javax.obex.SessionNotifier

a)- CITOLOGIA PERITONEAL

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Considera-se que a possibilidade de ocorrer disseminação peritoneal de células neoplásicas não se OLPLWDDRVWXPRUHVDYDQoDGRVSRGHQGRHPERUDUDUDPHQWHRFRUUHUQR³HDUO\FDQFHU´FRPRpUHIHULGR SRU<DPDPRWR HW DO  7DPEpP 5RVHQEHUJ HW DO  UHSRUWDP D RFRUUrQFLD GH FLWRORJLD SRVLWLYDHPGHGRHQWHVFRPWXPRUHVHP(VWDGLR,9HUL¿FDUDPTXHDFLWRORJLDSRVLWLYDQmR DIHFWDRSURJQyVWLFRGRVWXPRUHVHP(VWDGLR,DPDVDIHFWDDVREUHYLYrQFLDQRVWXPRUHV,E&RPEDVH neste estudo, os autores consideram que a presença de células neoplásicas no líquido peritoneal se DVVRFLDjLQYDVmRHPSURIXQGLGDGH7HjPHWDVWL]DomRJDQJOLRQDU.

A disseminação intra-peritoneal pode ocorrer na forma de carcinomatose macroscópica ou de células OLYUHV FRP RX VHP DVFLWH 'LVFXWHVH D SRVVLELOLGDGH GH QR SUpRSHUDWyULR DYDOLDU D H[LVWrQFLD GH GLVVHPLQDomR LQWUDSHULWRQHDO SRU PpWRGRV QmR LQYDVLYRV HP FRPSDUDomR FRP D FLWRORJLD ODSDURVFySLFDHFRPDFLWRORJLDLQWUDRSHUDWyULD

&KDPDGROHWDOQRHVWXGRGHGRHQWHVYHUL¿FDUDPTXHD7$&HVSLUDOWHPXPDVHQVLELOLGDGH GHSDUDDYDOLDUDLQYDVmRGDVHURVDHGHSDUDDYDOLDUDinvasão ganglionar, mas não WHPFDSDFLGDGHSDUDGHWHFWDUDVPHWiVWDVHVSHULWRQHDLV<DQJHWDOFRPSDUDUDPDVHQVLELOLGDGH GLDJQyVWLFDSDUDGHWHFWDUPHWiVWDVHVSHULWRQHDLVGR3(77$&FRPD7$&HVSLUDOGHDOWD YHORFLGDGH,JXDOPHQWH/LPHWDOFRPSDUDUDPD3(7FRPD7$&WHQGRYHUL¿FDGR TXHD7$&WHPPHOKRUFDSDFLGDGHGLDJQyVWLFDTXHD3(7

3HORFRQWUiULR&KHQHWDOGHPRQVWUDUDPTXHD3(7WHPPHOKRUFDSDFLGDGHGLDJQyVWLFDTXHD TAC para detectar PHWiVWDVHVJDQJOLRQDUHVPDVTXHRPHOKRUUHVXOWDGRVHREWpPFRPDFRQMXJDomR

dos dois métodos.

&KDQJHWDOHVWXGDUDPHPGRHQWHVDUHODomRHQWUHDDVFLWHGLDJQRVWLFDGDSRU7$&HD disseminação peritoneal e concluiram que quando a ascite é de pequeno volume, estimado em menos TXHFFDSHQDVVHYHUL¿FDFDUFLQRPDWRVHHPDGRVFDVRV(PFRQWUDSDUWLGDRFRUUH FDUFLQRPDWRVHHPDGRVFDVRVTXDQGRRYROXPHpVXSHULRUDFF(PFRQVHTXrQFLDD FLUXUJLDUDGLFDOGHYHVHUUHDOL]DGDPHVPRTXDQGRpGHWHFWDGDXPDDVFLWHGHSHTXHQRYROXPH /HHHWDOHVWXGDUDPGRHQWHVGRVTXDLVWLQKDPDVFLWHHWLQKDP PHWiVWDVHVSHULWRQHDLVHYHUL¿FDUDPTXHDHFRHQGRVFRSLDIRLXPPpWRGRPDLVVHJXURTXHD7$& SDUDGLDJQRVWLFDUDDVFLWH 4XDQWRDRYDORUGDODSDURVFRSLDGHHVWDGLDPHQWRFRPFLWRORJLDVmRUHIHULGRVUHVXOWDGRVGLIHUHQWHV pelos vários autores:



