UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - Surgery Prof. Achim...
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Transcript of UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - Surgery Prof. Achim...
![Page 1: UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - Surgery Prof. Achim Schneider, MD, MPH CURRICULUM VPH y Cancer Cervical UICC.](https://reader036.fdocuments.in/reader036/viewer/2022062500/5665b4f21a28abb57c9501c6/html5/thumbnails/1.jpg)
UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
CURRICULUM
VPH y Cancer CervicalUICC
![Page 2: UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - Surgery Prof. Achim Schneider, MD, MPH CURRICULUM VPH y Cancer Cervical UICC.](https://reader036.fdocuments.in/reader036/viewer/2022062500/5665b4f21a28abb57c9501c6/html5/thumbnails/2.jpg)
UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
01 Capítulo 6.c.2
Métodos de tratamiento – cirugía
Prof. Achim Schneider, MD, MPHCharité Universitätsmedizin Berlin, Germany
![Page 3: UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - Surgery Prof. Achim Schneider, MD, MPH CURRICULUM VPH y Cancer Cervical UICC.](https://reader036.fdocuments.in/reader036/viewer/2022062500/5665b4f21a28abb57c9501c6/html5/thumbnails/3.jpg)
UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
02 Cáncer del cuello uterino • Diagnóstico
• Estadío
• Tratamiento
- Cirugía
- Radioterapia
- Quimioterapia
• Seguimiento
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
03 Sistema de Estadificación FIGO
Estadío I Estadío II
Estadío III Estadío IV
![Page 5: UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - Surgery Prof. Achim Schneider, MD, MPH CURRICULUM VPH y Cancer Cervical UICC.](https://reader036.fdocuments.in/reader036/viewer/2022062500/5665b4f21a28abb57c9501c6/html5/thumbnails/5.jpg)
UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
04 Opciones de tratamiento primario
TRATAMIENTO PRIMARIO
Cirugía
Cirugía Radio-quimioterapia
Radioterapia
Radio-quimioterapia
Radio-quimioterapia Cirugía
Quimioterapia
Quimioterapia Cirugía
![Page 6: UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - Surgery Prof. Achim Schneider, MD, MPH CURRICULUM VPH y Cancer Cervical UICC.](https://reader036.fdocuments.in/reader036/viewer/2022062500/5665b4f21a28abb57c9501c6/html5/thumbnails/6.jpg)
UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
05 Éxito Terapéutico
Source: Informe Anual de FIGO
Radioterapia Cirugía
Estadío FIGO
Haza
rd R
ati
o
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
06Comparación de cirugía y radioterapia en pacientes con estadío FIGO IBCirugía Radioterapia
Supervivencia 85% 85%
Complicaciones severas
Fístula urológica 1 - 2%Fístula intestinal o urológica
1.4 – 5.3%
Vagina Encortecimiento pequeñoFibrosis o posible estenosis, particularmente en mujeres
postmenopáusicas
Ovario Se puede preservar
Castración, el traslado quirúrgico de los ovarios
fuera de la pelvis solamente preserva la función de los
ovarios en 50% de las mujeres
Efectos crónicos Atonía de vejiga 3%Fibrosis de los intestinos y/o
de la vejiga 6 – 8%
AplicabilidadMejores candidatas < 70
años, < 100 kg y en buena condición física
Toda paciente es candidata potencialmente
Mortalidad quirúrgica
1%
< 1% (primordialmente el resultado de embolismo
pulmonar durante el tratamiento intracavitario)
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
07 Histerectomía extendida o radical
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
08 Tratamiento quirúrgico para cancer cervical estadío IA2 - IIB
Friedrich Schauta 1849 - 1919
Ernst Wertheim 1864 - 1920
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
09 Linfadenectomía
Infrarenal izquierda
Infra-mesentérica izquierda
Para-aortica derecha
Pelvisparametrio
Cysterna chyli
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
10 Histerectomía radical (1)
Vejiga
Recto
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
11 Histerectomía radical (2)
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
12 Resección parametrial
![Page 14: UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - Surgery Prof. Achim Schneider, MD, MPH CURRICULUM VPH y Cancer Cervical UICC.](https://reader036.fdocuments.in/reader036/viewer/2022062500/5665b4f21a28abb57c9501c6/html5/thumbnails/14.jpg)
UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
13 Plexo hipógastrico
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
14 Histerectomía radical vaginal tipo III – Conservadora de nervios
Sensitividad(+)
Función motora (+)
Ute rusBla se
Ure te rBe c ke nb o d e n
Re ktumRecto
VejigaÚtero
Suelo pélvico
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
15 Tasa de supervivencia despues de una histerectomía radical vaginal• Estadío IA - IB1, ganglios linfáticos libres de tumor (pN0),
sin afectación tumoral de los vasos sanguíneos y linfáticos (L+V=0)
• Sin factores de riesgo independientes
• n = 110 patients
• Tiempo de seguimiento: 44 (1-89) meses
• Supervivencia
>36 meses: n = 70 (64%)
>60 meses: n = 36 (33%)
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
16 Complicaciones luego de una histerectomía radical• Temprano
- Hemorragia
- Formación de fístula
- Estenosis del ureter
- Embolismo pulmonar
- Infección
- Íleo
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
17
• Tardía
- Linfocele
- Control de vejiga
- Obstipación
- Sensibilidad
Complicaciones luego de una histerectomía radical
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
18 Traquelectomía radical (1)
Daniel Dargent
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
19 Traquelectomía radical (2)
![Page 21: UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - Surgery Prof. Achim Schneider, MD, MPH CURRICULUM VPH y Cancer Cervical UICC.](https://reader036.fdocuments.in/reader036/viewer/2022062500/5665b4f21a28abb57c9501c6/html5/thumbnails/21.jpg)
UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
20 Traquelectomía radical (3)• Precondiciónes
- Deséan mantener fertilidad
- Estadío pT1A1 L1
- pT1A2
- pT1B1 < 2 cm
- Sin afectación tumoral de vasos sanguíneos
- Ganglios linfáticos libre de tumor(pN0)
- Margen de resección endocervical ≥ 0.5cm
- Longitud cervical residual de 1 cm
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
21
Gracias!
Esta presentación se encuentra disponible en: www.uicc.org/curriculum