Current state and future perspectives for palliative care in Latin America with a special focus on Peru.

The evolution of palliative care in Latin America has been slow compared with other parts of the world, especially developed countries. Current data show inequality in the development of palliative care in the region and those differences are also evident within countries between urban and rural populations. Peru is situated in the low-ranking group in terms of palliative care services in Latin America. The main reasons are a lack of education and funding and misconceptions about palliative care. Limited access to the use of opioids and regulatory barriers are also common features. The development of more palliative care units in Peru, as well as in other Latin American countries, is needed to ensure access to adequate and timely treatment for patients receiving palliative care.

Carcinoma bilateral de mama en crisis visceral / Bilateral breast carcinoma in visceral crisis

El carcinoma bilateral de mama es poco frecuente y raro, es bueno definir si ocurre de forma sincrónica o de forma metacrónica , definir si la lesión en la segunda mama es metástasis o un tumor primario usando criterios patológicos , el estadío y condición clínica . Ya que orienta en el pronóstico y tratamiento especializado a seguir. Presentamos el caso de una paciente con cáncer de mama ECIV por metástasis de mama contralateral en estado de crisis visceral al debut , con anatomía patológica de carcinoma ductal infiltrante de mama, grado 2, componente in situ ausente en ambas mama , RE(70%)RP(80%)Cerb2-,Ki67 30% en mama derecha y RE(100%)RP(80%)Cerb2-Ki67 20% en mama izquierda. Se realizó tomografía de tórax-abdomen-pelvis, evidenciándose derrame pleural bilateral y ascitis en gran volumen. Se decide iniciar tratamiento con quimioterapia sistémica alcanzándose respuesta completa radiológica y clínica. Tras conseguir buen control de la enfermedad se decidió iniciar primera línea hormonal.

Bilateral breast carcinoma is rare and infrequent , it is good to define if it occurs synchronously or metachronously, to define if the lesion in the second breast is metastasis or a primary tumor using pathological criteria, the state and clinical condition . For the prognosis and specialized treatment to follow. We present the case of a patient with ECIV breast cancer due to contralateral breast metastasis in a state of visceral crisis at debut, with pathological anatomy of grade 2 infiltrating ductal carcinoma of the breast, absent in situ component in both breast , RE (70%) , RP (80%), Cerb2 negative, Ki67 30% in the right breast and RE (100%) RP (80%) Cerb2-Ki67 20% left breast. A chest-abdomen-pelvis tomography was performed, showing pleural effusion. bilateral and large volume ascites. It was decided to start treatment with systemic chemotherapy, reaching a complete radiological and clinical response. After achieving good control of the disease, the first hormonal line will be sought.