1R HVWXGR GH  GRHQWHV FRQVLGHUDGRV LQLFLDOPHQWH FRPR FDQGLGDWRV SDUD FLUXUJLD FXUDWLYD 6RWLURSRXORVHWDOQDDYDOLDomRODSDURVFySLFDGHWHUPLQDUDPXPHVWDGLRVXSHULRUHP GRVFDVRVGRVTXDLVHPIRLGHWHFWDGDGLVVHPLQDomRLQWUDSHULWRQHDO$FLWRORJLDGROtTXLGR SHULWRQHDOQmRDFUHVFHQWRXLQIRUPDomR(PGRVGRHQWHVDFLUXUJLDIRLFRQWUDLQGLFDGDFRPR WHUDSrXWLFDLQLFLDO1RFDVRGRVWXPRUHVDYDQoDGRV7RX76RQJHWDOHVWXGDUDPGRHQWHV SRU ODSDURVFRSLD RV TXDLV WLQKDP SUpYLD LQGLFDomR SDUD FLUXUJLD FXUDWLYD (P  D FLUXUJLD IRLH[FOXtGDFRPRWHUDSrXWLFDLQLFLDO1RHVWXGRGH*UDDIHWDOHQYROYHQGRGRHQWHVD ODSDURVFRSLDGHHVWDGLDPHQWROHYRXjDOWHUDomRGDGHFLVmRWHUDSrXWLFDHP

$ FLWRORJLD SRGH GHWHFWDU GLVVHPLQDomR SHULWRQHDO PHVPR QRV GRHQWHV TXH QD ODSDURVFRSLD QmR WrPGLVVHPLQDomRDSDUHQWH1DWKHWDOQRHVWXGRGHGRHQWHVHQFRQWUDUDPFDUFLQRPDWRVH PDFURVFySLFDHP1RVUHVWDQWHVGRHQWHVDFLWRORJLDSHUPLWLXGHWHFWDUGLVVHPLQDomR HPPDLV2VGRHQWHVFRPFDUFLQRPDWRVHPDFURVFySLFDWLYHUDPXPDVREUHYLYrQFLDPpGLD GHPHVHVHQTXDQWRRVGRHQWHVVyFRPFLWRORJLDSRVLWLYDWLYHUDPXPDVREUHYLYrQFLDGHPHVHV TXHVXELXSDUDPHVHVQRVTXH¿]HUDPTXLPLRWHUDSLD

1DNDJDZD HW DO  HVWXGDUDP  GRHQWHV HP TXH FRPSDUDUDP RV PpWRGRV LPDJLROyJLFRV FRQYHQFLRQDLVFRPDODSDURVFRSLDPDFURVFySLFDHFRPDFLWRORJLDODSDURVFySLFD(PGRVFDVRV IRLIHLWRRGLDJQyVWLFRGHGLVVHPLQDomRSHULWRQHDOSHORVPpWRGRVFOiVVLFRV1RVUHVWDQWHVGRHQWHVD ODSDURVFRSLDSHUPLWLXRGLDJQyVWLFRGHFDUFLQRPDWRVHPDFURVFySLFDHPGRVFDVRV1RVUHVWDQWHV DFLWRORJLDSHUPLWLXRGLDJQyVWLFRGHGLVVHPLQDomRSHULWRQHDOPLFURVFySLFDHPGRVFDVRV 7DPEpPTXDQWRDRYDORUSURJQyVWLFRGDFLWRORJLDVmRUHIHULGRVUHVXOWDGRVGLIHUHQWHV0L\DVKLURHWDO HPHVWXGRMiUHIHULGRUHVSHLWDQWHDGRHQWHVFRPWXPRUHVDYDQoDGRVHQYROYHQGRDVXE VHURVDRXFDPDGDVPDLVSURIXQGDV¿]HUDPRODYDGRGRIXQGRGHVDFRGH'RXJODVFRPFFGHVRUR ¿VLROyJLFR9HUL¿FDUDPTXHDSyVUHVVHFomRFLU~UJLFDDVREUHYLYrQFLDDRVWUrVDQRVIRLGHSDUDRV GRHQWHVFRPGLVVHPLQDomRPDFURVFySLFDSDUDRVGRHQWHVDSHQDVFRPFLWRORJLDSRVLWLYDH para os doentes que não apresentavam disseminação macroscópica nem microscópica.

