{"id":2158,"date":"2025-12-11T15:06:50","date_gmt":"2025-12-11T12:06:50","guid":{"rendered":"https:\/\/wiki.dev.voka.io\/diseases\/uncategorized\/cancer-de-mama\/"},"modified":"2026-04-13T11:32:19","modified_gmt":"2026-04-13T08:32:19","slug":"cancer-de-mama","status":"publish","type":"diseases_post","link":"https:\/\/wiki.dev.voka.io\/pt\/doencas\/oncologia\/cancer-de-mama\/","title":{"rendered":"C\u00e2ncer de mama: causas, sintomas, classifica\u00e7\u00e3o, diagn\u00f3stico, tratamento e progn\u00f3stico"},"content":{"rendered":"<p><?xml encoding=\"UTF-8\" ?><\/p>\n<p>O c\u00e2ncer de mama \u00e9 a neoplasia maligna mais comumente diagnosticada e a segunda causa mais comum de morte por c\u00e2ncer em mulheres. Entre os homens, esse tumor \u00e9 extremamente raro (0,5 a 1% do total de casos). <\/p>\n<p>Segundo a OMS, em 2022, o c\u00e2ncer de mama foi diagnosticado em 2,3 milh\u00f5es de mulheres em todo o mundo e causou 670 mil mortes. <\/p>\n<p>Essa neoplasia maligna \u00e9 relatada em todos os pa\u00edses do mundo, com incid\u00eancia significativamente maior em pa\u00edses com alto \u00cdndice de Desenvolvimento Humano (IDH) em compara\u00e7\u00e3o com pa\u00edses com baixo IDH (1:12 vs. 1:27), mas com menor taxa de mortalidade (1:71 vs. 1:48).<\/p>\n<p><a href=\"https:\/\/catalog.voka.io\/en\/pathology\/436c862c-ea12-40ad-b117-1cf8ef5cd7e1\/4be06637-3010-484b-8e0f-6d604f4bb42c\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Modelos 3D<\/a> de neoplasias malignas da mama:<\/p>\n<div class=\"carousel-block\">\n<div class=\"swiper carousel-swiper carousel-swiper-block_69ef5dbdd9bb6\">\n<div class=\"swiper-wrapper\">\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/inflammatory-breast-cancer.webp\" alt=\"C\u00e2ncer de mama inflamat\u00f3rio\"><span class=\"small-text-article text-main-text-color\">C\u00e2ncer de mama inflamat\u00f3rio<\/span><\/div>\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/breast-sarcoma.webp\" alt=\"Sarcoma de mama\"><span class=\"small-text-article text-main-text-color\">Sarcoma de mama<\/span><\/div>\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/pagets-disease-of-the-nipple.webp\" alt=\"Doen\u00e7a de Paget do mamilo\"><span class=\"small-text-article text-main-text-color\">Doen\u00e7a de Paget do mamilo<\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"swiper-article-carousel__controls\">\n<div class=\"swiper-article-carousel__pagination-container swiper-article-carousel__pagination-container-block_69ef5dbdd9bb6\"><\/div>\n<div class=\"swiper-article-carousel__arrows\"><button class=\"swiper__arrow swiper__arrow--prev carousel-swiper-button-prev swiper__arrow swiper__arrow--prev carousel-swiper-button-prev-block_69ef5dbdd9bb6\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"40\" viewbox=\"0 0 40 40\" fill=\"none\"><path d=\"M20 3.75C16.7861 3.75 13.6443 4.70305 10.972 6.48862C8.29969 8.27419 6.21689 10.8121 4.98696 13.7814C3.75704 16.7507 3.43524 20.018 4.06225 23.1702C4.68926 26.3224 6.23692 29.2179 8.50952 31.4905C10.7821 33.7631 13.6776 35.3107 16.8298 35.9378C19.982 36.5648 23.2493 36.243 26.2186 35.013C29.1879 33.7831 31.7258 31.7003 33.5114 29.028C35.297 26.3557 36.25 23.2139 36.25 20C36.2455 15.6916 34.5319 11.561 31.4855 8.51454C28.439 5.46806 24.3084 3.75455 20 3.75ZM23.3844 25.3656C23.5005 25.4818 23.5926 25.6196 23.6555 25.7714C23.7184 25.9231 23.7507 26.0858 23.7507 26.25C23.7507 26.4142 23.7184 26.5769 23.6555 26.7286C23.5926 26.8804 23.5005 27.0182 23.3844 27.1344C23.2682 27.2505 23.1304 27.3426 22.9786 27.4055C22.8269 27.4683 22.6643 27.5007 22.5 27.5007C22.3358 27.5007 22.1731 27.4683 22.0214 27.4055C21.8696 27.3426 21.7318 27.2505 21.6156 27.1344L15.3656 20.8844C15.2494 20.7683 15.1572 20.6304 15.0943 20.4787C15.0314 20.3269 14.999 20.1643 14.999 20C14.999 19.8357 15.0314 19.6731 15.0943 19.5213C15.1572 19.3696 15.2494 19.2317 15.3656 19.1156L21.6156 12.8656C21.7318 12.7495 21.8696 12.6574 22.0214 12.5945C22.1731 12.5317 22.3358 12.4993 22.5 12.4993C22.6643 12.4993 22.8269 12.5317 22.9786 12.5945C23.1304 12.6574 23.2682 12.7495 23.3844 12.8656C23.5005 12.9818 23.5926 13.1196 23.6555 13.2714C23.7184 13.4231 23.7507 13.5858 23.7507 13.75C23.7507 13.9142 23.7184 14.0769 23.6555 14.2286C23.5926 14.3804 23.5005 14.5182 23.3844 14.6344L18.0172 20L23.3844 25.3656Z\" fill=\"#B5C0CD\"><\/path><\/svg><\/button><button class=\"swiper__arrow swiper__arrow--next carousel-swiper-button-next swiper__arrow swiper__arrow--next carousel-swiper-button-next-block_69ef5dbdd9bb6\" tabindex=\"0\" aria-label=\"Next slide\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"40\" viewbox=\"0 0 40 40\" fill=\"none\"><path d=\"M20 3.75C16.7861 3.75 13.6443 4.70305 10.972 6.48862C8.29969 8.27419 6.21689 10.8121 4.98696 13.7814C3.75704 16.7507 3.43524 20.018 4.06225 23.1702C4.68926 26.3224 6.23692 29.2179 8.50952 31.4905C10.7821 33.7631 13.6776 35.3107 16.8298 35.9378C19.982 36.5648 23.2493 36.243 26.2186 35.013C29.1879 33.7831 31.7258 31.7003 33.5114 29.028C35.297 26.3557 36.25 23.2139 36.25 20C36.2455 15.6916 34.5319 11.561 31.4855 8.51454C28.439 5.46806 24.3084 3.75455 20 3.75ZM23.3844 25.3656C23.5005 25.4818 23.5926 25.6196 23.6555 25.7714C23.7184 25.9231 23.7507 26.0858 23.7507 26.25C23.7507 26.4142 23.7184 26.5769 23.6555 26.7286C23.5926 26.8804 23.5005 27.0182 23.3844 27.1344C23.2682 27.2505 23.1304 27.3426 22.9786 27.4055C22.8269 27.4683 22.6643 27.5007 22.5 27.5007C22.3358 27.5007 22.1731 27.4683 22.0214 27.4055C21.8696 27.3426 21.7318 27.2505 21.6156 27.1344L15.3656 20.8844C15.2494 20.7683 15.1572 20.6304 15.0943 20.4787C15.0314 20.3269 14.999 20.1643 14.999 20C14.999 19.8357 15.0314 19.6731 15.0943 19.5213C15.1572 19.3696 15.2494 19.2317 15.3656 19.1156L21.6156 12.8656C21.7318 12.7495 21.8696 12.6574 22.0214 12.5945C22.1731 12.5317 22.3358 12.4993 22.5 12.4993C22.6643 12.4993 22.8269 12.5317 22.9786 12.5945C23.1304 12.6574 23.2682 12.7495 23.3844 12.8656C23.5005 12.9818 23.5926 13.1196 23.6555 13.2714C23.7184 13.4231 23.7507 13.5858 23.7507 13.75C23.7507 13.9142 23.7184 14.0769 23.6555 14.2286C23.5926 14.3804 23.5005 14.5182 23.3844 14.6344L18.0172 20L23.3844 25.3656Z\" fill=\"#B5C0CD\"><\/path><\/svg><\/button><\/div>\n<\/div>\n<\/div>\n<p><script defer>\n    document.addEventListener('DOMContentLoaded', function() {\n        const imagesCarouselSwiper = new Swiper('.carousel-swiper-block_69ef5dbdd9bb6', {\n            slidesPerView: 1,\n            spaceBetween: 20,\n            loop: true,\n            pagination: {\n                el: '.swiper-article-carousel__pagination-container-block_69ef5dbdd9bb6',\n                clickable: true,\n            },\n            navigation: {\n                nextEl: '.carousel-swiper-button-next-block_69ef5dbdd9bb6',\n                prevEl: '.carousel-swiper-button-prev-block_69ef5dbdd9bb6',\n            },\n        })\n    })\n<\/script><\/p>\n<h2 class=\"wp-block-heading\" id=\"etiologia\">Etiologia<\/h2>\n<p>Os <strong>fatores de risco para c\u00e2ncer de mama<\/strong> atualmente incluem:<\/p>\n<ul class=\"wp-block-list\">\n<li>Sexo feminino;<\/li>\n<li>Idade: a doen\u00e7a \u00e9 detectada com mais frequ\u00eancia em idades mais avan\u00e7adas (per\u00edodo perimenop\u00e1usico e menop\u00e1usico);<\/li>\n<li>Hist\u00f3rico familiar e presen\u00e7a de muta\u00e7\u00f5es gen\u00e9ticas: ser portador de uma muta\u00e7\u00e3o nos genes BRCA1 e BRCA2 \u00e9 a muta\u00e7\u00e3o mais importante;<\/li>\n<li>In\u00edcio precoce da menarca (antes dos 12 anos de idade);<\/li>\n<li>Primeiro parto ap\u00f3s os 30 anos ou nuliparidade;<\/li>\n<li>Menopausa tardia (ap\u00f3s os 55 anos);<\/li>\n<li>Obesidade;<\/li>\n<li>Abuso de \u00e1lcool e tabaco;<\/li>\n<li>Hist\u00f3rico de exposi\u00e7\u00e3o \u00e0 radia\u00e7\u00e3o ionizante.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\" id=\"patogenese\">Patog\u00eanese<\/h2>\n<p>A patog\u00eanese do c\u00e2ncer de mama n\u00e3o \u00e9 totalmente compreendida. Uma combina\u00e7\u00e3o de fatores de risco gen\u00e9ticos e ambientais, incluindo dist\u00farbios hormonais, desempenha um papel na oncog\u00eanese.<\/p>\n<p>Atualmente, est\u00e1 comprovada a alta probabilidade de desenvolvimento de c\u00e2ncer de mama em pacientes com muta\u00e7\u00f5es nos genes BRCA1, BRCA2 e PALB-2. Al\u00e9m disso, foi identificada a associa\u00e7\u00e3o do c\u00e2ncer de mama com muta\u00e7\u00f5es nos genes STK11, CHEK2, CDH1 e PTEN. A maioria das muta\u00e7\u00f5es (at\u00e9 90 a 95%) s\u00e3o espor\u00e1dicas; apenas em 5 a 10% dos pacientes elas s\u00e3o heredit\u00e1rias.<\/p>\n<p>Dist\u00farbios hormonais, como o desequil\u00edbrio entre os n\u00edveis de progesterona e estrog\u00eanio, dist\u00farbios da tireoide, obesidade e outras doen\u00e7as end\u00f3crinas, levam \u00e0 hiperplasia do epit\u00e9lio glandular e, em combina\u00e7\u00e3o com outros fatores de risco, causam o desenvolvimento de patologias tumorais.<\/p>\n<h2 class=\"wp-block-heading\" id=\"classificacao-do-cancer-de-mama\">Classifica\u00e7\u00e3o do c\u00e2ncer de mama<\/h2>\n<h3 class=\"wp-block-heading\" id=\"por-estrutura-histologica\">Por estrutura histol\u00f3gica<\/h3>\n<p>Dependendo da estrutura histol\u00f3gica, distinguem-se os seguintes tipos de tumores malignos da mama:<\/p>\n<h4 class=\"wp-block-heading\" id=\"h-\u044d\u043f\u0438\u0442\u0435\u043b\u0438\u0430\u043b\u044c\u043d\u044b\u0435-\u043e\u043f\u0443\u0445\u043e\u043b\u0438\">Tumores epiteliais<\/h4>\n<ul class=\"wp-block-list\">\n<li>Carcinoma invasivo n\u00e3o especificado; <\/li>\n<li>Carcinoma pleom\u00f3rfico; <\/li>\n<li>Carcinoma lobular invasivo <\/li>\n<li>Carcinoma tubular;<\/li>\n<li>Carcinoma cribriforme; <\/li>\n<li>Carcinoma mucinoso; <\/li>\n<li>Carcinoma medular; <\/li>\n<li>Carcinoma micropapilar invasivo; <\/li>\n<li>Carcinoma metapl\u00e1sico n\u00e3o especificado; <\/li>\n<li>Carcinoma de c\u00e9lulas escamosas; <\/li>\n<li>Carcinoma de c\u00e9lulas fusiformes; <\/li>\n<li>Carcinoma metapl\u00e1sico misto; <\/li>\n<li>Carcinoma mioepitelial; <\/li>\n<li>Carcinoma papil\u00edfero invasivo; <\/li>\n<li>Carcinoma de c\u00e9lulas acinares; <\/li>\n<li>Carcinoma mucoso-epiderm\u00f3ide; <\/li>\n<li>Carcinoma polim\u00f3rfico.