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Introducción y objetivo: Medir el impacto en la gestión del tratamiento del cáncer renal a partir de la implementación de acciones, incluyendo el comité de tumores renales, en el Hospital de Oncología del Centro Médico Nacional (CMN) Siglo XXI. Material y métodos: Estudio observacional retrospectivo sobre una muestra de pacientes con cáncer renal en la Unidad Médica de Alta Especialidad (UMAE), Hospital de Oncología del CMN Siglo XXI. Se seleccionaron indicadores de gestión para medir tiempo, eficiencia y nivel de cumplimiento de procesos clave en el flujo de un paciente con cáncer renal. Resultados: Se creó una base de datos con información de 741 pacientes con variables de distintas áreas terapéuticas. Tras 5 meses, se estimó un cumplimiento promedio de 37% en los indicadores evaluados. Tras 2 años, un cumplimiento del 47%. Conclusiones: La implementación de las acciones resultó en mejoras en la gestión y atención de pacientes con cáncer renal en la UMAE, Hospital de Oncología del CMN Siglo XXI, particularmente en el tiempo promedio entre referencia e inicio del tratamiento.

Objective. To analyze the coverage of lung cancer in Mexico and offer recommendations in this regard. Materials and methods. By means of the conformation of a multidisci­plinary group, we analyze the burden of the disease relative to the lung cancer and the access to the medical treatment offered by the different public health subsystems in Mexico. Results. Important inequalities in lung cancer care are documented among the different public health subsystems. Our data suggest differential access and coverage to both traditional treatments and existing therapeutic innovations and differences in the capacity of health service providers to guarantee the right to health protection without distinction. Conclusions. Recommendations are made on the need to improve actions for tobacco control, early diagnosis for lung cancer and inclusion of innovative therapies and homologa­tion among different public health service providers through financing via tobacco taxes.

Objective. To analyze cancer mortality in affiliates of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social -IMSS) and time trends in the risk of death due to cancer from 1989 to 2013. Materials and methods. A descriptive analysis of cancer mortality trends in beneficiaries of the IMSS was performed. Age and sex adjusted mortality rates were obtained using direct standardization with the WHO population. Changes in the risk of death due to cancer over time were evaluated using Poisson regression. Results. The absolute number of deaths due to cancer doubled from 1989 to 2013 due to increasing age of the affiliate population. The risk of death among affiliates decreased for the majority of cancers except for colon and rectal cancer. Conclusion. The risk of dying from cancer among IMSS affiliates showed a marked decrease, which may be due to an increase in detection and opportune treatment. DOI: http://dx.doi.org/10.21149/spm.v58i2.7784

Chronic noncommunicable diseases (NCDs), including can- cer, have become the leading cause of human morbidity and mortality. In Mexico, cancer is the third leading cause of death, with a high incidence among the economically active popula- tion, a high proportion of advanced stages at diagnosis and limited care coverage for patients. However, no public policy aimed at managing this important public health problem has been developed and implemented to date. This manuscript describes the first interinstitutional proposal of a National Program for Cancer Control, considering the known risk factors, early detection, treatment, palliative care and patient rehabilitation. This manuscript also outlines a series of thoughts on the difficulties and needs that the Mexican health system faces in achieving the main objectives of the program: to decrease the incidence of cancer, to increase survival and to improve the quality of life for this group of patients. DOI: http://dx.doi.org/10.21149/spm.v58i2.7804

Chronic noncommunicable diseases (NCDs), including cancer, have become the leading cause of human morbidity and mortality. In Mexico, cancer is the third leading cause of death, with a high incidence among the economically active population, a high proportion of advanced stages at diagnosis and limited care coverage for patients. However, no public policy aimed at managing this important public health problem has been developed and implemented to date. This manuscript describes the first interinstitutional proposal of a National Program for Cancer Control, considering the known risk factors, early detection, treatment, palliative care and patient rehabilitation. This manuscript also outlines a series of thoughts on the difficulties and needs that the Mexican health system faces in achieving the main objectives of the program: to decrease the incidence of cancer, to increase survival and to improve the quality of life for this group of patients.

