Documente Academic
Documente Profesional
Documente Cultură
Divulgao
ADENOCARCINOMA ENDOMETRIAL.
Contato:
esouzatrindade@gmail.com
34
A idade o fator
de risco mais
importante, e o
aumento da idade
diretamente
proporcional ao
risco para a doena.
Na ps-menopausa,
20% das mulheres
com sangramento
uterino tm
carcinoma. Aos 70
anos o risco sobe
para 50% e, se a
mulher for nulpara
ou diabtica,
chega a 87%
35
I*
Ia*
Ib*
II*
Tumor invade o estroma do colo do tero, mas sem se estender alm do tero**
III*
IIIa*
IIIb*
IIIc*
IIIc1*
IIIc2*
IV*
IVa*
IVb*
* G1, G2 e G3.
** O envolvimento glandular endocervical nico deve ser considerado como estadio Ie no mais como estdio II.
*** A citologia positiva deve ser relatada separadamente sem mudar o estadiamento.
Referncias bibliogrficas:
1. Rabban JT, Zaloudeck CJ. Minimal uterine serous carcinoma: current concepts in diagnosis and prognosis. Pathology 2007; 39:125-33.
2. Barakat RR, Markman M, Randall ME (ed). Principles and Practice of
Gynecologic Oncology. Fifth edition. Wolkers Kluwer, Lippincott Williams &
Wilkins. Philadelphia. 2009.
3. Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States,
2009: A review of current American Cancer Society guidelines and issues in
cancer screening. CA Cancer J Clin 2009; 59:27-41.
4. Di Saia PJ, Creasman WT (ed), Clinical Gynecologic Oncology. Eight edition.
Elsevier Saunders. Made in China. 2012.
5. Pickar JH. The endometrium from strogens alone to TSECs. Climateric
2009 Dec; 12(6):463-77.
6. Anderson AS, Caswell S. Obesity management anopportunity for cancer
prevention. Surgeon 2009 Oct; 7(5):282-5.
7. Feldman S, Cook EF, Harlow BL et al. Predicting endometrial cancer among
older women who present with abnormal vaginal bleeding. GynecolOncol
1995; 56:376.
8. Granberg S, Wikland M, Karlson B, et al. Endometrial thickness as measured
by endovaginal ultrasound for identifying endometrial abnormality. Am J ObstetGynecol 1991; 164:47.
9. Wang J, Wieslander C, Hansen G et al. Thin endometrial echo complex on
ultrasound does not reliably exclude type 2 endometrial cancers. GynecolOncol Apr 2006; 101(1):120.
10. Clark T, Barton P, Coomarasamy A et al. Investigating postmenopausal
36
Exame clnico:
Exames radiolgicos
RX do trax
Exames especficos
A realizao da bipsia diagnstica define o tipo e o grau histolgico do tumor (Quadro 2); com a histerectomia total e a anexectomia
bilateral definida a invaso miometrial, assim como o comprometimento do colo do tero e das tubas e ovrios; com o lavado peritoneal
ser definida a presena de clulas na cavidade abdominal; e a avaliao dos linfonodos permite diagnosticar metstase retroperitoneal plvica e/ou para-artica.
O exame de congelao do tero pode ser realizado para estabelecer com maior certeza a profundidade de invaso do miomtrio.
Dessa forma se faz o estadiamento do carcinoma endometrial, base
do planejamento da conduta teraputica.
bleeding for endometrial cancer: cost-effectiveness of initial diagnostic strategies. BJOG 2006; 113:502.
11. American College of Obstetricians and Gynecologists. The role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. ACOG
Committee Opinion No. 440. ObstetGynecol 2009; 114:409.
12. Stovall TG, Photopulos GJ, Poston WM, et al: Pipelle endometrial sampling
in patients with known endometrial carcinoma. ObstetGynecol 1991; 77:954.
13. Goldschmit R, Katz Z, Blickstein I, et al. The accuracy of endometrial Pipelle sampling with or without sonographic measurement of endometrial
thickness. ObstetGynecol 1993; 82:727.
14. LeitaoJr MM, et al. Comparison of D&C and office endometrial biopsy accuracy in patients with FIGO grade 1 endometrial adenocarcinoma. GynecolOncol 2009; 113:105.
15. Clark TJ, Voit D, Gupta JK, et al. Accuracy of hysteroscopy in the diagnosis
of endometrial cancer and hyperplasia a systematic quantitative review. JAMA
2002; 288:1610.
16. Kinkel K, Forstner R, Danza FM, et al. Staging of endometrial cancer with
MRI. Guidelines of the European Society of Urogenital Imaging. EurRadiol.
2009;16(7):1565-74.
17. Kisu I, Bano K, Lin LY et al. Preoperative and intraoperative assessment of
myometrial invasion in endometrial cancer: comparison of magnetic resonance
imaging and frozen sections. ActaObstetGynecol 2013 May 92(5):525-35.
18. FIGO Committee on Gynecologic Oncology. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J GynecolObstet 2009;
105:103-4.