Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 248
Article in Chinese | WPRIM | ID: wpr-928873


CT image based organ segmentation is essential for radiotherapy treatment planning, and it is laborious and time consuming to outline the endangered organs and target areas before making radiation treatment plans. This study proposes a fully automated segmentation method based on fusion convolutional neural network to improve the efficiency of physicians in outlining the endangered organs and target areas. The CT images of 170 postoperative cervical cancer stage IB and IIA patients were selected for network training and automatic outlining of bladder, rectum, femoral head and CTV, and the neural network was used to localize easily distinguishable vessels around the target area to achieve more accurate outlining of CTV.

Female , Humans , Image Processing, Computer-Assisted , Neural Networks, Computer , Organs at Risk , Pelvis , Tomography, X-Ray Computed , Uterine Cervical Neoplasms/surgery
Femina ; 49(7): 444-448, 20210731. tab
Article in Portuguese | LILACS | ID: biblio-1290595


A exenteração pélvica pode curar pacientes com câncer de colo do útero com recorrência central após radioterapia e quimioterapia. A avaliação pré-operatória é essencial para excluir doença metastática e evitar cirurgias desnecessárias nesse cenário. O objetivo do presente estudo é avaliar a sobrevida de uma série de casos de pacientes submetidas à exenteração pélvica em clínica privada de Teresina. Este é o resultado parcial de um estudo observacional, retrospectivo, transversal e descritivo, realizado em uma clínica privada especializada no tratamento do câncer em Teresina, PI, Brasil, de junho de 2002 a fevereiro de 2020. Cinco pacientes foram incluídas no estudo, com idades entre 29 e 62 anos. No presente estudo, a sobrevida mediana foi de 44,8 meses. Duas pacientes estão vivas e sem doença com seguimento de 201 e 5 meses, respectivamente.(AU)

Pelvic exenteration can heal patients with cervical cancer with central recurrence after radiotherapy and / or chemotherapy. Preoperative evaluation is essential to exclude metastatic disease and to avoid unnecessary surgery in this scenario. The objective of the present study is to evaluate the survival of a series of cases of patients submitted to pelvic exenteration in a private clinic in Teresina. This is the partial result of an observational, retrospective, cross-sectional and descriptive study, conducted at a private clinic specialized in cancer treatment in Teresina, Brazil, from June 2002 to February 2020. Five patients were included in the study, aged between 29 and 62 years. In the present study, the median survival was 44,8 months. Two patients are alive and without disease with a follow-up of 201 and 5 months, respectively.(AU)

Humans , Female , Pelvic Exenteration/statistics & numerical data , Survival Analysis , Uterine Cervical Neoplasms/surgery , Neoplasm Recurrence, Local/epidemiology , Survival , Brazil/epidemiology , Cross-Sectional Studies
Rev. bras. ginecol. obstet ; 43(4): 329-333, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280035


Abstract Introduction Malignant mesonephric tumors are uncommon in the female genital tract, and they are usually located where embryonic remnants of Wolffian ducts are detected, such as the uterine cervix. The information about these tumors, their treatment protocol, and prognosis are scarce. Case report A 60-year-old woman with postmenopausal vaginal bleeding was initially diagnosed with endometrial carcinoma. After suspicion co-testing, the patient underwent a loop electrosurgical excision of the cervix and was eventually diagnosed with mesonephric adenocarcinoma. She was subjected to a radical hysterectomy, which revealed International Federation of Gynecology and Obstetrics (FIGO) IB1 stage, and adjuvant radiotherapy. The follow-up showed no evidence of recurrence after 60 months. Conclusion We present the case of a woman with cervical mesonephric adenocarcinoma. When compared with the literature, this case had the longest clinical follow-up without evidence of recurrence, which reinforces the concept that these tumors are associated with a favorable prognosis if managed according to the guidelines defined for the treatment of patients with cervical adenocarcinomas. Though a rare entity, it should be kept in mind as a differential diagnosis for other cervical cancers.

Humans , Female , Uterine Cervical Neoplasms/diagnosis , Mesonephroma/diagnosis , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/embryology , Uterine Cervical Neoplasms/pathology , Radiotherapy, Adjuvant , Diagnosis, Differential , Hysterectomy , Mesonephroma/surgery , Mesonephroma/embryology , Mesonephroma/pathology , Middle Aged , Neoplasm Invasiveness
Chinese Journal of Oncology ; (12): 981-988, 2021.
Article in Chinese | WPRIM | ID: wpr-920979


Cervical cancer is a common gynecologic malignancy. Most patients with early-stage cervical cancer received unnecessary systemic pelvic lymphadenectomy, which increased the risk of surgical complications. At present, sentinel lymph node biopsy has been applied in the clinical practice of cervical cancer abroad, however it is still at the starting stage in China in need of application and promotion. The Obstetrics and Gynecology Committee of Chinese Research Hospital Association invited domestic experts in the field of gynecologic oncology to discuss the application value, patient evaluation, technical methods, operation steps, pathological examination and many other key points of sentinel lymph node biopsy based on the current research status, and reached the consensus of clinical application on sentinel lymph node biopsy in cervical cancer to guide the standardized application of the technique in China.

Consensus , Female , Humans , Lymph Node Excision , Lymph Nodes/surgery , Lymphatic Metastasis , Neoplasm Staging , Sentinel Lymph Node/surgery , Sentinel Lymph Node Biopsy , Uterine Cervical Neoplasms/surgery
Chinese Journal of Oncology ; (12): 736-742, 2021.
Article in Chinese | WPRIM | ID: wpr-887468


Cervical cancer is the most common gynecologic malignancy. Radical hysterectomy for early-stage cervical cancer could cause damage to pelvic autonomic nerves, leading to postoperative urination, defecation and sexual dysfunction. In order to improve the postoperative quality of life, the international Querleu-Morrow (Q-M) surgical classification system recommends the nerve-sparing radical hysterectomy (type-C1) as the mainstay operation. The Gynecologic Oncology Group affiliated to Chinese Obstetricians and Gynecologists Association has invited a number of domestic specialists and conducted in-depth discussions on key issues such as anatomical basis, surgical indications, techniques, postoperative evaluation for nerve-sparing radical hysterectomy. Finally, the specialists reach a consensus to guide the standardized application of this procedure in China.

China , Consensus , Female , Humans , Hysterectomy , Quality of Life , Uterine Cervical Neoplasms/surgery
Rev. Méd. Paraná ; 79(1): 52-54, 2021.
Article in Portuguese | LILACS | ID: biblio-1282428


O câncer de colo de útero é uma doença invasiva causada pelo vírus oncogênico do HPV. Sendo o terceiro câncer maligno mais comum na mulher. O tratamento das lesões de câncer colo uterino é realizado a partir de métodos ablativos ou excisionais. Este estudo teve como objetivo avaliar o sucesso e a frequência de margens livres nas peças cirúrgicas obtidas por meio de cirurgia de alta frequência (CAF), utilizando uma alça diatérmica triangular modificada. Foi um estudo transversal, retrospectivo e descritivo. Os dados foram obtidos através de prontuários de pacientes submetidas a CAF com documentação do exame anatomopatológico, entre 07/10/15 até 31/08/2020. A coleta foi realizada em 34 pacientes que realizaram esse tratamento. Os resultados mostraram que 29 pacientes tiveram margens tanto ectocervical como endocervical livre. Conclui-se que a técnica utilizando a alça diatérmica triangular modificada mostrou-se eficaz no tratamento de lesões no colo do útero por HPV

