Diagnóstico e tratamento do câncer do colo uterino durante a gestação

Autores

  • Carla Vitola Gonçalves Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
  • Geraldo Duarte Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
  • Juvenal Soares Dias da Costa Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
  • Alessandra Cristina Marcolin Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
  • Mônia Steigleder Bianchi Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
  • Daison Dias Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
  • Luis Cláudio de Velleca e Lima Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

Palavras-chave:

Neoplasia do colo do útero, Displasia do colo do útero, Diagnóstico, Resultado de tratamento, Protocolos clínicos, Gravidez

Resumo

CONTEXTO E OBJETIVO: Um terço dos carcinomas de colo ocorrem no período reprodutivo, sendo que esta é a segunda causa de morte por câncer nessa fase. A freqüência estimada do carcinoma de colo uterino na gravidez é de um caso para cada 1.000 a 5.000 gestações. O objetivo foi informar sobre as dificuldades frente ao diagnóstico e manejo da neoplasia cervical durante a gravidez. MATERIAIS E MÉTODOS: Revisão sistemática da literatura foi realizada no PubMed, Cochrane, Excerpta Medica (Embase), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO), usando as seguintes palavras: gestação, câncer cervical, diagnóstico e manejo. RESULTADOS: A literatura apresenta consenso quanto ao diagnóstico do carcinoma cervical e a conduta das lesões pré-neoplásicas durante a gestação. No manejo do carcinoma invasor há grande divergência quanto à idade gestacional considerada como limite para a adoção da observação em vez do tratamento imediato. CONCLUSÃO: Toda paciente com citologia alterada deve realizar colposcopia, a qual indicará e a biópsia. A conização é reservada para pacientes com suspeita de invasão. As lesões de alto grau devem ser acompanhadas durante a gestação e reavaliadas após o parto. Em casos de carcinoma invasor em gestantes com até 12 semanas o tratamento da paciente é priorizado. Nos diagnósticos ocorridos no segundo trimestre, pode-se aguardar a maturidade pulmonar fetal e o uso da quimioterapia para estabilizar a doença até o momento do parto parece ser viável.

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Biografia do Autor

Carla Vitola Gonçalves, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

MD. Adjunct professor, Mother-Child Department, Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil.

Geraldo Duarte, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

MD, PhD. Titular professor, Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.

Juvenal Soares Dias da Costa, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

MD. Adjunct professor, Department of Social Medicine, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil.

Alessandra Cristina Marcolin, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

MD. Gynecologist and Obstetrician, Hospital das Clínicas (HC), Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.

Mônia Steigleder Bianchi, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

Undergraduate medical student, Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil.

Daison Dias, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

Undergraduate medical student, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil.

Luis Cláudio de Velleca e Lima, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo

Undergraduate medical student, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil.

Referências

Jacobs IA, Chang CK, Salti GI. Coexistence of pregnancy and cancer. Am Surg. 2004;70(11):1025-9.

Simcock B, Shafi M. Invasive cancer of the cervix. Obstetrics, Gynaecology and Reproductive Medicine. 2007;17(6):181-7. Available from: http://www.obstetrics-gynaecology-journal. com/article/S1751-7214(07)00080-2/abstract. Accessed in 2009 (Nov 25).

Lishner M. Cancer in pregnancy. Ann Oncol. 2003;14(Suppl 3):iii31-6.

Pavlidis NA. Coexistence of pregnancy and malignancy. Oncologist. 2002;7(4):279-87.

Traen K, Svane D, Kryger-Baggesen N, Bertelsen K, Mogensen O. Stage Ib cervical can- cer during pregnancy: planned delay in treatment--case report. Eur J Gynaecol Oncol. 2006;27(6):615-7.

Nguyen C, Montz FJ, Bristow RE. Management of stage I cervical cancer in pregnancy. Obstet Gynecol Surv. 2000;55(10):633-43.

Monego HI, Magno V, Appel M, Reis R, Capp E, Rivoire W. Câncer na gestação. In: Freitas F, Martins-Costa S, Lopes JG, editores. Rotinas em obstetrícia. 5a ed. Porto Alegre: ARTMED; 2006. p. 563-69.

Nygård M, Daltveit AK, Thoresen SO, Nygård JF. Effect of an antepartum Pap smear on the coverage of a cervical cancer screening programme: a population-based prospective study. BMC Health Serv Res. 2007;7:10.

Van Calsteren K, Vergote I, Amant F. Cervical neoplasia during pregnancy: diagnosis, mana- gement and prognosis. Best Pract Res Clin Obstet Gynaecol. 2005;19(4):611-30.

Eitan R, Abu-Rustum NR. Management of cervical carcinoma diagnosed during pregnancy. Primary Care Update for Ob/Gyns. 2003;10(4):196-200. Available from: http://cat.inist.fr

/?aModele=afficheN&cpsidt=15065438. Accessed in 2009 (Nov 25).

American College of Obstetricians and Gynecologists. ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas. Number 35, May 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;78(1):79-91.

