Etkileşimlerin Yönetildiği Yüksek Seviyeli Kullanıcı Arayüzü Örneği

a)- LOCALIZAÇÃO DO TUMOR

7UDGLFLRQDOPHQWHFRQVLGHUDVHTXHDORFDOL]DomRGRWXPRUFRQGLFLRQDRSURJQyVWLFRTXHpPDLV IDYRUiYHOSDUDRVWXPRUHVGRDQWURHPDLVUHVHUYDGRSDUDRVWXPRUHVGRWHUoRSUR[LPDOIyUQL[H MXQomRHVRIDJRJiVWULFD(VWDQRomRHVWiOLJDGDDRIDFWRGHVHFRQVLGHUDUTXHQRWHUoRSUR[LPDO predominam os tumores de tipo difuso ou misto, enquanto no terço distal predominam os tumores de tipo intestinal.

6RXVDHWDOHPQRHVWXGRGHGRHQWHVYHUL¿FDUDPTXHHP3RUWXJDOQmRRFRUUHUDLQYHUVmR da localização e que continuavam a predominar os tumores do antro, sendo os tumores do cárdia LQFOXtGRVQRJUXSRGRVWXPRUHVGRWHUoRVXSHULRU

6RXVDHWDOFRQ¿UPDUDPQRHVWXGRGHGRHQWHVTXHSUHGRPLQDDORFDOL]DomRGLVWDO2V WXPRUHVGRDQWURDSUHVHQWDPDVPHOKRUHVVREUHYLYrQFLDVHQmRVHREVHUYDPGLIHUHQoDVVLJQL¿FDWLYDV HPUHODomRjVREUHYLYrQFLDHQWUHDVUHVWDQWHVORFDOL]Do}HV2VWXPRUHVGRFiUGLDWrPXPFRPSRUWDPHQWR distinto dos tumores do antro, mas partilham características com os tumores do fundo e do corpo. A IUHTXrQFLDGDPHWDVWL]DomRJDQJOLRQDUpGHQRVWXPRUHVGRFiUGLDHGHQRVWXPRUHVGR IXQGRFRUSRRXVHMDXPFRPSRUWDPHQWRVHPHOKDQWHHPUHODomRDHVWHSDUkPHWUR

6RXVDHWDOGHPRQVWUDUDPTXHWDPEpPDOJXPDVFDUDFWHUtVWLFDVRQFRELROyJLFDVVmRVHPHOKDQWHVQR FiUGLDHQRFRQMXQWRIXQGRFRUSRFRPRpRFDVRGDH[SUHVVmRGDSURWHtQDFRGL¿FDGDSHORJHQHERBB2. 1LWWL HW DO  FRQVLGHUDP TXH RV WXPRUHV GR WHUoR SUR[LPDO DSUHVHQWDP PDLRUHV GLPHQV}HV SHQHWUDomRPDLVSURIXQGDQDSDUHGHJiVWULFDPDLRUIUHTXrQFLDGHLQYDVmRYDVFXODUPHWDVWL]DomR



.LPHWDOUHSRUWDQGRVHjEDVHGHGDGRVGR06.&&UHIHUHPTXHRVWXPRUHVGDMXQomR HVRIDJRJiVWULFD GHVHQYROYHP PHWiVWDVHV JDQJOLRQDUHV HP  GRV FDVRV RV WXPRUHV GR WHUoR SUR[LPDOHPRVWXPRUHVGRFRUSRHPHRVWXPRUHVGRDQWURHP1RVWXPRUHVGRWHUoR SUR[LPDORVJkQJOLRVSDUDFiUGLFRVHVWmRHQYROYLGRVHPGRVFDVRVRVGDSHTXHQDFXUYDWXUDHP HRVGRKLORHVSOpQLFRHP

+DQD]DNL.HWDOUHFRUUHQGRDRVUHJLVWRVGR1DWLRQDO&DQFHU&HQWHU+RVSLWDOGH7yTXLR GHVFUHYHPDSHUFHQWDJHPGHFDVRVHPTXHDVYiULDVFDGHLDVJDQJOLRQDUHVHVWmRPHWDVWL]DGDVHP função da localização do tumor.

