Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic cancer in Spain.

The management of patients with pancreatic cancer has advanced over the last few years. We convey a multidisciplinary group of experts in an attempt to stablish practical guidelines for the diagnoses, staging and management of these patients. This paper summarizes the main conclusions of the working group. Patients with suspected pancreatic ductal adenocarcinoma should be rapidly evaluated and referred to high-volume centers. Multidisciplinary supervision is critical for proper diagnoses, staging and to frame a treatment plan. Surgical resection together with chemotherapy offers the highest chance for cure in early stage disease. Patients with advanced disease should be classified in treatment groups to guide systemic treatment. New chemotherapeutic regimens have resulted in improved survival. Symptomatic management is critical in this disease. Enrollment in a clinical trial is, in general, recommended.

SEOM Clinical Guideline for the diagnosis and treatment of esophageal cancer (2016).

Esophageal cancer (EC) is an aggressive tumor that represents the 6th most common cause of cancer death worldwide. The estimated incidence in Spain is 2090 cases/year. Two main pathological subtypes exist, squamous cell carcinoma and adenocarcinoma. The main differences between them are localization and underlying factors which are the principal cause of the recent incidence changes observed in west countries. Staging techniques and treatment options which combine surgery, chemotherapy and radiotherapy, reflected the high complexity of the EC management. An undeniably multidisciplinary approach is, therefore, required. In this guide, we review the status of current diagnosis and treatment, define evidence and propose recommendations.

SEOM Clinical Guideline for the diagnosis and treatment of esophageal cancer (2016)

Esophageal cancer (EC) is an aggressive tumor that represents the 6th most common cause of cancer death worldwide. The estimated incidence in Spain is 2090 cases/year. Two main pathological subtypes exist, squamous cell carcinoma and adenocarcinoma. The main differences between them are localization and underlying factors which are the principal cause of the recent incidence changes observed in west countries. Staging techniques and treatment options which combine surgery, chemotherapy and radiotherapy, reflected the high complexity of the EC management. An undeniably multidisciplinary approach is, therefore, required. In this guide, we review the status of current diagnosis and treatment, define evidence and propose recommendations (AU)

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Clinical guideline SEOM: hepatocellular carcinoma

Hepatocellular carcinoma (HCC) represents the second leading cause of cancer-related death worldwide. Surveillance with abdominal ultrasound every 6 months should be offered to patients with a high risk of developing HCC: Child-Pugh A-B cirrhotic patients, all cirrhotic patients on the waiting list for liver transplantation, high-risk HBV chronic hepatitis patients (higher viral load, viral genotype or Asian or African ancestry) and patients with chronic hepatitis C and bridging fibrosis. Accurate diagnosis, staging and functional hepatic reserve are crucial for the optimal therapeutic approach. Characteristic findings on dynamic CT/MR of arterial hyperenhancement with "washout" in the portal venous or delayed phase are highly specific and sensitive for a diagnosis of HCC in patients with previous cirrhosis, but a confirmed histopathologic diagnosis should be done in patients without previous evidence of chronic hepatic disease. BCLC classification is the most common staging system used in Western countries. Surgical procedures, local therapies and systemic treatments should be discussed and planned for each patient by a multidisciplinary team according to the stage, performance status, liver function and comorbidities. Surgical interventions remain as the only curative procedures but both local and systemic approaches may increase survival and should be offered to patients without contraindications (AU)

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Clinical guideline SEOM: hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) represents the second leading cause of cancer-related death worldwide. Surveillance with abdominal ultrasound every 6 months should be offered to patients with a high risk of developing HCC: Child-Pugh A-B cirrhotic patients, all cirrhotic patients on the waiting list for liver transplantation, high-risk HBV chronic hepatitis patients (higher viral load, viral genotype or Asian or African ancestry) and patients with chronic hepatitis C and bridging fibrosis. Accurate diagnosis, staging and functional hepatic reserve are crucial for the optimal therapeutic approach. Characteristic findings on dynamic CT/MR of arterial hyperenhancement with "washout" in the portal venous or delayed phase are highly specific and sensitive for a diagnosis of HCC in patients with previous cirrhosis, but a confirmed histopathologic diagnosis should be done in patients without previous evidence of chronic hepatic disease. BCLC classification is the most common staging system used in Western countries. Surgical procedures, local therapies and systemic treatments should be discussed and planned for each patient by a multidisciplinary team according to the stage, performance status, liver function and comorbidities. Surgical interventions remain as the only curative procedures but both local and systemic approaches may increase survival and should be offered to patients without contraindications.