Objective: to value diagnostic stage and direct costs due to cervical cancer in insured workers and IMSS beneficiaries patients, during first year of treatment., Methods: 80 records of patients with confirmed diagnosis of cervical cancer during 2000-2003 were analyzed. The study was made under provider public health services perspective, with focus in costs incidence during 2009., Results: 27 (34 %) of total records corresponding to insured worker and 53 (66 %) to beneficiaries. No differences were finding in diagnostic stage. In bout groups stage II was the most common. The cost due medical care adds up to $91,064.00 during first year of treatment in workers. The main costs were identified in sickness absence certification (31 %), image exams (24 %) consulting room (19 %), radiotherapy sessions (10 %) and hospitalization (9 %)., Conclusions: cervical cancer is a frequent disease that affects women in their productive and reproductive age. Frequently their diagnosis is made in advanced stages, which increase medical attention cost. It is convenient to introduce more effective preventive actions, including the workplace.

Introduction: Ovarian cancer (OC) is the third most common gynecologic malignancy worldwide. Most of cases it is of epithelial origin. At the present time there is not a standardized screening method, which makes difficult the early diagnosis. The 5-year survival is 90% for early stages, however most cases present at advanced stages, which have a 5-year survival of only 5-20%. GICOM collaborative group, under the auspice of different institutions, have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia., Material and Methods: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of two days in which a debate was held. These statements are the conclusions reached by agreement of the participant members., Results: No screening method is recommended at the time for the detection of early lesions of ovarian cancer in general population. Staging is surgical, according to FIGO. In regards to the pre-surgery evaluation of the patient, it is recommended to perform chest radiography and CT scan of abdomen and pelvis with IV contrast. According to the histopathology of the tumor, in order to consider it as borderline, the minimum percentage of proliferative component must be 10% of tumor's surface. The recommended standardized treatment includes primary surgery for diagnosis, staging and cytoreduction, followed by adjuvant chemotherapy Surgery must be performed by an Oncologist Gynecologist or an Oncologist Surgeon because inadequate surgery performed by another specialist has been reported in 75% of cases. In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10-30% of all cases, and systematic limphadenectomy, necessary to be able to obtain an adequate surgical staging. Fertility-sparing surgery will be performed in certain cases, the procedure should include a detailed inspection of the contralateral ovary and also negative for malignancy omentum and ovary biopsy. Until now, laparoscopy for diagnostic-staging surgery is not well known as a recommended method. The recommended chemotherapy is based on platin and taxanes for 6 cycles, except in Stage IA, IB and grade 1, which have a good prognosis. In advanced stages, primary cytoreduction is recommended as initial treatment. Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer. Radiotherapy can be used to palliate symptoms. Follow up of the patients every 2-4 months for 2 years, every 3-6 months for 3 years and anually after the 5th year is recommended. Evaluation of quality of life of the patient must be done periodically., Conclusions: In the present, there is not a standardized screening method. Diagnosis in early stages means a better survival. Standardized treatment includes primary surgery with the objective to perform an optimal cytoreduction followed by chemotherapy Treatment must be individualized according to each patient. Radiotherapy can be indicated to palliate symptoms.

Introduction: Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm., Material and Methods: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members., Results: Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis., Conclusions: Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.

Objective: To identify the associated factors for non-compliance among women for the cervical cancer screening program., Methods: A case-control study was carried out in which cases were women who were just diagnosed with cervical cancer (confirmed with pathological study); controls were women not having cervical cancer (negative pathological study). Cases and controls had the same age, lived in the same geographical area and were selected from the primary care facilities. Lack of compliance for cervical cancer screening was defined as the time since the last cytology (no previous Pap test or > or =3 years since last Pap test). A logistic regression analysis served to identify the associated factors to the lack of compliance., Results: There were 279 cases and 392 controls included in the study. The rate of non-compliance among cases was 76.7% and among controls was 29.6%. Among cases 45.5% had never undergone Pap test compared with 9.9% of controls. Main risk factors for non-compliance to attend to cervical cancer screening were age > 65 years (aOR = 2.9, 95% CI 1.6-5-3); illiteracy (aOR = 3.8, 95% CI 1.7-6); use of public transportation to attend to the preventive service (aOR = 2.3, 95% CI 1.2-6.4); more than five pregnancies (aOR = 3.0, 95% CI 1.6-5.3) and lack of knowledge about cervical cancer (aOR = 4.2, 95% CI 3.6-7.2)., Conclusion: The rate of non-compliance close to 30% was high; social and cultural risk factors were the most relevant.