Palle C, Bangsbøll S, Andreasson B. Cervical intraepithelial neoplasia in pregnancy. Acta Obstet Gynecol Scand. 2000;79(4):306-10.

Vlahos G, Rodolakis A, Diakomanolis E, et al. Conservative management of cervical intraepi- thelial neoplasia (CIN(2-3)) in pregnant women. Gynecol Obstet Invest. 2002;54(2):78-81.

Sarkar S, Yusif S, Egan D. Cervical screening during pregnancy. Ir Med J. 2006;99(9): 284-5.

Morimura Y, Fujimori K, Soeda S, et al. Cervical cytology during pregnancy--comparison with non-pregnant women and management of pregnant woman with abnormal cytology. Fukushima J Med Sci. 2002;48(1):27-37.

Chhieng DC, Elgert P, Cangiarella JF, Cohen JM. Significance of AGUS Pap smears in pregnant and postpartum women. Acta Cytol. 2001;45(3):294-9.

He GF, Bian ML, Wang Y, Liu XY. Cervical cytological screening and management in pregnant and postpartum women. Clin Med Sci J. 2005;20(4):242-6.

Kyrgiou M, Tsoumpou I, Vrekoussis T, et al. The up-to-date evidence on colposcopy practice and treatment of cervical intraepithelial neoplasia: the Cochrane colposcopy & cervical cytopatho- logy collaborative group (C5 group) approach. Cancer Treat Rev. 2006;32(7):516-23.

Baldauf JJ, Dreyfus M, Ritter J, Philippe E. Colposcopy and directed biopsy reliability during pregnancy: a cohort study. Eur J Obstet Gynecol Reprod Biol. 1995;62(1):31-6.

Zoundi-Ouango O, Morcel K, Classe JM, Burtin F, Aundrain O, Levêque J. Lésions cervica- les utérines pendant la grossesse: diagnostic et prise en charge [Uterine cervical lesions during pregnancy: diagnosis and management. J Gynecol Obstet Biol Reprod (Paris). 2006;35(3):227-36.

Douvier S, Filipuzzi L, Sagot P. Prise en charge d’une néoplasie intra-épithéliale du col de l’utérus en cours de grossesse [Management of cervical intra-epithelial neoplasm during pregnancy]. Gynecol Obstet Fertil. 2003;31(10):851-5.

Robova H, Rob L, Pluta M, et al. Squamous intraepithelial lesion-microinvasive carcinoma of the cervix during pregnancy. Eur J Gynaecol Oncol. 2005;26(6):611-4.

Demeter A, Sziller I, Csapó Z, Szánthó A, Papp Z. Outcome of pregnancies after cold-kni- fe conization of the uterine cervix during pregnancy. Eur J Gynaecol Oncol. 2002;23(3): 207-10.

Fambrini M, Penna C, Fallani MG, et al. Feasibility and outcome of laser CO2 conization performed within the 18th week of gestation. Int J Gynecol Cancer. 2007;17(1):127-31.

Kal HB, Struikmans H. Radiotherapy during pregnancy: fact and fiction. Lancet Oncol. 2005;6(5):328-33.

International Commission on Radiological Protection. Pregnancy and medical radiation. Ann ICRP. 2000;30(1):iii-viii,1-43.

Aldrich JE, Bilawich AM, Mayo JR. Radiation doses to patients receiving computed tomogra- phy examinations in British Columbia. Can Assoc Radiol J. 2006;57(2):79-85.

Karam A, Feldman N, Holschneider CH. Neoadjuvant cisplatin and radical cesarean hyste- rectomy for cervical cancer in pregnancy. Nat Clin Pract Oncol. 2007;4(6):375-80.

Nagayama M, Watanabe Y, Okumura A, Amoh Y, Nakashita S, Dodo Y. Fast MR imaging in obstetrics. Radiographics. 2002;22(3):563-80; discussion 580-2.

Ackermann S, Gehrsitz C, Mehlhorn G, Beckmann MW. Management and course of histo- logically verified cervical carcinoma in situ during pregnancy. Acta Obstet Gynecol Scand. 2006;85(9):1134-7.

Frega A, Scirpa P, Corosu R, et al. Clinical management and follow-up of squamous in- traepithelial cervical lesions during pregnancy and postpartum. Anticancer Res. 2007;27(4C):2743-6.

Jakobsson M, Gissler M, Sainio S, Paavonen J, Tapper AM. Preterm delivery after surgical tre- atment for cervical intraepithelial neoplasia. Obstet Gynecol. 2007;109(2 Pt 1):309-13.

Kaplan KJ, Dainty LA, Dolinsky B, et al. Prognosis and recurrence risk for patients with cer- vical squamous intraepithelial lesions diagnosed during pregnancy. Cancer. 2004;102(4): 228-32.

Smith LH, Dalrymple JL, Leiserowitz GS, Danielsen B, Gilbert WM. Obstetrical deliveries as- sociated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol. 2001;184(7):1504-12; discussion 1512-3.

