active ovarian cancer survivors and healthy women. METHODS: A cross-sectional study was performed in 103 successfully treated ovarian cancer survivors and 220 healthy women. All women had engaged in sexual activity within the previous 3 months, and ovarian cancer survivors were under surveillance after primary treatment without evidence of disease. QoL and sexual functioning were assessed using three questionnaires; the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), Ovarian Cancer Module (EORTC QLQ-OV28), and the Female Sexual Function Index (FSFI). Propensity score matching was used to adjust covariates between the ovarian cancer survivor and healthy women groups. In total, 73 ovarian cancer survivors and 73 healthy women were compared. RESULTS: Poorer social functioning (mean, 82.4 vs. 90.9; p=0.010) and more financial difficulties (mean, 16.4 vs. 7.8; p=0.019) were observed among ovarian cancer survivors than among healthy women. Sexuality, both in terms of desire, arousal, lubrication, orgasm, satisfaction, and pain and in terms of interest in sex, sexual activity, and enjoyment of sex (EORTC QLQ-OV28) were similar between the groups. However, vaginal dryness was more problematic in ovarian cancer survivors, with borderline statistical significance (p=0.081). CONCLUSION: Sexuality was not impaired in ovarian cancer survivors who were without evidence of disease after primary treatment and having sexual activities, compared with healthy women, whereas social functioning and financial status did deteriorate. Prospective cohort studies are needed.

A Huge Mucinous Cystadenoma Complicating Third Trimester of Pregnancy with Previous Two Caesarean Sections.

The incidence of ovarian tumor complicating caesarean section was about 1 in 200 caesarean births while ovarian tumors complicated termination of pregnancy in 1 of 594 procedures. Any type of Ovarian mass can be encountered during pregnancy, but the most common are cystic. Because pregnant women are usually young, malignant tumors are relatively uncommon. A patient third gravida with previous 2 caesarean sections presented in an emergency with complaints of persistent pain in abdomen for last 7 days with gestational age of 35 weeks and 3 days. Emergency Caesarean section was done to deliver an alive male baby of 2.25 Kg with good Apgar score. Intraoperative finding was suggestive of a huge multiloculated left ovarian mass of approximately. 40×30×15 cm weighing 20 Kg with straw coloured mucinous fluid. Up to 3 liters of fl uid aspirated before delivering the cyst out of the abdomen. Left salpingoopherectomy was done and specimen sent for histopathological examination that showed Mucinous cystadenoma of the ovary. Post operative period remain uneventful.

Características clínicas y epidemiológicas de tumores de ovario en la Clínica Centenario Peruano Japonesa durante el 2009 y 2010 / Clinical and epidemiological characteristics of ovarian tumors in Japanese Peruvian

Objetivo: describir las características clínicas y epidemiológicas de los tumores de ovario. Material y Métodos: estudio de tipo cuantitativo, descriptivo retrospectivo de corte transversal y observacional. Se evaluaron 83 historias clínicas de pacientes con diagnóstico confirmado de tumor de ovario. Se elaboró un instrumento tomando como base los estudios realizados por Quero Hernandez, el mismo que fue sometido a juicio de experto para obtener su validación que correspondi¢óa 0.79, según coeficiente de Holsti. El procesamiento de datos se realizó mediante el programa estadistico SPSS versión 15 en espñ¤ol. Resultados: la edad media correspondió a 37.92 y DS ñ13.96, la edad minima correspondió a 17 años y de 77 años como edad maxima. El 53 % de las pacientes no tenian paridad, con relación al inicio de menarquia 54% referieron haber presentado entre 12 y 13 años. No existe relación entre los antecedentes y el uso de anticonceptivos en las pacientes estudiadas. El 87% de los pacientes ha referido tener dolor y el 22% aumento de volumen. Los medios de ayuda diagnóstica más empleados corresponden a ecograf¡a y CA125. Se encontró 11 pacientes con niveles superiores de 35U/ml. El diagnóstico anatomopatológico de tipo benigno correspondio a 97.59% y de 2.41% para patología maligna. Conclusiones: el diagnóstico en la mayor¡a de los casos fue clínico. Siendo el dolor y el aumento de volumen abdominal la mayor sintomatología. El CA 125 no fue de ayuda diagnóstica.

Objective: to describe the clinical and epidemiological characteristics of ovarian tumors. Material and Methods: a quantitative, descriptive retrospective cross-sectional and observational stud. A total of 83 medical records of patients with confirmed diagnosis of ovarian tumor were part of this study. A tool was developed based on the studies of Quero Hernandez, the same that was submitted for validation by an expert which corresponded to 0.79 according to the Holsti coefficient. Data processing was performed using SPSS version 15 in Spanish. Results: the mean age corresponded to 37.92 ñ 13.96 SD, the minimum age was 17 and the maximum was 77. 53% of the patients had not given birth, the start of menarche for 54% was between 12 and 13 years. There is no relationship between the background and the use of contraceptives in the patients studied. 87% of patients had pain and 22% increase in volume. The most used methods of diagnosis were the ultrasound and CA125 (11 patients had more than 35U/ml). The pathologic diagnosis of benign type corresponded to 97.59% and 2.41% for malignancy.Conclusions: the diagnoses in the majority of cases was clinical, were pain and increased volume were the major symptoms. CA125 was not useful for diagnosis.

