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consenso-venezolano-en-cc3a1ncer-epitelial-de-ovario-2013

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240<br />

Primer Cons<strong>en</strong>so Nacional <strong>de</strong> cáncer <strong>epitelial</strong> <strong>de</strong> <strong>ovario</strong><br />

intersticial <strong>de</strong> la trompa. La histerectomía<br />

aum<strong>en</strong>ta la morbilidad operatoria pero facilita<br />

el manejo hormonal posterior y evitaría el riesgo<br />

<strong>de</strong> <strong>de</strong>sarrollo <strong>de</strong> una neoplasia <strong>en</strong> la trompa<br />

reman<strong>en</strong>te a nivel intersticial (24) . Se requiere<br />

una evaluación histopatológica exhaustiva <strong>de</strong><br />

los <strong>ovario</strong>s y trompas obt<strong>en</strong>idos <strong>en</strong> el marco <strong>de</strong><br />

una cirugía profiláctica con el fin <strong>de</strong> <strong>de</strong>scartar un<br />

cáncer oculto, cuya ocurr<strong>en</strong>cia se estima <strong>en</strong> un<br />

3 % <strong>en</strong> las paci<strong>en</strong>tes con mutaciones BRCA (35,36) .<br />

La edad recom<strong>en</strong>dada para la anexectomía<br />

bilateral es <strong>en</strong>tre 35 y 40 años o al completar<br />

la paridad (36) . El lavado peritoneal durante la<br />

anexectomía bilateral <strong>en</strong> paci<strong>en</strong>tes <strong>de</strong> alto riesgo<br />

permite id<strong>en</strong>tificar carcinoma peritoneal oculto,<br />

si<strong>en</strong>do es<strong>en</strong>cial la evaluación exhaustiva <strong>de</strong> la<br />

pelvis y <strong>de</strong> todas las superficies peritoneales;<br />

sin embargo, se necesitan más estudios para<br />

recom<strong>en</strong>dar la citología peritoneal como parte<br />

<strong>de</strong>l protocolo <strong>de</strong> cirugía <strong>de</strong> interv<strong>en</strong>ción <strong>de</strong><br />

riesgo (36-38) .<br />

No hay evid<strong>en</strong>cia convinc<strong>en</strong>te <strong>de</strong> un efecto<br />

prev<strong>en</strong>tivo <strong>de</strong> la actividad física <strong>en</strong> el <strong>de</strong>sarrollo<br />

<strong>de</strong> cáncer <strong>de</strong> <strong>ovario</strong> (39) . El uso <strong>de</strong> f<strong>en</strong>retidina,<br />

retinoi<strong>de</strong> sintético, como quimioprev<strong>en</strong>ción no<br />

hormonal <strong>en</strong> paci<strong>en</strong>tes <strong>de</strong> alto riesgo se <strong>en</strong>cu<strong>en</strong>tra<br />

aún <strong>en</strong> etapa experim<strong>en</strong>tal (40,41) .<br />

La dieta rica <strong>en</strong> fécula (OR:1,2) y la ingesta<br />

<strong>de</strong> carnes rojas (OR:1,5) aum<strong>en</strong>tan el riesgo <strong>de</strong><br />

cáncer <strong>de</strong> <strong>ovario</strong>. Los alim<strong>en</strong>tos <strong>de</strong> orig<strong>en</strong> animal,<br />

el pescado, vitaminas, vegetales crudos, y con<br />

alto cont<strong>en</strong>ido <strong>de</strong> fibra no aum<strong>en</strong>tan el riesgo <strong>de</strong><br />

cáncer <strong>de</strong> <strong>ovario</strong>. Una dieta baja <strong>en</strong> grasa, podría<br />

disminuir la incid<strong>en</strong>cia <strong>de</strong> cáncer <strong>de</strong> <strong>ovario</strong> (41-43) .<br />

REFERENCIAS<br />

1. Ministerio <strong>de</strong>l Po<strong>de</strong>r Popular para la Salud, Programa<br />

<strong>de</strong> Oncología. Registro Nacional <strong>de</strong> Cáncer. V<strong>en</strong>ezuela<br />

<strong>2013</strong>. Disponible <strong>en</strong>: URL:www.mpps.gob.ve.<br />

