ABSTRACT
INTRODUCTION: Ovarian cancer (OC) is the third most common gynecologic malignancy worldwide. Most of cases it is of epithelial origin. At the present time there is not a standardized screening method, which makes difficult the early diagnosis. The 5-year survival is 90% for early stages, however most cases present at advanced stages, which have a 5-year survival of only 5-20%. GICOM collaborative group, under the auspice of different institutions, have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of two days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: No screening method is recommended at the time for the detection of early lesions of ovarian cancer in general population. Staging is surgical, according to FIGO. In regards to the pre-surgery evaluation of the patient, it is recommended to perform chest radiography and CT scan of abdomen and pelvis with IV contrast. According to the histopathology of the tumor, in order to consider it as borderline, the minimum percentage of proliferative component must be 10% of tumor's surface. The recommended standardized treatment includes primary surgery for diagnosis, staging and cytoreduction, followed by adjuvant chemotherapy Surgery must be performed by an Oncologist Gynecologist or an Oncologist Surgeon because inadequate surgery performed by another specialist has been reported in 75% of cases. In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10-30% of all cases, and systematic limphadenectomy, necessary to be able to obtain an adequate surgical staging. Fertility-sparing surgery will be performed in certain cases, the procedure should include a detailed inspection of the contralateral ovary and also negative for malignancy omentum and ovary biopsy. Until now, laparoscopy for diagnostic-staging surgery is not well known as a recommended method. The recommended chemotherapy is based on platin and taxanes for 6 cycles, except in Stage IA, IB and grade 1, which have a good prognosis. In advanced stages, primary cytoreduction is recommended as initial treatment. Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer. Radiotherapy can be used to palliate symptoms. Follow up of the patients every 2-4 months for 2 years, every 3-6 months for 3 years and anually after the 5th year is recommended. Evaluation of quality of life of the patient must be done periodically. CONCLUSIONS: In the present, there is not a standardized screening method. Diagnosis in early stages means a better survival. Standardized treatment includes primary surgery with the objective to perform an optimal cytoreduction followed by chemotherapy Treatment must be individualized according to each patient. Radiotherapy can be indicated to palliate symptoms.
Subject(s)
Ovarian Neoplasms , Aftercare , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Combined Modality Therapy , Drug Resistance, Neoplasm , Early Diagnosis , Female , Genes, Neoplasm , Humans , Laparoscopy , Lymph Node Excision , Neoadjuvant Therapy , Neoplasm Staging/standards , Neoplastic Syndromes, Hereditary/genetics , Omentum/surgery , Organoplatinum Compounds/administration & dosage , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/epidemiology , Ovarian Neoplasms/genetics , Ovarian Neoplasms/pathology , Ovarian Neoplasms/therapy , Ovariectomy/methods , Palliative Care , Quality of Life , Radiotherapy, Adjuvant , Salvage Therapy , Taxoids/administration & dosageABSTRACT
INTRODUCTION: Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis. CONCLUSIONS: Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.
Subject(s)
Carcinoma , Endometrial Neoplasms , Antineoplastic Agents/therapeutic use , Carcinoma/diagnosis , Carcinoma/epidemiology , Carcinoma/pathology , Carcinoma/therapy , Chemotherapy, Adjuvant , Combined Modality Therapy , Diagnostic Imaging , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/epidemiology , Endometrial Neoplasms/pathology , Endometrial Neoplasms/therapy , Estrogen Antagonists/adverse effects , Estrogen Replacement Therapy/adverse effects , Estrogens/adverse effects , Evidence-Based Medicine , Female , Humans , Hysterectomy/methods , Laparoscopy , Lymph Node Excision , Mass Screening , Mexico , Neoplasm Staging/methods , Radiotherapy, Adjuvant , Risk Factors , Salvage Therapy , Tamoxifen/adverse effectsABSTRACT
El carcinoma de cérvix en etapa clínica IB1 hasta el IIA puede ser tratado mediante cirugía radical o radioterapia con resultados similares. Sin embargo, la elección dependerá de cada caso en particular. La histectomía radical con linfadenectomía pélvica bilateral y muestreo de ganglios paraaórticos ofrece la oportunidad de poder disponer de la pieza quirúrgica para estudio histopatológico y de brindar una serie de parámetros pronósticos y predictores de recurrencia, que en un momento dado pueden normar la decisión en el tratamiento adyuvante de esta pacientes. Se han descrito infinidad de factores asociados al pronóstico: tamaño del tumor, permeación vascular y linfática, profundidad de la lesión, grado histológico, presencia de enfermedad ganglionar metastásica, angiogénesis, presencia de infección por el virus del papiloma humano (VPH), infiltrado linfocitario peritumoral y edad, entre otros, Objetivos. Determinar los posibles factores pronóstico de recurrencia y definir el perfil de alto riesgo para falla a tratamiento quirúrgico. Material y métodos. Estudio retrospectivo en paciente con cáncer cervicouterino epidermoide tratadas con histerectomía radical, atendidas entre el 1 de enero de 1989 y el 31 de diciembre de 1995 en el Instituto Nacional de Cancerología de México. Fueron evaluados diferentes parámetros para posible riesgo de falla a tratamiento: edad; tamaño del tumor; etapa clínica; grado de diferenciación: permeación vascular y linfática; estatus ganglionar; profundidad de invasión al estroma y a parametrios; márgenes quirúrgicos; queratinización celular y presencia del virus del papiloma humano. Todas las pacientes se estadificaron de acuerdo a los lineamientos de la Federación Internacional de Ginecología y Obstetricia...