/LHWDOSHVTXLVDUDPVLPXOWkQHDPHQWHDH[LVWrQFLDGHFpOXODVQHRSOiVLFDVHR&($QRODYDGR SHULWRQHDOGHGRHQWHV$FLWRORJLDIRLSRVLWLYDHPGRVFDVRVHR&($HP$PERVVH relacionaram com a invasão em profundidade do tumor e com a PHWDVWL]DomRJDQJOLRQDU. O maior YDORUSURJQyVWLFRIRLREWLGRFRPR&($&HWLQHWDOHVWXGDUDPVLPXOWDQHDPHQWHR&($VpULFR R&($SHULWRQHDOHDFLWRORJLDSHULWRQHDOHPGRHQWHV2&($VpULFRIRLVXSHULRUDQJPOHP GRVFDVRVHUHODFLRQRXVHFRPDVPHWiVWDVHVKHSiWLFDV2&($SHULWRQHDOIRLVXSHULRUDQJPO HPGRVGRHQWHVHUHODFLRQRXVHFRPDVPHWiVWDVHVKHSiWLFDVHFRPDLQYDVmRGDVHURVDYLVFHUDO HSDULHWDO$FLWRORJLDSHULWRQHDOIRLSRVLWLYDHPGRVFDVRVHUHODFLRQRXVHFRPDVPHWiVWDVHV KHSiWLFDV%HQWUHPHWDOFRQGX]LUDPXPHVWXGRQR06.&&HQYROYHQGRGRHQWHVHP TXHDFLWRORJLDGRODYDGRSHULWRQHDOSRUODSDURVFRSLDIRLSRVLWLYDHPGRVFDVRV$FLWRORJLD positiva relacionou-se com a invasão em profundidade T, mas não com a PHWDVWL]DomRJDQJOLRQDU.

$VREUHYLYrQFLDPpGLDSDUDRVGRHQWHVFRPFLWRORJLDSRVLWLYDIRLGHPHVHVHQTXDQWRTXHSDUD RVGRHQWHVFRPFLWRORJLDQHJDWLYDIRLGHPHVHV

1RTXHUHVSHLWDjFLWRORJLDLQWUDRSHUDWyULD5LEHLURHWDOHVWXGDUDPGRHQWHVQRVTXDLVD FLWRORJLDIRLSRVLWLYDHPGRVFDVRV$FLWRORJLDSRVLWLYDQmRVHUHODFLRQRXFRPDPHWDVWL]DomR

ganglionar 2V GRHQWHVFRPFLWRORJLDSRVLWLYDWLYHUDPXPD VREUHYLYrQFLDPpGLDGH  PHVHV HQTXDQWRRVGRHQWHVFRPFLWRORJLDQHJDWLYDWLYHUDPXPDVREUHYLYrQFLDPpGLDGHPHVHV&KXZD HWDOHVWXGDUDPDFLWRORJLDSRUYLDODSDURWyPLFDHPGRHQWHV$FLWRORJLDIRLSRVLWLYDHP GRVGRHQWHVHUHODFLRQRXVHFRPDSURIXQGLGDGHGHLQYDVmR7FRPDPHWDVWL]DomRJDQJOLRQDU HjGLVWkQFLDHFRPDVREUHYLYrQFLDGRVGRHQWHV



b) INFECÇÃO DA MUCOSA GÁSTRICA POR Helicobacter pylori

A infecção pelo Helicobacter pylori+SEDFWpULDGHVFULWDSRU:DUUHQH0DUVKDOOHPWHP VLGRDPSODPHQWHHVWXGDGDFRPRIDFWRUSUHFXUVRUGDRQFRJpQHVHJiVWULFDQmRVyQRTXHUHVSHLWD ao carcinoma, mas também em relação ao linfoma.