2. [No authors List]. Estimated cancer incid<strong>en</strong>ce,<br />

mortality, preval<strong>en</strong>ce and disability adjusted life years<br />

(DALYs) Worldwi<strong>de</strong> in 2008. Disponible <strong>en</strong>: URL:<br />

http://www.globocan.iarc.fr<br />

3. Cramer DW. The epi<strong>de</strong>miology of <strong>en</strong>dometrial and<br />

ovarian cancer. Hematol Oncol Clin North Am.<br />

2012;26(1):1-12.<br />

4. Chiaffarino F, Pelucchi C, Parazzini F, Negri E,<br />

Franceschi S, Talamini R, et al. Reproduce and<br />

hormonal factors and ovarian cancer. Ann Oncol.<br />

2001;12(3):337-341.<br />

5. Purdie DM, Bain CJ, Siskind V, Webb PM, Gre<strong>en</strong> AC.<br />

Ovulation and risk of epithelial ovarian cancer. Int J<br />

Cancer. 2003;104(2):228-332.<br />

6. Tsilidis K, All<strong>en</strong> NE, Key TJ, Dossus L, Lukanova<br />

A, Bakk<strong>en</strong> K, et al. Oral contraceptive use and<br />

reproductive factors and risk of ovarian cancer in the<br />

European Prospective Investigation into Cancer and<br />

Nutrition. Br J Cancer. 2011;105(9):1436-1442.<br />

7. Schorge JO, Mo<strong>de</strong>sitt SC, Coleman RL, Cohn DE,<br />

Kauff ND, Duska LR, et al. SGO White paper on<br />

ovarian cancer: Etiology, scre<strong>en</strong>ing and surveillance.<br />

Gynecol Oncol. 2010;119(1):7-17.<br />

8. Braem MGM, Onland-Moret NC, Van <strong>de</strong>r Brandt<br />

PA, Goldbohm RA, Peeters PHM, Kruitwag<strong>en</strong> R, et<br />

al. Reproductive and hormonal factors in association<br />

with ovarian cancer in the Netherlands cohort study.<br />

Am J Epi<strong>de</strong>miol. 2010;172(10):1181-1189.<br />

9. Saleemuddin A, Folkins AK, Garrett L, Garber J, Muto<br />

MG, Crum CP, et al. Risk factors for a serous cancer<br />

precursor (“p53 signature”) in wom<strong>en</strong> with inherited<br />

BRCA mutations. Gynecol Oncol. 2008;111(2):226-<br />

232.<br />

10. Lakhani SR, Manek S, P<strong>en</strong>ault-Llorca F, Flanagan<br />

A, Arnout L, Merrett S, et al. Pathology of ovarian<br />

cancers in BRCA1 and BRCA2 carriers. Clin Cancer<br />

Res. 2004;10:2473-2481.<br />

11. Singer G, Stöhr R, Cope L, Dehari R, Hartmann A,<br />

Cao DF, et al. Patterns of p53 mutations separate<br />

ovarian serous bor<strong>de</strong>rline tumors and low and high<br />

gra<strong>de</strong> <strong>de</strong> carcinomas and provi<strong>de</strong> support for a new<br />

mo<strong>de</strong>l of ovarian carcinog<strong>en</strong>esis: A mutational analysis<br />

with immunohistochemistry correlation. Am J Surg<br />

Pathol. 2005;29:218-224.<br />

12. Jelovac D, Armstrong DK. Rec<strong>en</strong>t progress in the<br />

diagnosis and treatm<strong>en</strong>t of ovarian cancer. CA Cancer<br />

J Clin. 2011;61:183-203.<br />

13. Goff BA, Man<strong>de</strong>l LS, Drescher CW, Urban N, Gough<br />

S, Schurman KM, et al. Developm<strong>en</strong>t of an ovarian<br />

cancer symptom in<strong>de</strong>x: Possibilities for earlier<br />

<strong>de</strong>tection. Cancer. 2007;109(2):221-227.<br />

14. Colombo N, Peiretti M, Parma G, Lapresa M, Mancari<br />

R, Carinelli S, et al. Newly diagnosed and relapsed<br />

Vol. 26, Nº 3, septiembre 2014

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