Cervical cancer is an invasive disease caused by the oncogenic virus HPV. It's the third most common malign cancer in women. The treatment of the cervical cancer lesions is performed by ablative or excisional techniques. This study's objective was to evaluate the success and frequency of resection margins on surgical resections obtained by large loop excision of the transformation zone (LEEP), using a modified triangular diathermy loop. It was a cross-sectional, retrospective and descriptive study. The data was obtained through the records of patients who had undergone LEEP with the documentation of the anatomopathological examination between October 7th 2015 and August 31st 2020. The collection was performed in 34 patients who had undergone this treatment. The results showed that 29 patients had both ectocervical and endocervical resection margins. The conclusion was that the technique using a modified triangular diathermy loop presented itself as effective in the cervical cancer lesions treatment

Humans , Female , Papillomaviridae , Uterine Cervical Neoplasms/surgery , Cervix Uteri , Colposcopy
Rev. bras. ginecol. obstet ; 42(5): 266-271, May 2020. graf
Article in English | LILACS | ID: biblio-1137827


Abstract Objective To observe if the histopathological result of a conization performed after cervical adenocarcinoma in situ diagnosis is compatible with the histopathological analysis of a subsequent hysterectomy. Methods The present descriptive and observational research consisted of the analysis of the medical records of 42 patients who were diagnosed with in situ adenocarcinoma postconization. The analysis consisted of whether there was compatibility between the histopathological reports of conization and hysterectomy and if there was an association between adenocarcinoma in situ and another neoplasia (squamous disease). Interpretation of any immunohistochemistry reports obtained was also performed. In addition, clinical and epidemiological data were also analyzed. Results A total of 42 conizations were performed, 33 (79%) were cold knife conizations and 9 (21%) were loop electrosurgical excision procedures (LEEPs). Of the patients analyzed, 5 (10%) chose not to undergo subsequent hysterectomy to preserve fertility or were < 25 years old. Out of the 37 patients with adenocarcinoma in situ who underwent subsequent hysterectomy, 6 (16%) presented with residual disease. This findingprovedincompatiblewiththe finding of the conizations, which had ruled out invasive cancer. Conclusion The prevalence of adenocarcinoma in situ increased in the past years. There is still a large part of the medical literature that advocates the use of conservative treatment for this disease, even though it is common knowledge that it is a multifocal disease. However, the majority of studies advocate that hysterectomy should remain the preferred treatment for women who have already completed their reproductive purpose.

Resumo Objetivo Observar se o resultado proveniente de uma conização realizada após o diagnóstico de adenocarcinoma cervical in situ é compatível com a análise histopatológica da histerectomia. Métodos A pesquisa foi descritiva e observacional e consistiu na análise de prontuário de 42 pacientes que tiveram o diagnóstico de adenocarcinoma in situ obtidas por conização. Foram analisados se havia compatibilidade entre os laudos de conização e histerectomia, margens do cone, se havia associação com outra patologia (doença escamosa) e interpretação de eventuais laudos histoquímicos obtidos. Além disso, também foram analisados dados clínico-epidemiológicos. Resultados Foram realizadas 42 conizações, sendo 33 (79%) por cone clássico e 9 (21%) por cirurgia de alta frequência. Das pacientes analisadas, 5 (10%) não foram submetidas a histerectomia por desejarem manter a fertilidade ou por terem idade < 25 anos. Das 37 pacientes com adenocarcinoma in situ no exame prévio realizado e que foram submetidas à histerectomia posteriormente, 6 (16%) apresentaram doença residual após o procedimento cirúrgico, apresentando laudos do anatomopatológico pós-histerectomia incompatíveis com o achado na conização que atestava margens livres. Conclusão A prevalência do adenocarcinoma in situ vemaumentando cada vez mais. Ainda há uma grande parte da literatura que defende o uso do tratamento conservador para esta doença, mesmo sabendo que ela é uma doença multifocal e que pode estar presente mesmo em situações nas quais o anatomopatológico evidencie margens livres. Tendo em vista essas características, a maioria preconiza que a histerectomia continua a ser o tratamento preferencial nas mulheres que já completaram o seu intuito reprodutivo.

Humans , Female , Adolescent , Adult , Young Adult , Adenocarcinoma/pathology , Uterine Cervical Neoplasms/pathology , Conization , Neoplasm Invasiveness/diagnosis , Adenocarcinoma/surgery , Uterine Cervical Neoplasms/surgery , Medical Records , Predictive Value of Tests , Hysterectomy , Neoplasm Invasiveness/pathology
Rev. chil. obstet. ginecol. (En línea) ; 85(1): 3-13, feb. 2020. tab
Article in Spanish | LILACS | ID: biblio-1092770


INTRODUCCIÓN: El cáncer cervical es una patología común en países en vías de desarrollo. La histerectomía radical es el estándar de manejo en estadios tempranos sin deseo de fertilidad. La linfadenectomía paraaórtica como parte del tratamiento quirúrgico es controversial. El objetivo de este estudio es determinar la frecuencia de compromiso ganglionar paraaórtico en una serie retrospectiva de pacientes con carcinoma cervical estadio IB1 (clasificación FIGO 2009) llevadas a histerectomía radical mas linfadenectomía pélvica y paraaórtica en el Instituto Nacional de Cancerología durante el periodo de enero 1 de 2009 a marzo 31 de 2017. MÉTODOS: Estudio descriptivo, retrospectivo. Se describieron variables clínicas, operatorias e histopatológicas. Se determinó la frecuencia de compromiso ganglionar a nivel paraaórtico o pélvico, y concurrente. Se realizó análisis univariado en el software estadístico R Project versión 3.6.0. RESULTADOS: Se incluyeron 88 casos. El promedio de edad fue 44,24 ± 9,99 años. La mediana del número de ganglios pélvicos y paraaórticos resecados fue de 23 (6-68) y 4 (1-25), respectivamente. En el 12,5% de las pacientes se observó compromiso tumoral ganglionar pélvico. No se detectó compromiso metastásico de ganglios paraórticos en ningún caso. Dos pacientes presentaron recaída ganglionar paraaórtica durante el seguimiento, recibiendo tratamiento con quimioterapia y quimiorradioterapia de campo extendido, respectivamente. CONCLUSIÓN: En este estudio no se detectó compromiso paraaórtico en pacientes con cáncer cervical IB1 sometidas a histerectomía radical. Este resultado se debe considerar al ofrecer linfadenectomía paraaórtica en pacientes con ganglios pélvicos aparentemente normales en el acto operatorio y/o en los estudios de imágenes prequirúrgicas.

INTRODUCTION: Cervical cancer is a common pathology in developing countries. Radical hysterectomy is the standard of management in early stages without desire for fertility. Paraaortic lymphadenectomy as part of surgical treatment is controversial. The objective of this study is to determine the frequency of paraaortic lymph node involvement in a retrospective series of patients with stage IB1 cervical carcinoma (FIGO 2009 classification) underwent to radical hysterectomy plus pelvic and paraaortic lymphadenectomy at the Instituto Nacional de Cancerologia during the period of January 1 2009 to March 31 2017. METHODS: Descriptive, retrospective study. Clinical, operative, and histopathological variables were described. The frequency of paraaortic, pelvic, concurrent lymph node involvement and adjuvant treatment was determined. A univariate analysis of the variables was performed in the R project statistical software version 3.6.0. RESULTS: 88 cases were included. The mean age was 44,24 ± 9,99 years. The median number of resected pelvic and para-aortic nodes was 23 (6-68) and 4 (1-25), respectively. In 12,5 % of the patients, involvement of the pelvic lymph nodes was present. No patient had paraaortic lymph node involvement. Two patients presented para-aortic lymph node relapse during follow-up, receiving treatment with chemotherapy and extended field chemoradiotherapy, respectively. CONCLUSION: In this study, the frequency of paraaortic involvement in patients with cervical cancer IB1 was 0%. This result should be considered when offering paraaortic lymphadenectomy in patients with apparently normal pelvic nodes in presurgical imaging studies and during the procedure.

