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Protocolo diagnóstico y terapéutico de la enfermedad ósea tumoral metastásica
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-02-01 DOI: 10.1016/j.med.2025.02.005
C. Fernández-Reino, J.M. Abuelo-Rey, P. Pardo-Guzmán, P. Freijido-Álvarez, U. Anido-Herranz, J. Ruíz-Bañobre, R. López-López
{"title":"Protocolo diagnóstico y terapéutico de la enfermedad ósea tumoral metastásica","authors":"C. Fernández-Reino,&nbsp;J.M. Abuelo-Rey,&nbsp;P. Pardo-Guzmán,&nbsp;P. Freijido-Álvarez,&nbsp;U. Anido-Herranz,&nbsp;J. Ruíz-Bañobre,&nbsp;R. López-López","doi":"10.1016/j.med.2025.02.005","DOIUrl":"10.1016/j.med.2025.02.005","url":null,"abstract":"<div><div>The bone is the most frequent site of solid tumor metastasis, which occur in up to 85% of prostate cancers and 40% of renal cancers. Complications (skeletal-related events —SER—) occur in approximately half of patients with bone metastases, representing an important source of comorbidities that affect not only quality of life, but also the survival of patients with cancer. The diagnosis is based on clinical suspicion and imaging tests, with biopsies reserved for select patients. Treatment is predominantly palliative, with the main objective being symptom relief (pain being the most common) and recovery of the patient's functionality through systemic (bisphosphonates and denosumab) and local (radiotherapy and surgery) treatment.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 26","pages":"Pages 1552-1556"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo terapéutico del dolor en el paciente oncológico
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-01-01 DOI: 10.1016/j.med.2025.01.006
B. Gómez Díez, P. Pérez Segura
{"title":"Protocolo terapéutico del dolor en el paciente oncológico","authors":"B. Gómez Díez,&nbsp;P. Pérez Segura","doi":"10.1016/j.med.2025.01.006","DOIUrl":"10.1016/j.med.2025.01.006","url":null,"abstract":"<div><div>Cancer pain is multidimensional and requires a comprehensive approach. A good anamnesis is essential in order to identify the characteristics of the pain and to be able to categorize it as nociceptive or neuropathic; background or breakthrough; or mild, moderate, or severe pain. Depending on these characteristics, treatment will be initiated with non-opioid analgesics or weak or potent opioids. Additional adjuvant therapies will be added depending on the cause of the pain, managing at all times the adverse effects that appear. In addition, the possibility of local treatment with radiotherapy or surgery or interventional treatment will be evaluated.</div><div>In regard to the use of potent opioids, the most suitable option will be chosen for each patient, treatment will be initiated with the corresponding dose, and it will be titrated with an extra dose until reaching the specific dose for each patient, which may vary during the oncologic process. In case of therapeutic failure or toxicity, rotation from one opioid to another can be considered, monitoring adverse effects for specific management.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 24","pages":"Pages 1443-1447"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cáncer de mama
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-01-01 DOI: 10.1016/j.med.2025.01.002
A. Escudero García, P. Pérez Segura
{"title":"Cáncer de mama","authors":"A. Escudero García,&nbsp;P. Pérez Segura","doi":"10.1016/j.med.2025.01.002","DOIUrl":"10.1016/j.med.2025.01.002","url":null,"abstract":"<div><div>Breast cancer is a health problem with a high incidence worldwide. It is a heterogeneous disease, with anatomical-pathological and molecular differences and a highly variable clinical behavior. It is divided into three main subtypes according to the immunohistochemical presence or absence of hormone receptors (HR) or human epidermal growth factor receptor 2 (HER2): hormonal breast cancer (HR positive/HER2 negative; accounting for approximately two-thirds of diagnoses), HER2 positive breast cancer, and triple negative breast cancer (tumors that express neither HR nor HER2). Early diagnosis and preventive strategies in high-risk women, such as carriers of pathogenic variants in cancer susceptibility genes, are essential in order to increase patient survival. In addition, advances in knowledge of its etiopathogenesis have improved therapeutic strategies and, consequently, disease prognosis.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 24","pages":"Pages 1412-1422"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143135596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo de indicaciones terapéuticas y paliativas de cirugía y radioterapia en el cáncer de mama
