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>Revistas >Revista de Investigación Clínica >Año 2011, No. 6


Gallardo-Rincón D, Cantú-de-León D, Alanís-López P, Álvarez-Avitia MÁ, Bañuelos-Flores J, Herbert-Núñez GS, Oñate-Ocaña LF, Pérez-Montiel MD, Rodríguez-Trejo A, Ruvalcaba-Limón E, Serrano-Olvera A, Ortega-Rojo A, Cortés-Esteban P, Erazo-Valle A, Gerson-Cwilich R, De-la-Garza-Salazar J, Green-Renner D, León-Rodríguez E, Morales-Vásquez F, Poveda-Velasco A, Aguilar-Ponce JL, Alva-López LF, Alvarado-Aguilar S, Alvarado-Cabrero I, Aquino-Mendoza CA, Aranda-Flores CE, Bandera-Delgado A, Barragán-Curiel E, Barrón-Rodríguez P, Brom-Valladares R, Cabrera-Galeana PA, Calderillo-Ruiz G, Camacho-Gutiérrez S, Capdeville-García D, Cárdenas-Sánchez J, Carlón-Zárate E, Carrillo-Garibaldi Ó, Castorena-Roji G, Cervantes-Sánchez G, Coronel-Martínez JA, Chanona-Vilchis JG, Díaz-Hernández V, Escudero-de-los Ríos P, Garibay-Cerdenares O, Gómez-García E, Herrera-Montalvo LA, Hinojosa-García LM, Isla-Ortiz D, Jiménez-López J, Lavín-Lozano AJ, Limón-Rodríguez JA, López-Basave HN, López-García SC, Maffuz-Aziz A, Martínez-Cedillo J, Martínez-López DM, Medina-Castro JM, Melo-Martínez C, Méndez-Herrera C, Montalvo-Esquivel G, Morales-Palomares MÁ, Morán-Mendoza A, Morgan-Villela G, Mota-García A, Muñoz-González DE, Ochoa-Carrillo FJ, Pérez-Amador M, Recinos-Money E, Rivera-Rivera S, Robles FJU, Rojas-Castillo E, Rojas-Marín C, Salas-Gonzáles E, Sámano-Nateras L, Santibañez-Andrade M, Santillán-Gómez A, Silva-García A, Silva JA, Solorza-Luna G, Tabarez-Ortiz AR, Talamás-Rohana P, Tirado-Gómez LL, Torres-Lobatón A, Quijano-Castro F
Tercer Consenso Nacional de Cáncer de Ovario 2011.
Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México “GICOM”

Rev Invest Clin 2011; 63 (6)

Idioma: Español
Referencias bibliográficas: 175
Paginas: 665-702
Archivo PDF: 339.35 Kb.

[Texto completo - PDF]

RESUMEN

Introducción. El cáncer de ovario (CO) representa la tercera neoplasia ginecológica más frecuente a nivel mundial. La mayoría de los casos son de tipo epitelial. Actualmente no existe un método de tamizaje estandarizado, lo que dificulta el diagnóstico temprano. La supervivencia a cinco años es de 90% para las etapas tempranas; sin embargo, la mayoría de los casos se presentan en etapas avanzadas, las cuales tienen una supervivencia a cinco años de 5-20%. Grupo GICOM, en colaboración y bajo el auspicio de las diferentes instituciones, realizó el siguiente consenso con la finalidad de dar recomendaciones para el manejo de las pacientes con este tipo de neoplasia. Material y métodos. Este consenso se realizó mediante paneles independientes de profesionales de la salud en el campo de la ginecología oncológica, las preguntas y declaraciones realizadas fueron con base en una revisión exhaustiva y sistemática de la literatura hecha en el marco de una reunión de dos días en donde se llevó a cabo un debate abierto. Estas declaraciones corresponden a las conclusiones alcanzadas por acuerdo de sus integrantes. Resultados. Actualmente no se recomienda un método de tamizaje para detección de lesiones tempranas en cáncer de ovario en la población general. La estadificación es quirúrgica según los lineamientos de la FIGO. Como estudios preoperatorios se recomienda la realización de telerradiografía de tórax y TAC de abdomen y pelvis con contraste intravenoso. Con base en la patología del tumor, para considerarlo como limítrofe, el porcentaje mínimo de componente proliferativo es de 10% del total de la superficie del tumor. El tratamiento estándar recomendado incluye cirugía primaria con fines de diagnóstico, estadificación y citorreducción, seguido de quimioterapia adyuvante. La cirugía debe ser realizada por un ginecólogo oncólogo o cirujano oncólogo, ya que la tasa de cirugías inadecuadas al ser realizadas por otro especialista es hasta de 75%. En cuanto a la cirugía, se recomienda realizar omentectomía total, ya que se han documentado metástasis subclínicas en 10-30% de los casos, además de linfadenectomía sistemática, necesaria para obtener una etapificación quirúrgica adecuada. La cirugía preservadora de fertilidad se realizará en casos seleccionados, la cual deberá incluir evaluación detallada del ovario contralateral y biopsia de epiplón negativos a malignidad. Hasta este momento el papel de la laparoscopia en cirugía diagnóstica-estadificadora no es bien conocido. La quimioterapia recomendada se basa en platino y taxanos por 6 ciclos, excepto en EC IA y IB y grado 1, las cuales tienen buen pronóstico. En la etapa avanzada se recomienda la citorreducción primaria como abordaje inicial. La cirugía de mínima invasión no es un procedimiento quirúrgico recomendado para el tratamiento del CO avanzado. La radioterapia en etapa avanzada tiene utilidad como tratamiento paliativo de síntomas. Se recomienda seguimiento de las pacientes cada 2-4 meses por dos años, posteriormente cada 3-6 meses por tres años y anualmente después del quinto año. Se debe realizar medición de la calidad de vida de la paciente de forma continua. Conclusiones. Actualmente no existe un método de tamizaje estandarizado. El diagnóstico en etapas más tempranas permite una mayor supervivencia. El tratamiento estándar es la cirugía primaria con el objetivo de citorreducción óptima seguido de quimioterapia. El tratamiento debe de ser individualizado de acuerdo con cada paciente. El tratamiento con radioterapia se indica para paliación de síntomas.


Palabras clave: Cáncer, Ovario, Cirugía, Radioterapia, Quimioterapia.


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