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Cancro gástrico precoce : a propósito de um caso clínico
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O cancro gástrico continua a ser um importante problema de saúde global, sendo crucial a sua deteção e tratamento precoce para melhorar a sobrevida dos doentes. Este Trabalho Final de Mestrado tem como objetivo fornecer uma revisão sobre o cancro gástrico precoce, com foco na sua definição, sintomas, diagnóstico, terapêutica, prognóstico e seguimento.
O cancro gástrico precoce corresponde ao carcinoma invasivo limitado à mucosa ou submucosa gástrica, independentemente de invasão ganglionar, associado a um prognóstico mais favorável em comparação com estádios mais avançados. Reconhecendo a importância da deteção precoce, este trabalho aborda a apresentação clínica e sintomas associados, enfatizando a necessidade de atenção entre profissionais de saúde para a identificação de novos casos.
A avaliação diagnóstica do cancro gástrico precoce envolve várias modalidades, incluindo endoscopia com técnicas avançadas de imagem, como narrow band imaging (NBI) que melhora a deteção e caracterização de irregularidades da mucosa e do padrão vascular, permitindo a deteção precisa de lesões displásicas e neoplasias precoces do tubo digestivo. A análise histopatológica continua a ser essencial para confirmar o diagnóstico e avaliar o grau de displasia e invasão tumoral.
As estratégias terapêuticas para o cancro gástrico precoce incluem a resseção endoscópica, utilizando técnicas como a disseção endoscópica da submucosa (DES), e abordagens cirúrgicas como a gastrectomia com disseção ganglionar. A DES tem surgido como uma alternativa minimamente invasiva à cirurgia, permitindo a resseção em bloco de neoplasias em estádios iniciais, com baixas taxas de recorrência e resultados favoráveis a longo prazo.
O presente trabalho menciona as características, vantagens e limitações das modalidades diagnósticas e terapêuticas de cancro gástrico precoce. Além disso, refere alguns cronogramas de seguimento propostos por várias diretrizes.
Por conseguinte, é realizada uma revisão da literatura relativa à patologia em questão, seguida da apresentação e discussão de um caso clínico no contexto da revisão realizada.
Gastric cancer remains a significant global health burden, with early detection and treatment being crucial for improving patient outcomes. This Master's thesis aims to provide a comprehensive overview of early gastric cancer, focusing on its definition, symptoms, diagnosis, treatment, prognosis and follow-up. Early gastric cancer refers to an invasive carcinoma confined to the mucosa or submucosa of the stomach, irrespective of lymph node metastases, offering a more favorable prognosis compared to advanced-stage gastric cancers. Recognizing the importance of early detection, this manuscript explores the clinical presentation and symptoms associated with early gastric cancer, emphasizing the need for attentiveness among healthcare professionals in identifying potential cases. The diagnostic evaluation of early gastric cancer involves various modalities, including endoscopy with advanced imaging techniques such as narrow band imaging (NBI), which enhances detection and characterization of mucosal and vascular irregularities allowing for more accurate detection of dysplasia and early cancers of the digestive tract. Histopathological analysis remains essential in confirming the diagnosis and assessing the degree of dysplasia and tumoral invasion. Treatment strategies for early gastric cancer encompass a range of options, including endoscopic resection using techniques like endoscopic submucosal dissection (ESD) and surgical approaches like gastrectomy with lymph node dissection. ESD has emerged as a minimally invasive alternative to surgery, allowing for en bloc resection of early tumors with low rates of recurrence and favorable long-term outcomes. This manuscript discusses the characteristics, advantages and limitations of the diagnostic and treatment modalities of early gastric cancer. Furthermore, it also addresses some follow-up schedules proposed by different guidelines. We performed a literature review related to the specific pathology, followed by the presentation and discussion of a clinical case in the context of the literature review.
Gastric cancer remains a significant global health burden, with early detection and treatment being crucial for improving patient outcomes. This Master's thesis aims to provide a comprehensive overview of early gastric cancer, focusing on its definition, symptoms, diagnosis, treatment, prognosis and follow-up. Early gastric cancer refers to an invasive carcinoma confined to the mucosa or submucosa of the stomach, irrespective of lymph node metastases, offering a more favorable prognosis compared to advanced-stage gastric cancers. Recognizing the importance of early detection, this manuscript explores the clinical presentation and symptoms associated with early gastric cancer, emphasizing the need for attentiveness among healthcare professionals in identifying potential cases. The diagnostic evaluation of early gastric cancer involves various modalities, including endoscopy with advanced imaging techniques such as narrow band imaging (NBI), which enhances detection and characterization of mucosal and vascular irregularities allowing for more accurate detection of dysplasia and early cancers of the digestive tract. Histopathological analysis remains essential in confirming the diagnosis and assessing the degree of dysplasia and tumoral invasion. Treatment strategies for early gastric cancer encompass a range of options, including endoscopic resection using techniques like endoscopic submucosal dissection (ESD) and surgical approaches like gastrectomy with lymph node dissection. ESD has emerged as a minimally invasive alternative to surgery, allowing for en bloc resection of early tumors with low rates of recurrence and favorable long-term outcomes. This manuscript discusses the characteristics, advantages and limitations of the diagnostic and treatment modalities of early gastric cancer. Furthermore, it also addresses some follow-up schedules proposed by different guidelines. We performed a literature review related to the specific pathology, followed by the presentation and discussion of a clinical case in the context of the literature review.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Cancro gástrico precoce Endoscopia digestiva alta Narrow band imaging Resseção endoscópica Gastroenterologia