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-01-01 DOI: 10.1016/j.med.2025.01.008
A. Escudero García, P. Pérez Segura
{"title":"Protocolo de indicaciones terapéuticas y paliativas de cirugía y radioterapia en el cáncer de mama","authors":"A. Escudero García,&nbsp;P. Pérez Segura","doi":"10.1016/j.med.2025.01.008","DOIUrl":"10.1016/j.med.2025.01.008","url":null,"abstract":"<div><div>The therapeutic approach to early breast cancer aims to reduce the recurrence rate and increase the cure rate for patients, reducing the psychological impact and comorbidity that arise from the treatments. Conservative surgery and mastectomy show similar results in terms of survival. Indications for a lymphadenectomy have decreased thanks to the implementation of the sentinel lymph node technique in initial surgical staging or after neoadjuvant treatment and to the role of adjuvant axillary radiotherapy in reducing local and distant recurrences.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 24","pages":"Pages 1452-1457"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cáncer de endometrio
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-01-01 DOI: 10.1016/j.med.2025.01.004
M. García Gómez, P. Pérez Segura
{"title":"Cáncer de endometrio","authors":"M. García Gómez,&nbsp;P. Pérez Segura","doi":"10.1016/j.med.2025.01.004","DOIUrl":"10.1016/j.med.2025.01.004","url":null,"abstract":"<div><div>Endometrial cancer is the most common gynecological cancer in developed countries and its incidence is increasing in Spain. There are modifiable lifestyle-related risk factors, such as obesity, metabolic syndrome, and estrogen exposure, as well as genetic factors, with Lynch syndrome being particularly significant. Traditionally, it was classified into two subtypes: endometrioid/type I and non-endometrioid/type II. However, it is now divided into four molecular subtypes with distinct prognoses: POLE mutation, microsatellite instability, TP53 mutation, and no specific molecular profile. The treatment depends on the stage of the disease. In early stages, surgery is curative. In advanced stages where surgery is feasible, it should be performed, but always combined with other adjuvant treatments (chemotherapy, radiotherapy). The new molecular classification allows for more targeted treatments in metastatic stages.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 24","pages":"Pages 1432-1438"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Melanoma cutáneo
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-01-01 DOI: 10.1016/j.med.2025.01.001
B. Gómez Díez, P. Pérez Segura
{"title":"Melanoma cutáneo","authors":"B. Gómez Díez,&nbsp;P. Pérez Segura","doi":"10.1016/j.med.2025.01.001","DOIUrl":"10.1016/j.med.2025.01.001","url":null,"abstract":"<div><div>Cutaneous melanoma is the most aggressive cutaneous neoplasm. The most important causative factor is excessive sun exposure, although it can also have a familial component. Early identification of suspicious lesions is essential. The ABCDE rule and the «ugly duckling» sign can be used and identification should be confirmed via an excisional biopsy. When the diagnosis of melanoma is confirmed, a molecular and extension study by means of a dermoscopy, a whole body imaging test, and regional lymph node study must be performed in order to correctly stage the melanoma and decide on the treatment. If it is in the localized stage, a proper enlargement of margins, selective sentinel lymph node biopsy, or lymphadenectomy will be performed, depending on the case, and the addition of systemic adjuvant therapy will be assessed. In the case of advanced melanoma, first-line treatment will be determined based on the need for symptomatic relief, <em>BRAF</em> gene mutational status, presence of brain metastases, and whether or not these are symptomatic. The main medical treatments for melanoma are anti-CTLA4 (ipilimumab) and anti-PD1 (nivolumab and pembrolizumab) checkpoint inhibitors and the combination of <em>BRAF</em> inhibitors with MEK inhibitors (dabrafenib with trametinib, cobimetinib with vemurafenib, and encorafenib with binimetinib).</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 24","pages":"Pages 1401-1411"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143135595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo de prevención del cáncer de mama y ginecológico
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-01-01 DOI: 10.1016/j.med.2025.01.007