<\/li>\n<\/ul>\n<h4 class=\"wp-block-heading\" id=\"h-\u043d\u0435\u0438\u043d\u0432\u0430\u0437\u0438\u0432\u043d\u044b\u0435-\u043e\u043f\u0443\u0445\u043e\u043b\u0438\">Tumores n\u00e3o invasivos<\/h4>\n<ul class=\"wp-block-list\">\n<li>Carcinoma ductal in situ;<\/li>\n<li>Carcinoma lobular cl\u00e1ssico in situ;<\/li>\n<li>Carcinoma lobular pleom\u00f3rfico in situ.<\/li>\n<\/ul>\n<h4 class=\"wp-block-heading\" id=\"h-\u043c\u0435\u0437\u0435\u043d\u0445\u0438\u043c\u0430\u043b\u044c\u043d\u044b\u0435-\u043e\u043f\u0443\u0445\u043e\u043b\u0438\">Tumores mesenquimais<\/h4>\n<ul class=\"wp-block-list\">\n<li>Lipossarcoma;<\/li>\n<li>Angiossarcoma; <\/li>\n<li>Rabdomiossarcoma; <\/li>\n<li>Osteossarcoma; <\/li>\n<li>Leiomiossarcoma.<\/li>\n<\/ul>\n<h4 class=\"wp-block-heading\" id=\"h-\u0444\u0438\u0431\u0440\u043e\u044d\u043f\u0438\u0442\u0435\u043b\u0438\u0430\u043b\u044c\u043d\u044b\u0435-\u043e\u043f\u0443\u0445\u043e\u043b\u0438\">Tumores fibroepiteliais<\/h4>\n<ul class=\"wp-block-list\">\n<li>Tumor filoide com maligniza\u00e7\u00e3o.<\/li>\n<\/ul>\n<h4 class=\"wp-block-heading\" id=\"h-\u043e\u043f\u0443\u0445\u043e\u043b\u0438-\u0441\u043e\u0441\u043a\u0430\">Tumores de mamilo<\/h4>\n<ul class=\"wp-block-list\">\n<li>Doen\u00e7a de Paget do mamilo.<\/li>\n<\/ul>\n<h4 class=\"wp-block-heading\" id=\"h-\u043e\u043f\u0443\u0445\u043e\u043b\u0438-\u043c\u043e\u043b\u043e\u0447\u043d\u043e\u0439-\u0436\u0435\u043b\u0435\u0437\u044b-\u0443-\u043c\u0443\u0436\u0447\u0438\u043d\">Tumores mam\u00e1rios em homens:<\/h4>\n<ul class=\"wp-block-list\">\n<li>Carcinoma invasivo;<\/li>\n<li>Carcinoma in situ.<\/li>\n<\/ul>\n<p>Al\u00e9m disso, o c\u00e2ncer de mama inflamat\u00f3rio \u00e9 distinguido separadamente.<\/p>\n<h3 class=\"wp-block-heading\" id=\"por-estado-do-receptor-e-atividade-proliferativa\">Por estado do receptor e atividade proliferativa<\/h3>\n<p>Dependendo da presen\u00e7a de receptores de estrog\u00eanio, progesterona e HER2\/neu no tumor e da taxa de divis\u00e3o celular, distinguem-se os seguintes subtipos de c\u00e2ncer de mama:<\/p>\n<ol class=\"wp-block-list\">\n<li><strong>Luminal A<\/strong>. Este tipo inclui tumores que possuem receptores para estrog\u00eanio e progesterona ou apenas estrog\u00eanio, s\u00e3o negativos para HER2 e t\u00eam um \u00edndice de atividade proliferativa Ki-67 inferior a 20%.<\/li>\n<li><strong>Luminal B<\/strong>. Este tipo inclui tumores com \u00edndice Ki-67 superior a 20%, que ret\u00eam receptores de estrog\u00eanio e progesterona, e cujo status HER2 pode ser positivo ou negativo.<\/li>\n<li><strong>Positivo para HER2<\/strong>. Este tipo inclui tumores positivos para HER2 que n\u00e3o possuem receptores para estrog\u00eanio e progesterona.<\/li>\n<li><strong>Triplo-negativo<\/strong>. Negativo para estrog\u00eanio e progesterona, negativo para HER2.<\/li>\n<\/ol>\n<p>Os subtipos luminal A e luminal B do c\u00e2ncer de mama se desenvolvem a partir das c\u00e9lulas epiteliais dos ductos e l\u00f3bulos e, clinicamente, tendem a ter um progn\u00f3stico mais favor\u00e1vel em compara\u00e7\u00e3o com outros subtipos. <\/p>\n<p>O subtipo triplo-negativo caracteriza-se pelo curso mais agressivo e met\u00e1stase precoce, mas \u00e9 o mais sens\u00edvel \u00e0 quimioterapia. Isso significa que, se o tratamento for iniciado em tempo oportuno, ele contribui para uma boa resposta \u00e0 terapia e remiss\u00e3o persistente em muitos pacientes.<\/p>\n<h3 class=\"wp-block-heading\" id=\"classificacao-tnm-e-estagios-do-cancer-de-mama\">Classifica\u00e7\u00e3o TNM e est\u00e1gios do c\u00e2ncer de mama<\/h3>\n<p>A classifica\u00e7\u00e3o TNM \u00e9 utilizada para avaliar o tumor prim\u00e1rio (categoria T), o estado dos linfonodos regionais (categoria N), a presen\u00e7a de met\u00e1stases distantes (categoria M) e definir os est\u00e1gios da preval\u00eancia do processo tumoral com base nos crit\u00e9rios obtidos.<\/p>\n<p>Existe uma classifica\u00e7\u00e3o cl\u00ednica (cTNM), em que as categorias s\u00e3o determinadas com base em achados cl\u00ednicos, e uma classifica\u00e7\u00e3o patol\u00f3gica (pTNM), em que as categorias s\u00e3o estabelecidas com base em achados histol\u00f3gicos.<\/p>\n<h4 class=\"wp-block-heading\" id=\"h-\u043f\u0435\u0440\u0432\u0438\u0447\u043d\u0430\u044f-\u043e\u043f\u0443\u0445\u043e\u043b\u044c-\u0442\">Tumor prim\u00e1rio (T)<\/h4>\n<ul class=\"wp-block-list\">\n<li>Tx \u2014 n\u00e3o foi poss\u00edvel avaliar o tumor prim\u00e1rio;<\/li>\n<li>T0 \u2014 o tumor prim\u00e1rio \u00e9 indetect\u00e1vel;<\/li>\n<li>Tis (CDIS) \u2014 carcinoma ductal in situ;<\/li>\n<li>Tis (LCIS) \u2014 carcinoma lobular in situ;<\/li>\n<li>Tis (Paget) \u2014 Doen\u00e7a de Paget do mamilo in situ;<\/li>\n<li>T1 \u2014 tumor com at\u00e9 2 cm de di\u00e2metro:\n<ul class=\"wp-block-list\">\n<li>T1mi \u2014 tumor com at\u00e9 1 mm de di\u00e2metro;<\/li>\n<li>T1a \u2014 tumor com 1 a 5 mm de di\u00e2metro;<\/li>\n<li>T1b \u2014 tumor com 5 a 10 mm de di\u00e2metro;<\/li>\n<li>T1c \u2014 tumor com 10 a 20 mm de di\u00e2metro.<\/li>\n<\/ul>\n<\/li>\n<li>T2 \u2014 tumor com 2 a 5 cm de di\u00e2metro;<\/li>\n<li>T3 \u2014 tumor com mais de 5 cm de di\u00e2metro;<\/li>\n<li>T4 \u2014 tumor de qualquer tamanho com dissemina\u00e7\u00e3o direta para a parede tor\u00e1cica e\/ou pele (mas n\u00e3o isolado na derme):\n<ul class=\"wp-block-list\">\n<li>T4a \u2014 dissemina\u00e7\u00e3o para a parede tor\u00e1cica (mas n\u00e3o invas\u00e3o isolada dos m\u00fasculos peitorais);<\/li>\n<li>T4b \u2014 edema cut\u00e2neo (incluindo o sintoma de casca de lim\u00e3o), n\u00f3dulos sat\u00e9lites ipsilaterais e\/ou ulcera\u00e7\u00e3o;<\/li>\n<li>T4c \u2014 presen\u00e7a de caracter\u00edsticas t\u00edpicas tanto de T4a quanto de T4b;<\/li>\n<li>T4d \u2014 c\u00e2ncer de mama inflamat\u00f3rio.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><a href=\"https:\/\/catalog.voka.io\/en\/models\/436c862c-ea12-40ad-b117-1cf8ef5cd7e1\/4be06637-3010-484b-8e0f-6d604f4bb42c\/fe903102-1266-4cc0-8b0d-1a04e4dfa5c6\/edfdeacf-2f75-4f86-8eb4-bf90c9f3366b\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Modelos 3D<\/a> de c\u00e2ncer de mama lobular invasivo:<\/p>\n<div class=\"carousel-block\">\n<div class=\"swiper carousel-swiper carousel-swiper-block_69ef5dbddc3cb\">\n<div class=\"swiper-wrapper\">\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/invasive-lobular-carcinoma-t1.webp\" alt=\"C\u00e2ncer lobular invasivo T1\"><span class=\"small-text-article text-main-text-color\">C\u00e2ncer lobular invasivo T1<\/span><\/div>\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/invasive-lobular-carcinoma-t2.webp\" alt=\"C\u00e2ncer lobular invasivo T2\"><span class=\"small-text-article text-main-text-color\">C\u00e2ncer lobular invasivo T2<\/span><\/div>\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/invasive-lobular-carcinoma-t3.webp\" alt=\"C\u00e2ncer lobular invasivo T3\"><span class=\"small-text-article text-main-text-color\">C\u00e2ncer lobular invasivo T3<\/span><\/div>\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/invasive-lobular-carcinoma-t4.webp\" alt=\"C\u00e2ncer lobular invasivo T4\"><span class=\"small-text-article text-main-text-color\">C\u00e2ncer lobular invasivo T4<\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"swiper-article-carousel__controls\">\n<div class=\"swiper-article-carousel__pagination-container swiper-article-carousel__pagination-container-block_69ef5dbddc3cb\"><\/div>\n<div class=\"swiper-article-carousel__arrows\"><button class=\"swiper__arrow swiper__arrow--prev carousel-swiper-button-prev swiper__arrow swiper__arrow--prev carousel-swiper-button-prev-block_69ef5dbddc3cb\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"40\" viewbox=\"0 0 40 40\" fill=\"none\"><path d=\"M20 3.75C16.7861 3.75 13.6443 4.70305 10.972 6.48862C8.29969 8.27419 6.21689 10.8121 4.98696 13.7814C3.75704 16.7507 3.43524 20.018 4.06225 23.1702C4.68926 26.3224 6.23692 29.2179 8.50952 31.4905C10.7821 33.7631 13.6776 35.3107 16.8298 35.9378C19.982 36.5648 23.2493 36.243 26.2186 35.013C29.1879 33.7831 31.7258 31.7003 33.5114 29.028C35.297 26.3557 36.25 23.2139 36.25 20C36.2455 15.6916 34.5319 11.561 31.4855 8.51454C28.439 5.46806 24.3084 3.75455 20 3.75ZM23.3844 25.3656C23.5005 25.4818 23.5926 25.6196 23.6555 25.7714C23.7184 25.9231 23.7507 26.0858 23.7507 26.25C23.7507 26.4142 23.7184 26.5769 23.6555 26.7286C23.5926 26.8804 23.5005 27.0182 23.3844 27.1344C23.2682 27.2505 23.1304 27.3426 22.9786 27.4055C22.8269 27.4683 22.6643 27.5007 22.5 27.5007C22.3358 27.5007 22.1731 27.4683 22.0214 27.4055C21.8696 27.3426 21.7318 27.2505 21.6156 27.1344L15.3656 20.8844C15.2494 20.7683 15.1572 20.6304 15.0943 20.4787C15.0314 20.3269 14.999 20.1643 14.999 20C14.999 19.8357 15.0314 19.6731 15.0943 19.5213C15.1572 19.3696 15.2494 19.2317 15.3656 19.1156L21.6156 12.8656C21.7318 12.7495 21.8696 12.6574 22.0214 12.5945C22.1731 12.5317 22.3358 12.4993 22.5 12.4993C22.6643 12.4993 22.8269 12.5317 22.9786 12.5945C23.1304 12.6574 23.2682 12.7495 