Uterine Cervical Neoplasms/surgery , Hysterectomy/methods , Lymph Node Excision/methods , Aorta, Abdominal , Pelvis/surgery , Epidemiology, Descriptive , Retrospective Studies , Analysis of Variance , Colombia , Hysterectomy/statistics & numerical data , Lymph Node Excision/statistics & numerical data , Mesentery/surgery
Rev. saúde pública (Online) ; 54: 27, 2020. tab, graf
Article in English | LILACS | ID: biblio-1094408


ABSTRACT OBJECTIVES To determine the efficacy and safety of the use of cryotherapy, cold knife or thermocoagulation compared to Loop Electrosurgical Excision Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia. METHODS Systematic review with meta-analysis of randomized controlled trials in women with cervical intraepithelial neoplasia undergoing treatment with cryotherapy, cold knife, or thermo-coagulation compared with LEEP, to estimate its efficacy and safety. The search was conducted on MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus, until September 2018. RESULTS The total of 72 studies were identified, of which only 8 studies met the inclusion criteria. The treatment of CIN with cold knife decreases the risk of residual disease compared with LEEP (RR, 0.54, 95%CI, 0.30-0.96, p = 0.04). The management of premalignant lesions with cryotherapy, compared with LEEP, increases the risk of disease recurrence by 86% (RR, 1.86, 95%CI, 1.16-2.97, p = 0.01), increases the risk of infections (RR, 1.17, 95%CI, 1.08-1.28, p < 0.001) and reduces the risk of minor bleeding by 51% (RR, 0.49, 95%CI) %, 0.40-0.59, p ≤ 0.001). CONCLUSIONS The treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease. Nevertheless, cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections.

RESUMEN OBJETIVOS Evaluar la eficacia y seguridad del uso de crioterapia, cono frio o termo-coagulación en comparación con el procedimiento de escisión electroquirúrgica en asa (LEEP) para el manejo de neoplasias intraepiteliales cervicales. MÉTODOS Revisión sistemática de ensayos controlados aleatorizados en mujeres con neoplasia intraepitelial cervical en tratamiento con crioterapia, cono frio, o termo coagulación y LEEP, para estimar su eficacia y seguridad. La búsqueda se realizó en MEDLINE/PUBMED, Registro Cochrane Central de Ensayos Controlados (CENTRAL) y Scopus, hasta setiembre de 2018. RESULTADOS Se identificaron 72 estudios, ocho cumplieron los criterios de inclusión. Cono frio disminuyó el riesgo de enfermedad residual en comparación con LEEP (RR 0,54; IC del 95%, 0,30-0,96, p = 0,04). Crioterapia en comparación con LEEP incrementó el riesgo de recurrencia de enfermedad en un 86,0% (RR 1,86; IC del 95%, 1,16-2,97, p = 0,01) con un tiempo de seguimiento de seis a 24 meses, y de infecciones (RR, 1,17; IC del 95%, 1,08-1,28, p < 0,001); pero redujo el riesgo de sangrado menor en un 51,0% (RR 0,49; IC del 95%, 0,40-0,59, p ≤ 0,001). CONCLUSIONES Cono frio reduce el riesgo de enfermedad residual. Sin embargo, la crioterapia reduce el riesgo de sangrado menor en las 24 horas posteriores al tratamiento e incrementa el riesgo de recurrencia de enfermedad y de infecciones.

Humans , Female , Uterine Cervical Neoplasms/surgery , Cryotherapy/methods , Cervical Intraepithelial Neoplasia/surgery , Conization/methods , Electrocoagulation/methods , Postoperative Complications , Uterine Cervical Neoplasms/pathology , Risk , Risk Factors , Cervical Intraepithelial Neoplasia/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/pathology
Rev. Col. Bras. Cir ; 47: e20202443, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1136574


RESUMO Objetivos: Analisar os resultados de morbidade e sobrevida após cirurgias curativas e paliativas em pacientes com câncer cervical recidivado após tratamento primário com radioterapia e quimioterapia. Outro objetivo foi avaliar os fatores associados aos procedimentos curativos e não curativos. Métodos: Coorte retrospectiva de pacientes submetidos à cirurgias curativas e paliativas, entre janeiro de 2011 a dezembro de 2017, em um centro de alta complexidade em oncolologia. O desfecho da morbidade foi relatado de acordo com a classificação de Clavien-Dindo e a análise de sobrevida foi realizada pelo método de Kaplan-Meir. Para avaliar os fatores associados aos procedimentos, foi realizada análise univariada pelo teste U de Mann-Whitney. Resultados: Foram realizadas duas histerectomias radicais, três exenterações pélvicas com intenção curativa e cinco exenterações pélvicas paliativas. No grupo curativo, houve complicações maiores em 40% dos casos, e o tempo mediano de sobrevida foi 16 meses. No grupo paliativo, houve complicações maiores em 60% dos casos, e o tempo mediano de sobrevida foi 5 meses. Estadiamento avançado (p=0,02), sintomas (p=0,04), tamanho do tumor maior que cinco centímetros (p=0,04) e mais de três órgãos envolvidos (p=0,003) foram fatores significativamente associados a cirurgia não curativa. Conclusões: As taxas de morbidade foram maiores no grupo paliativo, e o tempo mediano de sobrevida foi menor no grupo paliativo do que no grupo curativo, entretanto esta diferença na sobrevida não teve significância estatística. Estádio avançado, sintomas, tamanho tumoral e número de órgãos envolvidos são fatores que devem ser levados em consideração na indicação de resgate cirúrgico.

ABSTRACT Objectives: To analyze the results of morbidity and survival after curative and palliative surgery in recurrent cervical cancer patients who underwent chemoradiation as their primary treatment. Another goal was to assess the factors associated with curative and non-curative procedures. Methods: This was a retrospective cohort consisting of patients undergoing surgery curative and palliative from January 2011 to December 2017 at a high complexity oncology center. Outcome of morbidity was reported according to the Clavien-Dindo classification, and survival analysis was carried out using the Kaplan-Meir method. To assess the factors associated with the procedures, a univariate analysis using the Mann-Whitney U test was performed. Results: Two radical hysterectomies, three pelvic exenterations with curative intent, and five palliatives pelvic exenterations were performed. In the curative group, there were major complications in 40% of the cases, and the median survival time was 16 months. In the palliative group, there were major complications in 60% of the cases, and the median survival time was 5 months. Advanced staging (p-value= 0.02), symptoms (p-value=0.04), tumor size greater than five centimeters (p-value=0.04), and more than three organs involved (p-value=0.003) were factors significantly associated with non-curative surgery. Conclusions: The morbidity rates of this study were higher in palliative group, and the median survival time was lower in the palliative group than the curative group, but this difference in survival was not statistically significant. Advanced stage, symptoms, tumor size and number of organs involved are factors that should be taken into consideration when indicating surgical salvage.

