Câncer de endométrio
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- sangramento vaginal pós-menopausa (SVP)
Outros fatores diagnósticos
- massa uterina, útero fixo ou massa anexial indicando doença extrauterina
- menstruação ou sangramento vaginal anormal em uma mulher na pré-menopausa
- dor (abdominal ou pélvica) e perda de peso
- sintomas de doença metastática
- sinais de doença metastática
Fatores de risco
- sobrepeso e obesidade
- idade >50 anos
- hiperplasia endometrial
- estrogênio endógeno sem oposição
- estrogênio exógeno sem oposição
- uso de tamoxifeno (mulheres menopausadas)
- resistência insulínica
- história familiar de câncer colorretal ou de endométrio
- história familiar de câncer de mama ou câncer do ovário
- história familiar de síndrome de Lynch (câncer colorretal hereditário sem polipose)
- história familiar de síndromes do PTEN
- síndrome do ovário policístico
- radioterapia
- sedentarismo
- dieta
- nuliparidade e infertilidade
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- ultrassonografia pélvica (transvaginal)
- biópsia ambulatorial do endométrio (com ou sem histeroscopia ambulatorial) e histopatologia
- histeroscopia, dilatação e curetagem (D&C) e histopatologia
- citologia cervical (citologia em meio líquido ou esfregaço de Papanicolau)
- Hemograma completo
Investigações a serem consideradas
- análise molecular de tumores
- avaliação genética
- nível de CA-125 (antígeno oncofetal 125) sérico
- histerossonografia de infusão de solução salina
- ureia e creatinina (teste da função renal)
- TFHs
- radiografia torácica
- TC do tórax, abdome e pelve
- ressonância nuclear magnética (RNM) de útero, pelve e abdome
- tomografia por emissão de pósitrons/tomografia computadorizada (PET/TC)
Algoritmo de tratamento
carcinoma endometrioide em estádio IA sem considerar a preservação da fertilidade
carcinoma endometrioide em estádio IA considerando a preservação da fertilidade
carcinoma endometrioide de estádio IB ou II
carcinoma endometrioide em estádios III a IV; todos os carcinomas não endometrioides (alto risco)
doença recorrente ou incurável
Colaboradores
Autores
Alexander B. Olawaiye, MD, MRCOG, FACOG, FACS
Associate Professor
Division of Gynecologic Oncology
Department of Obstetrics, Gynecology, and Reproductive Sciences
Magee-Womens Hospital of UPMC
University of Pittsburgh School of Medicine
Pittsburgh
PA
Declarações
ABO is on the scientific advisory board for AstraZeneca, GlaxoSmithKline, Clovis, and Genentech.
Richard T. Penson, MD, MRCP
Clinical Director
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
Boston
MA
Declarações
RTP declares that his institution has received research funding from Array BioPharma Inc., AstraZeneca, Genentech, and Vascular Biogenics Ltd on his behalf. RTP has received research funding from Genentech Inc., ImClone Systems Inc., Endocyte Inc., AstraZeneca, Eisai Inc., Amgen Inc., and Vascular Biogenics Ltd. He has been paid for participating in scientific advisory boards for AbbVie, AstraZeneca, Baxalta Oncology, Clovis Oncology, Curio Science, Eisai Inc., Endocyte Inc., Genentech, Janssen Oncology (J&J), Merck & Co., Mersana Therapeutics Inc., NewLink Genetics, Nexus Global Group, Pieris Pharma Inc., Roche Inc., Sutro Biopharma, Syndax Pharmaceuticals, Tesaro Inc., and Vascular Biogenics Ltd. RTP was an expert witness for Aventis Pharma S.A. vs. Apotex Inc. in 2009. RTP has received royalties from: BMJ, Blackwell Publishing Medicine at a glance, and UpToDate Advance Medical: Second Medical Opinion.
Agradecimentos
Dr Alexander B. Olawaiye and Dr Richard T. Penson would like to gratefully acknowledge Dr Larissa J. Lee, their co-contributor who has sadly died, and to acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.
Declarações
NSH and AHR declare that they have no competing interests.
Revisores
Susan A. Davidson, MD
Associate Professor/Chief
Gynecologic Oncology
S/M Obstetrics & Gynecology (UCD)
University of Colorado Health Sciences Center
Aurora
CO
Declarações
SAD declares that she has no competing interests.
Svetlana Mironov, MD
Attending Radiologist
Assistant Professor of Radiology
Memorial Sloan-Kettering Cancer Center
New York
NY
Disclosures
SM declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: uterine neoplasms [internet publication].Full text
Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021 Jan;31(1):12-39.Full text Abstract
Oaknin A, Bosse TJ, Creutzberg CL, et al. Endometrial cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Sep;33(9):860-77.Full text Abstract
Amant F, Mirza MR, Koskas M, et al. Cancer of the corpus uteri. Int J Gynaecol Obstet. 2018 Oct;143 Suppl 2:37-50.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hiperplasia endometrial
- Pólipo endometrial
- Endometriose
More DifferentialsGuidelines
- Suspected cancer: recognition and referral
- NCCN clinical practice guidelines in oncology: uterine neoplasms
More GuidelinesPatient information
Hysterectomy
More Patient information
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