{"id":4617,"date":"2018-12-17T08:00:34","date_gmt":"2018-12-17T08:00:34","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/cancer-gastrico-precoce-com-ulceracao-sera-que-e-facil-caracterizar\/"},"modified":"2022-06-17T14:06:17","modified_gmt":"2022-06-17T14:06:17","slug":"cancer-gastrico-precoce-com-ulceracao-sera-que-e-facil-caracterizar","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/cancer-gastrico-precoce-com-ulceracao-sera-que-e-facil-caracterizar\/","title":{"rendered":"C\u00c2NCER G\u00c1STRICO PRECOCE COM ULCERA\u00c7\u00c3O: SER\u00c1 QUE \u00c9 F\u00c1CIL CARACTERIZAR?"},"content":{"rendered":"<p>&nbsp;<\/p>\n<p>A defini\u00e7\u00e3o de C\u00e2ncer g\u00e1strico precoce inclui les\u00f5es que acometem as camadas mucosa e submucosa independente do acometimento linf\u00e1tico. Alguns problemas surgem \u00e0 partir da\u00ed:<\/p>\n<ul>\n<li>A defini\u00e7\u00e3o de c\u00e2ncer g\u00e1strico precoce leva em conta a possibilidade de met\u00e1stase linf\u00e1tica;<\/li>\n<li>O tratamento endosc\u00f3pico est\u00e1 indicado para les\u00f5es com risco zero ou risco negligenci\u00e1vel de met\u00e1stases linf\u00e1ticas (Figura 1);<\/li>\n<li>V\u00e1rios autores sugerem uma esp\u00e9cie de \u201credefini\u00e7\u00e3o\u201d do conceito de c\u00e2ncer g\u00e1strico precoce levando em considera\u00e7\u00e3o as crescentes indica\u00e7\u00f5es de tratamento endosc\u00f3pico;<\/li>\n<li>Sabe-se que a presen\u00e7a de ulceras \u00e9 um dos fatores que impacta nas taxas de met\u00e1stases linf\u00e1ticas e, portanto, nas indica\u00e7\u00f5es de tratamento endosc\u00f3pico para o c\u00e2ncer g\u00e1strico precoce;<\/li>\n<li>Ser\u00e1 que \u00e9 f\u00e1cil diagnosticar e caracterizar ulcera\u00e7\u00f5es nas les\u00f5es g\u00e1stricas precoces?<\/li>\n<\/ul>\n<div id=\"attachment_9730\" style=\"width: 808px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/egc1.png\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-9730\" class=\"size-full wp-image-9730\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/egc1.png\" alt=\"\" width=\"798\" height=\"251\"><\/a><p id=\"caption-attachment-9730\" class=\"wp-caption-text\">FIGURA 1. INDICA\u00c7\u00d5ES CL\u00c1SSICAS E EXPANDIDAS PARA O TRATAMENTO ENDOSC\u00d3PICO DO C\u00c2NCER G\u00c1STRICO PRECOCE<\/p><\/div>\n<p>&nbsp;<\/p>\n<p>De acordo com as diretrizes japonesas existem quatro fatores que impactam nas indica\u00e7\u00f5es de tratamento endosc\u00f3pico para o c\u00e2ncer g\u00e1strico precoce: tamanho, diferencia\u00e7\u00e3o, profundidade e presen\u00e7a de ulcera\u00e7\u00f5es (FIGURA 1).&nbsp; Tr\u00eas desses fatores (tamanho, profundidade e presen\u00e7a de ulcera\u00e7\u00e3o) s\u00e3o usualmente determinados durante o exame endosc\u00f3pico.<\/p>\n<p>No estudo original de Gotoda, no ano 2000, as ulcera\u00e7\u00f5es foram definidas com base na avalia\u00e7\u00e3o patol\u00f3gica de esp\u00e9cimes cir\u00fargicos de acordo com a presen\u00e7a de converg\u00eancia de pregas, fibrose na submucosa ou deformidade de camada muscular pr\u00f3pria, e n\u00e3o em altera\u00e7\u00f5es descritas durante o exame endosc\u00f3pico das les\u00f5es.