Clinical presentation of ovarian tumors

To determine the frequency and various clinical presentations of ovarian tumors. Descriptive study. Department of Obstetrics and Gynaecology Sandeman Provincial Teaching Hospital Quetta, from January 2010 to December 2010. All patients with ovarian cysts and / tumors suspected on clinical grounds and investigations and later underwent laparotomy were included. The symptoms were grouped into various. categories like gastrointestinal, constitutional, urinary etc. The study included 65 patients. There were 50 [76%] benign and 15 [23%] malignant tumors. Seven patients with benign tumors were asymptomatic, while 90% had abdominal pain. Abdominal mass was present in 24% of the patients with benign tumors and in 66% with malignant tumors. Gastrointestinal symptoms were present in both the groups but frequency was higher in malignant tumors. Constitutional symptoms like loss of weight and appetite were reported in malignant group only. More than 75% of the malignant tumors presented in advanced stage of the disease [stages 3 and 4]. On histopathology benign cysts were mostly functional follicular/luteal cysts in nature [25%]. On the other hand histopathology of malignant tumors revealed that in majority of the patients tumors originated from epithelial surface [serous carcinoma 45% and mucinous carcinoma 25%].Women presented mostly in the advanced stages of malignancy. Symptoms were mostly nonspecific and vague

Epidemiologia de cáncer de ovario en el Hospital Nacional Guillermo Almenara Irigoyen entre enero 2007 y diciembre 2011 / Ovarian cancer epidemiology at the National Hospital Guillermo Almenara Irigoyen between January 2007 and December 2011

OBJETIVO: Conocer la prevalencia, incidencia hospitalaria y epidemiologia del cáncer de ovario en el HNGAI entre enero 2007 y diciembre 2011. PACIENTES Y MÉTODO: Estudio retrospectivo, descriptivo, transversal, epidemiológico de 46 pacientes con tumoraciones malignas de ovario atendidas entre 2007 y 2011 con expedientes completos. RESULTADOS: Los resultados mostraron que la mayor incidencia de Cáncer de Ovario fue entre las edades de 51 y 60 años, asimismo el Adenocarcinoma fue el tipo de neoplasia que se encontró con mayor frecuencia, siendo el subtipo cistoadenocarcinoma mucinoso el más común. En cuanto a los exámenes auxiliares para la ayuda diagnóstica, la ecografía y tomografía pudieron discernir entre maligno y benigno en la mayoría de los casos. (Figura 10 y 11) La mayoría de las pacientes permanecieron entre 6-10 días hospitalizadas luego de la cirugía. El promedio de tiempo operatorio fue entre 2 a 3 horas. En la mayoría de los casos, el resultado anatomopatologico del tumor extraído durante la cirugía estuvo disponible dentro del día de la operación.CONCLUSIONES: Se observó dos picos de edades más frecuentes relacionadas al cáncer de ovario, entre: 10-20 años y 51-60 años. La menarquía temprana no constituyo un factor de riesgo para cáncer de ovario. De todos los casos revisados, no se encontró antecedentes personales ni familiares de cáncer de ovario. Se observó que las complicaciones intraoperatorias y post operatorias fueron muy escasas. El tiempo de hospitalización fue en promedio entre 6-10 días. El tiempo operatorio promedio fue entre 2-3 horas. El resultado anatomopatologico del tumor de ovario fue determinado con mayor frecuencia dentro del día de la cirugía.

OBJETIVE: Determine the prevalence, incidence and epidemiology of ovarian cancer in HNGAI between January 2007 and December 2011. PATIENTS AND METHODS: Retrospective, descriptive, transversal, epidemiological study of 46 patients with ovarian malignancies treated between 2007 and 2011 with complete records. RESULTS: Results showed that the highest incidence of ovarian cancer is between ages 51-60, and adenocarcinoma was the most frequent histological type, subtype mucinous cystadenocarcinoma being the most common. Respecting auxiliary exams for diagnostic help, ultrasound and CT scan could differentiate between malignity and benignity in most cases. (Figures 10 and 11). Most patients were hospitalized between 6-10 days after surgery. The average operating time was between 2 to 3 hours. In most cases, the histopathology of the tumor removed during surgery was available in a day or less of the operation date. CONCLUSIONS: Two peaks were observed for relationship between age and ovarian cancer: 10-20 years old and 51-60 years old. Early menarche did not constitute a risk factor for ovarian cancer. From all reviewed cases, we didnÆt find personal or family history related to ovarian cancer. Intraoperative and postoperative complications were rare. The length of hospital stay was on average between 6-10 days. Mean operative time was between 2-3 hours. The pathology of the ovarian tumor was identified most frequently in the day of surgery.