O estadiamento deve ser realizado clinicamente e conta com o auxílio de exames de imagem e histopatológico. Atualmente, ele segue a classificação da Federação Internacional de Ginecologia e Obstetrícia (FIGO), variando de I até IV, em ordem crescente de gravidade, como descrito na tabela a seguir:
Tabela 1 – Correlação do estadiamento FIGO do câncer de colo uterino com os achados de Ressonância Magnética (RM)
Fonte: Ressonância magnética no estadiamento dos tumores de colo uterino, 2017.
A via de metastização desse tipo de neoplasia é, preferencialmente, linfática e hematogênica, sendo acometido um número progressivamente maior de linfonodos à medida que o câncer avança localmente e à distância. No estadiamento, o toque retal é muito importante, pois permite avaliar o acometimento de paramétrio, que, uma vez atingido, indica um estadiamento do câncer, no mínimo, 2B. Isso significa que, para o tratamento, será necessário realizar radioterapia neoadjuvante, já que ainda há impossibilidade de realizar cirurgia up-front. Só é possível adotar a cirurgia como conduta, se a lesão for restrita ao colo e com menos de 4 cm.
Exames como: Ultrassonografia (USG) endovaginal, Tomografia Computadorizada (TC) de tórax, abdome e pelve, Ressonância Magnética (RM) de pelve e Tomografia por Emissão de Pósitrons (do inglês, Positron Emission Tomography — PET) associada à Tomografia Computadorizada (PET-TC) de corpo inteiro são úteis na avaliação do estádio do câncer de colo uterino. Apesar de nem sempre disponível, atualmente, a RM de pelve é um importante exame para estadiamento do câncer de colo uterino, pois possibilita uma avaliação mais acurada que o exame físico na avaliação do paramétrico, cujo comprometimento define a conduta. Em caso de contraindicação à RM, a USG endovaginal pode ser adotada para o estadiamento.
Ademais, é válido destacar que RM é aplicável para avaliação de partes moles, sendo útil na avaliação de parâmetros como local, dimensão, profundidade e acometimento vaginal, parametrial, retal ou vesical de lesões macroscópicas. Deve ser indicada a partir do estádio IB1. A partir do estádio IB2, sugere-se complementação da RM por PET-TC ou TC de tórax, abdome e pelve. Para avaliação de comprometimento de linfonodos, a técnica mais sensível é o PET-TC de corpo inteiro, sendo útil tanto para definição de conduta em pacientes até o estádio IB2 quanto avaliação prognóstica em pacientes do estádio IIB em diante.
Referências:
CAMISÃO, C. C. et al. Ressonância magnética no estadiamento dos tumores de colo uterino. Radiologia Brasileira, v. 40, n. 3, p. 207-215, 2007. Disponível em: https://doi.org/10.1590/S0100-39842007000300014. Acesso em: 11 dez. 2023.
Estadiamento. Dr. Rodrigo Moraes Oncologia, 2022. Disponível em: https://drrodrigomoraes.com.br/estadiamento/. Acesso em: 11 dez. 2022.
FEDERAÇÃO BRASILEIRA DAS ASSOCIAÇÕES DE GINECOLOGIA E OBSTETRÍCIA. Câncer do colo do útero. Protocolo de Ginecologia, n. 8, 2021. Disponível em: https://sogirgs.org.br/area-do-associado/Cancer-do-colo-do-utero-2021.pdf. Acesso em: 11 dez. 2023.
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