23.3844 12.8656C23.5005 12.9818 23.5926 13.1196 23.6555 13.2714C23.7184 13.4231 23.7507 13.5858 23.7507 13.75C23.7507 13.9142 23.7184 14.0769 23.6555 14.2286C23.5926 14.3804 23.5005 14.5182 23.3844 14.6344L18.0172 20L23.3844 25.3656Z\" fill=\"#B5C0CD\"><\/path><\/svg><\/button><button class=\"swiper__arrow swiper__arrow--next carousel-swiper-button-next swiper__arrow swiper__arrow--next carousel-swiper-button-next-block_69ef5dbddc3cb\" tabindex=\"0\" aria-label=\"Next slide\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"40\" viewbox=\"0 0 40 40\" fill=\"none\"><path d=\"M20 3.75C16.7861 3.75 13.6443 4.70305 10.972 6.48862C8.29969 8.27419 6.21689 10.8121 4.98696 13.7814C3.75704 16.7507 3.43524 20.018 4.06225 23.1702C4.68926 26.3224 6.23692 29.2179 8.50952 31.4905C10.7821 33.7631 13.6776 35.3107 16.8298 35.9378C19.982 36.5648 23.2493 36.243 26.2186 35.013C29.1879 33.7831 31.7258 31.7003 33.5114 29.028C35.297 26.3557 36.25 23.2139 36.25 20C36.2455 15.6916 34.5319 11.561 31.4855 8.51454C28.439 5.46806 24.3084 3.75455 20 3.75ZM23.3844 25.3656C23.5005 25.4818 23.5926 25.6196 23.6555 25.7714C23.7184 25.9231 23.7507 26.0858 23.7507 26.25C23.7507 26.4142 23.7184 26.5769 23.6555 26.7286C23.5926 26.8804 23.5005 27.0182 23.3844 27.1344C23.2682 27.2505 23.1304 27.3426 22.9786 27.4055C22.8269 27.4683 22.6643 27.5007 22.5 27.5007C22.3358 27.5007 22.1731 27.4683 22.0214 27.4055C21.8696 27.3426 21.7318 27.2505 21.6156 27.1344L15.3656 20.8844C15.2494 20.7683 15.1572 20.6304 15.0943 20.4787C15.0314 20.3269 14.999 20.1643 14.999 20C14.999 19.8357 15.0314 19.6731 15.0943 19.5213C15.1572 19.3696 15.2494 19.2317 15.3656 19.1156L21.6156 12.8656C21.7318 12.7495 21.8696 12.6574 22.0214 12.5945C22.1731 12.5317 22.3358 12.4993 22.5 12.4993C22.6643 12.4993 22.8269 12.5317 22.9786 12.5945C23.1304 12.6574 23.2682 12.7495 23.3844 12.8656C23.5005 12.9818 23.5926 13.1196 23.6555 13.2714C23.7184 13.4231 23.7507 13.5858 23.7507 13.75C23.7507 13.9142 23.7184 14.0769 23.6555 14.2286C23.5926 14.3804 23.5005 14.5182 23.3844 14.6344L18.0172 20L23.3844 25.3656Z\" fill=\"#B5C0CD\"><\/path><\/svg><\/button><\/div>\n<\/div>\n<\/div>\n<p><script defer>\n    document.addEventListener('DOMContentLoaded', function() {\n        const imagesCarouselSwiper = new Swiper('.carousel-swiper-block_69ef5dbddc3cb', {\n            slidesPerView: 1,\n            spaceBetween: 20,\n            loop: true,\n            pagination: {\n                el: '.swiper-article-carousel__pagination-container-block_69ef5dbddc3cb',\n                clickable: true,\n            },\n            navigation: {\n                nextEl: '.carousel-swiper-button-next-block_69ef5dbddc3cb',\n                prevEl: '.carousel-swiper-button-prev-block_69ef5dbddc3cb',\n            },\n        })\n    })\n<\/script><\/p>\n<p>As categorias cT e pT s\u00e3o correspondentes entre si.<\/p>\n<h4 class=\"wp-block-heading\">Linfonodos regionais (N)<\/h4>\n<p><strong>Classifica\u00e7\u00e3o cl\u00ednica<\/strong> (cN):<\/p>\n<ul class=\"wp-block-list\">\n<li>cNx \u2014 \u0440\u0435\u0433\u0438\u043e\u043d\u0430\u0440\u043d\u044b\u0435 \u043b\u0438\u043c\u0444\u0430\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0443\u0437\u043b\u044b \u043d\u0435 \u043c\u043e\u0433\u0443\u0442 \u0431\u044b\u0442\u044c \u043e\u0446\u0435\u043d\u0435\u043d\u044b;<\/li>\n<li>cN0 \u2014 \u043c\u0435\u0442\u0430\u0441\u0442\u0430\u0437\u044b \u0432 \u0440\u0435\u0433\u0438\u043e\u043d\u0430\u0440\u043d\u044b\u0445 \u043b\u0438\u043c\u0444\u0430\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0443\u0437\u043b\u0430\u0445 \u043d\u0435 \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u044f\u044e\u0442\u0441\u044f;<\/li>\n<li>cN1 \u2014 \u043c\u0435\u0442\u0430\u0441\u0442\u0430\u0437\u044b \u0432 \u0438\u043f\u0441\u0438\u043b\u0430\u0442\u0435\u0440\u0430\u043b\u044c\u043d\u044b\u0445 \u043f\u043e\u0434\u043c\u044b\u0448\u0435\u0447\u043d\u044b\u0445 \u043b\u0438\u043c\u0444\u043e\u0443\u0437\u043b\u0430\u0445 I\u2013II \u0443\u0440\u043e\u0432\u043d\u0435\u0439, \u0432\u043a\u043b\u044e\u0447\u0430\u044f \u043c\u0438\u043a\u0440\u043e\u043c\u0435\u0442\u0430\u0441\u0442\u0430\u0437\u044b (cN1mi) \u0440\u0430\u0437\u043c\u0435\u0440\u0430\u043c\u0438 \u0431\u043e\u043b\u0435\u0435 0,2 \u043c\u043c, \u043d\u043e \u043c\u0435\u043d\u0435\u0435 2,0 \u043c\u043c;<\/li>\n<li>cN2 \u2014 \u043c\u0435\u0442\u0430\u0441\u0442\u0430\u0437\u044b \u0432 \u0438\u043f\u0441\u0438\u043b\u0430\u0442\u0435\u0440\u0430\u043b\u044c\u043d\u044b\u0445 \u043f\u043e\u0434\u043c\u044b\u0448\u0435\u0447\u043d\u044b\u0445 \u043b\u0438\u043c\u0444\u043e\u0443\u0437\u043b\u0430\u0445 I\u2013II \u0443\u0440\u043e\u0432\u043d\u0435\u0439, \u0441\u043f\u0430\u044f\u043d\u043d\u044b\u0435 \u043c\u0435\u0436\u0434\u0443 \u0441\u043e\u0431\u043e\u0439 (cN2a), \u0438\u043b\u0438 \u0438\u0437\u043e\u043b\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0439 \u043c\u0435\u0442\u0430\u0441\u0442\u0430\u0437 \u0432 \u0438\u043f\u0441\u0438\u043b\u0430\u0442\u0435\u0440\u0430\u043b\u044c\u043d\u043e\u043c \u0438\u043d\u0442\u0440\u0430\u043c\u0430\u043c\u043c\u0430\u0440\u043d\u043e\u043c \u043b\u0438\u043c\u0444\u043e\u0443\u0437\u043b\u0435 (cN2b);<\/li>\n<li>cN3 \u2014 \u043d\u0430\u043b\u0438\u0447\u0438\u0435 \u043c\u0435\u0442\u0430\u0441\u0442\u0430\u0437\u043e\u0432 \u0432 \u0438\u043f\u0441\u0438\u043b\u0430\u0442\u0435\u0440\u0430\u043b\u044c\u043d\u044b\u0445 \u043f\u043e\u0434\u043a\u043b\u044e\u0447\u0438\u0447\u043d\u044b\u0445 \u043b\u0438\u043c\u0444\u043e\u0443\u0437\u043b\u0430\u0445 (\u043b\u0438\u043c\u0444\u043e\u0443\u0437\u043b\u044b III \u0443\u0440\u043e\u0432\u043d\u044f) (cN3a), \u0438\u043b\u0438 \u043d\u0430\u043b\u0438\u0447\u0438\u0435 \u0438\u043d\u0442\u0440\u0430\u043c\u0430\u043c\u043c\u0430\u0440\u043d\u044b\u0445 \u0438\u043f\u0441\u0438\u043b\u0430\u0442\u0435\u0440\u0430\u043b\u044c\u043d\u044b\u0445 \u043c\u0435\u0442\u0430\u0441\u0442\u0430\u0437\u043e\u0432 \u0432\u043c\u0435\u0441\u0442\u0435 \u0441 \u043c\u0435\u0442\u0430\u0441\u0442\u0430\u0437\u0430\u043c\u0438 \u0432 \u043f\u043e\u0434\u043c\u044b\u0448\u0435\u0447\u043d\u044b\u0445 \u043b\u0438\u043c\u0444\u043e\u0443\u0437\u043b\u0430\u0445 I\u2013II \u0443\u0440\u043e\u0432\u043d\u044f (cN3b), \u0438\u043b\u0438 \u043d\u0430\u043b\u0438\u0447\u0438\u0435 \u043c\u0435\u0442\u0430\u0441\u0442\u0430\u0437\u043e\u0432 \u0432 \u0438\u043f\u0441\u0438\u043b\u0430\u0442\u0435\u0440\u0430\u043b\u044c\u043d\u044b\u0445 \u043d\u0430\u0434\u043a\u043b\u044e\u0447\u0438\u0447\u043d\u044b\u0445 \u043b\u0438\u043c\u0444\u043e\u0443\u0437\u043b\u0430\u0445 (cN3c).<\/li>\n<\/ul>\n<ul class=\"wp-block-list\"><\/ul>\n<p><strong>Classifica\u00e7\u00e3o Patol\u00f3gica<\/strong> (pN):<\/p>\n<ul class=\"wp-block-list\">\n<li>pNx \u2014 n\u00e3o foi poss\u00edvel avaliar os linfonodos regionais;<\/li>\n<li>pN0 \u2014 n\u00e3o foram determinadas met\u00e1stases em linfonodos regionais:\n<ul class=\"wp-block-list\">\n<li>pN0(i+) \u2014 o exame morfol\u00f3gico revela apenas c\u00e9lulas tumorais isoladas (ITCs) \u2014 c\u00e9lulas tumorais individuais, ou agrupamentos delas, de no m\u00e1ximo 0,2 mm;<\/li>\n<li>pN0(mol+) \u2014 met\u00e1stases n\u00e3o foram detectadas por exame morfol\u00f3gico, ITCs foram detectadas por m\u00e9todos n\u00e3o morfol\u00f3gicos (PCR).<\/li>\n<\/ul>\n<\/li>\n<li>pN1 \u2013 micromet\u00e1stases ou met\u00e1stases em 1 a 3 linfonodos axilares ipsilaterais e\/ou met\u00e1stases em linfonodos intramam\u00e1rios, conforme a bi\u00f3psia do linfonodo sentinela, mas n\u00e3o detect\u00e1veis clinicamente:\n<ul class=\"wp-block-list\">\n<li>pN1mi \u2014 micromet\u00e1stases (maiores que 0,2 mm, mas menores que 2,0 mm);<\/li>\n<li>pN1a \u2014 met\u00e1stases em 1 a 3 linfonodos axilares ipsilaterais (pelo menos um deles com mais de 2,0 mm de di\u00e2metro);<\/li>\n<li>pN1b \u2014 met\u00e1stases (excluindo ITCs) para linfonodos sentinela intramam\u00e1rios;<\/li>\n<li>pN1c \u2014 combina\u00e7\u00e3o dos crit\u00e9rios pN1a e pN1b.<\/li>\n<\/ul>\n<\/li>\n<li>pN2 \u2014 met\u00e1stases em 4 a 9 linfonodos axilares ou met\u00e1stases clinicamente detect\u00e1veis em linfonodos intramam\u00e1rios na aus\u00eancia de met\u00e1stases em linfonodos axilares:\n<ul class=\"wp-block-list\">\n<li>pN2a \u2014 met\u00e1stases em 4 a 9 linfonodos axilares (pelo menos um dos quais \u00e9 maior que 2,0 mm);<\/li>\n<li>pN2b \u2014 met\u00e1stases clinicamente detect\u00e1veis em linfonodos intramam\u00e1rios na aus\u00eancia de met\u00e1stases em linfonodos axilares.<\/li>\n<\/ul>\n<\/li>\n<li>pN3 \u2014 met\u00e1stases em 10 ou mais linfonodos axilares, ou met\u00e1stases em linfonodos subcl\u00e1vios, ou met\u00e1stases clinicamente detect\u00e1veis em linfonodos intramam\u00e1rios ipsilaterais na presen\u00e7a de met\u00e1stases em linfonodos axilares dos n\u00edveis I\u2013II, ou mais de 3 met\u00e1stases em linfonodos axilares na presen\u00e7a de met\u00e1stases em linfonodos intramam\u00e1rios sentinela (mas n\u00e3o clinicamente detect\u00e1veis), ou met\u00e1stases em linfonodos supraclaviculares:\n<ul class=\"wp-block-list\">\n<li>pN3a \u2014 met\u00e1stase em 10 ou mais linfonodos axilares (pelo menos um dos quais com di\u00e2metro superior a 2,0 mm), ou met\u00e1stase para linfonodos subcl\u00e1vios;<\/li>\n<li>pN3b \u2014 met\u00e1stases clinicamente detect\u00e1veis em linfonodos intramam\u00e1rios ipsilaterais na presen\u00e7a de met\u00e1stases em linfonodos axilares dos n\u00edveis I-II, ou mais de 3 met\u00e1stases em linfonodos axilares na presen\u00e7a de met\u00e1stases em linfonodos intramam\u00e1rios sentinela (mas n\u00e3o clinicamente detect\u00e1veis);<\/li>\n<li>pN3c \u2014 met\u00e1stase para linfonodos supraclaviculares.