CES2019-02: Ginecología oncológica III (visión del oncólogo clínico)
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Clase de enfoque de la paciente con cáncer ginecológico, desde la perspectiva de oncología clínica
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CES2019-02: Ginecología oncológica III (visión del oncólogo clínico)
- 1. 2019-02
- 2. Ovarian cancer / Fallopian tube / Peritoneal carcinomatosis Stage I One or both ovaries (or fallopian tube) involvement Stage II Whole tumor burden below pelvic brim - Primary peritoneal carcinoma Stage III Peritoneal involvement outside the pelvis - Retroperitoneal lymph-nodes Stage IV Extra- abdominal involvement - Liver, spleen, transmural bowel, etc Simplified FIGO staging system for Ovarian Cancer
- 3. Endometrial cancer Stage I Confined to the corpus uteri (including endocervical glandular component) Stage II Tumor involves stroma component of the uterine cervix (no tumor beyond the uterus) Stage III Tumor invades the serosa, adventitia, vagina or parametrium Stage IVa Tumor invading the bladder mucosa or the rectal mucosa Simplified FIGO staging system for Endometrial Cancer Stage IVb Distant metastasis
- 4. Cervical cancer Stage I Confined to the uterus Stage II Beyond the uterus but not to the pelvic wall or lower third of the vagina Stage III Extension to the pelvic wall, or lower third of the vagina, or causing hydronephrosis (or non- functioning kidney) Stage IVa Tumor invading the bladder mucosa or the rectal mucosa, or extension beyond the true pelvis Simplified FIGO staging system for Cervical Cancer Stage IVb Distant metastasis
- 6. - histology:
- 7. NEW TNM proposal for cervical cancer
- 8. 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
- 9. Stage distribution USA SEER, Accessed, 2019
- 10. GYN oncologist
- 11. 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…
- 12. Types of radical histerectomy
- 13. Pareja knows his stuff
- 14. 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
- 17. TNM Enough tnm to guide therapy for cervical cancer Bulky IB2, IIA2, Stage III, IVA Definitive Chemo-rt Cisplatin-based
- 18. 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)
- 19. 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
- 21. “sorpresas te de la vida” Ruben blades
- 23. FIGO CANCER REPORT 2018 (Bhatla N. Int J Gynecol Obstetrics 2018; 143 (Suppl. Cervical cancer
- 24. TNM Enough tnm to guide therapy for cervical cancer Stage IV-B Palliative chemotherapy Cisplatin-based
- 25. Cisplatin + Paclitaxel +/- Bevacizumab
- 26. 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. 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
- 31. 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
- 32. 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
- 33. 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
- 35. TNM for ovarian cancer
- 37. Ovarian cancer stage distribution
- 38. 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
- 39. 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)
- 40. 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
- 49. 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
- 52. 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)
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