$VVLPQRVWXPRUHVGRWHUoRGLVWDODVFDGHLDVPDLVIUHTXHQWHPHQWHLQYDGLGDVVmRDD DDHD 1RVWXPRUHVGRWHUoRPpGLRDVFDGHLDVPDLVIUHTXHQWHPHQWHLQYDGLGDVVmRDDD DHD 1RVWXPRUHVGRWHUoRSUR[LPDODVFDGHLDVPDLVIUHTXHQWHPHQWHLQYDGLGDVVmRDD DDHD

2V HVWXGRV GH .\NXFKL HW DO  QR -DSmR QmR SHUPLWLUDP GH¿QLU XP SDGUmR WRSRJUi¿FR GRV JkQJOLRVPHWDVWL]DGRVRTXHFRQVWLWXLXPDIRUWHOLPLWDomRSDUDDOJXPDVWpFQLFDVFRPRDSHVTXLVD GRJkQJOLRVHQWLQHODFXMRLQWHUHVVHVHH[S}HPDLVjIUHQWHQRFDStWXORVREUHPHWDVWL]DomRQR³HDUO\ JDVWULFFDQFHU´<RNRWD7DQDND

1RFDVRSDUWLFXODUGRVWXPRUHVORFDOL]DGRVQRFRWRJiVWULFR6RXVDHWDOGHPRQVWUDUDPTXHHVWHV WXPRUHVHYLGHQFLDPFRPSRUWDPHQWRGLIHUHQWHQRTXHVHUHIHUHDRVH[RDRWDPDQKRHjFODVVL¿FDomR de Lauren. Nos restantes parâmetros, incluindo a PHWDVWL]DomRJDQJOLRQDU, o seu comportamento é

VHPHOKDQWHDRGRVWXPRUHVGRFiUGLDHGRIXQGRFRUSR b)- DIMENSÃO DO TUMOR

$GLPHQVmRWHPVLGRXWLOL]DGDSRUDOJXQVDXWRUHVFRPRSDUkPHWURGHGH¿QLomRGHSURJQyVWLFR2 limite de dimensão referenciado é variável com os autores e com a situação, não havendo portanto XPYDORUFRQVHQVXDO(QFRQWUDPRVHVWXGRVXWLOL]DQGRFRPRUHIHUrQFLDRVFPQRVFDVRVGH³HDUO\ JDVWULFFDQFHU´RVFPRVFPRXRVFP 1mRVyQRVWXPRUHVLQYDVLYRVDGLPHQVmRpFRQVLGHUDGDFRPRIDFWRUGHSURJQyVWLFR'L6LHQDHWDO FRQVLGHUDPTXHQDVVLWXDo}HVGH³HDUO\FDQFHU´RVWXPRUHVFRPGLPHQVmRLQIHULRUDFP DSHQDVGHVHQYROYHPPHWiVWDVHVJDQJOLRQDUHVHPGRVFDVRV2*UXSR,WDOLDQR3DUDR(VWXGRGR &DQFUR*iVWULFRFRQVLGHUDTXHFPpRYDORUGHIURQWHLUDSDUDRULVFRGHPHWDVWL]DomRJDQJOLRQDU )ROOL  $LQGD SDUD HVWHV WXPRUHV 6LHZHUW HW DO  FRQVLGHUDP TXH D PXFRVHFWRPLD endoscópica só se deve praticar em tumores intra-mucosos com menos que 2cm.

(PUHODomRDRVWXPRUHVLQYDVLYRV.LPHWDOFRQVLGHUDPFPFRPRYDORUGHUHIHUrQFLDSDUDR ULVFRGHPHWDVWL]DomRJDQJOLRQDU$GLPHQVmRWHPVLGRUHIHULGDFRPRIDFWRUGHSURJQyVWLFRDWHUHP conta em relação ao risco de metastização do hilo esplénico e da necessidade de praticar esplenectomia. $VVLP.LNXFKLHWDOFRQVLGHUDPTXHDHVSOHQHFWRPLDp~WLOQRVWXPRUHVSUR[LPDLV7FRP PDLVTXHFP3DUD7DNHXFKLHWDODHVSOHQHFWRPLDpQHFHVViULDQRVWXPRUHV7RXQRVWXPRUHV SUR[LPDLVFRPPDLVTXHFP 2YDORUGHFPpUHIHULGRSRU:DQJHWDOFRPRDGLPHQVmRDSDUWLUGDTXDODH[SUHVVmRGH 08&WHPYDORUSURJQyVWLFR<RQHPXUDHWDOFRQVLGHUDPTXHRVWXPRUHVFRPGLPHQVmR VXSHULRUDFPDSUHVHQWDPVREUHH[SUHVVmRGH.LFRPPDLRUIUHTXrQFLD3RURXWURODGR6DWRHW