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h4 class=\"wp-block-heading\">Met\u00e1stases distantes (categoria M)<\/h4>\n<ul class=\"wp-block-list\">\n<li>M0 \u2014 n\u00e3o foram detectadas met\u00e1stases distantes;<\/li>\n<li>M1 \u2014 foram identificadas met\u00e1stases distantes.<\/li>\n<\/ul>\n<p>As categorias cM e rM s\u00e3o correspondentes entre si.<\/p>\n<h4 class=\"wp-block-heading\">Est\u00e1gios do c\u00e2ncer de mama<\/h4>\n<figure class=\"wp-block-table table-to-cards\">\n<table class=\"has-fixed-layout\">\n<thead>\n<tr>\n<th class=\"has-text-align-center\" data-align=\"center\"><strong>Est\u00e1gio<\/strong><\/th>\n<th class=\"has-text-align-center\" data-align=\"center\"><strong>\u0422<\/strong><\/th>\n<th class=\"has-text-align-center\" data-align=\"center\"><strong>N<\/strong><\/th>\n<th class=\"has-text-align-center\" data-align=\"center\"><strong>\u041c<\/strong><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">0<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">Tis<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">N0<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">M0<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">IA<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">T1 (incluindo T1mi)<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">N0<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">M0<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">IB<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">T0, T1 (incluindo T1mi)<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">N1mi<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">M0<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">IIA<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">T0, T1 (incluindo T1mi)<br \/>T2<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">N1<\/p>\n<p>N0<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">M0<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">IIB<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">T2<br \/>T3<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">N1<br \/>N0<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">M0<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">IIIA<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">T0, T1 (incluindo T1mi), T2<br \/>T3<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">N2<\/p>\n<p>N1, N2<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">M0<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">IIIB<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">T4<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">N0, N1, N2<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">M0<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">IIIC<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">qualquer T<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">N3<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">M0<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">IV<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">qualquer T<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">qualquer N<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">M1<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/figure>\n<h2 class=\"wp-block-heading\" id=\"apresentacao-clinica-do-cancer-de-mama\">Apresenta\u00e7\u00e3o cl\u00ednica do c\u00e2ncer de mama<\/h2>\n<h3 class=\"wp-block-heading\" id=\"sintomas-e-localizacao-do-cancer-de-mama\">Sintomas e localiza\u00e7\u00e3o do c\u00e2ncer de mama<\/h3>\n<p>Nos est\u00e1gios iniciais, quando o tamanho do tumor prim\u00e1rio n\u00e3o ultrapassa 1 a 2 cm, a doen\u00e7a geralmente \u00e9 assintom\u00e1tica e s\u00f3 \u00e9 detectada mediante exames de triagem (ultrassom, mamografia).<\/p>\n<p>A presen\u00e7a de uma massa palp\u00e1vel \u00e9 o sintoma mais comum do c\u00e2ncer de mama. O tumor \u00e9 caracterizado por um formato arredondado, consist\u00eancia densa e geralmente \u00e9 indolor \u00e0 palpa\u00e7\u00e3o. O tamanho da massa pode variar de alguns mil\u00edmetros a dezenas de cent\u00edmetros. O tamanho gigante do tumor \u00e9 t\u00edpico do tumor filoide maligno, dos sarcomas de mama e do c\u00e2ncer de mama localmente avan\u00e7ado. Tumores de tamanho pequeno s\u00e3o t\u00edpicos do c\u00e2ncer de mama lobular e da doen\u00e7a de Paget.<\/p>\n<p>Os tumores podem ser solit\u00e1rios ou m\u00faltiplos, localizados em uma mama ou afetando ambas. <\/p>\n<p>Nos est\u00e1gios iniciais, a neoplasia se desloca facilmente em rela\u00e7\u00e3o aos tecidos circundantes; a pele que cobre a massa n\u00e3o sofre altera\u00e7\u00f5es. Quando o processo tumoral se espalha, ocorre o chamado sintoma \u201ccasca de lim\u00e3o\u201d, caracterizado por altera\u00e7\u00f5es na pele (incha\u00e7o, espessamento, poros mais dilatados que fazem a apar\u00eancia da pele lembrar a casca de um lim\u00e3o, da\u00ed seu nome) e nos tecidos subjacentes devido \u00e0 linfostase causada pelo bloqueio das vias linf\u00e1ticas pelas massas tumorais.<\/p>\n<p>Os <strong>sintomas<\/strong> a seguir tamb\u00e9m s\u00e3o diagnosticados em casos de c\u00e2ncer de mama:<\/p>\n<ul class=\"wp-block-list\">\n<li>Sinal de \u201cader\u00eancia\u201d \u2014 ao tentar puxar a pele sobre o tumor formando uma dobra, aparece uma depress\u00e3o;<\/li>\n<li>Umbilica\u00e7\u00e3o \u2014 retra\u00e7\u00e3o da pele sobre o tumor;<\/li>\n<li>Retra\u00e7\u00e3o do mamilo, incha\u00e7o da ar\u00e9ola \u2014 sintoma de Krause;<\/li>\n<li>Incha\u00e7o e hiperemia da pele da mama;<\/li>\n<li>Deformidade mam\u00e1ria;<\/li>\n<li>A ulcera\u00e7\u00e3o da pele acima do tumor \u00e9 poss\u00edvel quando este invade a \u00e1rea afetada, com o desenvolvimento de sangramento de intensidade vari\u00e1vel, bem como infec\u00e7\u00e3o da ferida com o desenvolvimento de complica\u00e7\u00f5es purulentas-s\u00e9pticas.<\/li>\n<\/ul>\n<p>Uma massa palp\u00e1vel de consist\u00eancia densa na regi\u00e3o axilar e supraclavicular indica dissemina\u00e7\u00e3o do processo tumoral para os linfonodos regionais. As met\u00e1stases nos g\u00e2nglios linf\u00e1ticos podem ser \u00fanicas ou m\u00faltiplas, podem estar localizadas separadamente ou formar conglomerados tumorais.<\/p>\n<p>A apresenta\u00e7\u00e3o cl\u00ednica do c\u00e2ncer de mama \u00e9 diversa e depende de muitos fatores, como o tipo morfol\u00f3gico do tumor, a localiza\u00e7\u00e3o do tumor, o est\u00e1gio do tumor e as caracter\u00edsticas fisiol\u00f3gicas do paciente.<\/p>\n<h3 class=\"wp-block-heading\" id=\"formas-clinicas-do-cancer-de-mama\">Formas cl\u00ednicas do c\u00e2ncer de mama<\/h3>\n<p>As seguintes variantes de c\u00e2ncer de mama s\u00e3o de grande import\u00e2ncia cl\u00ednica:<\/p>\n<h4 class=\"wp-block-heading\" id=\"h-\u043d\u0435\u0438\u043d\u0432\u0430\u0437\u0438\u0432\u043d\u044b\u0439-\u043f\u0440\u043e\u0442\u043e\u043a\u043e\u0432\u043e\u0439-\u0440\u0430\u043a-\u0438\u043b\u0438-\u043f\u0440\u043e\u0442\u043e\u043a\u043e\u0432\u0430\u044f-\u043a\u0430\u0440\u0446\u0438\u043d\u043e\u043c\u0430-in-situ-dcis\">C\u00e2ncer ductal n\u00e3o invasivo, ou carcinoma ductal in situ (CDIS)<\/h4>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/intraductal-carcinoma-in-situ.webp\" alt=\"C\u00e2ncer intraductal in situ\"><figcaption class=\"wp-element-caption\">C\u00e2ncer intraductal in situ: <a href=\"https:\/\/catalog.voka.io\/en\/models\/436c862c-ea12-40ad-b117-1cf8ef5cd7e1\/4be06637-3010-484b-8e0f-6d604f4bb42c\/3718d7a7-0b3d-4e2f-a87e-e8e9b2e13d17\/e44f197f-3ea3-414a-b9be-1b0f1e539799\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">modelo 3D<\/a><\/figcaption><\/figure>\n<p>\u00c9 a variante mais comum de c\u00e2ncer de mama n\u00e3o invasivo. O CDIS se desenvolve a partir do epit\u00e9lio da unidade ductolobular e pode se espalhar ao longo do sistema ductal at\u00e9 o mamilo, mas a membrana basal ou a camada de c\u00e9lulas mioepiteliais permanece intacta. O CDIS pode ser um precursor do carcinoma ductal invasivo, fazendo com que a sua detec\u00e7\u00e3o e tratamento tenham grande valor progn\u00f3stico.<\/p>\n<p>O CDIS \u00e9 geralmente assintom\u00e1tico, sendo detectado mediante mamografia de triagem (70 a 90% de todos os casos). <\/p>\n<p>Os <strong>sintomas<\/strong> t\u00edpicos do carcinoma ductal in situ incluem:<\/p>\n<ul class=\"wp-block-list\">\n<li>Presen\u00e7a de secre\u00e7\u00e3o sanguinolenta, por vezes castanha, no mamilo;<\/li>\n<li>Massa tumoral palp\u00e1vel na regi\u00e3o retroareolar (ocorre em 1 a 5% dos casos).<\/li>\n<\/ul>\n<figure class=\"wp-block-video\" id=\"animacao-3d-carcinoma-ductal-in-situ\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/ductal-carcinoma-in-situ.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D: carcinoma ductal in situ<\/figcaption><\/figure>\n<h4 class=\"wp-block-heading\">C\u00e2ncer ductal invasivo<\/h4>\n<p>O c\u00e2ncer ductal invasivo representa de 50 a 75% de todos os c\u00e2nceres de mama invasivos. <\/p>\n<p>Clinicamente, manifesta-se pela presen\u00e7a de uma massa tumoral palp\u00e1vel na mama, de consist\u00eancia densa e geralmente indolor. Quando o processo tumoral se espalha, os sintomas cut\u00e2neos descritos acima se juntam a eles.<\/p>\n<h4 class=\"wp-block-heading\">C\u00e2ncer lobular n\u00e3o invasivo<\/h4>\n<p>O c\u00e2ncer lobular n\u00e3o invasivo, ou carcinoma lobular in situ, \u00e9 frequentemente multic\u00eantrico e pode estar localizado em m\u00faltiplos focos em uma das mamas (at\u00e9 70%) ou em ambas (em 20 a 60% dos pacientes).