RESUMO
BACKGROUND: Optimal upfront treatment of patients with advanced ovarian cancer is complex and requires the adequate function of a multidisciplinary team. Specific standard of quality of care needs to be taken into consideration. METHODS: A literature search in PubMed was performed using the following criteria: ("ovarian neoplasms"[MeSH Terms] OR ("ovarian"[All Fields] AND "neoplasms"[All Fields]) OR "ovarian neoplasms"[All Fields] OR ("ovarian"[All Fields] AND "cancer"[All Fields]) OR "ovarian cancer"[All Fields])"[Date - Publication]: "2018/01/14"[Date - Publication]). RESULTS: This article describes how to optimize the surgical management of advanced ovarian cancer, to achieve the best results in terms of survival and quality of life. For this purpose, this document will cover aspects related to pre-, intra- and postoperative care of newly diagnosed advanced ovarian cancer patients. CONCLUSION: Optimizing upfront treatment of patients with advanced ovarian cancer is complex and requires a structured quality management program including the wise judgment of a multidisciplinary team. Surgeries performed by gynecologic oncologists with formal training in cytoreductive techniques at referral centers are crucial factors to obtain better clinical and oncological outcomes. However, other factors such as the patient's clinical status, the hospital infrastructure and equipment, as well as the tumor biology of each individual patient should also be taken into account before deciding on an initial therapeutic strategy for advanced-stage ovarian cancer to offer patients the best quality of care.
Assuntos
Procedimentos Cirúrgicos de Citorredução/normas , Neoplasias Ovarianas/cirurgia , Qualidade da Assistência à Saúde , Qualidade de Vida , Idoso , Feminino , Humanos , Metanálise como Assunto , Prognóstico , Espanha , Carga TumoralRESUMO
OBJECTIVE: To determine the incidence of serous tubal intraepithelial carcinoma (STIC) after risk reduction salpingo-oophorectomy(RRSO), and to describe oncological outcomes after RRSO. MATERIALS AND METHODS: BRCA pathogenic mutation carriers who had undergone an RRSO were evaluated in this retrospective multicenter observational study. Patients were only included when fallopian tubes were analyzed following the protocol for Sectioning and Extensively Examining the FIMbria (SEE-FIM). Surgeries were performed between June 2010 and April 2017 at eight Spanish hospitals. RESULTS: A total of 359 patients met the inclusion criteria. STIC was diagnosed in 3 (0.8%) patients; one of them underwent surgical staging due to positive peritoneal washing, with absence of disease at the final pathology report. None of the three patients received adjuvant chemotherapy and were free of disease at last follow-up. Fallopian tube and ovarian carcinoma were diagnosed in 5 (1.4%) and 1 (0.3%), respectively. At a median (range) follow-up time of 29 (3-92) months, five patients had a newly diagnosed breast cancer. Other types of cancer, which were diagnosed during the follow-up time, included: serous primary peritoneal carcinoma (n = 1), serous endometrial carcinoma (n = 1), colon (n = 1), pancreas (n = 1), jaw (n = 1), and lymphoma (n = 1). Seven patients died due to different types of cancer: breast (n = 4), pancreas (n = 1), jaw (n = 1), and colon (n = 1). CONCLUSION: The incidence of STIC after RRSO in BRCA mutation carriers is low (0.8%) and it presents an excellent oncological outcome. Patients after RRSO, however, run the risk to develop other types of cancer during follow-up and should be properly advised before the prophylactic surgery.