Humans , Male , Female , Adult , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/mortality , Palliative Care , Retrospective Studies , Kaplan-Meier Estimate , Hysterectomy , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging
Rev. chil. obstet. ginecol. (En línea) ; 84(6): 425-434, dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1092758


Resumen Objetivo Evaluar el rendimiento diagnóstico de la técnica de azul patente (disponible en todo el territorio nacional) en el ganglio centinela para la estadificación del cáncer cérvico uterino y en-dometrial. Método Estudio prospectivo realizado entre enero de 2014 y diciembre de 2018. Se evaluó la técnica de azul patente para la detección de ganglio centinela en la estadificación del cáncer cérvico uterino y endometrial, antes de la linfadenectomía pélvica estándar. La inyección del azul patente se aplicó en el cuello uterino (1 cc 1 cm de profundidad y 1 cc superficial) a las 3 y 9 horas, 20 minutos antes del inicio de la cirugía (laparotomía o laparoscópica). La identifica-ción y extracción del ganglio centinela fue realizado por un ginecólogo oncólogo certificado y evaluado mediante histología tradicional con hematoxilina y eosina (H&E). Resultado Se realiza-ron un total de 80 cirugías. El ganglio centinela se identificó en 75 (94%) pacientes, 60 (75%) bilateralmente; Con una detección media de 1,9 nodos por paciente. El sitio de identificación más frecuente fue la fosa obturatriz (43,9%), seguida de los vasos ilíacos externos. Otro 2,6% de los nodos fueron encontrados en sitios poco comunes. Entre los ganglios linfáticos seleccio-nados, 10 casos fueron positivos para el cáncer. No hubo ganglio centinela falso negativo. La tasa de detección fue del 83%, con una especificidad del 95%. Conclusiones Los datos aquí expuestos nos permiten estandarizar e implementar el uso de gan-glio centinela con azul patente. El uso de GC adecua la cirugía a la necesidad de la paciente, con una clara disminución en la incidencia de complicaciones asociadas a la linfadenectomía. Este trabajo forma parte de un estudio inicial el cual se debe complementar con el uso de la tin-ción de verde de indocianina y el estudio anatomo patológico con ultraestadiaje para obtener una validación e implementación adecuada del GC en la etapificación en cáncer de cérvix y endo-metrio.

SUMMARY Objective To assess the diagnostic performance of patent blue dye technique (available in the whole country) in sentinel lymph node for cervical and endometrial cancer staging. Methods A prospective cohort study was conducted between January 2014 to December 2018. Patent blue dye technique was assessed for the detection of sentinel lymph node in cervical and endometrial cancer staging, before standard pelvic lymphadenectomy. Blue dye injection was applied in the cervix (1cc 1cm deep and 1cc superficial) at 3 and 9 hour, 20 minutes prior start-ing a surgery (laparotomy or laparoscopic). The sentinel lymph node was collected by a certified surgeon and assessed by traditional histologic hematoxylin and eosin stain. Results A total of 80 surgeries were performed. The sentinel lymph node was identified in 75 (94%) patients, 60 (75%) bilaterally; with an average detection of 1,9 nodes per patient. The most common site of identifi-cation was the obturator fossa, followed by the external iliac vessels (43,9%). 2,6% of the nodes were found in uncommon sites. 10 lymph nodes were cancer-positive. There were no false neg-ative sentinel node.Overall in our cohort the detection rate was 83% for specificity 95%. Conclusions Our data presented in this publication allow us to safely standardize and implement a sentinel lymph node technique with patent blue. This technique will allow us to adapt the sur-gery for the patient's needs, diminishing the incidence of complications associated with lym-phadenectomy. This is the first stage of our work which we must complement with indocyanine green and pathological study with ultrastaging to obtain an adequate validation and implementa-tion of sentinel node in cervical and endometrial cancer staging.

Humans , Female , Adult , Middle Aged , Aged , Uterine Cervical Neoplasms/surgery , Endometrial Neoplasms/surgery , Coloring Agents , Sentinel Lymph Node/surgery , Uterine Cervical Neoplasms/diagnosis , Endometrial Neoplasms/diagnosis , Laparoscopy , Sentinel Lymph Node/anatomy & histology , Indocyanine Green
Femina ; 47(1): 55-60, 20190131. ilus
Article in Portuguese | LILACS | ID: biblio-1046493


O câncer do colo do útero é o câncer mais comum na gravidez, com uma estimativa de 1 a 12 casos por 10.000 gestações. Com a melhora do rastreio do câncer do colo do útero e uma tendência feminina de engravidar em idade mais avançada, observa-se que cerca de 43% das pacientes diagnosticadas com câncer do colo do útero têm menos de 45 anos e 20% a 28% são menores de 40 anos. O diagnóstico e o tratamento da doença na gravidez são difíceis e desafiadores, pois geram angústia para a gestante, sua família e os profissionais de saúde. Novos estudos destacam que a preservação da fertilidade e a qualidade de vida estão se tornando preocupações cada vez mais importantes de mulheres jovens com câncer e que os procedimentos cirúrgicos devem ser menos invasivos. O comitê de oncologia da FIGO revisou o sistema de estadiamento do câncer do colo do útero. Este artigo discute o diagnóstico e tratamento do câncer do colo do útero com base no estágio da doença, incluindo atenção a questões de fertilidade e qualidade de vida.(AU)

Cervical cancer is the most common cancer in pregnancy, with an estimated 1-12 cases per 10,000 pregnancies. With improved cervical cancer screening and a tendency to become pregnant at a later age, it is noted that about 43% of patients diagnosed with cervical cancer are younger than 45 and 20-28% are younger than 40 years. Diagnosis and treatment of the disease in pregnancy are difficult and challenging, as they create distress for pregnant women, their families and health professionals. New studies highlight that preserving fertility and quality of life are becoming increasingly important concerns for young women with cancer and that surgical procedures should be less invasive. The FIGO oncology committee reviewed the staging system for cervical cancer. This article discusses the diagnosis and treatment of cervical cancer based on the stage of the disease, including attention to issues of fertility and quality of life.(AU)

Humans , Female , Pregnancy , Pregnancy Complications, Neoplastic/pathology , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/radiotherapy , Uterine Cervical Neoplasms/diagnostic imaging , Prognosis , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/epidemiology , Pregnancy, High-Risk
São Paulo; s.n; 2019. 50 p. ilust, tabelas, quadros.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1179152