<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/lobular-carcinoma-in-situ.webp\" alt=\"C\u00e2ncer lobular in situ\"><figcaption class=\"wp-element-caption\">C\u00e2ncer lobular in situ: <a href=\"https:\/\/catalog.voka.io\/en\/models\/436c862c-ea12-40ad-b117-1cf8ef5cd7e1\/4be06637-3010-484b-8e0f-6d604f4bb42c\/58f02f95-0b53-4418-8764-30cbe712b023\/eb33c6c2-57ce-4e4f-9fbe-49518aab7442\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">modelo 3D<\/a><\/figcaption><\/figure>\n<p>Clinicamente, geralmente \u00e9 assintom\u00e1tico, sendo detectado mediante mamografia de triagem.<\/p>\n<figure class=\"wp-block-video\" id=\"animacao-3d-carcinoma-lobular-in-situ\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/lobular-carcinoma-in-situ.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D: carcinoma lobular in situ<\/figcaption><\/figure>\n<h4 class=\"wp-block-heading\">C\u00e2ncer lobular invasivo<\/h4>\n<p>O c\u00e2ncer lobular invasivo representa cerca de 10 a 15% de todos os c\u00e2nceres de mama invasivos.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/invasive-lobular-carcinoma-t2.webp\" alt=\"C\u00e2ncer lobular invasivo T2\"><figcaption class=\"wp-element-caption\">C\u00e2ncer lobular invasivo T2: modelo 3D<\/figcaption><\/figure>\n<p>Devido ao pequeno tamanho do tumor, pode permanecer assintom\u00e1tico por um longo per\u00edodo. Os primeiros sintomas podem ser o aumento dos linfonodos axilares devido a les\u00f5es metast\u00e1ticas. O c\u00e2ncer lobular invasivo \u00e9 a causa mais comum de c\u00e2ncer de mama multic\u00eantrico (uma ou ambas as mamas podem ser afetadas).<\/p>\n<figure class=\"wp-block-video\" id=\"animacao-3d-cancer-lobular-invasivo\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/invasive-lobular-carcinoma.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D: c\u00e2ncer lobular invasivo<\/figcaption><\/figure>\n<h4 class=\"wp-block-heading\">Doen\u00e7a de Paget do mamilo<\/h4>\n<p>A doen\u00e7a de Paget do mamilo \u00e9 uma forma relativamente rara de c\u00e2ncer de mama em que a pele da ar\u00e9ola e do mamilo \u00e9 afetada. Ela \u00e9 geralmente combinada com carcinoma ductal in situ ou carcinoma ductal invasivo (em 80 a 90% dos casos), mas pode ocorrer isoladamente.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/pagets-disease-of-the-nipple.webp\" alt=\"Doen\u00e7a de Paget do mamilo\"><figcaption class=\"wp-element-caption\">Doen\u00e7a de Paget do mamilo: <a href=\"https:\/\/catalog.voka.io\/en\/models\/436c862c-ea12-40ad-b117-1cf8ef5cd7e1\/4be06637-3010-484b-8e0f-6d604f4bb42c\/77bf5950-817d-489d-9fde-b28351c23655\/fc81cbe5-4c4a-4e4b-b337-ed0a7d0db2e8\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">modelo 3D<\/a><\/figcaption><\/figure>\n<p><strong>Os principais sintomas da doen\u00e7a de Paget<\/strong> s\u00e3o:<\/p>\n<ul class=\"wp-block-list\">\n<li>Manifesta\u00e7\u00f5es cut\u00e2neas:\n<ul class=\"wp-block-list\">\n<li>Incha\u00e7o;<\/li>\n<li>Hiperemia;<\/li>\n<li>Condi\u00e7\u00f5es esfoliativas;<\/li>\n<li>Eros\u00f5es cobertas por crostas.<\/li>\n<\/ul>\n<\/li>\n<li>Achatamento e retra\u00e7\u00e3o do mamilo;<\/li>\n<li>Coceira, ard\u00eancia e dor na regi\u00e3o do mamilo;<\/li>\n<li>Presen\u00e7a de tumor denso palp\u00e1vel na regi\u00e3o retroareolar.<\/li>\n<\/ul>\n<figure class=\"wp-block-video\" id=\"animacao-3d-doenca-de-paget-do-mamilo\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/pagets-disease-of-the-breast.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D: doen\u00e7a de Paget do mamilo<\/figcaption><\/figure>\n<h4 class=\"wp-block-heading\">C\u00e2ncer de mama inflamat\u00f3rio<\/h4>\n<p>O c\u00e2ncer de mama inflamat\u00f3rio \u00e9 uma variante relativamente rara do c\u00e2ncer de mama, caracterizada por um curso r\u00e1pido e agressivo, com envolvimento de toda a mama e met\u00e1stase precoce.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/inflammatory-breast-cancer.webp\" alt=\"C\u00e2ncer de mama inflamat\u00f3rio\"><figcaption class=\"wp-element-caption\">C\u00e2ncer de mama inflamat\u00f3rio: <a href=\"https:\/\/catalog.voka.io\/en\/models\/436c862c-ea12-40ad-b117-1cf8ef5cd7e1\/4be06637-3010-484b-8e0f-6d604f4bb42c\/4f6891c9-c924-4ebe-9706-73af176ac700\/d870b1ab-781c-4d47-ba3f-e4a35d601908\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">modelo 3D<\/a><\/figcaption><\/figure>\n<p>Ao contr\u00e1rio de outras formas de c\u00e2ncer de mama, na variante inflamat\u00f3ria geralmente n\u00e3o h\u00e1 tumor palp\u00e1vel. <\/p>\n<p><strong>Os principais sintomas do c\u00e2ncer de mama inflamat\u00f3rio<\/strong> s\u00e3o:<\/p>\n<ul class=\"wp-block-list\">\n<li>Incha\u00e7o e vermelhid\u00e3o da pele da mama;<\/li>\n<li>Deformidade mam\u00e1ria;<\/li>\n<li>Retra\u00e7\u00e3o do mamilo;<\/li>\n<li>Sintoma proeminente de casca de lim\u00e3o.<\/li>\n<\/ul>\n<p>Essa variante de c\u00e2ncer de mama requer diagn\u00f3stico diferencial com les\u00f5es infecciosas da mama.<\/p>\n<figure class=\"wp-block-video\" id=\"animacao-3d-cancer-de-mama-inflamatorio\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/inflammatory-breast-cancer-type.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D: c\u00e2ncer de mama inflamat\u00f3rio<\/figcaption><\/figure>\n<h4 class=\"wp-block-heading\">Sarcomas de mama<\/h4>\n<p>Os sarcomas de mama s\u00e3o tumores mesenquimais raros (cerca de 1%) da mama, caracterizados por um curso agressivo, crescimento tumoral r\u00e1pido e met\u00e1stase precoce, predominantemente hematog\u00eanica. <\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/breast-sarcoma.webp\" alt=\"Sarcoma de mama \"><figcaption class=\"wp-element-caption\">Sarcoma de mama: modelo 3D<\/figcaption><\/figure>\n<p>O desenvolvimento do sarcoma de mama deve-se tanto a anomalias gen\u00e9ticas do desenvolvimento (s\u00edndrome de Li-Fraumeni, neurofibromatose tipo 1, polipose adenomatosa familiar) quanto ao impacto de fatores externos (contato prolongado com compostos de ars\u00eanico, cloreto de vinila, agentes alquilantes, consequ\u00eancias da radioterapia na regi\u00e3o tor\u00e1cica no tratamento de outras neoplasias malignas).<\/p>\n<p><strong>O principal sintoma do sarcoma de mama<\/strong> \u00e9 a presen\u00e7a de um tumor denso de crescimento r\u00e1pido na mama, que pode atingir tamanho gigante com a forma\u00e7\u00e3o de \u00e1reas de necrose tumoral, ulcera\u00e7\u00e3o da pele, invas\u00e3o dos tecidos circundantes com o desenvolvimento de s\u00edndrome dolorosa e sangramento erosivo (na aus\u00eancia de tratamento cir\u00fargico oportuno).<\/p>\n<figure class=\"wp-block-video\" id=\"animacao-3d-sarcoma-de-mama\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/breast-sarcoma.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D: sarcoma de mama<\/figcaption><\/figure>\n<h4 class=\"wp-block-heading\">Tumor filoide maligno<\/h4>\n<p>O tumor filoide maligno \u00e9 um tumor fibroepitelial raro, caracterizado por crescimento r\u00e1pido, curso agressivo e met\u00e1stase precoce, principalmente hematog\u00eanica. Pode ser um tumor prim\u00e1rio ou desenvolver-se a partir de um fibroadenoma filoide da mama.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/malignant-phyllodes-tumor-of-breast.webp\" alt=\"Tumor filoide maligno da mama\"><figcaption class=\"wp-element-caption\">Tumor filoide maligno da mama: <a href=\"https:\/\/catalog.voka.io\/en\/models\/436c862c-ea12-40ad-b117-1cf8ef5cd7e1\/4be06637-3010-484b-8e0f-6d604f4bb42c\/131a29b4-da19-4582-a625-cec56e8b0519\/e240afb9-e84a-4bd1-8a36-d94a782dd28c\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">modelo 3D<\/a><\/figcaption><\/figure>\n<p>O tumor filoide maligno, assim como os sarcomas da mama, requer tratamento cir\u00fargico agressivo (mastectomia) seguido de acompanhamento regular devido \u00e0 baixa sensibilidade do tumor ao tratamento de quimiorradia\u00e7\u00e3o. <\/p>\n<figure class=\"wp-block-video\" id=\"animacao-3d-tumor-filoide-maligno-da-mama\"><video controls><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/oncology\/breast-cancer\/malignant-phyllodes-tumor-of-breast.webm\" type=\"video\/webm\"><\/source><\/video><figcaption class=\"wp-element-caption\">Anima\u00e7\u00e3o 3D: tumor filoide maligno da mama <\/figcaption><\/figure>\n<h2 class=\"wp-block-heading\" id=\"diagnostico-de-cancer-de-mama\">Diagn\u00f3stico de c\u00e2ncer de mama<\/h2>\n<h3 class=\"wp-block-heading\" id=\"historico-e-exame-fisico\">Hist\u00f3rico e exame f\u00edsico<\/h3>\n<p>Ao coletar o hist\u00f3rico m\u00e9dico, observe que identificar o c\u00e2ncer de mama em parentes consangu\u00edneos de primeiro grau \u00e9 crucial para reconhecer formas familiares da doen\u00e7a. O aconselhamento gen\u00e9tico obrigat\u00f3rio \u00e9 indicado para esses pacientes e seus familiares.<\/p>\n<p>O exame inicial inclui o exame e a palpa\u00e7\u00e3o da mama e das \u00e1reas de met\u00e1stase regional (regi\u00f5es axilar e supraclavicular). <\/p>\n<p><strong>O exame <\/strong>come\u00e7a em p\u00e9<strong>:<\/strong><\/p>\n<ul class=\"wp-block-list\">\n<li>S\u00e3o avaliadas a simetria das mamas e a mobilidade ao levantar e abaixar os bra\u00e7os;<\/li>\n<li>S\u00e3o verificadas as altera\u00e7\u00f5es cut\u00e2neas: edema, hiperemia, retra\u00e7\u00e3o da pele, ulcera\u00e7\u00e3o;<\/li>\n<li>A retra\u00e7\u00e3o do mamilo e a secre\u00e7\u00e3o mamilar s\u00e3o avaliadas.