Oncofer(lidad Hospital Universitario FSFB

Transcripción

1 Oncofer(lidad Hospital Universitario FSFB Ricardo Mar(n O., M.D., MSc, FACOG Daniel Sanabria., M.D., FACOG Ricardo Rueda S., M.D., FRCSC, FACOG Eduardo Castro V., M.D., FACOG Andrés Gu(érrez A., M.D. Dpto Gin- Ob y Reproducción Humana Sección de Oncología Ginecológica Sección de Medicina Reproduc(va REPROTEC

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6 Agentes Asociados con Amenorrea

7 SINDROME DE CANCER DE MAMA - OVARIO HEREDITARIO DR ALEJANDRO OROZCO PLAZAS CIRUJANO DE MAMA Y TUMORES DE TEJIDOS BLANDOS INC /FUNDACION SANTA FE DE BOGOTA MARZO 11 DE 2014

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9 MUTACIONES BRCA 1 Y 2 : INCREMENTAN EL RIESGO DE CÁNCER DE MAMA MAS QUE OTROS FACTORES

10 MUTACIONES EN BRCA INCREMENTAN EL RIESGO DE CÁNCER DE SENO Y OVARIO

11 Printed by Lucas Drucaroff on 6/14/2013 2:40:07 PM. For personal use only. Not approved for distribution. Copyright 2013 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version Updates Genetic/Familial High-Risk Assessment: Breast and Ovarian NCCN Guidelines Index Genetics Table of Contents Discussion Updates in Version of the NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast and Ovarian from Version include: Genetic/Familial High-Risk Assessment: Hereditary Breast and Ovarian Cancer: BR/OV-1 HBOC-1 An affected individual A personal history of breast cancer + one or more of the following 1st bullet was added: A known mutation in a breast cancer 2nd sub-bullet was modified: Diagnosed any age 50 y with 1 close blood susceptibility gene within the family. relative with breast cancer 6th bullet was reorganized and modified: 1 family member on 6th sub-bullet was modified: Diagnosed at any age with 2 close blood same side of family with a combination of breast cancer and 1 of relatives with breast cancer and/or epithelial ovarian cancer at any age. the following (especially if early onset): pancreatic cancer, 7th sub-bullet was modified: Diagnosed at any age with 2 close blood aggressive prostate cancer (Gleason score 7) ; sarcoma, relatives with pancreatic cancer or aggressive prostate cancer (Gleason adrenocortical carcinoma, brain tumors, endometrial cancer, score 7) at any age. leukemia/lymphoma; thyroid cancer, dermatologic manifestations 5th bullet was modified: Personal history of pancreatic cancer or aggressive and/or macrocephaly; hamartomatous polyps of GI tract on the prostate cancer (Gleason score 7) at any age with 2 close blood relatives with same side of family; diffuse gastric cancer (Also for an unaffected individual) breast and/or ovarian and/or pancreatic or aggressive prostate cancer (Gleason An unaffected individual score 7) at any age. A known mutation in a breast cancer susceptibility gene within the Family history only family was moved as the first bullet. 1st bullet was added : Clinical judgement should be used to determine if the 2 breast primaries, either in 1 individual or 2 different individuals patient has reasonable likelihood of a mutation... from the same side of family (maternal or paternal) was separated 2nd bullet was modified: Testing of unaffected family members individuals into 2nd and 3rd bullets. should only be considered when an appropriate affected family member is Footnotes unavailable for testing. no affected family member is available and then the Footnote e was modified by adding: Ovarian/fallopian unaffected family member with the highest probability of mutation should be tube/primary peritoneal cancers are component tumors of tested. hereditary non-polyposis colorectal cancer/lynch syndrome... 3rd bullet was modified: Significant limitations of interpreting test results for Footnote f was modified:...requirements for inclusion may be an unaffected individua l should be discussed. modified (eg, women of Ashkenazi Jewish descent with breast or HBOC testing criteria not met, Cancer screening as per NCCN Screening ovarian or pancreatic cancer at any age). Guidelines replaced See NCCN Breast Cancer Screening and Diagnosis Footnote h was added: For hamartomatous colon polyps in Guidelines. conjunction with breast cancer and hyperpigmented macules of the Footnotes lips and oral mucosa... Footnote a was modified:...further personalized risk assessment, genetic counseling, and often genetic testing and management and Other BR/OV-2 malignancies Melanoma has been reported in some HBOC families include Focused physical exam clarified by adding: conducted by physician prostate and melanoma. or nurse and noting the findings related to Cowden syndrome Footnote e was modified: Close blood relatives include first-, second-, and Cowden syndrome specific: third-degree relatives on same side of family. Dermatologic, including oral mucosa Head circumference Continued on next page Thyroid (enlarged or nodular on palpation) Version , 06/10/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. UPDATES

12 MANEJO DE PACIENTES Síndrome de Cáncer de Mama y Ovario Hereditario SEGUIMIENTO MANEJO MEDICO: QUIMIOPREVENCION TRATAMIENTOS PROFILACTICOS: CIRUGIA

13 Síndrome de Cáncer de Mama y Ovario Hereditario CONSEJERIA GENETICA

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16 SOCIEDADES MÉDICAS / GUÍAS

17 Equipo mul(disciplinario Oncofer(lidad FSFB Ginecología y Obstetricia: Dr Ricardo MarNn O Oncología Ginecológica: Dr Daniel Sanabria Medicina Reproduc(va: Biología Reproduc(va: Cirugía General Seno: Oncología Clínica: Medicina Interna: Oncología pediátrica : Psiquiatría: Urología: Gené(ca: Dr Ricardo Rueda Dr Eduardo Castro Dr Andrés Gu(érrez Dra Eliana Bonilla Dra Juliana Salamanca Dra Julia Mejía Dr Alejandro Orozco Dr Carlos Vargas Dr Andrés Barrera

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37 Preservación Fer(lidad U T E R O

38 Traquelectomía Radical

39 Cáncer de Endometrio LNGIUS Progestágenos

40 Leiomiomas Uterinos Consideraciones para preservación fer(lidad: Miomectomía (laparoscopia/abierta) 6 meses post- op /histeroscopia consultorio ERA ( >/= 35 años) Reserva ovárica limitada: RFA, AMH bajos Co- morbilidad: Anemia Pareja (+) : Vitrificación embriones Pareja (- ) : Vitrificación de ovocitos

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42 Subrogación Uterina

43 Indicaciones Ausencia de Utero: quirúrgica, congénita Malformación uterina: Müllerianas Enfermedad uterina: Leiomiomas, adenomiosis Enfermedad endometrial: Sind Asherman Iso-inmunización Rhesus Salud materna Otras: psiquiátricas, sociales, cosméticas, conveniencia, etc.

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