Introdução: O tratamento cirúrgico do câncer do colo do uterino consiste numa ressecção radical com necessidade de parametrectomia, acrescentando assim morbidade ao tratamento, talvez, não necessária em pacientes com doença inicial. Objetivo: Avaliar a não-inferioridade da histerectomia extrafascial em comparação à histerectomia radical modificada, ambas com linfadenectomia pélvica bilateral, em termos de eficácia e segurança para tratamento dos tumores de colo uterino em estádio IA2 ­ IB1 ≤ 2cm. Casuística e métodos: Quarenta e duas mulheres portadoras de câncer do colo uterino em estadios clínicos IA2 a IB1 com tumores ≤ 2cm, candidatas a tratamento cirúrgico eletivo com intenção curativo foram randomizadas 1:1 para realização de histerectomia extrafacial ou histerectomia radical modificada no período entre maio de 2015 a abril de 2018, 40 foram avaliadas. Características clínicas e patológicas foram coletadas de forma prospectiva. Os dados de qualidade de vida foram coletados com o uso do questionário EORTC QLQ-30. Resultados: Ambos os grupos apresentaram, tanto as características clínicas (Idade, Peformance Status, ASA, Estadiamento clínico e tamanho da lesão no exame físico no pré-operatório), quanto as características tumorais no anatomo patológicas (subtipo, Grau de diferenciação, tamanho maior que 2 cm, invasão angiolifática, número de linfonodos dissecados, presença de linfonodo metastático e invasão estromal) similares. O tempo cirúrgico mediano foi maior (199,5 minutos) no grupo de histerectomia radical modificada, com uma diferença de 49,5 minutos (p=0,003), assim como o tempo de sondagem vesical no pós-operatório também foi maior em pacientes submetidas a histerectomia radical modificada (p=0,043). Não houve mortalidade pós-operatória (nos primeiros 30 dias) e a taxa de complicações pós-operatórias foi similar, com 15% e 20% (p=1,000), assim como o a necessidade de adjuvânica com 30% e 20% (p=0,480), para os braços de histerectomia extrafascial e radical modificada, respectivamente. Houve similariedade nas escalas de funcionalidade física ou sintomas entre ambos os braços do estudo antes e 6 meses após o procedimento cirúrgico, exceto a função emocional que melhorou no grupo de histerectomia radical modificada após 6 meses, quando comparado com o mesmo grupo de pacientes antes da cirurgia. O seguimento mediano foi de 16,2 meses e a sobrevida livre de doença em 2 anos (análise interina) foi de 95% e 100% nos braços histerectomia fascial e radical modificada, respectivamente (p=0,405). Uma paciente faleceu após 25 meses de seguimento, no grupo da histerectomia extrafascial, devido a progressão de doença regional. Conclusão: A histerectomia extrafascial apresentou uma baixa morbidade e mostrou-se segura no tratamento das pacientes com câncer de colo uterino inicial e não parece ser inferior à histerectomia radical modificada nesse contexto, e a parametrectomia talvez seja desnessária nesse subgrupo populacional. As análises dos dados do desfecho primário, após um maior seguimento, são esperadas antes da realização da conclusão final

Introduction: Surgical treatment of cervical cancer consists of a radical resection requiring parametrectomy, thus adding morbidity to the treatment, perhaps not necessary in patients with initial disease. Objective: To evaluate non-inferiority of simple hysterectomy in comparison to radical modified hysterectomy, both inclunding bilateral pelvic lynphadenectomy, in terms of efficacy and safety for treatment of uterine cervical tumors in stage IA2 - IB1 ≤ 2cm. Methods: Forty-two women with uterine cervical cancer in clinical stages IA2 to IB1 with tumors ≤ 2 cm, candidates for elective surgical treatment with curative intent were randomized 1: 1 to perform simple hysterectomy or modified radical hysterectomy in the period from May 2015 to April 2018, 40 were evaluated. Clinical and pathological characteristics were collected prospectively. Health-related quality of life was assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Results: Clinical characteristics (age, Peformance Status, ASA, clinical staging and lesion size in the preoperative physical examination), as well as tumor characteristics in anatomical pathology (subtype, degree of differentiation, size greater than 2 cm, angiolipathic invasion, dissected node's number, nodal metastasis and stromal invasion) were well balanced between the treatment groups. The median surgical time was greater (195 minutes) in the modified radical hysterectomy group, with a difference of 49,5 minutes (p = 0.003), such as, postoperative bladder catheterization days was also higher in patients submitted to modified radical hysterectomy (p = 0.043). There was no postoperative mortality (in the first 30 days) among all patients and the rate of postoperative complications was similar, with 15% and 20% (p = 1,000), as well as the need for adjuvante treatment with 30% and 20% (p = 0.480) for the arms of simple and modified radical hysterectomy, respectively. Global health or quality of life and physical functioning scores were similar between groups, before and 6 months after the surgeries, except for the emotional function, that improved in the group of modified radical hysterectomy after 6 months when compared with the same group of patients prior to surgery. The median follow-up was 16.2 months and the 2-year disease free survival (interim analysis) was 95% and 100% in the simple hysterectomy's and modified radical's arms, respectively (p = 0.405). Only one patient died after 25 months of follow-up in the simple hysterectomy group due to regional disease progression. Conclusion: Simple hysterectomy presented low morbidity and it was safe in the treatment of patients with early stage cervical cancer and does not appear to be inferior to modified radical hysterectomy in this context, and parametrectomy may be not necessary in this population subgroup. We wait the final analysis of the primary endpoint

Humans , Female , Adult , Middle Aged , Aged , Quality of Life , Uterine Cervical Neoplasms/surgery , Prospective Studies , Hysterectomy , Neoplasm Staging
Rev. Col. Bras. Cir ; 46(1): e2077, 2019. tab
Article in Portuguese | LILACS | ID: biblio-990368


RESUMO Objetivo: analisar a expressão do Fator de Crescimento do Endotélio Vascular (VEGF), seu receptor (VEGFR-2), idade e tipo histológico de carcinomas avançados de colo uterino com relação à resposta clínica à quimioterapia neoadjuvante. Métodos: foram incluídas 40 pacientes com diagnóstico de carcinoma de colo uterino (IB2 e IVA), com biópsias prévias ao tratamento. Todas as pacientes foram submetidas à quimioterapia neoadjuvante e avaliadas quanto à resposta clínica e à expressão do VEGF. Considerou-se boa resposta clínica uma regressão tumoral total ou maior do que 50%. Resultados: em relação à resposta à quimioterapia, 18 pacientes (45%) apresentaram boa resposta e 22 (55%), má resposta. Quanto à expressão do VEGF, em 16 pacientes foi considerada positiva e em 24, negativa. Quando os casos foram analisados separadamente em relação à resposta à quimioterapia, somente a expressão positiva de VEGF foi associada à boa resposta clínica (p=0,0157). Conclusão: a expressão de VEGF mostrou ser isoladamente, um importante marcador de boa resposta ao tratamento quimioterápico neoadjuvante das pacientes com carcinoma avançado de colo uterino.

ABSTRACT Objective: to analyze the expression of Vascular Endothelial Growth Factor (VEGF), its receptor (VEGFR-2), age and histological type of advanced cervical carcinomas with respect to the clinical response to neoadjuvant chemotherapy. Methods: we studied 40 patients with cervical carcinoma (IB2 and IVA) diagnosed by biopsies prior to treatment. All patients underwent neoadjuvant chemotherapy and evaluation for clinical response and expression of VEGF. We considered a tumor regression greater than 50% as a good clinical response. Results: eighteen patients (45%) had good response to chemotherapy, and 22 (55%), poor response. VEGF expression was positive in 16 patients and negative in 24. When analyzed separately for response to chemotherapy, only the positive expression of VEGF was associated with good clinical response (p=0.0157). Conclusion: VEGF expression alone was an important marker of good response to neoadjuvant chemotherapy in patients with advanced carcinoma of the cervix.