<\/li>\n<\/ul>\n<p><strong>Palpa\u00e7\u00e3o:<\/strong><\/p>\n<ul class=\"wp-block-list\">\n<li>Com a paciente em p\u00e9 e deitada de costas, come\u00e7ando pelos quadrantes superiores e seguindo no sentido hor\u00e1rio, ambas as mamas s\u00e3o palpadas para avaliar a presen\u00e7a de secre\u00e7\u00e3o no mamilo ao pression\u00e1-lo.<\/li>\n<li>Em seguida, palpam-se os g\u00e2nglios linf\u00e1ticos axilares e supraclaviculares.<\/li>\n<\/ul>\n<p>Recomenda-se que todas as mulheres realizem o autoexame das mamas mensalmente, no mesmo dia do ciclo menstrual (idealmente na primeira fase do ciclo, entre o 7.\u00ba e o 10.\u00ba dia).<\/p>\n<h3 class=\"wp-block-heading\" id=\"mamografia\">Mamografia<\/h3>\n<p>A mamografia \u00e9 o principal m\u00e9todo de diagn\u00f3stico do c\u00e2ncer de mama, especialmente para as formas n\u00e3o invasivas da doen\u00e7a. Sinais radiol\u00f3gicos:<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Para o c\u00e2ncer intraductal in situ<\/strong>, a caracter\u00edstica radiol\u00f3gica t\u00edpica \u00e9 a presen\u00e7a de microcalcifica\u00e7\u00f5es agrupadas. Ao realizar uma ductografia, os principais sinais s\u00e3o a deforma\u00e7\u00e3o do ducto e o sintoma de \u201camputa\u00e7\u00e3o\u201d (interrup\u00e7\u00e3o abrupta do ducto devido \u00e0 obstru\u00e7\u00e3o tumoral). <\/li>\n<li>O principal sinal radiol\u00f3gico do <strong>c\u00e2ncer de mama infiltrativo<\/strong> \u00e9 a presen\u00e7a de uma massa de formato irregular, sem limites definidos, estrutura heterog\u00eanea, alta densidade (acima do tecido mam\u00e1rio), com presen\u00e7a de estrias e agrupamentos de microcalcifica\u00e7\u00f5es no tumor e \u00e1reas adjacentes, al\u00e9m de edema cut\u00e2neo.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"ultrassom\">Ultrassom<\/h3>\n<p>O ultrassom, juntamente com a mamografia, est\u00e1 entre os principais m\u00e9todos de diagn\u00f3stico por imagem de tumores mam\u00e1rios.<\/p>\n<p><strong>Os principais sinais ultrassonogr\u00e1ficos<\/strong> de neoplasia maligna da mama s\u00e3o:<\/p>\n<ul class=\"wp-block-list\">\n<li>Presen\u00e7a de uma massa hipoecoica com limites irregulares e indistintos;<\/li>\n<li>Estrutura heterog\u00eanea que pode gerar uma sombra ac\u00fastica dorsal;<\/li>\n<li>A dimens\u00e3o vertical \u00e9 geralmente igual \u00e0 dimens\u00e3o horizontal;<\/li>\n<li>Presen\u00e7a de fluxo sangu\u00edneo no exame Doppler.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"imagens-por-ressonancia-magnetica-rm\">Imagens por resson\u00e2ncia magn\u00e9tica (RM)<\/h3>\n<p>A resson\u00e2ncia magn\u00e9tica (RM) \u00e9 utilizada como m\u00e9todo para esclarecer o diagn\u00f3stico. <\/p>\n<p>A resson\u00e2ncia magn\u00e9tica \u00e9 recomendada como m\u00e9todo de triagem anual para pacientes com alto risco de desenvolver c\u00e2ncer de mama (portadoras de muta\u00e7\u00f5es gen\u00e9ticas, particularmente BRCA1 e BRCA2).<\/p>\n<p> Al\u00e9m disso, a resson\u00e2ncia magn\u00e9tica permite a visualiza\u00e7\u00e3o de tumores intraductais da mama sem calcifica\u00e7\u00f5es, o que \u00e9 um desafio para a ultrassonografia e a mamografia.<\/p>\n<p>Os <strong>sintomas patognom\u00f4nicos do c\u00e2ncer de mama na resson\u00e2ncia magn\u00e9tica<\/strong> s\u00e3o:<\/p>\n<ul class=\"wp-block-list\">\n<li>Limites indistintos do tumor;<\/li>\n<li>Bordas pontiagudas do tumor;<\/li>\n<li>Acumula\u00e7\u00e3o de contraste desigual.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"biopsia-por-aspiracao-com-agulha-fina\">Bi\u00f3psia por aspira\u00e7\u00e3o com agulha fina<\/h3>\n<p>A bi\u00f3psia por aspira\u00e7\u00e3o com agulha fina (BAAF) \u00e9 utilizada principalmente para verificar met\u00e1stases em linfonodos regionais. A BAAF de tumores mam\u00e1rios \u00e9 atualmente menos utilizada do que a bi\u00f3psia por agulha grossa devido \u00e0 necessidade de determinar o tipo morfol\u00f3gico do tumor antes do tratamento espec\u00edfico. Portanto, \u00e9 raramente realizada.<\/p>\n<h3 class=\"wp-block-heading\" id=\"biopsia-por-agulha-grossa\">Bi\u00f3psia por agulha grossa<\/h3>\n<p>A bi\u00f3psia por agulha grossa de um tumor mam\u00e1rio permite determinar o tipo morfol\u00f3gico do tumor, o que possibilita o planejamento individualizado de t\u00e1ticas de tratamento espec\u00edficas com o maior efeito previs\u00edvel.<\/p>\n<p>A bi\u00f3psia por agulha grossa com determina\u00e7\u00e3o do status dos receptores do tumor (presen\u00e7a de receptores de estrog\u00eanio e progesterona, HER2\/neu e Ki-67) \u00e9 realizada para decidir sobre a quimioterapia neoadjuvante e \u00e9 obrigat\u00f3ria antes de iniciar o tratamento espec\u00edfico.<\/p>\n<h2 class=\"wp-block-heading\" id=\"principios-basicos-do-tratamento-do-cancer-de-mama\">Princ\u00edpios b\u00e1sicos do tratamento do c\u00e2ncer de mama<\/h2>\n<p>O tratamento do c\u00e2ncer de mama baseia-se na determina\u00e7\u00e3o do tipo morfol\u00f3gico do tumor, na sua sensibilidade a este ou aquele tipo de terapia e na preval\u00eancia do processo tumoral. Ele inclui cirurgia, quimioterapia, terapia hormonal, terapia direcionada e radioterapia.<\/p>\n<h3 class=\"wp-block-heading\" id=\"terapia-cirurgica\">Terapia cir\u00fargica<\/h3>\n<p>O tratamento cir\u00fargico \u00e9 uma das principais etapas da terapia de neoplasias malignas da mama. Pode ser realizado na primeira etapa do tratamento especializado ou ap\u00f3s ciclos de quimioterapia neoadjuvante.<\/p>\n<p>O tratamento cir\u00fargico \u00e9 indicado para todos os pacientes com tumor ressec\u00e1vel na aus\u00eancia de met\u00e1stases distantes. Pacientes com c\u00e2ncer de mama avan\u00e7ado podem ser submetidas \u00e0 mastectomia paliativa (se houver risco de sangramento, por raz\u00f5es sanit\u00e1rias).<\/p>\n<p>Atualmente, o padr\u00e3o ouro para o tratamento cir\u00fargico do c\u00e2ncer de mama \u00e9 a ressec\u00e7\u00e3o curativa (lumpectomia) com bi\u00f3psia do linfonodo sentinela na presen\u00e7a de met\u00e1stases clinicamente indetect\u00e1veis ou com dissec\u00e7\u00e3o dos linfonodos axilares na presen\u00e7a de met\u00e1stases clinicamente detect\u00e1veis.<\/p>\n<p>Ao realizar cirurgia conservadora da mama, \u00e9 obrigat\u00f3rio realizar o exame morfol\u00f3gico intraoperat\u00f3rio das margens de ressec\u00e7\u00e3o para verificar a presen\u00e7a de tumor. Em caso de margem positiva, indica-se nova dissec\u00e7\u00e3o at\u00e9 que seja obtida uma resposta negativa ou se realize uma mastectomia (quando for tecnicamente imposs\u00edvel obter uma margem negativa).<\/p>\n<p>Em pacientes com les\u00f5es multic\u00eantricas, \u00e9 indicada a microcalcifica\u00e7\u00f5es difusas na mama e c\u00e2ncer de mama inflamat\u00f3rio, a mastectomia com bi\u00f3psia do linfonodo sentinela ou dissec\u00e7\u00e3o dos linfonodos axilares.<\/p>\n<p>Na presen\u00e7a de portadoras de muta\u00e7\u00f5es nos genes BRCA1 e BRCA2 em pacientes com diagn\u00f3stico de c\u00e2ncer de mama, \u00e9 razo\u00e1vel considerar a realiza\u00e7\u00e3o de mastectomia bilateral devido ao alto risco de desenvolvimento de c\u00e2ncer na segunda mama. <\/p>\n<p>As cirurgias reconstrutivas da mama podem ser realizadas simultaneamente \u00e0 remo\u00e7\u00e3o do tumor ou posteriormente, ap\u00f3s a conclus\u00e3o do tratamento especializado. Atualmente, n\u00e3o h\u00e1 evid\u00eancias de associa\u00e7\u00e3o entre o risco de recorr\u00eancia da doen\u00e7a e o momento da cirurgia reconstrutiva; portanto, a mamoplastia em um \u00fanico est\u00e1gio pode ser recomendada para melhorar a qualidade de vida das pacientes. A mamoplastia tardia pode ser recomendada quando implantes s\u00e3o necess\u00e1rios e a radioterapia est\u00e1 planejada para o per\u00edodo p\u00f3s-operat\u00f3rio, pois isso aumenta o risco de contratura (fibro)capsular.<\/p>\n<h3 class=\"wp-block-heading\" id=\"tratamento-de-quimioterapia\">Tratamento de quimioterapia<\/h3>\n<p>A quimioterapia pode ser realizada tanto no pr\u00e9-operat\u00f3rio (terapia neoadjuvante) quanto no p\u00f3s-operat\u00f3rio (terapia adjuvante) para alcan\u00e7ar melhores resultados no tratamento.<\/p>\n<h4 class=\"wp-block-heading\">Quimioterapia adjuvante<\/h4>\n<p>A administra\u00e7\u00e3o de quimioterapia adjuvante (QTA) ap\u00f3s tratamento cir\u00fargico curativo \u00e9 determinada pelo tipo morfol\u00f3gico do tumor e pela extens\u00e3o da dissemina\u00e7\u00e3o tumoral.<\/p>\n<p>Em tumores do tipo luminal A, al\u00e9m da terapia hormonal, a quimioterapia \u00e9 prescrita em casos de dissemina\u00e7\u00e3o tumoral extensa (pT>=3, pN>=2), baixo grau de diferencia\u00e7\u00e3o tumoral (G3), pacientes com menos de 35 anos de idade com invas\u00e3o linfovascular acentuada e alto risco de recorr\u00eancia tumoral. O regime padr\u00e3o de QTA inclui 4 ciclos de AC (doxorrubicina + ciclofosfamida) e 6 ciclos de CMF (ciclofosfamida + metotrexato + fluorouracilo).<\/p>\n<p>Em casos de c\u00e2ncer de mama do tipo luminal B e com status HER2 negativo, s\u00e3o indicadas a terapia hormonal e a quimioterapia adjuvante com antraciclinas (doxorrubicina) e taxanos (paclitaxel, docetaxel).<\/p>\n<p>Em casos de c\u00e2ncer de mama do tipo luminal B e com status positivo para HER2, a quimioterapia adjuvante (antraciclinas, taxanos), bem como a terapia hormonal e a terapia anti-HER2\/neu, tamb\u00e9m s\u00e3o indicadas.<\/p>\n<p>Em casos de c\u00e2ncer de mama n\u00e3o luminal positivo para HER2, s\u00e3o indicados ciclos de quimioterapia com antraciclinas e taxanos, al\u00e9m da terapia anti-HER2\/neu.<\/p>\n<p>No c\u00e2ncer de mama triplo-negativo, tamb\u00e9m s\u00e3o indicados ciclos de quimioterapia com antraciclinas e taxanos. \u00c9 poss\u00edvel utilizar prepara\u00e7\u00f5es de platina em pacientes com muta\u00e7\u00e3o BRCA1.