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
El carcinoma cervicouterino es la neoplasia más frecuente en México. Pese a los esfuerzos de detección temprana en nuestro país, la tasa de mortalidad permanece sin modificaciones importantes. La radioterapia y cirugía son las modalidades terapéuticas primarias; sin embargo, la quimioterapia cada vez está siendo más utilizada. En la enfermedad metastásica o recurrente, el cisplatino continua siendo la droga más efectiva; sin embargo, los resultados del tratamiento con quimioterapia no han podido mejorarse y la mediana de supervivencia permanece sin cambios. Por lo tanto, es necesario seguir ensayando nuevas combinaciones y nuevas drogas. La quimioterapia adyuvante con o sin radioterapia secuencial en estadios clínicos tempranos de alto riesgo no ha mostrado ser útil. En estadios localmente avanzados (IIB a IVA) la quimioterapia neoadyuvante seguida de radioterapia no es mejor que la radioterapia sola, mientras que la neoadyuvancia seguida de cirugía es una modalidad muy prometedora tanto en tumores tempranos (IB2 a IIA) como localmente avanzados. Estudios recientes de quimio-radioterapia concomitante tanto de manera adyuvante o como tratamiento definitivo demuestran la superioridad de este tratamiento al compararlo con radioterapia estándar. En conclusión, a pesar de que el uso de quimioterapia neoadyuvante o adyuvante en el carcinoma cervicouterino sigue siendo experimental, parece ser una modalidad prometedora. El tratamiento óptimo de estas pacientes aún está por definirse, por lo tanto debe alentarse la participación de las enfermas en estudios clínicos que evalúen las diversas modalidades terapéuticas. Para las pacientes que por algún motivo se traten fuera de protocolos clínicos y requieran radioterapia, los estudios sugieren que deben recibir quimioterapia concomitante con la radioterapia.