A. Escudero García, B. Gómez Díez, P. Pérez Segura
{"title":"Protocolo de prevención del cáncer de mama y ginecológico","authors":"A. Escudero García,&nbsp;B. Gómez Díez,&nbsp;P. Pérez Segura","doi":"10.1016/j.med.2025.01.007","DOIUrl":"10.1016/j.med.2025.01.007","url":null,"abstract":"<div><div>Prevention strategies are a fundamental part of public health programs to prevent the development of cancer (primary prevention) and increase its early detection (secondary prevention). For breast cancer, secondary prevention programs such as mammography screening in the general population are of note. For cervical cancer, there is opportunistic screening with cervical cytology and human papillomavirus (HPV) testing. Primary prevention includes vaccination strategies to prevent HPV infection and subsequent malignant transformation of the cervical epithelium, which can lead to cervical carcinoma. Other primary prevention measures are risk reduction strategies, such as prophylactic bilateral mastectomy or bilateral salpingoophorectomy in the case of high-risk pathogenic variants within the hereditary breast and ovarian cancer syndrome.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 24","pages":"Pages 1448-1451"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hallazgo de bultoma mamario en paciente premenopáusica
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-01-01 DOI: 10.1016/j.med.2025.01.009
B. Gómez Díez, P. Pérez Segura
{"title":"Hallazgo de bultoma mamario en paciente premenopáusica","authors":"B. Gómez Díez,&nbsp;P. Pérez Segura","doi":"10.1016/j.med.2025.01.009","DOIUrl":"10.1016/j.med.2025.01.009","url":null,"abstract":"","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 24","pages":"Pages 1458.e1-1458.e4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo de evaluación de los biomarcadores moleculares y celulares en el cáncer de mama
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-01-01 DOI: 10.1016/j.med.2025.01.005
A. Escudero García, P. Pérez Segura
{"title":"Protocolo de evaluación de los biomarcadores moleculares y celulares en el cáncer de mama","authors":"A. Escudero García,&nbsp;P. Pérez Segura","doi":"10.1016/j.med.2025.01.005","DOIUrl":"10.1016/j.med.2025.01.005","url":null,"abstract":"<div><div>Breast cancer is a heterogeneous disease with a highly variable clinical behavior. It is important to know the prognostic and predictive factors in order to define patients’ risk after diagnosis and to be able to select the best treatment in each case. Prognostic markers include clinical (age, disease stage), pathological (tumor grade, Ki67, estrogen receptor, human epidermal growth factor receptor 2 (HER2), histology), and molecular (Oncotype Dx®, Mammaprint®, Endopredict®, or Prosigma® provide prognostic information in luminal disease) factors. This protocol reviews the immunohistochemical and molecular classification of breast cancer as well as its main prognostic and/or predictive factors.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 24","pages":"Pages 1439-1442"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cáncer de ovario
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-01-01 DOI: 10.1016/j.med.2025.01.003
M. García Gómez, P. Pérez Segura
{"title":"Cáncer de ovario","authors":"M. García Gómez,&nbsp;P. Pérez Segura","doi":"10.1016/j.med.2025.01.003","DOIUrl":"10.1016/j.med.2025.01.003","url":null,"abstract":"<div><div>Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in developed countries and both its incidence and mortality are increasing. Risk factors include both genetic elements, such as mutations in the <em>BRCA1/2</em> genes and others involved in the DNA error repair system, and lifestyle. Epithelial ovarian cancer is classified into five histological subtypes with distinct molecular characteristics and different prognoses. Early diagnosis is difficult due to nonspecific symptoms and the absence of effective screening. Therefore, most cases are diagnosed in advanced stages. Treatment depends on the stage. In early stages (I-II), treatment consists of complete cytoreductive surgery. Adjuvant chemotherapy with carboplatin and paclitaxel is used in stages II and I high grade disease. In advanced disease (stages IIIC-IV), neoadjuvant chemotherapy followed by interval surgery is indicated if complete primary cytoreduction is not feasible. Maintenance therapy includes bevacizumab and/or PARP inhibitors.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 24","pages":"Pages 1423-1431"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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