Takushi M, Moromizato H, Sakumoto K, Kanazawa K. Management of invasive carcinoma of the uterine cervix associated with pregnancy: outcome of intentional delay in treatment. Gynecol Oncol. 2002;87(2):185-9.

Charkviani L, Charkviani T, Natenadze N, Tsitsishvili Z. Cervical carcinoma and pregnancy. Clin Exp Obstet Gynecol. 2003;30(1):19-22.

Duarte G, Cunha SP, Mauad Filho F, Nogueira AA, Berezowski AT, Rodrigues R. Câncer e Gravidez. In: Duarte G, Cunha SP, Mauad Filho F, Nogueira AA, Berezowski AT, Rodrigues R, editores. Protocolos de condutas em gestação de alto risco. Ribeirão Preto: FUNPEC; 2003. p. 71-85.

Germann N, Haie-Meder C, Morice P, et al. Management and clinical outcomes of pregnant patients with invasive cervical cancer. Ann Oncol. 2005;16(3):397-402.

Benedet JL, Bender H, Jones H 3rd, Ngan HY, Pecorelli S. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet. 2000;70(2):209-62.

Holland CM, Shafi MI. Radical hysterectomy. Best Pract Res Clin Obstet Gynaecol. 2005;19(3):387-401.

Dueñas-Gonzales A, Cetina L, Mariscal I, de la Garza J. Modern management of locally advanced cervical carcinoma. Cancer Treat Rev. 2003;29(5):389-99.

Marana HR, de Andrade JM, da Silva Mathes AC, Duarte G, da Cunha SP, Bighetti S. Chemo- therapy in the treatment of locally advanced cervical cancer and pregnancy. Gynecol Oncol. 2001;80(2):272-4.

Caluwaerts S, VAN Calsteren K, Mertens L, et al. Neoadjuvant chemotherapy followed by radical hysterectomy for invasive cervical cancer diagnosed during pregnancy: report of a case and review of the literature. Int J Gynecol Cancer. 2006;16(2):905-8.

Bader AA, Petru E, Winter R. Long-term follow-up after neoadjuvant chemotherapy for high- risk cervical cancer during pregnancy. Gynecol Oncol. 2007;105(1):269-72.

Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004;5(5):283-91.

Covens AL, van der Putten HW, Fyles AW, et al. Laparoscopic ovarian transposition. Eur J Gynaecol Oncol. 1996;17(3):177-82

Morice P, Thiam-Ba R, Castaigne D, et al. Fertility results after ovarian transposition for pelvic malignancies treated by external irradiation or brachytherapy. Hum Reprod. 1998;13(3):660-3.

Zinger M, Liu JH, Husseinzadeh N, Thomas MA. Successful surrogate pregnancy after ovarian transposition, pelvic irradiation and hysterectomy. J Reprod Med. 2004;49(7):573-4.

Seli E, Tangir J. Fertility preservation options for female patients with malignancies. Curr Opin Obstet Gynecol. 2005;17(3):299-308.

Whitworth A. New options expand possibilities for fertility preservation in cancer patients. J Natl Cancer Inst. 2006;98(19):1358-60.

Marhhom E, Cohen I. Fertility preservation options for women with malignancies. Obstet Gynecol Surv. 2007;62(1):58-72

Siddiqui G, Kurzel RB, Lampley EC, Kang HS, Blankstein J. Cervical dysplasia in preg- nancy: progression versus regression post-partum. Int J Fertil Womens Med. 2001;46(5): 278-80.

Smith LH, Danielsen B, Allen ME, Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol. 2003;189(4):1128-35.

Baloglu A, Uysal D, Aslan N, Yigit S. Advanced stage of cervical carcinoma undiagnosed during antenatal period in term pregnancy and concomitant metastasis on episiotomy scar during delivery: a case report and review of the literature. Int J Gynecol Cancer. 2007;17(5):1155-9.

Dalrymple JL, Gilbert WM, Leiserowitz GS, et al. Pregnancy-associated cervical cancer: obs- tetric outcomes. J Matern Fetal Neonatal Med. 2005;17(4):269-76.

Zemlickis D, Lishner M, Degendorfer P, Panzarella T, Sutcliffe SB, Koren G. Maternal and fetal outcome after invasive cancer in pregnancy. J Clin Oncol. 1991;9(11):1956-61.

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Publicado

2009-11-11

Como Citar

1.
Gonçalves CV, Duarte G, Costa JSD da, Marcolin AC, Bianchi MS, Dias D, Lima LC de V e. Diagnóstico e tratamento do câncer do colo uterino durante a gestação. Sao Paulo Med J [Internet]. 11º de novembro de 2009 [citado 15º de outubro de 2025];127(6):359-65. Disponível em: https://periodicosapm.emnuvens.com.br/spmj/article/view/1915

Edição

v. 127 n. 6 (2009)

Seção

Artigo de Atualização

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Creative Commons License
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.