Humans , Female , Adult , Aged , Carcinoma, Squamous Cell/drug therapy , Adenocarcinoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Uterine Cervical Neoplasms/drug therapy , Carcinoma, Adenosquamous/drug therapy , Vascular Endothelial Growth Factor Receptor-2/therapeutic use , Biopsy , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Adenocarcinoma/surgery , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/pathology , Cervix Uteri , Prospective Studies , Cisplatin , Carcinoma, Adenosquamous/surgery , Carcinoma, Adenosquamous/pathology , Neoadjuvant Therapy , Middle Aged , Neoplasm Staging
Rev. méd. Urug ; 34(2): 82-88, jun. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-904998


Introducción: el cáncer de cuello uterino es el cuarto más frecuente a nivel mundial en mujeres. En estadios precoces la cirugía es el tratamiento de elección. El tratamiento quirúrgico estándar es la histerectomía radical tipo C1 y linfadenectomía pélvica. La vía de abordaje clásicamente utilizada en Uruguay es la laparotomía. Los resultados oncológicos por las diferentes vías de abordaje se consideran equiparables. Presentamos la primera serie de casos publicada en Uruguay de tratamiento quirúrgico de mínima invasión en cáncer de cuello uterino. Método: estudio descriptivo prospectivo de serie de casos. Se incluyen todas las pacientes operadas por cáncer de cuello uterino invasor como tratamiento primario con vía de abordaje de mínima invasión, desde enero de 2013 hasta diciembre de 2016 en la Clínica Ginecotocológica A del Centro Hospitalario Pereira Rossell. Resultados: se operaron 17 pacientes: 14 histerectomía radical laparoscópica + linfadenectomía pélvica laparoscópica y 3 histerectomía radical vaginal + linfadenectomía pélvica laparoscópica. Edad media: 44 años. Tiempo quirúrgico medio: 261 minutos. Tiempo medio de internación posoperatoria: cinco días. Conversión a laparotomía: dos casos. Se resecaron una media de 14,4 ganglios pélvicos. Ningún caso con márgenes comprometidos. Hubo dos lesiones vesicales. Ningún caso de sangrado severo, transfusión, lesión intestinal, vascular ni ureteral. No hubo ningún caso de infección, dehiscencia, trombosis, reintervención o readmisión. No hubo recurrencias, con media de seguimiento de 29 meses. Conclusiones: la cirugía de mínima invasión es factible para el tratamiento del cáncer de cuello uterino en estadios precoces en nuestro medio, obteniendo un buen resultado anatomopatológico, quirúrgico y oncológico con baja morbilidad.

Introduction: Cervical cancer is the fourth most frequent cancer in women around the world. Surgery is the first choice for treatment in early stages. The standard surgical treatment is Type C1 Radical Hysterectomy and pelvic lymphadenectomy. Laparotomy is the typical surgical approach used in Uruguay. Oncologic results are similar for the different surgical approaches. The study presents the first case series of minimally invasive cervical treatment of cervical cancer published in Uruguay. Method: descriptive, prospective study of a series of cases. All patients operated at the Gynecological Clinic "A", Pereira Rossell Hospital from January 2013 until December 2016 for invasive cervical cancer with minimally invasive approach as the primary treatment were included in the study. Results: 17 patients were operated: 14 Radical Laparoscopic hysterectomy + laparoscopic pelvic lymphadenectomy and 3 radical vaginal hysterectomy + laparoscopic pelvic lymphadenectomy. Average ager: 44 years old. Average surgical time: 261 minutes. Average post-surgery hospital stay: 5 days. 2 cases changed into laparotomy. An average of 14.4 pelvic lymph nodes were resected. In no case were margins compromised. Two bladder lesions, no cases of severe bleeding, transfusion, intestine, vascular or ureteral lesions. No cases of infection, deshicence, thrombosis, reoperation or readmission. NO recurrence, average follow up was 29 months. Conclusions: minimally invasive surgery is a feasible treatment for early stages cervical cancer in our country, obtaining good anatomopathological, surgical and oncological results, morbility being low.

Introdução: O câncer de colo uterino é o quarto tipo de câncer mais frequente entre mulheres em todo o mundo. Em estádios precoces a cirurgia é o tratamento de eleição. O tratamento cirúrgico padrão é a Histerectomia Radical Tipo C1 e a linfadenectomia pélvica. No Uruguai a via de abordagem classicamente utilizada é a laparotomia. Os resultados oncológicos pelas diferentes vias de abordagem são considerados equivalentes. Apresentamos a primeira serie de casos publicados no Uruguai, de tratamento cirúrgico minimamente invasivo no câncer de colo uterino. Métodos: Estudo descritivo prospectivo de serie de casos. Foram incluídas todas as pacientes operadas por câncer de colo uterino invasor como tratamento primário com via de abordagem minimamente invasiva, no período janeiro de 2013 ­ dezembro de 2016 na Clínica Ginecotocológica "A", Hospital Pereira Rossell. Resultados: foram operadas 17 pacientes: 14 Histerectomia Radical Laparoscópica + linfadenectomia pélvica laparoscópica e 3 Histerectomia Radical Vaginal + linfadenectomia pélvica laparoscópica. Idade media: 44 anos. Tempo médio da cirurgia: 261 minutos. Tempo médio de internação pós-operatória: 5 dias. Conversão a laparotomia: 2 casos. Foi ressecada uma média de 14,4 gânglios pélvicos. Nenhum caso apresentou comprometimento das margens. Foram registradas 2 lesões vesicais. Não se observaram casos de sangramento severo, transfusão, lesão intestinal, vascular nem ureteral. Não se registraram casos de infecção, deiscência, tromboses, intervenção ou reinternação. Não foram registradas recorrências, com um seguimento médio de 29 meses. Conclusões: a cirurgia minimamente invasiva é factível para o tratamento do câncer de colo uterino em estádios precoces no nosso meio, mostrando bons resultados anatomopatológicos, cirúrgicos e oncológicos com baixa morbidade.

Female , Minimally Invasive Surgical Procedures , Uterine Cervical Neoplasms/surgery , Hysterectomy/methods , Laparoscopy/statistics & numerical data
Rev. chil. obstet. ginecol. (En línea) ; 83(2): 130-138, abr. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959497


RESUMEN Fundamento: La persistencia del virus papiloma posterior a la conización del cuello uterino, se ha considerado un factor de riesgo para la persistencia de lesiones intra epiteliales (LIE) causadas por virus papiloma. Para determinar la asociación entre persistencia de lesión cervical y la presencia del virus papiloma posterior a la conización del cuello uterino, se realizó un estudio observacional prospectivo en un grupo de 123 pacientes portadoras de lesiones intraepiteliales de alto grado (LIEAG) tratadas con conización. Material y métodos: Se siguieron a 123 pacientes portadoras de LIEAG, ingresadas a la Unidad de Patología Cervical entre Abril de 2013 y Abril de 2014, las que fueron seguidas por 2 años hasta Abril de 2016. Se realizó genotipificación antes, y entre 4 a 6 meses posterior a la conización. Los datos se tabularon considerando la edad, paridad, tipo de virus, persistencia de LIE, reconización o requerimiento de histerectomía posterior. Resultados: La mediana de la edad fue de 37 años, el 91% fueron multíparas, y solo el 9% fueron nulíparas. El 56% ingresó por NIE III y el 44% por NIE II. Los virus más frecuentes fueron el 16, 31,58, 52 y 56. La persistencia de virus papiloma se constató en el 37% de las pacientes conizadas. La persistencia de LIE se observó en el 27% de las pacientes que fueron positivas para virus papiloma posterior a la conización, en comparación a sólo el 5% en las que fueron negativas. Del total de pacientes positivas para virus papiloma posterior a la conización, 12 de ellas presentaron persistencia de lesión confirmadas histológicamente por biopsia cervical, 8 pacientes requirieron recono por LIE de alto grado, 2 pacientes fueron a histerectomía y en 2 casos se realizó seguimiento estricto por NIE I. Cuando la tipificación post cono fue negativa solamente 3 pacientes requirieron conización y en sólo una se realizó seguimiento estricto por NIE I. Conclusión: La persistencia del virus papiloma posterior a la conización se asocia a mayor persistencia de LIEAG, mayor frecuencia de reconización o histerectomía posterior.