6HJXQGR 3HUHLUD  D VXD FDSDFLGDGH SDUD VREUHYLYHU HP PHLR iFLGR H FULDU DGHVmR jV células epiteliais permite-lhe desenvolver infecção crónica. A adesão do Hp às células da mucosa JiVWULFDGHVHQFDGHLDXPDUHVSRVWDLQÀDPDWyULDFXMDLQWHQVLGDGHpYDULiYHOHPIXQomRGDHVWLUSH bacteriana, da presença de outros factores ambientais e das características do hospedeiro. A EDFWpULDWHPDFDSDFLGDGHGHVHJUHJDUVXEVWkQFLDVTXHDSURWHJHPGDDFomREDFWHULFLGDGRPHLR $UHVSRVWDLQÀDPDWyULDOHYDjSURGXomRGH,/` e TNF-_, os quais inibem a produção de ácido FORUtGULFRDXPHQWDQGRRULVFRGDJDVWULWHFUyQLFDHSHUPLWLQGRDFRORQL]DomRSRURXWUDVEDFWpULDV O meio alcalino, que assim se cria, facilita a formação de nitrosaminas e estimula a produção de JDVWULQDLQGX]LQGRSUROLIHUDomRFHOXODU2+SSURGX]SURWHtQDYDFXROL]DQWHYDF$TXHLQGX]D IRUPDomRGHYDF~RORVQDVFpOXODVHSLWHOLDLV2SURFHVVRLQÀDPDWyULROHYDjOLEHUWDomRGHUDGLFDLV livres e alterações no DNA. A situação pode evoluir para a metaplasia intestinal.

$OJXQVHVWXGRVGHPRQVWUDUDPTXHR+SDFWLYDRVUHFHSWRUHVGHWLSRWLURVLQDTXLQDVHFRPRRV FRGL¿FDGRVSRUERBB2(*)5HF0(7HVWLPXODQGRDLQYDVmRWXPRUDO,JXDOPHQWH2OLYHLUDHW DOGHPRQVWUDUDPTXHDEDFWpULDLQGX]LQYLWURDLQYDVmRGDVFpOXODVHSLWHOLDLVJiVWULFDV )LJXHLUHGRHWDOGHPRQVWUDUDPTXHRSURFHVVRGHFDUFLQRJpQHVHSRGHHVWDUUHODFLRQDGR FRP D LQWHUDFomR HQWUH DV FDUDFWHULVWLFDV GH +S H GR KRVSHGHLUR ([LVWH HOHYDGR ULVFR GH GHVHQYROYLPHQWRGHFDUFLQRPDJiVWULFRTXDQGRRFRUUHHPVLPXOWkQHRDLQIHFomRSRUHVWLUSHV YLUXOHQWDV H DOJXQV SROLPRU¿VPRV SUyLQÀDPDWyULRV GH ,/`, que é um potente inibidor da VHFUHomRJiVWULFDHLQGXWRUGDUHVSRVWDLQÀDPDWyULDjLQIHFomRSRU+S,JXDOPHQWHIRLGHPRQVWUDGD uma relação semelhante com o TNF-_.