SEOM clinical guidelines for using molecular markers in clinical practice

Nowadays, treatment selection for most types of cancers is based on anatomical, histological and clinical criteria, which are defi ned by the selection criteria used in registration phase III trials. However, different cancers present distinct molecular features, so the current approach results in a lack of specificity of cancer therapy, which is associated with decreased efficacy and unnecessary toxicities and costs. Molecular diagnostics has proved able to predict the efficacy of selected targeted therapies. This allows the selection of specific treatments for different types of cancer, increasing their efficiency. Even though the number of treatments for solid tumours that can be selected based on molecular diagnostic tools is limited, much effort is being put into the identification of new biomarkers. This guideline reviews molecular diagnostic biomarkers that allow selection of specific therapies that have obtained regulatory approval as treatment of solid tumours (AU)

Deteccion de la infección por virus papiloma humano en hombres: Penescopía como método de cribado / Detection of infection by human papilloma virus in men: Peniscopy as screening method

Este trabajo es el resultado de la preocupación relativa y la escasa atención que se le presta al hombre, como portador y posible trasmisor del Virus Papiloma Humano. La población estudiada quedó conformada por 45 hombres, de 18 a 60 años de edad, que concurrieron al consultorio de Dermatología del Hospital Dr. J M Cullen de la ciudad de Santa Fe. Se confeccionó una ficha clínica protocolizada y se les realizó una penescopía. La penescopía resultó positiva en el 53,3% de la muestra tomada. Se encontró asociación estadísticamente significativa con la falta de uso del preservativo regularmente (p=0,01) y con la promiscuidad (p=0,008). No se vislumbró asociación estadísticamente significativa entre el resultado de la penescopía con otras patologías y antecedentes personales relacionados. Las lesiones encontradas fueron: máculas (p=0,037), pápulas (p=0,000) y vegetaciones (p=0,245). Los resultados señalan que es recomendable realizar penescopía como instrumento diagnóstico, especialmente por ser económica y simple de efectuar. Además se concluyó que el uso de preservativo de manera regular así como evitar la promiscuidad, son esenciales para la prevención de infecciones con VPH.

Introduction: in most of the cases, the Human Papilloma Virus (HPV) infection is transmitted through sexual contact. The competent immune system limits its spread, making it latent or subclinical, and its clinical symptoms rarely result in high mortality. It's difficult to estimate precisely its incidence in males due to the lack of epidemiological studies. In this work, the peniscopy was selected as the screening method of the subclinical disease due to its high sensitivity and low cost. General objective: to detect male carriers of the Human Papilloma Virus (HPV), possible transmitters of the virus. Material and methods: the population studied consisted of 45 men, between 18 and 60 years old, who assisted to the Dermatology Department of the Hospital J M Cullen in the city of Santa Fe due to different conditions, between the months of July and December, 2007. A clinical record was made and a peniscopy was performed as screening method. A non experimental, prospective, descriptive and cross-section design was employed. The Statistical Package for the Social Science (SPSS) 11.5® program was used. In the descriptive analysis, the statistical association was determined by means of the chi-square test and contingency tables. A statistically significant association was considered when p<0.05 was found. Results: the peniscopy was positive in 53.3% of the sample taken. A statistically significant association was found due to the lack of regularity in the use of condom (p=0.01) and to promiscuity (p=0.008). The lesions found were maculae (p=0.037), papules (p=0.000) and vegetations (p=0.245). Conclusion: the results show that it's advisable to perform a peniscopy as a diagnostic measure, specially because it is inexpensive and simple to perform. The regular use of condom, as well as the avoidance of promiscuity, is essential to prevent HPV infections.