uicc hpv and cervical cancer curriculum chapter 6.c.2. methods of treatment - surgery prof. achim...
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![Page 1: UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - Surgery Prof. Achim Schneider, MD, MPH UICC HPV e CÂNCER CERVICAL CURRÍCULO](https://reader034.vdocuments.us/reader034/viewer/2022051820/552fc0f8497959413d8b577e/html5/thumbnails/1.jpg)
UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
UICC
HPV e CÂNCERCERVICALCURRÍCULO
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
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01 Capítulo 6.c.2
Métodos de Tratamento - Cirurgia
Prof. Achim Schneider, MD, MPHCharité Universitätsmedizin Berlim, Alemanha
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
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02 Câncer cervical
• Diagnósticos
• Estadiamento
• Terapia
- Cirurgia
- Radiação
- Terapia Sistêmica
• Acompanhamento pós tratamento
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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 Estadiamento FIGO
Estágio I Estágio II
Estádio III Estágio IV
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
04 Opções para terapia primária
TERAPIA PRIMÁRIA
Cirurgia
Cirurgia Radioquimioterapia
Radioterapia
Radioquimioterapia
Radioquimioterapia Cirurgia
Quimioterapia
Quimioterapia Cirurgia
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
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05 Sucesso terapêutico
Fonte: Relatório Anual FIGO
Radioterapia Cirurgia
Estádiamento FIGO
Taxa d
e p
eri
gos
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
06Comparison de cirurgia e radioterapia em pacientes em estádio IB de FIGO CIRURGIA RADIOTERAPIA
Sobrevida 85% 85%
Complicações graves
Fístula urológica 1 a 2%Fístula intestinal e
urológica 1,4 a 5,3%
Vagina Pequeno encurtamento
Fibrose ou possível esternose especialmente
em mulheres pós-menopausa
Ovário Pode ser preservado
Castração, translocação externa cirúrgica da pelvis pode salvar a
função ovariana apenas em 50%
Efeitos crônicos
Bexiga atônica em 3%Fibrose do intestino e da
bexiga em 6 a 8%
Aplicabilidade
As melhores candidatas são < 70 anos, < 100 kg de peso corporal e em boas condições geral
Todas as pacientes são candidatas potenciais
Mortalidade cirúrgica
1%
< 1% (principalmente via embolia pulmonar durante a terapia
intracavitária)
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
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07 Histerectomia estendida ou radical
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
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08 Terapia cirúrgica para o câncer cervical de estádio 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 Linfadenectomia
Infra-renal esquerda
Inframesentérica esquerda
Para-aórtica direita
PélvicoParamétrico
Cisterna de quilo
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
10 Histerectomia radical (1)
Bexiga
Reto
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
11 Histerectomia radical (2)
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
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12 Ressecção paramétrica
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
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13 Plexo hipogástrico
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
Slide
14 Histerectomia vaginal radical do tipo III - Suporte do nervo
Sensibilidade(+)
Função motora +Ute rusBla se
Ure te rBe c ke nb o d e n
Re ktumReto
BexigaÚtero
Assoalho 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 Taxa de sobrevida depois de histerectomia vaginal radical
• Estágio IA - IB1, nódulos linfáticos livres de tumor (pN0), sem invasão de célula tumoral e de vasos linfáticos (L+V=0)
• Sem fatores de risco independentes
• n = 110 pacientes
• Tempo de acompanhamento: 44 (1-89) meses
• Sobrevida
>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
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16 Complicações após a histerectomia radical
• Precoce
- Perda de sangue
- Formação de fístula
- Estenose do ureter
- Embolia pulmonar
- Infecção
- Obstrução total do intestino
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
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17
• Tardio
- Linfocele
- Controle da bexiga
- Constipação
- Sensibilidade
Complicações após a histerectomia radical
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.2. Methods of treatment - SurgeryProf. Achim Schneider, MD, MPH
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18 Traquelectomia 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 Traquelectomia 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
20 Traquelectomia radical (3)
• Pré-condições
- Busca de correlação
- pT1A1 L1
- pT1A2
- pT1B1 < 2 cm
- Sem invasão de vasos sanguíneos
- Nódulos linfáticos sem tumor (pN0)
- Ressecção endocervical com uma margem de 0,5 cm
- Comprimento residual cervical 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
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21
Obrigado
Esta apresentação está disponível em www.uicc.org/curriculum