<\/p>\n<p>Nas rotinas de avalia\u00e7\u00e3o dos pacientes portadores de les\u00f5es g\u00e1stricas precoces, a defini\u00e7\u00e3o da presen\u00e7a ou n\u00e3o de ulcera\u00e7\u00e3o \u00e9 feita durante o exame de endoscopia que antecede o tratamento do paciente, seja ele endosc\u00f3pico ou cir\u00fargico. Fica a d\u00favida se a caracteriza\u00e7\u00e3o inadequada dessas ulcera\u00e7\u00f5es poderia conduzir os pacientes a tratamentos mais agressivos e, por vezes, desnecess\u00e1rios.<\/p>\n<p>Sung Park e colaboradores conduziram um estudo muito interessante, publicado no peri\u00f3dico Clinical Endoscopy no ano de 2017, &nbsp;para avaliar se os endoscopistas eram capazes de diagnosticar a presen\u00e7a de ulcera\u00e7\u00e3o durante a caracteriza\u00e7\u00e3o de uma les\u00e3o g\u00e1strica precoce. Endoscopistas receberam um question\u00e1rio via e-mail com sete imagens endosc\u00f3picas de les\u00f5es bem diferenciadas tratadas cirurgicamente (FIGURA 2). Em quatro delas (imagens A, B, E e G) havia ulcera\u00e7\u00e3o descrita durante a an\u00e1lise histopatol\u00f3gica (fibrose em camada submucosa ou muscular pr\u00f3pria).<\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/ulceraegc2-e1546643621511.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" class=\"aligncenter size-full wp-image-9723\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/ulceraegc2-e1546643621511.png\" alt=\"\" width=\"640\" height=\"537\"><\/a><\/p>\n<p>A conclus\u00e3o dos autores foi que a defini\u00e7\u00e3o da presen\u00e7a ou n\u00e3o de ulcera\u00e7\u00e3o variou bastante entre os endoscopistas, principalmente para as les\u00f5es que n\u00e3o apresentavam ruptura da integridade mucosa e nem converg\u00eancia de pregas (FIGURA 3).&nbsp; A presen\u00e7a de ulcera\u00e7\u00e3o foi superestimada nos grupos com menor experi\u00eancia endosc\u00f3pica, o que levaria esse grupo a indicar tratamentos mais \u201cagressivos\u201d para um grupo de pacientes que poderia se beneficiar do tratamento endosc\u00f3pico.<\/p>\n<div id=\"attachment_9725\" style=\"width: 731px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/ulceraegc3.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" aria-describedby=\"caption-attachment-9725\" class=\"wp-image-9725 size-full\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/ulceraegc3.jpg\" alt=\"\" width=\"721\" height=\"423\"><\/a><p id=\"caption-attachment-9725\" class=\"wp-caption-text\">FIGURA 3. RESUMO DAS RESPOSTAS AOS QUESTION\u00c1RIOS (Adaptada do artigo original de Park, SM et al. Clinical Endoscopy 2017)<\/p><\/div>\n<p>&nbsp;<\/p>\n<p>A maior parte dos endoscopistas ficou mais \u00e0 vontade para diagnosticar ulcera\u00e7\u00f5es quando haviam depress\u00f5es e rupturas da integridade da mucosa (nas figuras A,B,C e G). A presen\u00e7a de converg\u00eancia de pregas n\u00e3o foi valorizada como um aspecto associado \u00e0 presen\u00e7a de ulcera\u00e7\u00f5es. Cerca de 64% dos endoscopistas diagnosticaram a les\u00e3o E como sem ulcera\u00e7\u00e3o, quando na verdade a presen\u00e7a de converg\u00eancia de pregas traduz a presen\u00e7a de fibrose em submucosa ou em camadas mais profundas, ou seja, significa ulcera\u00e7\u00e3o.<\/p>\n<p>Os autores deixam a mensagem que o diagn\u00f3stico de ulcera\u00e7\u00e3o no c\u00e2ncer g\u00e1strico precoce ainda envolve muitos questionamentos e dificuldades e que treinamento e experi\u00eancia do endoscopista&nbsp; s\u00e3o fundamentais para melhorar as indica\u00e7\u00f5es de tratamento endosc\u00f3pico.