A incidência do câncer de endométrio tem aumentado de forma progressiva nos países desenvolvidos e em desenvolvimento. A etiopatogenia clássica é o estímulo estrogênico contínuo sem a oposição progestacional.
Os fatores de risco clássicos são sobrepeso e obesidade, pós-menopausa, menarca precoce e menopausa tardia, nuliparidade, terapia hormonal exclusiva com estrogênio, anovulação crônica, diabetes mellitus, hipertensão arterial sistêmica, uso de tamoxifeno, tumor das células da granulosa e síndrome de Lynch. Já as múltiplas gestações, uso de anticoncepcionais hormonais e tabagismo são os fatores de proteção.
O câncer de endométrio costuma provocar sintomas muito precocemente. Sangramento pós-menopausa é o principal deles. Todavia, nas pacientes com estenose cervical, pode ocorrer hematometra e/ou piometra. Todas as pacientes com sangramento pós-menopausa devem ser submetidas a uma ultrassonografia pélvica transvaginal. Apesar de, epidemiologicamente, a principal causa desse sintoma ser atrofia endometrial, a ultrassonografia irá avaliar a espessura (eco) endometrial. Existem divergências no que tange ao ponto de corte, e algumas delas consideram 4 mm, e outras 5 mm como valores que, acima dos quais, a histeroscopia com biópsia endometrial estará indicada.
O tipo histológico mais prevalente de câncer de endométrio é o carcinoma endometrioide. Ele é dividido em baixo grau — quando a diferenciação histológica é G1 ou G2 — e alto grau — quando a diferenciação histológica é G3. Quanto maior o grau, menor é a diferenciação histológica. Outros tipos histológicos são o seroso, o de células claras e o carcinossarcoma. Todos esses tipos são também chamados de tumores de alto grau.
O conhecimento dessa divisão em baixo e alto grau é importante para a realização do estadiamento e da conduta. Outro fator relevante é a classificação molecular que passou a ser considerada na diretriz da Federação Internacional de Ginecologia e Obstetrícia (FIGO) de 2023. É realizada a análise molecular por meio da identificação de mutações patogênicas (POLE) e a imuno-histoquímica.
REFERÊNCIAS
BEREK, J. et al. FIGO staging of endometrial cancer: 2023. International Journal of Gynecology & Obstetrics, [s. l.], v. 162, n. 2, p. 383-394, 2023. Disponível em https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/ijgo.14923. Acesso em: 18 jan. 2024.
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