Introduction: Laparoscopic hysterectomy (LH) is a safe surgical approach that offers patients a faster recovery. However, its use in malignant or premalignant gynecological lesions is not well established. The objective of the present study was to show the feasibility of LH in a tertiary cancer center., Material and Methods: We conducted a descriptive analysis of patients with histologically proven malignant or premalignant uterine lesions who underwent to LH. Surgical time, bleeding complications, and hospital stay were evaluated., Results: Twenty-five patients were included with a mean age of 45 years. Ten LH (40%) with or without salpingo-oophorectomy for premalignant or preinvasive malignant lesions were done, five surgical staging procedures for endometrial cancer (20%) and seven radical hysterectomies for cervical cancer (28%). In three patients, conversion from laparotomy (12%) was necessary for operative complications (two cases) or technical problems (one case). Mean operative time for the entire group was 207 min, mean bleeding 204 mL and mean hospital stay was 2.5 days. Postoperative complications were present in two patients, hematoma in the vaginal cupola (one case) and temporary bladder dysfunction (one case)., Conclusions: In the present trial we described our initial experience in LH for the treatment of malignant and premalignant gynecologic diseases. Our results suggest that it is a safe and feasible surgical approach. Long-term surveillance studies are necessary for the evaluation of recurrence patterns and overall survival.

Objective: A survey that compared two alternatives (conservative and radical surgery) is presented on ovarian cancer treatment evaluating its effect on progression-free survival and fertility, in a 10-year time period, in Mexican women., Methods: 72 women between 11 and 58 years old with unilateral ovarian cancer in different stages were studied. Several methods were analyzed: (1) progression-free survival, using Mantel and Haenzsel test to compare in terms of life curves and the Kaplan-Meier method. The exposure variable was surgery type, using the Mantel-Cox test to evaluate the difference in life curves by clinical stages and by surgery type; (2) fertility was evaluated in women who received conservative surgery, considering the cumulative pregnancy rate in women successfully pregnant after surgical and/or adjuvant treatment., Results: There were no difference in survival curves when evaluating progression-free survival, in either group (Z = 1.09 and Pr > (z) = 0.27). During the study period, we found that 87.5% of patients were alive with no evidence of disease. There were no differences in survival curves when evaluating progression-free survival according to surgery type and clinical stage (chi 2 = 0.66, P = 0.88). Restart of menstruation in patients with conservative surgery occurred before 6 months in 89% of the sample, 22 women with possible parity had a 59.1% cumulative pregnancy rate., Conclusion: The outcomes from this survey carried out in Mexico show that conservative treatment of ovarian cancer in early clinical stages is an efficient alternative to preserve reproductive function in young women, and does not show differences in progression-free survival compared to radical surgery.

This is a retrospective review of 63 patients with diagnosis of microinvasive cervical carcinoma. Diagnostic methodology included etiology, colposcopy, biopsy and cervical conization. Study parameters were: age, symptomatology, type of treatment and survival. The treatment to be established was chosen according to adverse prognostic factors, such as invasion depth, lymphovascular permeation, invasion pattern. The patients with an invasion depth up to 1 mm (IA1, FIGO) may be conservatively treated by cervical conization, if fertility is to be kept; there is risk of metastasis or recurrence. The patients with invasion of 1 to 5 mm (IA2, FIGO) may have a greater risk of recurrence and lymph node disease; the treatment should be individualized. There are no specific colposcopic data about microcarcinoma, and because of that, diagnostic precision is not high; however, colposcopy shows the adequate site for biopsy sampling, identifies vaginal extension areas and may influence the treatment.