 DOGHPRQVWUDUDPTXHDGLPHQVmRQmRWHPUHODomRFRPDH[SUHVVmRGDSURWHtQDFRGL¿FDGDSHOR JHQHERBB2. c)- CLASSIFICAÇÃO DE BORRMANN 'HDFRUGRFRPDOJXQVDXWRUHVD&ODVVL¿FDomRGH%RUUPDQQEDVHDGDQRDVSHFWRPDFURVFySLFRGR WXPRUWHPVLJQL¿FDGRSURJQyVWLFRHPUHODomRDRFDUFLQRPDJiVWULFR $FODVVL¿FDomRSRGHVHUHVWDEHOHFLGDQRPRPHQWRGDUHDOL]DomRGDHQGRVFRSLDRXQRH[DPHDQiWRPR SDWROyJLFRPDFURVFySLFR $FODVVL¿FDomRSUHYrTXDWURWLSRV7KH5R\DO&ROOHJHRI3DWKRORJLVWV Tipo I – Tumores com aspecto polipóide

Tipo II – 7XPRUHVFRPDVSHFWRIXQJLIRUPHRXYHJHWDQWH Tipo III – Tumores ulcerados

Tipo IV – 7XPRUHVGLIXVDPHQWHLQ¿OWUDWLYRV (PSDUWLFXODUGLVFXWHVHVHRWLSR%RUUPDQQ,9LQ¿OWUDWLYRpXPIDFWRUGHSURJQyVWLFRLQGHSHQGHQWH 'HDFRUGRFRP$FHWWDHWDORVWXPRUHV%RUUPDQQ,9FRUUHVSRQGHPDGRWRWDOFRPXPD VREUHYLYrQFLDGHDRVDQRV1RVWXPRUHV%RUUPDQQ,9DSHQDVVmR7RX71RVWXPRUHV GHWLSR,9DSHQDVIRUDPHQFRQWUDGRVGHFDVRVVHPPHWiVWDVHVJDQJOLRQDUHV1HQTXDQWR QRVRXWURVWLSRVRVWXPRUHV1UHSUHVHQWDP1mRVyDVPHWiVWDVHVJDQJOLRQDUHVVmRPDLV frequentes nestes tumores, como também as metástases à distância. A maioria dos doentes estão em HVWDGLR,,,RX,9QDDOWXUDGRGLDJQyVWLFR

0F1HHO HW DO  DQDOLVDUDP DV FDUDFWHUtVWLFDV GRV WXPRUHV H D VREUHYLYrQFLD SyVRSHUDWyULD GHDFRUGRFRPRVWLSRVGH%RUUPDQQ$VREUHYLYrQFLDIRLPHOKRUQRVGRHQWHVFRPWXPRUHVFRP FUHVFLPHQWRH[RItWLFRWLSRV,H,,2VGRHQWHVFRPWXPRUHVWLSR,,,H,9DSUHVHQWDYDPPHWiVWDVHV

ganglionaresFRPPDLRUIUHTXrQFLDHWLYHUDPVREUHYLYrQFLDVPDLVFXUWDV

0RHQLJ HW DO  GHPRQVWUDUDP TXH DV PHWiVWDVHV JDQJOLRQDUHV QR KLOR HVSOpQLFR VmR PDLV frequentes nos tumores Borrmann IV.