2FDUFLQRPDJiVWULFRIRLKiPXLWRDVVRFLDGRjDFomRGHQLWURVDPLQDVH[yJHQDVSURYHQLHQWHVGD GLHWDGRWDEDFRHGHRXWUDVRULJHQV$LQWHUDFomRHQWUHDVQLWURVDPLQDVHQGyJHQDVDLQIHFomR SRU +S H D 9LW& QD FDUFLQRJpQHVH JiVWULFD FRP H[FHSomR SDUD D ORFDOL]DomR QR FiUGLD IRL HVWXGDGD SRU -DNV]\Q HW DO  QR kPELWR GR HVWXGR (3,& ± (852*$67 )RL DYDOLDGD D LQJHVWmRGHFDUQHYHUPHOKDIRUQHFHGRUDGH+HPHTXHpQLWURVDGR$IRUPDomRGHQLWURVDPLQDV DXPHQWDQDLQIHFomRSRU+SSURYDYHOPHQWHGHYLGRjPDLRUOLEHUWDomRGH12$9LW&H[HUFH XPHIHLWRSURWHFWRUSRUTXHQHXWUDOL]DRVUDGLFDLVOLYUHVHSRUWDQWRGLPLQXLDIRUPDomRJiVWULFDGH produtos nitrosados. Para além disso, as nitrosaminas afectam directamente o crescimento de Hp. 2HVWXGRGHPRQVWURXTXHKiUHODomRHQWUHDIRUPDomRGHQLWURVDPLQDVHQGyJHQDVDLQIHFomRSRU +SHRVQtYHLVGH9LW&QRSURFHVVRGHFDUFLQRJpQHVHJiVWULFDFRPH[FHSomRSDUDRFDUFLQRPD do cárdia.

&KDQHWDOGHPRQVWUDUDPTXHDLQIHFomRSRU+SVHDVVRFLDDDOWHUDo}HVQDH[SUHVVmRGH Sialil Lewis X e do risco de desenvolvimento de metaplasia intestinal.

3DUNHWDOGHIHQGHPTXHDJDVWULWHLQGX]LGDSRU+SOHYDjGH¿FLHQWHUHSDUDomRGR'1$ motivo pela qual a Instabilidade de Microssatélites é mais frequente nos carcinomas de doentes infectados por esta bactéria.

6HJXQGR/DQHWDODDFomRGH+SQDFDUFLQRJpQHVHJiVWULFDWDPEpPVHGHYHjLQGXomRGH mutações na p53.

1mR HQFRQWUiPRV QD OLWHUDWXUD UHIHUrQFLDV UHODWLYDV j LQÀXrQFLD GD LQIHFomR SRU +S QD



c)- METAPLASIA INTESTINAL

A metaplasia intestinal, enquanto precursora da displasia, constitui uma lesão pré-neoplásica em UHODomRDRFDUFLQRPDJiVWULFRGHWLSRLQWHVWLQDO3RGHVHUFODVVL¿FDGDHP7LSR,RXFRPSOHWDWLSR LQWHVWLQRGHOJDGRH7LSRV,,H,,,RXLQFRPSOHWD

Considera-se que a infecção por Hp desempenha um papel importante no desenvolvimento da metaplasia.

$PHWDSODVLDLQWHVWLQDOUHODFLRQDVHFRPDOJXPDVRQFRSURWHtQDVFRQIRUPHIRLUHIHULGRQDVHFomR anterior.

6FRWLQLRWLV HW DO  PRVWUDUDP TXH D DFWLYLGDGH SUROLIHUDWLYD LQGLFDGD SHOD H[SUHVVmR GH .L SRGHHVWDUDXPHQWDGDQDPHWDSODVLDLQWHVWLQDO&DUDFWHULVWLFDPHQWHKiH[SUHVVmRGH6LDOLO7QQD metaplasia intestinal.

