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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2010, Número 6

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Rev Invest Clin 2010; 62 (6)


Primer Consenso Mexicano de Cáncer de Endometrio Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México “GICOM”

Ruvalcaba-Limón E, Cantú-de-León D, León-Rodríguez E, Cortés-Esteban P, Serrano-Olvera A, Morales-Vásquez F, Sosa-Sánchez R, Poveda-Velasco A, Crismatt-Zapata A, Santillán-Gómez A, Aguilar-Jiménez C, Alanís-López P, Alfaro-Ramírez P, Álvarez-Avitia MÁ, Aranda-Flores CE, Arias-Ceballos JHR, Arrieta-Rodríguez O, Barragán-Curiel E, Botello-Hernández D, Brom-Valladares R, Cabrera-Galeana PA, Cantón-Romero JC, Capdeville-García D, Cárdenas-Sánchez J, Castorena-Roji G, Cepeda-López FR, Cervantes-Sánchez G, Cetina-Pérez LC, Coronel-Martínez JA, Cortés-Cárdenas SA, Cruz-López JC, de la Garza-Salazar JG, Díaz-Romero C, Dueñas-González A, Valle-Solís AE, Escudero-de los Ríos P, Flores-Álvarez E, García-Matus R, Gerson-Cwilich R, González-Enciso A, González-de-León C, Guevara-Torres AG, Herbert-Núñez GS, Hernández-Hernández C, Hernández-Hernández DM, Isla-Ortiz D, Jesús-Sandoval R, Jiménez-Cervantes C, Kuri-Exsome R, López-Obispo JL, Maffuz-Aziz A, Martínez-Barrera LM, Medina-Castro JM, Montalvo-Esquivel G, Mora-Aguilar VH, Morales-Palomares MÁ, Morán-Mendoza A, Morgan-Villela G, Mota-García A, Muñoz-González DE, Murillo-Cruz DA, Novoa-Vargas A, Ochoa-Carrillo FJ, Oñate-Ocaña LF, Ortega-Rojo A, Palacios-Martínez AG, Palomeque-López A, Pérez-Montiel MD, Quijano-Castro F, Rivera-Rivera S, Rivera-Rubí LM, Robles-Flores JU, Rodríguez-Trejo A, Salas-Gonzáles E, Silva JA, Solorza-Luna G, Souto-del-Bosque R, Tirado-Gómez LL, Torrescano-González S, Torres-Lobatón A, Trejo-Durán E, Villavicencio-Valencia V, Gallardo-Rincón D

Idioma: Español
Referencias bibliográficas: 74
Paginas: 585-605
Archivo PDF: 148.14 Kb.


RESUMEN

Introducción. El cáncer de endometrio (CE) es la segunda neoplasia ginecológica más frecuente a nivel mundial, más común en la peri y postmenopausia. Mayor frecuencia para la variedad endometrioide. Supervivencia a largo plazo en la etapa clínica temprana es mayor a 80%, mientras que en las etapas avanzadas es menor a 50%. En nuestro país no existe un manejo totalmente estandarizado entre instituciones. Grupo GICOM, en colaboración y bajo el auspicio de las diferentes instituciones, ha realizado 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 a una revisión exhaustiva y sistemática de la literatura, hechas en el marco de una reunión de cuatro días en donde se llevó a cabo un debate abierto. Estas declaraciones corresponden a las conclusiones alcanzadas por acuerdo de sus integrantes. Resultados. El escrutinio se debe hacer sólo a mujeres con alto riesgo (diabéticas, historia familiar de cáncer de colon hereditario no polipósico, S. Lynch tipo II). El grosor endometrial en pacientes es mejor evaluado mediante US transvaginal, un grosor mayor o igual a 5 mm debe ser biopsiado. Las mujeres que toman tamoxifeno deben ser monitoreadas con este método. Sangrado transvaginal es la manifestación inicial, todas las mujeres que posterior a la menopausia presenten sangrado vaginal deben ser estudiadas. El Diagnóstico se hace mediante biopsia guiada por histerescopia. La RMN es el mejor estudio radiológico de estadificación preoperatoria. El estudio transoperatorio evalúa grado histológico, profundidad de infiltración miometrial, extensión de la enfermedad a cérvix y afectación de los anexos. Se realiza panhisterectomía con linfadenectomía pélvica y para-aórtica excepto en variedad endometrioide Grado 1 y 2, afectación menor de 50% del miometrio, sin evidencia de enfermedad fuera del útero. Omentectomía se recomienda variedad no endometrioide. La cirugía debe ser realizada por parte de un ginecólogo oncólogo o un cirujano oncólogo, se puede hacer por laparoscopía, especialmente en pacientes diabéticas e hipertensas por ser menos mórbida. El tratamiento adyuvante posterior a la cirugía incluye a la radioterapia dirigida a la pelvis, braquiterapia y quimioterapia. A las pacientes con EC III y IV se les debe practicar cirugía con intención de lograr citorreducción óptima, ya que tiene impacto en la supervivencia (51 m vs. 14 m). El tratamiento de la recurrencia puede ser de nuevo con cirugía dependiendo del patrón de la recaída, tratamiento sistémico hormonal o de quimioterapia. El seguimiento es principalmente clínico de manera seriada. Conclusiones. Existe un programa de escrutinio sólo para pacientes de alto riesgo, el tratamiento multidisciplinario impacta en mejor supervivencia y control local de la enfermedad, incluye cirugía, radioterapia y quimioterapia, el tratamiento hormonal se reserva para casos seleccionados de recurrencia. Este es el primer producto de un Grupo Colaborativo Mexicano en Ginecología Oncológica en dar recomendaciones para un manejo estandarizado en una neoplasia específica.


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