<\/p>\n<h4 class=\"wp-block-heading\">Quimioterapia neoadjuvante<\/h4>\n<p>A quimioterapia neoadjuvante (QTNA) no processo tumoral prim\u00e1rio ressec\u00e1vel permite melhorar o progn\u00f3stico, criando condi\u00e7\u00f5es para a realiza\u00e7\u00e3o de cirurgias conservadoras da mama e, em alguns casos, alcan\u00e7ar a regress\u00e3o patomorfol\u00f3gica completa do tumor. Ela permite tornar o tumor ressec\u00e1vel no processo prim\u00e1rio irressec\u00e1vel, no caso de uma boa resposta tumoral ao tratamento.<\/p>\n<p>Os ciclos de QTNA s\u00e3o realizados at\u00e9 que o processo se estabilize ou at\u00e9 que o tumor regrida completamente. Normalmente, s\u00e3o prescritos de 6 a 8 ciclos de tratamento, com avalia\u00e7\u00e3o da efic\u00e1cia ap\u00f3s cada 2 ciclos. Caso n\u00e3o haja efeito ap\u00f3s os dois primeiros ciclos, \u00e9 poss\u00edvel alterar o regime de QTNA ou realizar tratamento cir\u00fargico.<\/p>\n<p>Em alguns casos, pacientes com c\u00e2ncer de mama luminal tipo A podem receber terapia hormonal como tratamento neoadjuvante por um per\u00edodo de 4 a 8 meses, com monitoramento constante da efic\u00e1cia do tratamento.<\/p>\n<h3 class=\"wp-block-heading\" id=\"terapia-hormonal\">Terapia hormonal<\/h3>\n<p>A terapia hormonal adjuvante \u00e9 indicada para todos os pacientes com tumores horm\u00f4nio-dependentes (luminal A, luminal B) e pode ser administrada imediatamente ap\u00f3s o tratamento cir\u00fargico (na aus\u00eancia de indica\u00e7\u00f5es para quimioterapia) ou ap\u00f3s ciclos de quimioterapia adjuvante. A terapia hormonal pode ser combinada com radioterapia e a administra\u00e7\u00e3o de medicamentos direcionados. A escolha dos medicamentos e a dura\u00e7\u00e3o da terapia hormonal dependem da idade da paciente (pr\u00e9-menopausa ou p\u00f3s-menopausa) e da presen\u00e7a de comorbidades ou fatores de mau progn\u00f3stico.<\/p>\n<p><strong>Fatores de mau progn\u00f3stico<\/strong> incluem:<\/p>\n<ul class=\"wp-block-list\">\n<li>Idade inferior a 35 anos;<\/li>\n<li>T3-4 e\/ou envolvimento de 4 ou mais linfonodos axilares;<\/li>\n<li>Tumores de baixo grau de diferencia\u00e7\u00e3o (G3);<\/li>\n<li>Status HER2\/neu positivo;<\/li>\n<li>Ki-67 elevado;<\/li>\n<li>Invas\u00e3o linfovascular proeminente.<\/li>\n<\/ul>\n<p>O medicamento de primeira linha para terapia hormonal \u00e9 o tamoxifeno, que pode ser prescrito tanto no per\u00edodo pr\u00e9-menopausa quanto no p\u00f3s-menopausa. A dura\u00e7\u00e3o m\u00ednima da administra\u00e7\u00e3o \u00e9 de 5 anos, ou de 10 anos na presen\u00e7a de pelo menos um fator de mau progn\u00f3stico (ou administra\u00e7\u00e3o de tamoxifeno por 5 anos, seguida de uma mudan\u00e7a para inibidores da aromatase por 5 anos, desde que a fun\u00e7\u00e3o ovariana esteja bloqueada\/falida).<\/p>\n<p>O uso de tamoxifeno est\u00e1 associado a um risco aumentado de complica\u00e7\u00f5es tromboemb\u00f3licas e hiperplasia endometrial, podendo chegar ao desenvolvimento de c\u00e2ncer endometrial. Pacientes em tratamento com tamoxifeno devem realizar ultrassonografia p\u00e9lvica transvaginal para avaliar a espessura e a estrutura do endom\u00e9trio antes de iniciar a terapia e a cada tr\u00eas meses durante todo o tratamento.<\/p>\n<p>Em pacientes na pr\u00e9-menopausa com alto risco de recorr\u00eancia tumoral, a ooforectomia bilateral ou a administra\u00e7\u00e3o de an\u00e1logos do horm\u00f4nio liberador de gonadotrofina (GnRH) s\u00e3o indicadas com a administra\u00e7\u00e3o de tamoxifeno.<\/p>\n<p>Os inibidores da aromatase s\u00e3o contraindicados em casos de fun\u00e7\u00e3o ovariana preservada e podem ser administrados a pacientes na menopausa ou ap\u00f3s bloqueio\/fal\u00eancia da fun\u00e7\u00e3o ovariana. Esta \u00faltima condi\u00e7\u00e3o \u00e9 alcan\u00e7ada atrav\u00e9s da realiza\u00e7\u00e3o de ooforectomia bilateral ou pela administra\u00e7\u00e3o de GnRH sob controle dos n\u00edveis de FSH e estradiol durante todo o per\u00edodo da terapia hormonal. Os inibidores da aromatase podem ser iniciados 6 a 8 semanas ap\u00f3s a primeira administra\u00e7\u00e3o de GnRH, desde que os n\u00edveis de FSH e estradiol compat\u00edveis com a menopausa sejam atingidos.<\/p>\n<p>Tomar inibidores da aromatase aumenta o risco de osteoporose. Nesse sentido, para esses pacientes, \u00e9 indicada a prescri\u00e7\u00e3o de vitamina D em uma dose de 800 a 2000 UI por dia e c\u00e1lcio em uma dose de 1300 mg por dia, com monitoramento peri\u00f3dico da densidade mineral \u00f3ssea (densitometria).<\/p>\n<p>Recomenda-se que pacientes na menopausa recebam \u00e1cido zoledr\u00f4nico 4 mg por via intravenosa duas vezes ao ano, durante 3 a 5 anos, para prevenir a osteoporose e reduzir o risco de progress\u00e3o tumoral.<\/p>\n<h3 class=\"wp-block-heading\" id=\"radioterapia\">Radioterapia<\/h3>\n<p>A radioterapia \u00e9 realizada em conjunto com cirurgias conservadoras da mama ou em caso de tumor prim\u00e1rio com tamanho superior a 5 cm, independentemente da extens\u00e3o da cirurgia realizada, bem como em caso de 4 ou mais met\u00e1stases em linfonodos axilares.<\/p>\n<p>A radioterapia em pacientes ap\u00f3s ciclos de quimioterapia adjuvante deve ser iniciada dentro de 3 a 4 semanas ap\u00f3s o t\u00e9rmino do tratamento, mas no m\u00e1ximo 6 meses ap\u00f3s a cirurgia. Pacientes que n\u00e3o t\u00eam indica\u00e7\u00e3o para quimioterapia adjuvante devem iniciar a radioterapia nas primeiras 8 semanas ap\u00f3s o tratamento cir\u00fargico.<\/p>\n<p>Os regimes de radioterapia s\u00e3o determinados individualmente, com base no tipo morfol\u00f3gico do tumor, na extens\u00e3o do processo e na presen\u00e7a de fatores progn\u00f3sticos adversos.<\/p>\n<h3 class=\"wp-block-heading\" id=\"terapia-direcionada\">Terapia direcionada<\/h3>\n<p>A terapia direcionada \u00e9 indicada para pacientes positivos para HER2\/neu. O trastuzumabe \u00e9 prescrito na dose de 6 mg\/kg uma vez a cada 3 semanas (primeira dose de 8 mg\/kg) ou 2 mg\/kg (primeira dose de 4 mg\/kg) semanalmente durante 1 ano. O trastuzumabe pode ser administrado por via subcut\u00e2nea na dose de 600 mg a cada 3 semanas, independentemente do peso do paciente.<\/p>\n<p>Devido \u00e0 cardiotoxicidade do medicamento, os pacientes que recebem terapia direcionada devem realizar ecocardiograma com monitoramento da fun\u00e7\u00e3o contr\u00e1til do cora\u00e7\u00e3o a cada 3 meses.<\/p>\n<p>Uma contraindica\u00e7\u00e3o \u00e0 administra\u00e7\u00e3o de trastuzumabe \u00e9 a diminui\u00e7\u00e3o da contratilidade mioc\u00e1rdica (fra\u00e7\u00e3o de eje\u00e7\u00e3o do ventr\u00edculo esquerdo inferior a 50%).<\/p>\n<p>A administra\u00e7\u00e3o de inibidores de CDK4\/6 (amebaciclib, palbociclib, ribociclib) em combina\u00e7\u00e3o com terapia hormonal antiestrog\u00eanica pode ser recomendada para o tratamento de pacientes com c\u00e2ncer de mama avan\u00e7ado ou metast\u00e1tico com receptor hormonal positivo que tenha progredido ap\u00f3s terapia end\u00f3crina ou pacientes com alto risco de progress\u00e3o tumoral.<\/p>\n<p>A administra\u00e7\u00e3o de inibidores de PaRP adjuvantes (olaparibe) \u00e9 aprovada na Uni\u00e3o Europeia como terapia adjuvante para pacientes com c\u00e2ncer de mama inicial negativo para HER2\/neu de alto risco com presen\u00e7a de muta\u00e7\u00f5es nos genes BRCA. O olaparibe pode ser usado como monoterapia ou em combina\u00e7\u00e3o com terapia hormonal se esses pacientes j\u00e1 tiverem recebido quimioterapia neoadjuvante ou adjuvante.<\/p>\n<h3 class=\"wp-block-heading\" id=\"tratamento-de-sarcomas-de-mama\">Tratamento de sarcomas de mama<\/h3>\n<p>O tratamento dos sarcomas de mama baseia-se principalmente no tratamento cir\u00fargico curativo. A cirurgia preferencial \u00e9 a mastectomia, devido ao r\u00e1pido crescimento e \u00e0 natureza agressiva da doen\u00e7a. A met\u00e1stase linfog\u00eanica n\u00e3o \u00e9 t\u00edpica, portanto, a dissec\u00e7\u00e3o de linfonodos em casos de met\u00e1stases clinicamente indetect\u00e1veis n\u00e3o \u00e9 razo\u00e1vel. <\/p>\n<p>A radioterapia \u00e9 ineficaz devido \u00e0 radiorresist\u00eancia dos tumores mesenquimais. Ela \u00e9 realizada na \u00e1rea do foco tumoral prim\u00e1rio para reduzir o risco de recorr\u00eancia do tumor em caso de d\u00favida sobre a efic\u00e1cia da cirurgia realizada. <\/p>\n<p>O tratamento padr\u00e3o de quimioterapia consiste na administra\u00e7\u00e3o de esquemas contendo drogas antrac\u00edclicas em combina\u00e7\u00e3o com cisplatina. Os seguintes regimes de poliquimioterapia s\u00e3o poss\u00edveis: CYVADIK (ciclofosf\u00e2nio + vincristina + doxorrubicina + dacarbazina), AP (doxorrubicina + cisplatina), PC (cisplatina + ciclofosf\u00e2nio). <\/p>\n<p>A terapia hormonal n\u00e3o \u00e9 utilizada devido \u00e0 aus\u00eancia de receptores de estrog\u00eanio e progesterona no tumor.<\/p>\n<p>Os princ\u00edpios do tratamento do tumor filoide maligno s\u00e3o semelhantes aos dos sarcomas de mama.<\/p>\n<div class=\"social-banner-block\">\n<div class=\"social-banner-content\">\n<p class=\"h5-title text-black\">Encontra mais conte\u00fados cientificamente exactos nas nossas redes sociais<\/p>\n<p><span class=\"social-banner-text text-grey\">Subscreve e n\u00e3o percas os recursos mais recentes<\/span><\/p>\n<div class=\"social-links-wrapper\"><a class=\"social-icon-link\" href=\"https:\/\/www.facebook.com\/VOKA3DAnatomyAndPathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/facebook.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.instagram.com\/voka.io\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/insta.