.DNHMLHWDODQDOLVDUDPDUHODomRHQWUHRVWXPRUHV%RUUPDQQ,9DH[SUHVVmRGH6LDOLO7Q e a PHWDVWL]DomRJDQJOLRQDU, concluindo que esta é mais frequente nos tumores Borrmann IV com H[SUHVVmRDXPHQWDGDGH6LDOLO7Q

2VWLSRV,H,,GH%RUUPDQQUHODFLRQDPVHFRPDH[SUHVVmRSRVLWLYDGHERBB27VXMLPRWR d)-GASTRINA SÉRICA

.RQWXUHN HW DO  GHPRQVWUDUDP TXH RV GRHQWHV FRP FDUFLQRPD JiVWULFR DSUHVHQWDP QtYHLV HOHYDGRVGHJDVWULQDVpULFD 6]DEy,HWDOGHPRQVWUDUDPTXHDJDVWULQDHVWLPXODDSUROLIHUDomRGDVFpOXODVGRFDUFLQRPD JiVWULFRHSRURXWURODGRUHJXODDUHPRGHODomRGDPXFRVDJiVWULFDHHVWLPXODDLQYDVmRGDVFpOXODV FRPRIRLHYLGHQFLDGRSRU:UREOHZVNLHWDO7DQJHWDOFRQVLGHUDPTXHDJDVWULQDSRGH HVWDUHQYROYLGDQRSURFHVVRLQLFLDOGHFDUFLQRJpQHVHJiVWULFD 0L\DMLHWDOGHPRQVWUDUDPTXHH[LVWHUHODomRHQWUHRQtYHOVpULFRGDJDVWULQDHRJUDXGH diferenciação dos tumores.

 GRHQWHV$WD[DGHUHVVHFomRFXUDWLYDIRLGHQRVGRHQWHVFRPJDVWULQDQRUPDOHQRVGRHQWHV FRPJDVWULQDHOHYDGD7RGRVRVGRHQWHVFRPJDVWULQDHOHYDGDPRUUHUDPQRSULPHLURDQR $JDVWULQDWDPEpPSRGHVHUGRVHDGDQDVFpOXODVWXPRUDLV6WHIKHQVHWDOQRHVWXGRGH GRHQWHVGHPRQVWUDUDPTXHRVWXPRUHVTXHDSUHVHQWDPFpOXODVSRVLWLYDVSDUDDJDVWULQDVHDVVRFLDP DVREUHYLYrQFLDVPDLVFXUWDV6HJXQGR+XUHWDORVGRHQWHVFXMRVWXPRUHVVmRSRVLWLYRVSDUDD JDVWULQDHSDUDRUHFHSWRUGDJDVWULQDWrPSLRUSURJQyVWLFR

e)- ALTERAÇÕES METABÓLICAS

$VDOWHUDo}HVPHWDEyOLFDVQRkPELWRGRFDQFURJiVWULFRWrPVLGRHVWXGDGDVTXHUQRTXHUHVSHLWDDR VLJQL¿FDGRGRHVWDGRPHWDEyOLFRQDHYROXomRGDGRHQoDTXHUQRTXHUHVSHLWDjVDOWHUDo}HVLQGX]LGDV SHODSUySULDGRHQoDTXHUDLQGDQRTXHUHVSHLWDjVFRQVHTXrQFLDVGDFLUXUJLD

Debatem-se não só as relações entre o cancro e as alterações metabólicas por ele provocadas, mas WDPEpPDVFRQVHTXrQFLDVGDVDOWHUDo}HVPHWDEyOLFDVQDFDUFLQRJpQHVHJiVWULFDHQDHYROXomRGD doença. 1RTXHUHVSHLWDjVDOWHUDo}HVPHWDEyOLFDVSURYRFDGDVSHORFDQFUR*DUyIRORHWDOFRQVLGHUDP TXHVHGHYHPDRHVWDGRGHFDWDEROLVPRLQGX]LGRSHORWXPRUjDQRUH[LDFRPGLPLQXLomRGDLQJHVWD HjGH¿FLHQWHDEVRUomR +XDQJHWDOGHWHFWDUDPSHUGDGHSHVRHPGRVGRHQWHVHËQGLFHGH0DVVD&RUSRUDO LQIHULRUDHP9HUL¿FDUDPLJXDOPHQWHTXHRVQtYHLVGHLQVXOLQDHGHOHSWLQDVHHQFRQWUDYDP UHGX]LGRV 0XUSK\ HW DO  YHUL¿FDUDP TXH QR SHUtRGR SUpRSHUDWyULR  GRV GRHQWHV DSUHVHQWDYDPSHUGDGHSHVRFRPXPËQGLFHGH0DVVD&RUSRUDOLQIHULRUD%XWWHUVHWDOHP GRVGRHQWHVFRPFDQFURJiVWULFRGHWHUPLQDUDPSHUGDGHSHVRFRUSRUDOVXSHULRUD