d)- CLASSIFICAÇÃO DE MING

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$FODVVL¿FDomREDVHDGDQRDVSHFWRPLFURVFySLFRGDVOHV}HVFRQVLGHUDGRLVWLSRVGHWXPRUHVRV WXPRUHVFRPFUHVFLPHQWRGHWLSRH[SDQVLYRHRVWXPRUHVFRPFUHVFLPHQWRGHWLSRLQ¿OWUDWLYR (P  0LQJ SURS{V TXH RV WXPRUHV GH WLSR H[SDQVLYR FRP FUHVFLPHQWR GH WLSR QRGXODU VH UHODFLRQDPFRPDPHWDSODVLDLQWHVWLQDOIRUPDPHVWUXWXUDVJODQGXODUHVHWrPPHOKRUVREUHYLYrQFLD TXHRVWXPRUHVGHWLSRLQ¿OWUDWLYR. (P5LEHLURHWDOQRHVWXGRGHGRHQWHVREVHUYDUDPTXHDSUHVHQWDYDPWXPRUHVGHWLSR H[SDQVLYRHGHWLSRLQ¿OWUDWLYR$FODVVL¿FDomRGH0LQJUHYHORXWHUVLJQL¿FDGRSURJQyVWLFR TXHVHUHODFLRQRXFRPDH[WHQVmRGDGRHQoD 5R\HWDOWDPEpPGHPRQVWUDUDPTXHDFODVVL¿FDomRGH0LQJWHPYDORUSURJQyVWLFRLQGHSHQGHQWH HTXHRVWXPRUHVGHWLSRLQ¿OWUDWLYRFRQGLFLRQDPVREUHYLYrQFLDVPDLVFXUWDV,JXDOPHQWH/XHENHHWDO QRHVWXGRGHGRHQWHVVXEPHWLGRVDFLUXUJLD'FRQFOXLUDPTXHDFODVVL¿FDomRUHSUHVHQWD XPIDFWRUGHSURJQyVWLFRLQGHSHQGHQWHTXHVHFRUUHODFLRQDFRPDFODVVL¿FDomRGH%RUUPDQQFRP a invasão em profundidade T e com a PHWDVWL]DomRJDQJOLRQDU. Os doentes com tumores de tipo

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No que respeita à PHWDVWL]DomRJDQJOLRQDU6KHQHWDOQRHVWXGRGHGRHQWHVYHUL¿FDUDP TXHH[LVWHUHODomRHQWUHRQ~PHURGHJkQJOLRVLQYDGLGRVHRDVSHFWRPDFURVFySLFRDGLPHQVmRHD ORFDOL]DomRPDVQmRH[LVWHUHODomRFRPDFODVVL¿FDomRGH0LQJ



e)- CLASSIFICAÇÃO HISTOLÓGICA DE LAUREN

(P/DXUHQGHVFUHYHXXPVLVWHPDGHFODVVL¿FDomRKLVWRFOtQLFDGRVFDUFLQRPDVJiVWULFRVTXH VHWRUQRXDFHLWHGHXPDPDQHLUDJHQHUDOL]DGD/DXUHQGLYLGLXRVWXPRUHVHPGLIXVRVHLQWHVWLQDLV UHIHULQGR DLQGD R VXEJUXSR GH WXPRUHV PLVWRV &RQVLGHURX TXH HVWD FODVVL¿FDomR WLQKD YDORU SURJQyVWLFRVHQGRRWLSRGLIXVRPDLVDJUHVVLYR 3RONRZVNLHWDOGHPRQVWUDUDPTXHDFODVVL¿FDomRGH/DXUHQFRQVWLWXLXPIDFWRUGHSURJQyVWLFR LQGHSHQGHQWH0DUUHOLHWDOREVHUYDUDPTXHRWLSRKLVWROyJLFRWHPLQÀXrQFLDQDVREUHYLYrQFLD dos doentes. 2VWXPRUHVGHWLSRLQWHVWLQDOVmRPDLVIUHTXHQWHVQDVUHJL}HVGHHOHYDGDLQFLGrQFLDGHFDQFURJiVWULFR DSUHVHQWDPVHHPGRHQWHVPDLVLGRVRVHDIHFWDPSUHGRPLQDQWHPHQWHDSRUomRGLVWDOGRHVW{PDJR 7rPGLVVHPLQDomRKHPDWRJpQHD&DOGDVHWDO