ABSTRACT Backgroud: The persistence of papilloma virus after conization of the cervix has been considered a risk factor for the persistence of cervical intra epithelial lesion (CIN) caused by papilloma virus. Aim: In order to determine the association between cervical lesion persistence and the presence of papilloma virus after conization, a prospective observational study was performed in a group of 123 patients with intraepithelial lesions treated with conization. Material and methods: We followed 123 patients with high grade CIN who were admitted to the Cervical Pathology Unit, between April 2013 and April 2014; they were followed for 2 years until April 2016. Viral genotyping was done before, and among the 4 to 6 months after the LEEP. Data were tabulated considering age, parity, type of virus, persistence of CIN, reconization or requirement of posterior hysterectomy. Results: The median age was 37 years, 91% were multiparous, and only 9% were nulliparous. 56% had NIE III and 44% NIE II. The most frequent viruses were 16, 31, 58, 52 and 56. The persistence of papillomavirus was present in 37% of patients. The persistence of CIN was observed in 27% of patients who were positive for papilloma virus after conization, compared to only 5% in those who were negative. Of the total number of patients positive for papilloma virus, in 12 of them had intra epitelial lesions were confirmed by cervical biopsy, 8 patients required recone for high grade CIN, 2 patients underwent hysterectomy, and 2 patients underwent follows up strictly by CIN I. When post cone typing was negative only 3 patients required conization and only one was followed strictly by CIN I.

Humans , Female , Adult , Middle Aged , Young Adult , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/virology , Conization , Papillomavirus Infections/pathology , Papillomaviridae/physiology , Biopsy , Uterine Cervical Neoplasms/complications , Prospective Studies , Follow-Up Studies , Cervical Intraepithelial Neoplasia/surgery , Cervical Intraepithelial Neoplasia/pathology , Colposcopy , Cytodiagnosis , Papillomavirus Infections/genetics , Observational Study
Rev. cuba. obstet. ginecol ; 43(2): 1-18, abr.-jun. 2017. tab
Article in Spanish | LILACS, CUMED | ID: biblio-901295


Introducción: el cáncer de cuello uterino es uno de los principales problemas de la salud pública en el mundo por sus altas tasas de incidencia y mortalidad en la mujer. Objetivos: describir el manejo de las pacientes diagnosticadas con cáncer cérvico uterino admitidas y atendidas en el Instituto Nacional de Oncología y Radiobiología. Método: estudio descriptivo, retrospectivo en una serie de 853 pacientes diagnosticadas con cáncer de cuello uterino (estadios IA-IVA, FIGO 2009). Se realizaron pruebas de hipótesis y análisis de supervivencia. Para la estimación de la supervivencia se utilizó el método estadístico de Kaplan-Meier. Se aplicó la prueba de Long Rank para comparar la supervivencia por estratos. Se consideró como diferencia estadísticamente significativa p< 0,05. Resultados: edad promedio de las pacientes, 49,7 años (DS: ± 13,9), 56,6 por ciento no se habían realizado la citología cervical. El seguimiento citológico, según establece el Programa de Diagnóstico Precoz del Cáncer de Cuello Uterino, se cumplió por 84,1 por ciento de las mujeres pesquisadas; en 15,9 por ciento de los casos, el periodo de seguimiento citológico fue superior a los 3 años. El carcinoma epidermoide fue la variedad histológica más frecuente (88,2 por ciento). Del total de pacientes, 87,1 por ciento fueron diagnosticadas en estadios localmente avanzados (FIGO IB2-IVA). La modalidad terapéutica más empleada fue la quimio radioterapia concurrente. La tasa de supervivencia global al diagnóstico fue de 47,2 por ciento. La mediana de supervivencia fue de 4 años. La edad al diagnóstico y el estadio del tumor mostraron una asociación estadísticamente significativa con la supervivencia global (p< 0,005). Conclusiones: la incidencia y mortalidad de cáncer de cuello uterino, así como su estabilidad en el último quinquenio, exigen la realización de estudios de mayor alcance e investigaciones dirigidas a la evaluación de los programas, sistemas y servicios de salud implicados(AU)

Introduction: cervical cancer is one of the main public health problems in the world due to its high incidence and mortality rates in women. Objective: to describe the management of patients diagnosed with uterine cervical cancer admitted and treated at the National Institute of Oncology and Radiobiology. Method: descriptive, retrospective study in a series of 853 patients diagnosed with cervical cancer (stages IA-IVA, FIGO 2009). Hypothesis testing and survival analysis were performed. The Kaplan-Meier statistical method was used to estimate survival. The Long Rank test was used to compare survival by strata. Statistically significant difference was considered p < 0.05. Results: mean age of the patients, 49.7 years (DS: ± 13.9), 56.6 percent had not performed the cervical cytology. Cytological follow-up, according to the Early Diagnosis Program of Cervical Cancer, was met by 84.1 percent of the women surveyed; in 15.9 percent of the cases, the cytological follow-up period was superior to 3 years. Epidermoid carcinoma was the most frequent histological variety (88.2 percent). Of the total number of patients, 87.1 percent were diagnosed in locally advanced stages (FIGO IB2-IVA). The most commonly used therapeutic modality was concurrent chemo radiotherapy. The overall survival rate at diagnosis was 47.2 percent. The median survival was 4 years. Age at diagnosis and tumor stage showed a statistically significant association with overall survival (p < 0.005). Conclusion: cervical cancer incidence and mortality, as well as its stability over the last five years, require more extensive studies and research aimed at evaluating the health programs, systems and services involved(AU)

Humans , Female , Adolescent , Adult , Middle Aged , Aged , Uterine Cervical Neoplasms/drug therapy , Uterine Cervical Neoplasms/therapy , Survival Analysis , Uterine Cervical Neoplasms/surgery , Epidemiology, Descriptive , Retrospective Studies
Rev. bras. ginecol. obstet ; 39(6): 288-293, June 2017. tab
Article in English | LILACS | ID: biblio-898869


Abstract Objective To evaluate the expressions of biomarkers p16 and Ki-67 in low-grade (LG) or high-grade (HG) lesions, and to relate them to risk factors and the recurrence of these lesions. Methods A retrospective case-control study of 86 patients with LG and HG lesions who underwent a loop electrosurgical excision procedure (LEEP) between 1999 and 2004. The control group was composed of 69 women with no recurrence, and the study group, of 17 patients with recurrence. All patients were followed-up over a two-year period after surgery, and screened every six months, including cytology and colposcopy. Biopsy samples collected from LEEP were submitted to immunohistochemical analysis for p16 and Ki-67. The statistical analysis was performed using the Statistical Package for the Social Sciences software (SPSS, IBM-SPSS, Inc., Chicago, IL, US), with a significant p < 0.05. Results The biomarkers p16 and Ki-67, separately or combined, showed no relation to recurrence on the total analysis. However, evaluating specifically HG lesions, the positive expression (2+ and 3 + ) of p16/Ki-67 was associated with recurrence (0.010). In addition, p16 isolated was also more expressive in HG lesions (2+ and 3 + , p= 0.018), but it was unrelated to recurrence. Conclusion Proteins p16 and Ki-67, both isolated and combined, are not reliable primary markers for the recurrence of cervical lesions in the majority of LG lesions. However, analyzing only the group with prior diagnosis of HG lesions, the expressions of p16 and of p16/Ki-67 were associated with recurrence, and they may be useful in monitoring these cases.