.L\DPD  HW DO  DYDOLDUDP D FRPSRVLomR FRUSRUDO SRU ELRLPSHGkQFLD H YHUL¿FDUDP TXH QR SHUtRGRSyVRSHUDWyULRLPHGLDWRVHYHUL¿FDSUHGRPLQDQWHPHQWHSHUGDGDVPDVVDVSURWHLFDVHQTXDQWR DPpGLRSUD]RVHYHUL¿FDSUHGRPLQDQWHPHQWHGLPLQXLomRGDPDVVDJRUGD

=KDQJHWDOFRQ¿UPDUDPLJXDOPHQWHTXHRVGRHQWHVFRPFDQFURJiVWULFRDSUHVHQWDPEDL[R Indice de Massa Corporal.

-LHWDOGHPRQVWUDUDPTXHRVGRHQWHVREHVRVHVWmRHPPDLRUULVFRGHGHVHQYROYHUFDQFURJiVWULFR 3RURXWURODGRQRVGRHQWHVREHVRV'KDUHWDOGHPRQVWUDUDPTXHDOLQIDGHQHFWRPLDpPHQRV H¿FD]FRPXPQ~PHURLQIHULRUGHJkQJOLRVUHVVHFDGRV2SLQLmRFRQWUiULDpGHIHQGLGDSRU*UHWVFKHOHW DOTXHFRQVLGHUDPTXHQmRKiGLIHUHQoDQRQ~PHURGHJkQJOLRVUHVVHFDGRVQRVGRHQWHVREHVRV SRUFRPSDUDomRFRPRVQmRREHVRV.RGHUDHWDOFRQVLGHUDPTXHDREHVLGDGHSRGHDXPHQWDUD GXUDomRHDVFRPSOLFDo}HVGDFLUXUJLDPDVQmRFRPSURPHWHDVREUHYLYrQFLDDORQJRSUD]R 4XDQWRjVFRQVHTXrQFLDVPHWDEyOLFDVGDFLUXUJLD%DHHWDOQRHVWXGRGHGRHQWHVHPTXH IRLIHLWDDQWURSRPHWULDWHVWHGHG[LORVHGRVHDPHQWRGH9LW%HELySVLDMHMXQDOYHUL¿FDUDPTXH H[LVWLDPiDEVRUomRGHJRUGXUDV&RQVWDWDUDPTXHQmRKDYLDGHSOHFomRGDVPDVVDVSURWHLFDVPDV H[LVWLDGHSOHFomRGDJRUGXUDFRUSRUDO 7VXEXUD\DHWDOYHUL¿FDUDPTXHQRSyVRSHUDWyULRRFRUUHXSHUGDGHSHVRHPGRVGRHQWHV $SUpDOEXPLQDHDDOEXPLQDHVWDYDPGLPLQXtGDVHPGRVGRHQWHV 4XDQWRDRVPpWRGRVGHDYDOLDomRGRHVWDGRPHWDEyOLFR*DUyIRORHWDOFRQVLGHUDPTXHR peso é um mau indicador e que portanto devem ser feitas determinações de antropometria, incluindo DSUHJDFXWkQHDWULFLSLWDOFLUFXQIHUrQFLDGREUDoRHFLUFXQIHUrQFLDPXVFXODUGREUDoR9HUL¿FDUDP



GLPLQXLomR GD FLUFXQIHUrQFLD GR EUDoR HP  GRV FDVRV H GD SUHJD FXWkQHD WULFLSLWDO HP  5HIHUHPXPDUHGXomRGHSUpDOEXPLQDHPGRVFDVRV

6LPRQVHWDOFRQVLGHUDPDELRLPSHGkQFLDFRPRXPERPPpWRGRSDUDHVWXGRGDFRPSRVLomR FRUSRUDOQRVGRHQWHVFRPFDQFURTXDQGRFRPSDUDGDFRPRXWURVPpWRGRVPDLVFRPSOH[RVFRPRD medição do potássio total ou a diluição de deutério.