Assuntos
Carcinoma in Situ/epidemiologia , Neoplasias das Tubas Uterinas/epidemiologia , Neoplasias Peritoneais/epidemiologia , Adulto , Idoso , Proteína BRCA1/genética , Neoplasias das Tubas Uterinas/genética , Neoplasias das Tubas Uterinas/cirurgia , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Neoplasias Peritoneais/genética , Salpingo-Ooforectomia , EspanhaRESUMO
BACKGROUND: It is important to know what a young gynecologic oncologist perceives as a need to achieve a good training in gynecologic oncology. OBJECTIVE: This study aims to evaluate the level of training in gynecologic oncology in Spain. METHODS: A Web-based anonymous questionnaire was sent via e-mail to Spanish trainees listed in European Network of Young Gynecological Oncology (ENYGO). The survey was developed in four sections: (1) general training in gynecologic oncology, (2) distribution of current clinical activity, (3) surgical training, and (4) perspective future gynecologic oncology. It contained 51 questions, with multiple-choice answers that had to be answered by the ENYGO members. RESULTS: The questionnaire was sent to 64 people listed in the ENYGO database. Of these, 37 members responded (response rate of 58%). Overall, more training in surgery is necessary, to perform radical oncological surgeries. It is claimed a sub-specialty recognition, to ensure an equalitarian and homogeneous training.
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Educação de Pós-Graduação em Medicina , Ginecologia/educação , Internato e Residência , Oncologia/educação , Adulto , Feminino , Humanos , Masculino , Espanha , Inquéritos e QuestionáriosRESUMO
Epithelial ovarian cancer (EOC) during pregnancy is a rare condition. The diagnosis and treatment strategies are therefore not well defined. The evidence is scarce and limited to small case reports or case series. In this review we describe the safety, utility and limitations of each diagnostic tool and surgical procedure in pregnant women with ovarian cancer. We also discuss the role of chemotherapy for ovarian cancer during pregnancy. Finally, we delineate different strategies of treatment according to the stage of the disease at diagnosis and gestational age. Due to the complexity of the management of EOC during pregnancy, patients should be referred to specialized centers. Gestational age at diagnosis, the initial surgical procedure, disease stage and patient's preferences are the key factors in the decision-making process to establish the best treatment strategy for each individual case.
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Neoplasias Epiteliais e Glandulares/terapia , Neoplasias Ovarianas/terapia , Complicações Neoplásicas na Gravidez/terapia , Carcinoma Epitelial do Ovário , Progressão da Doença , Feminino , Humanos , Oncologia/legislação & jurisprudência , Oncologia/métodos , Oncologia/tendências , Modelos Biológicos , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Ovarianas/patologia , Guias de Prática Clínica como Assunto , GravidezRESUMO
OBJECTIVE: To evaluate the effect of early versus delayed feeding after caesarean section on the woman's satisfaction. DESIGN: Randomised, controlled trial. SETTING: Tertiary care hospital. POPULATION: Healthy pregnant women were enrolled for the study during antenatal care visits. METHODS: Uncomplicated singleton pregnancies undergoing a planned or intrapartum caesarean section performed under regional anaesthesia were randomly assigned to either (1) a 'delayed feeding' group who started oral fluids 4 hours after surgery with diet introduced at 24 hours; or (2) an 'early feeding' group who were offered a regular diet within the first 8 hours. MAIN OUTCOME MEASURES: Primary outcome was the woman's satisfaction measured with a visual analogue scale (VAS) before their hospital discharge. The secondary outcomes were: pain, anorexia, abdominal distension, persistent nausea and/or vomiting, time to the first bowel movement and passage of flatus. RESULTS: Two hundred women were recruited, with 103 randomised to delayed feeding and 97 to early feeding. The woman's satisfaction (mean VAS +/- SD) was similar in both groups; 73 +/- 17 mm in the delayed feeding group and 77 +/- 13 mm in the early feeding group (P= 0.12). A statistically significant difference was observed in mean postoperative pain: 29 +/- 13 mm in the delayed feeding group versus 24 +/- 11 mm in the early feeding group (P= 0.008). No other significant differences in postoperative variables were recorded, and there were no major postoperative complications observed in either group. CONCLUSION: Early feeding after uncomplicated caesarean in low-risk women is equivalent in terms of the woman's satisfaction and the reduced perceived pain.