<\/p>\n<p>Um ponto interessante levantado por esse estudo foi que toda a fundamenta\u00e7\u00e3o das indica\u00e7\u00f5es de tratamento endosc\u00f3pico foi feita h\u00e1 cerca de 20 anos com base em esp\u00e9cimes cir\u00fargicos e com base na defini\u00e7\u00e3o histopatol\u00f3gica da presen\u00e7a de ulcera\u00e7\u00f5es, e n\u00e3o com base em aspectos endosc\u00f3picos. Os equipamentos endosc\u00f3picos evolu\u00edram bastante nesse per\u00edodo e hoje a maior parte dos servi\u00e7os disp\u00f5e de equipamentos com alta defini\u00e7\u00e3o de imagem e recursos de cromoscopia. Estudos que refor\u00e7am as indica\u00e7\u00f5es de tratamento endosc\u00f3pico com base em crit\u00e9rios endosc\u00f3picos que sejam de f\u00e1cil reconhecimento para o endoscopista se fazem necess\u00e1rios.<\/p>\n<p>Al\u00e9m disso, uma informa\u00e7\u00e3o pr\u00e1tica e de grande import\u00e2ncia para os endoscopistas, \u00e9 que a presen\u00e7a de ruptura da integridade da mucosa e a converg\u00eancia de pregas s\u00e3o aspectos importantes que definem a presen\u00e7a de ulcera\u00e7\u00f5es nas les\u00f5es g\u00e1stricas precoces.<\/p>\n<p>REFER\u00caNCIAS:<\/p>\n<ol>\n<li>Park SM, Kim BW, Kim JS et al. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28434216\">Can&nbsp;EndoscopicUlcerationsin&nbsp;Early&nbsp;Gastric Cancer&nbsp;Be Clearly Defined before&nbsp;EndoscopicResection? A Survey among Endoscopists.<\/a> Clin Endosc. 2017 Sep;50(5):473-478.<\/li>\n<li>Barreto SG, Windsor JA. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25829068\">Redefining&nbsp;earlygastric cancer.<\/a> Surg Endosc. 2016 Jan;30(1):24-37.<\/li>\n<li>Lee HL. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29017294\">Identificationof&nbsp;Ulcerationin Early Gastric Cancer before Resection is Not Easy: Need for a New Guideline for Endoscopic Submucosal Dissection Indication Based on Endoscopic Image.<\/a> Clin Endosc. 2017 Sep;50(5):410-411.<\/li>\n<li>Gotoda T, Yanagisawa A, Sasako M et al. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11984739\">Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers.<\/a> Gastric Cancer.&nbsp;2000Dec;3(4):219-225.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; A defini\u00e7\u00e3o de C\u00e2ncer g\u00e1strico precoce inclui les\u00f5es que acometem as camadas mucosa&hellip;<\/p>\n","protected":false},"author":1132,"featured_media":5295,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[270],"tipo":[153],"volume":[147],"class_list":["post-4617","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-270","tipo-endoscopia-digestiva-alta","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>C\u00c2NCER G\u00c1STRICO PRECOCE COM ULCERA\u00c7\u00c3O: SER\u00c1 QUE \u00c9 F\u00c1CIL CARACTERIZAR? &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/cancer-gastrico-precoce-com-ulceracao-sera-que-e-facil-caracterizar\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"C\u00c2NCER G\u00c1STRICO PRECOCE COM ULCERA\u00c7\u00c3O: SER\u00c1 QUE \u00c9 F\u00c1CIL CARACTERIZAR?\" \/>\n<meta property=\"og:description\" content=\"&nbsp; A defini\u00e7\u00e3o de C\u00e2ncer g\u00e1strico precoce inclui les\u00f5es que acometem as camadas mucosa e submucosa independente do acometimento linf\u00e1tico. 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