Cáncer de cérvix, ovario y endometrio... Visión del oncólogo

2. - histology:

3. NEW TNM proposal for cervical cancer

4. TNM
N0
N1:
Regional LNs
T1: cervix, only
T2: a little
Outside the
cervix
T3: pelvic wall
Or most vagina
M0: No distant
metastasis
M1: Distant
metastasis
T4: Other organs by
contiguity
LN: Lymph nodes
Enough tnm to guide
therapy for cervical cancer

5. Stage distribution USA
SEER, Accessed, 2019

6. GYN oncologist

7. TNM
T1: cervix, only
T2: a little
Outside the
cervix
Enough tnm to guide
therapy for cervical cancer
Non-bulky
IA1, IA2, Ib1, IIA1
Less than 4 cm
Bulky
IB2, IIA2, IIB…

8. Types of radical histerectomy

9. Pareja knows his stuff

10. TNM
Enough tnm to guide
therapy for cervical cancer
Non-bulky
IA1, IA2, Ib1, IIA1
Less than 4 cm
Surgery
(preferred)
Ie, Open radical Histerectomy
and pelvic lymphadenectomýy
RT or CHEMO RT
If surgery not an option
Less invasive surgery an
option for some patients
with very eraly disease for
fertility preservation

11. Lungs
REGIONAL involvement.
soft-tissues
Lymph-nodes
Bladder
rectum

12. Whole body
cXR
Chest ct

13. TNM
Enough tnm to guide
therapy for cervical cancer
Bulky IB2, IIA2,
Stage III, IVA
Definitive
Chemo-rt
Cisplatin-based

14. Cisplatino: 40 mg/m2/cada semana por 6 (Junto con teleterapia)
Teleterapia (EBR) – Lunes a viernes, por 6-7 semanas - 4000-5000 cGY
Braquiterapia (4000 -5000 cGy)
1 7 14 21 28 35 (Días)

15. Thomas, G. M. (1999). Improved Treatment for Cervical Cancer ? Concurrent Chemotherapy and Radiotherapy. New
England Journal of Medicine, 340(15), 1198–1200. https://doi.org/10.1056/NEJM199904153401509

17. “sorpresas te de la vida”
Ruben blades

19. FIGO CANCER REPORT 2018 (Bhatla N. Int J Gynecol Obstetrics 2018; 143 (Suppl.
Cervical cancer

20. TNM
Enough tnm to guide
therapy for cervical cancer
Stage IV-B
Palliative
chemotherapy
Cisplatin-based

21. Cisplatin + Paclitaxel +/- Bevacizumab

22. Thomas, G. M. (1999). Improved Treatment for Cervical Cancer ? Concurrent Chemotherapy and Radiotherapy. New
England Journal of Medicine, 340(15), 1198–1200. https://doi.org/10.1056/NEJM199904153401509

23. Thomas, G. M. (1999). Improved Treatment for Cervical Cancer ? Concurrent Chemotherapy and Radiotherapy. New
England Journal of Medicine, 340(15), 1198–1200. https://doi.org/10.1056/NEJM199904153401509

27. Ovarian Cancer Histologies
Epithelial - 85%
Older than 40
Serous
75%
Mucinous
20%
Bulky
Differential
diagnosis with
Pseudomixoma
Endometrioid
2%
Others
Clear cells
Brenner
Indifferentiated
tumors
Mixed histologies
DeVita. Cancer: Principles and Practice of Oncology, 9th Edition
Diapositiva diseñada por Ana Milena Roldán, MD

28. HISTOLOGÍA CÁNCER DE
OVARIO
5% GERMINALES
75% DE NEOPLASIAS OVÁRICAS MALIGNAS EN MUJERES <30 AÑOS
TERATOMA QUÍSTICO
Con frecuencia contienen
cabellos, dientes y hueso
calcificado.
1% malignos
Struma ovárico
DISGERMINOMA
Equivalente al
Seminoma del varón
10-15% bilaterales
B- HCG y AFP
OTROS:
Tumor del Seno
Endodérmico
Carcinoma
Embrionario
Coriocarcinoma
Gonadoblastoma
DeVita. Cancer: Principles and Practice of Oncology, 9th Edition
Diapositiva diseñada por Ana Milena Roldán, MD

29. HISTOLOGÍA
10% ESTROMA OVÁRICO
DE LA GRANULOSA
Productor de
estrógenos
Ocasionan
trastornos
menstruales y
pubertad precoz
T. C. DE LEYDIG Y
SERTOLI
Productor de
andrógenos
Ocasionan
virilización e
hirsutismo
TECOMAS
Productor de
estrógenos y
andrógenos
ANDROBLASTOMA
Productor de
andrógenos
Primera causa de
virilización de origen
ovárico
El patólogo también debe informar el grado de diferenciación:
Grado I para los bien diferenciados y Grado III para los pobremente diferenciados.
DeVita. Cancer: Principles and Practice of Oncology, 9th Edition
Diapositiva diseñada por Ana Milena Roldán, MD

31. TNM for ovarian cancer

33. Ovarian cancer stage distribution

34. Abdominal / Pelvic
imaging
Abdominal
distention
Suspicious
abdominal or
pelvic mass
Ovarian cancer
suspected
Ascites
Non-specific
Bloating
Pelvic/abdominal pain
Difficulty eating
Feeling full quickly
Urinary symptoms
(urgency, frequency)
Surgical candidate
Not a surgical
candidate

35. Surgical candidate
Stage IA or IB
Grade 1
-Endometroid
Surveillance
Stage IA or IB Grade 3 or Clear Cell
(some grade 2)
Stages IC-IV
Platinum-based
chemotherapy
Surveillance
GOG 218: Carboplatin +
Paclitaxel +/- Bevacizumab
(Stages III or IV)

36. Vergote (EORTC): Preoperative
Carboplatin + Paclitaxel x2-3 months
Not a surgical
candidate
Bulky stage III or IV disease. or poor
surgical candidate
Intervaldebunking
surgery
Biopsy

41. Endometrial - tnm

42. Endometrial - tnm

43. Endometrial cancer:
stage distribution

45. Pure endometrial cancer
Total hysterectomy and bilateral salpingo-
oophorectomy, and surgical staging
No cervical involvement
Total hysterectomy and bilateral
salpingo-oophorectomy, and surgical
staging
Cervical involvement
Preoperative
External-beam RT

46. Pure endometrial cancer

48. High-risk histology
Total hysterectomy and bilateral salpingo-
oophorectomy, and surgical staging
High-risk histology
Adjuvant systemic chemotherapy
Adjuvant RT (stages IB-IV) +
brachytherapy (All)

51. Antineoplastic agents