O tipo intestinal relaciona-se com lesões pré-neoplásicas, como a metaplasia intestinal, o que não se YHUL¿FDQRWLSRGLIXVR 'HDFRUGRFRP%UHVFLDQLHWDORVWXPRUHVGHWLSRGLIXVRDSUHVHQWDPVHHPGRHQWHVPDLV MRYHQVWrPFUHVFLPHQWRLQ¿OWUDWLYRHLQYDGHPDFDYLGDGHSHULWRQHDO-RRHWDOUHIHUHPTXHRV WXPRUHVGHVWHWLSRWrPPDLRULQFLGrQFLDGHPHWDVWL]DomRJDQJOLRQDU. 2VGLIHUHQWHVWLSRVKLVWROyJLFRVUHODFLRQDPVHFRPGLIHUHQWHVDOWHUDo}HVJHQpWLFDVHPROHFXODUHV $VVLPGHDFRUGRFRP3RONRZVNLHWDORWLSRLQWHVWLQDOWHPPDLRUH[SUHVVmRGRSURGXWRGR JHQHERBBHQTXDQWRRWLSRGLIXVRHVWiUHODFLRQDGRFRPDPXWDomRGRJHQHGDFDGHULQD(CDH1), FRPRIRLGHPRQVWUDGRSRUGLYHUVRVJUXSRVFRPR*D\WHUHWDO&DOGDVHWDO+XQWVPDQ HWDO=KRXHWDOH%URRNV:LOVRQHWDO2VWXPRUHVGHWLSRPLVWRDSUHVHQWDPXP FRPSRUWDPHQWRPDLVDJUHVVLYRQRTXHUHVSHLWDjGLPHQVmRLQYDVmRHPSURIXQGLGDGHHPHWDVWL]DomR JDQJOLRQDU=KHQJHWDO 1RHQWDQWRDFODVVL¿FDomRGH/DXUHQWHPDOJXPDVOLPLWDo}HV +iXPQ~PHURVLJQL¿FDWLYRGHWXPRUHVTXHQmRVHHQTXDGUDHPQHQKXPGRVGRLVWLSRV(VWHJUXSR GHWXPRUHVQmRFODVVL¿FiYHLVRX³LQGHWHUPLQDGRV´LQFOXHPRVWXPRUHVLQGLIHUHQFLDGRVVyOLGRVHRV PLVWRVFRH[LVWrQFLDGHIHQyWLSRLQWHVWLQDOHGLIXVR2VFDUFLQRPDVVyOLGRVSRGHPVHUFRQVLGHUDGRV como variante dos intestinais.

$WHQGHQGR D HVWD OLPLWDomR &DUQHLUR HW DO   SURSXVHUDP XPD QRYD FODVVL¿FDomR FRQKHFLGDFRPRFODVVL¿FDomRGH&DUQHLUR'HDFRUGRFRPHVWDFODVVL¿FDomRRVWXPRUHVGLYLGHP VH HP *ODQGXODUHV &pOXODV LVRODGDV 6yOLGRV H 0LVWRV 2V FDUFLQRPDV GH WLSR JODQGXODU H RV GH FpOXODVLVRODGDVFRUUHVSRQGHPQDFODVVL¿FDomRGH/DXUHQDFDUFLQRPDVGHWLSRLQWHVWLQDOHGLIXVR respectivamente.



f)- INVASÃO EM PROFUNDIDADE DA PAREDE GÁSTRICA

'HDFRUGRFRPDFODVVL¿FDomRGR$PHULFDQ-RLQW&RPPLWWHHRQ&DQFHU$-&&HGD,QWHUQDWLRQDO 8QLRQ$JDLQVW&DQFHU8,&&GHDLQYDVmRGRWXPRUHPSURIXQGLGDGHQDSDUHGHJiVWULFD considera-se em cinco níveis, com subdivisões:

Tis – Carcinoma in situ – carcinomas intra-epiteliais, sem invasão da lâmina própria

7D ± 7XPRUHVOLPLWDGRVjPXFRVDFRPLQYDVmRGDOkPLQDSUySULD T1b – Tumores com invasão da sub-mucosa

T2a – Tumores com invasão da muscular própria T2b – Tumores com invasão da sub-serosa

T3 – Tumores com penetração da serosa, sem invasão das estruturas adjacentes

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T1a – Tumor invade a lâmina própria ou a muscularis mucosae T1b – Tumor invade a submucosa

T2 – Tumor invade a muscular própria T3 – Tumor invade a subserosa

T4 – Tumor perfura a serosa ou invade estruturas adjacentes T4a –7XPRUSHUIXUDDVHURVDSHULWRQHXYLVFHUDO T4b – Tumor invade estruturas adjacentes.

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