Resumo Objetivo Avaliar as positividades dos biomarcadores p16 e Ki-67 em lesões de baixo grau (BG) ou de alto grau (AG), e relacioná-las com os fatores de risco e com a recidiva dessas lesões. Métodos Estudo retrospectivo caso-controle, com 86 pacientes com lesões de BG e AG, submetidas à conização por cirurgia de alta frequência entre 1999 e 2004. O grupo de controle foi constituído de 69 mulheres sem recidivas, e o grupo de estudo, de 17 pacientes que recidivaram. Todas as pacientes foram acompanhadas durante dois anos após a cirurgia, com controle a cada seis meses, incluindo citologia e colposcopia. As peças provenientes de cirurgia de alta frequência (CAF) foram submetidas a imunohistoquímica para p16 e Ki-67. A análise estatística foi realizada com o programa Statistical Package for the Social Sciences (SPSS, IBM-SPSS, Inc., Chicago, IL, EUA), com p significante quando < 0,05. Resultados Isoladamente ou em conjunto, p16 e Ki-67 não se relacionaram com as recidivas quando analisados na totalidade dos casos. Entretanto, avaliando especificamente as lesões de AG, a positividade (2+ e 3 + ) do conjunto p16/Ki-67 foi relacionada com recidiva (0,010). No mais, p16, isoladamente, foi também mais expresso nas lesões de AG (2+ e 3 + , p= 0,018), mas sem relação com recidiva. Conclusão Quando testadas na totalidade dos casos, as proteínas p16 e Ki-67, separadas ou em conjunto, se mostraram ineficientes como marcadores primários de recidiva de lesões precursoras. Entretanto, quando avaliadas somente no grupo diagnóstico prévio de lesão de AG, as expressões das proteínas p16 e p16/Ki-67 têm relação com a recidiva, e podem ser úteis no acompanhamento desses casos.

Humans , Female , Precancerous Conditions/diagnosis , Biomarkers, Tumor/analysis , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/chemistry , Ki-67 Antigen/analysis , Cyclin-Dependent Kinase Inhibitor p16/analysis , Neoplasm Recurrence, Local/diagnosis , Case-Control Studies , Uterine Cervical Neoplasms/surgery , Predictive Value of Tests , Retrospective Studies , Risk Factors , Conization/methods , Electrosurgery , Neoplasm Grading
Rev. bras. ginecol. obstet ; 39(1): 35-39, Jan. 2017. graf
Article in English | LILACS | ID: biblio-843902


ABSTRACT Robotic surgeries for cervical cancer have several advantages compared with lapa-rotomic or laparoscopic surgeries. Robotic single-site surgery has many advantages compared with the multiport approach, but its safety and feasibility are not established in radical oncologic surgeries. We report a case of a Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma whose radical hysterectomy, sentinel lymph node mapping, and lymph node dissection were entirely performed by robotic single-site approach. The patient recovered very well, and was discharged from the hospital within 24 hours.

RESUMO A cirurgia robótica para carcinoma do colo do útero apresenta vantagens quando comparada com cirurgias laparotômicas ou laparoscópicas. A cirurgia robótica de portal único tem muitas vantagens quando comparada com cirurgias de múltiplos acessos, porém a segurança e a viabilidade deste procedimento ainda não estão estabelecidas para cirurgias oncológicas radicais. Apresentamos um caso de carcinoma de colo do útero, tratado por histerectomia radical, identificação e biópsia de linfonodo sentinela e linfadenectomia pélvica realizada totalmente por cirurgia robótica de acesso único. A paciente recuperou-se bem e recebeu alta no primeiro dia pós-operatório.

Humans , Female , Adult , Hysterectomy/methods , Robotic Surgical Procedures , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/surgery , Sentinel Lymph Node Biopsy/methods
Oncol. clín ; 22(3): 95-100, 2017. graf
Article in Spanish | LILACS | ID: biblio-909375


El cáncer de cuello uterino (CCU) es la primera causa de muerte por cáncer en la provincia de Misiones. Objetivo primario: evaluación de las pacientes con CCU en estadios tempranos, sometidas a cirugía de Wertheim Meigs (WM). Objetivos secundarios: analizar las características clínico patológicas asociadas a los patrones de eficacia, en términos de SLR-SG y morbilidades. La búsqueda fue multidisciplinaria y activa, se seleccionaron mujeres con diagnóstico de CCU en estadios tempranos, tratadas con cirugía de WM, período 2010-2017. Se registraron datos clínico-patológicos y terapéuticos. Se calculó tasa de recurrencia local-sistémica, SLE y SG. Fuente de datos: RISMI (HC Informatizada), RITA (Registro de tumores), sub-registros de los servicios de ginecología y oncología. Se incluyeron 101 pacientes, edad promedio de 38 años. El 56% (57) se encontraba asintomático al momento del diagnóstico. La vía de abordaje fue laparotomía en el 97% (98), tiempo operatorio promedio 247 minutos. El promedio de días de internación post operatorio fue de 5.3. Ausencia de complicaciones post operatorias en 79% (80). Promedio de ganglios resecados 12, FIGO patológico IB en 42% (43). Realizaron adyuvancia 36% (35). Recurrencias loco-regionales y sistémicas 8% (5), tiempo medio a la recaída 37 meses. Mediana de seguimiento a 3 años: VSE 60% (35), PDSEG 27% (15), tasa de mortalidad específica 11% (6), VCE 6% (3). El CCU en estadios tempranos, diagnosticado y tratado por un grupo multidisciplinario en el Hospital Escuela de Agudos Dr. Ramón Madariaga, presentó patrones de eficacia y tasas de supervivencia enfermedad específica y de mortalidad, similar a las informadas en la literatura (AU)

Cervical cancer (CC) is the leading cause of cancer death in Misiones province. Primary objective: evaluation of patients with CCU in early stages submitted to Wertheim Meigs (WM) surgery. Secondary objectives: clinical pathological characteristics associated with efficacy patterns in terms of SLR-SG and morbidities. The research was multidisciplinary and active, we selected women with CC in early stages, treated with WM surgery, period 2010- 2017. Clinical-pathological and therapeutic data were recorded. Local-systemic recurrence rate, SLE, SG was calculated. Data source: RISMI (HC Computerized), RITA (Tumor Registry), subregistries of gynecology and oncology services. We included 101 patients, mean age 38 years. The 56% (57) were asymptomatic at the time of diagnosis. The approach was laparotomy in 97% (98), mean operative time 247 minutes. The mean number of days of post-operative hospitalization was 5.3. Absence of postoperative complications in 79% (80). Average resected nodes 12. Pathological IB in 42% (43). The 36% (35) performed adjuvancy). Locoregional and systemic recurrences 8% (5), mean time to relapse 37 months. Median followup at 3 years: VSE 60% (35), PDSEG 27% (15), specific mortality rate 11% (6), VCE 6% (3). The CC in early stages, diagnosed and treated by a multidisciplinary group in the Hospital Escuela de Agudos Dr. Ramón Madariaga, presents patterns of efficacy and survival rates, specific disease and mortality, similar to those reported in the literature (AU)

Humans , Female , Adult , Middle Aged , Adenocarcinoma , Carcinoma, Squamous Cell , Hysterectomy/methods , Uterine Cervical Neoplasms/surgery , Argentina , Carcinoma, Adenosquamous , Drug Therapy , Neoadjuvant Therapy , Postoperative Complications