guia nccn ca de mama 2015
TRANSCRIPT
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GUIA NCCN CA DE MAMA
2015
ADRIANA CARDONA ASTAIZA R4 CIRUGIA GENERAL U.CES
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EPIDEMIOLOGIA 253030 Casos nuevos de Ca de
mama invasivo Mortalidad 40430 64640 incidencia del Ca in situ Comportamiento
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FACTORES DE RIESGO
SEXO FEMENINO
EDAD
ANTECEDENTES FAMILIARES
MENARQUIA TEMPRANA
MENOPAUSIA TARDIA
PARIDAD TARDIA
TRH
EXPOSICION PREVIA A RADIADICION
ENF BENIGNA DE MAMA PROLIFERATIVA
DENSIDAD MAMARIA
BRCA 1/2
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MANIFESTACIONES CLINICAS CCL
X
30 % entre mamografí
as
Adenopatía axilar
Hueso Hígado
Pulmones
15 % Enfermeda
d mamo gráficamen
te oculta
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LOBULAR
Menos frecuente
lobulilos
DUCTAL
85-90%
INVASIVOS:MUCINOSO ,CARCINOMAS
TUBULARES , ADENOIDE QUISTICO
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RECEPTORES
COMPORTAMIENTO BIOLOGICO
COMPORTAMIENTO BIOLOGICO COMPLEJO
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LUMINAL ER(+)
PR(+)
LUMINAL A :ER , HER 2 BAJO
50 % DE LOS SUBTIPOS
MEJOR PRONOSTICO
LUMINAL B :10 %
BAJA ER , HER 2 VARIABLE
Ki 67
HER -2
HER 2
10 % CA DE MAMA
NEGATIVO ER Y PR
TERAPIA HER -2 DIRIGIDA
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BASAL
ER, PR Y HER 2 NEGATIVO
(TRIPLE NEGATIVO )
20 % DE CANCERES DE MAMA
PROLIFERACION
AGRESIVO
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ER , PR Y HER 2
ER
CA DUCTAL IN SITU
POSITIVO SI AL MENOS 1 %
ER + PRCA INVASIVO
RECURRENCIA
HER 2CA INVASIVO
PRIMERA RECURRENCIA
EVALUACION HORMONAL
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FAS
E 0
CARCINOMAS NO INVASIVOS
CLIS CDIS
CARCINOMA INVASIVO OPERABLE
ESTADIO CLINICO I ALGUNOS IIIA
CARCINOMA INVASIVO LOCORREGIONAL INOPERABLE
IIB,IIIC.ALGUNOS IIIA
METASTASICO
IV RECURRENTE
FASES
REVISIONDE LA PATOLOGIA
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TNM
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CIRUGIA CONSERVADORA DE LA MAMA
CONTRAINDICACIONES ABSOLUTAS
EMBARAZO
DESEOS DE PARIDAD
MICROCALCIFICACIONES EN LA MAMOGRAFIA
MARGENES POSITIVOS
GRAN COMPROMISO IMPIDE UNA UNICA INCISION
CONTRAINDICACIONES RELATIVAS
EXPOSICION A RADIACION PREVIA PARED TORAXICA
ENFERMEDAD DE TEJIDO CONECTIVO ACTIVA
TUMORES > 5 CM
MARGENES FOCALEMENTE POSITIVOS
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TERAPIA SISTEMICA ADYUVANTE
NO EN > 70 AÑOS
TUMORES < 0,5 CM CON GANGLIO ( -) TERAÍA ENDOCRINA
0,6 CM – 1CM INDIVIDUALIZAR
> 1 CM O AFECTACION GANGLIONAR ------QMT
CIRUGIA PARA LA ENFERMEDAD METASTASICA
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RECONSTRUCCION MAMARIA -ASPECTOS IMPORTANTES
CONTRAINDICACION PRESERVACION COMPLEJO AREOLA PEZON
RADIOTERAPIA E IMPLANTES
RECONSTRUCCION POR ETAPAS
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GRACIAS