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PEDRO HERNNDEZ MORN CIRUJANO ONCLOGO GINECLOGO ONCLOGO Jefe Servicio Ginecologa Oncolgica IREN NORTE 2013
PREVENCIN PRIMARIA:
TAMIZAJE:
Dx, Tx y Cuidados paliativos: - Ciruga Radical. - Radioterapia/BT - Quimioterapia. - Hormonoterapia. - Terapias Moleculares - Rehabilitacin.
TAMIZAJE: PAP Test. CBL Colposcopia. Test ADN PVH IVAA VILI Biopsia/Cono. Tx. Precncer
Diagnstico, Tx. y Cuidados Paliativos: - Ciruga Radical. - Teleterapia (RE) - Braquiterapia (RIC) - Quimioterapia. - Rehabilitacin.
THE LIFE COURSE TO PREVENT HPV INFECTION AND CERVICAL CANCER Persistent infection Cncer
WHO, 2013
15 years
30 years
45 years
Vaccination
Cancer treatment
Source: WHO 2006
PREVENCIN
INTERVENCIN EN EL CURSO DE LA VIDA
WHO, 2013
Grupo de riesgo
Mujer joven y adulta
PREVENCIN Y SCREENING
Prevencin Secundaria
Infeccin Precncer y Cncer VPH
Demora en el diagnstico
Dr. PEDRO HERNNDEZ MORN
CNCER MUERTE?
Dr. PEDRO HERNNDEZ MORN
The classical steps of cancer screening and prevention are screening, diagnosis and treatment, in bold capitals. Triage and Diagnosis and Risk Clarification are steps to clarify the risk of respective subpopulations (adapted from Solomon, 2003).
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The classical steps of cancer screening and prevention are screening, diagnosis and treatment, in bold capitals. Triage and Diagnosis and Risk Clarification are steps to clarify the risk of respective subpopulations (adapted from Solomon, 2003).
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PAP Testing
POSITIVE
ICA
VIA-IVAA
Guided Biopsy
Histology
CONO-HAV-HR
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CRVIX
OCE
VAGINA
FRNIX POSTERIOR
INFECCIN PERSISTENTE
NIA
ALTO RIESGO
NIC AG VAIN
VIN
PEDRO HERNNDEZ MORN
Cncer
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PAP Y COLPOSCOPIA
PAP Test Sensibilidad Especificidad Falsos Negativos Sampling error Screnning error Falsos Positivos
IVVA
55-60%
(Mx 70%)
* NIC AG: Rango 15-30% Cncer invasor: 40%, con rango de: 30-50%
Gynecologic Oncology, Berek-Hacker, 5th Edition, 2010.
Dr. PEDRO HERNNDEZ MORN
Regression*
Usually several years (up to > 20 years)
* Most cases of CIN spontaneously regress; less likely with higher grade lesions (cervical cancer does not regress). Estimated from total number of global females aged > 15 years. Data available at: http://www.who.int/hpvcentre/en (accessed Sept 2008); Castellsagu X, et al. Vaccine 2007; 25S:C1C26; Clifford GM, et al. Lancet 2005; 366:991998. Dr. Hernndez
Test Citologa
Test VPH IVAA VILI
91-99%
62-94% 44-97% 75-85%
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Sensibilidad y VPP
Prevencin Secundaria
Deteccin oportuna del Precncer y Cncer, con Diagnstico y Tratamiento apropiado
PAP
Preclnica: Screening
Clnica: Deteccin
OMS, PAHO
Prevencin y Screening
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CBL Normal
CBL: LSIL
LSIL
H-SIL
Citologa de CARCINOMA
Flujo vaginal
Sangrado post-coital
NIA
ALTO RIESGO
NIC AG VAIN
Cncer VIN
PEDRO HERNNDEZ MORN 38
INFECCIN PERSISTENTE
Colposcopia: ICA +
NIC AG
Colposcopia y Cncer
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Colposcopia: Schiller +
Cncer inicial Cncer avanzado
Colposcopia: Schiller +?
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el Cncer Cervical (Corporacin Arbor Vita) Ofrecen un mayor potencial para reducir el riesgo global de cncer. Mejoran la costo-eficacia y disminuyen la necesidad de capacitar al personal de salud.
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Test Moleculares
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V: Vaginal C: Cervical
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pronosticar el riesgo de cncer en el futuro. AMBOS CASOS:Test negativos: Controles en 5-8 AOS.
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NO HAY .. DIFERENCIA?
INEN