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.linkedin.com\/company\/voka-io\/posts\/?feedView=all\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/linkedin.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.youtube.com\/@vokaio\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/youtube.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.pinterest.com\/voka3danatomyandpathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/pinterest.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.tiktok.com\/@voka.io\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/tiktok.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/discord.gg\/7ejUpq8DRR\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/discord.svg\" alt=\"social link\"><\/a><\/div>\n<\/div>\n<p><img decoding=\"async\" class=\"social-banner-image\" loading=\"lazy\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/social-media-banner-mobile-image.webp\" alt=\"Banner background\"><\/div>\n<h2 class=\"wp-block-heading\" id=\"prognostico\">Progn\u00f3stico <\/h2>\n<p>O progn\u00f3stico de sobrevida no c\u00e2ncer de mama depende do tipo morfol\u00f3gico do tumor, da extens\u00e3o da doen\u00e7a (est\u00e1gio) no momento do diagn\u00f3stico e da presen\u00e7a de fatores progn\u00f3sticos adversos.<\/p>\n<p>Ap\u00f3s a conclus\u00e3o do tratamento especializado, os pacientes devem ser acompanhados e avaliados a cada 3 meses durante o primeiro ano, a cada 6 meses do segundo ao quinto ano e anualmente a partir de ent\u00e3o, pelo resto da vida.<\/p>\n<p>A taxa m\u00e9dia de sobrevida livre de progress\u00e3o em 5 anos \u00e9 de 80 a 98% para o est\u00e1gio I, 51 a 91% para o est\u00e1gio II, 10 a 50% para o est\u00e1gio III e menos de 10% para o est\u00e1gio IV.<\/p>\n<div>\n<h2 class=\"faq-title h2-article\" id=\"faq\">FAQ<\/h2>\n<div class=\"faq-section\">\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">1. Como o c\u00e2ncer de mama se manifesta?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">O sinal mais comum de c\u00e2ncer de mama em est\u00e1gio inicial \u00e9 a presen\u00e7a de uma massa palp\u00e1vel (n\u00f3dulo). Nos est\u00e1gios iniciais, o tumor geralmente n\u00e3o causa dor \u00e0 palpa\u00e7\u00e3o. Outros sintomas de c\u00e2ncer de mama podem incluir altera\u00e7\u00f5es na pele (como o \u201csintoma da casca de lim\u00e3o\u201d, estiramento ou vermelhid\u00e3o), deformidade da mama, retra\u00e7\u00e3o do mamilo ou secre\u00e7\u00e3o mamilar, especialmente secre\u00e7\u00e3o sanguinolenta.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">2. Quais s\u00e3o as causas do c\u00e2ncer de mama?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">As causas do c\u00e2ncer de mama n\u00e3o s\u00e3o totalmente compreendidas, mas uma combina\u00e7\u00e3o de fatores heredit\u00e1rios (muta\u00e7\u00f5es dos genes BRCA1, BRCA2, etc.), ambientais e dist\u00farbios hormonais desempenha um papel na carcinog\u00eanese. Os fatores de risco incluem sexo feminino, idade (perimenopausa), menarca precoce, nuliparidade, obesidade, abuso de \u00e1lcool e terapia de reposi\u00e7\u00e3o hormonal.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">3. O c\u00e2ncer de mama pode ser causado por fatores psicossom\u00e1ticos?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">O c\u00e2ncer de mama n\u00e3o \u00e9 uma doen\u00e7a com natureza psicossom\u00e1tica comprovada. As evid\u00eancias cient\u00edficas e as diretrizes cl\u00ednicas atuais n\u00e3o consideram fatores psicol\u00f3gicos (como o estresse) como causa direta do c\u00e2ncer de mama.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">4. O c\u00e2ncer de mama ocorre em homens e quais s\u00e3o os sintomas?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Sim, o c\u00e2ncer de mama ocorre em homens, mas \u00e9 extremamente raro (0,5 a 1% do n\u00famero total de casos). Os sintomas do c\u00e2ncer de mama em homens s\u00e3o semelhantes aos das mulheres: geralmente trata-se de um carcinoma invasivo que se manifesta como um n\u00f3dulo.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">5. O que \u00e9 carcinoma mam\u00e1rio e quais s\u00e3o os est\u00e1gios de sua progress\u00e3o?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">O carcinoma \u00e9 um tumor maligno composto por c\u00e9lulas epiteliais. Ele representa a maioria dos c\u00e2nceres de mama. A classifica\u00e7\u00e3o distingue os est\u00e1gios do c\u00e2ncer de mama (0 a IV) de acordo com o sistema TNM (tamanho do tumor, envolvimento dos linfonodos, met\u00e1stase), bem como os subtipos moleculares (por exemplo, luminal A\/B, positivo para HER2, triplo-negativo).<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">6. Qual a velocidade de dissemina\u00e7\u00e3o do c\u00e2ncer de mama?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">A velocidade com que o c\u00e2ncer de mama se desenvolve depende do tipo de c\u00e2ncer. Algumas formas (por exemplo, inflamat\u00f3rias, sarcomas, c\u00e2nceres triplo-negativos) s\u00e3o caracterizadas por um curso r\u00e1pido e agressivo e met\u00e1stase precoce. O subtipo Luminal A tende a ter um curso mais lento.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">7. O c\u00e2ncer de mama tem tratamento? E qual \u00e9 o progn\u00f3stico?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Sim, o c\u00e2ncer de mama tem tratamento. A abordagem atual, baseada em diretrizes cl\u00ednicas, \u00e9 abrangente e pode incluir cirurgia, quimioterapia, radioterapia, terapias hormonais e terapias direcionadas. O progn\u00f3stico e a sobrevida dependem do subtipo histol\u00f3gico do tumor e do est\u00e1gio em que o tratamento foi iniciado.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">8. Quanto tempo vive uma pessoa com c\u00e2ncer de mama?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">A expectativa de vida e as taxas de sobrevida global em casos de c\u00e2ncer de mama est\u00e3o diretamente relacionadas ao est\u00e1gio da doen\u00e7a no momento do diagn\u00f3stico. A taxa de sobrevida estat\u00edstica em cinco anos para mulheres no est\u00e1gio I \u00e9 de 80 a 98%; no est\u00e1gio II \u00e9 de 51 a 91%; no est\u00e1gio III \u00e9 de 10 a 50%; e no est\u00e1gio IV (presen\u00e7a de met\u00e1stases distantes) \u00e9 inferior a 10%.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">9. Para onde o c\u00e2ncer de mama faz met\u00e1stase?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">O c\u00e2ncer de mama faz met\u00e1stase, na maioria das vezes, por via linf\u00e1tica para os linfonodos regionais (axilares, supraclaviculares, intramam\u00e1rios). A met\u00e1stase hematog\u00eanica (atrav\u00e9s do sangue) \u00e9 t\u00edpica de formas agressivas (por exemplo, sarcomas) e em est\u00e1gios avan\u00e7ados.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sources-list-block sources-list-hidden\" id=\"referencias\">\n<div class=\"sources-list-content\">\n<div class=\"sources-list-title\">\n<p class=\"small-text-bold text-black sources-list-title-text\">Refer\u00eancias<\/p>\n<div class=\"sources-expand-button-wrapper-mobile\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n<div class=\"sources-list-items\">\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">1.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Cat\u00e1logo VOKA (VOKA Catalog). [Recurso eletr\u00f4nico] <\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/catalog.voka.io\/ <\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">2.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Diretrizes da NCCN para Pr\u00e1tica em Oncologia [NCCN Clinical Practice Guidelines in Oncology). C\u00e2ncer de mama, vers\u00e3o 4.2025 (Breast Cancer, version 4.2025) \u2013 17 de abril de 2025. [Internet].<\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/www.nccn.org\/guidelines\/guidelines-detail?category=1&id=1419<\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">3.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Diretrizes do Quinto Consenso Internacional da ESO-ESMO para C\u00e2ncer de Mama em Mulheres Jovens (BCY5) (ESO-ESMO Fifth International Consensus Guidelines for Breast Cancer in Young Women [BCY5]). [Internet].<\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/www.esmo.org\/guidelines\/esmo-consensus-recommendations-breast-cancer-in-young-women-bcy5 <\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">4.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>C\u00e2ncer de Mama Inicial: Diretriz de Pr\u00e1ticas Cl\u00ednicas da ESMO para diagn\u00f3stico, tratamento e acompanhamento. (Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up). [Internet].<\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/www.esmo.org\/guidelines\/esmo-clinical-practice-guideline-early-breast-cancer <\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">5.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Orienta\u00e7\u00e3o de Conv\u00edvio da ESMO: C\u00e2ncer de Mama Metast\u00e1tico (ESMO Living Guideline: \u200bMetastatic Breast Cancer). [Internet].<\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/www.esmo.org\/guidelines\/living-guidelines\/esmo-living-guideline-metastatic-breast-cancer <\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">6.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Protocolo cl\u00ednico \u201cAlgorithms of diagnosis and treatment of malignant neoplasms\u201d no Minist\u00e9rio da Sa\u00fade da Rep\u00fablica de Belarus datado de 06.07.2018. [Fonte em russo] (\u041a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u043f\u0440\u043e\u0442\u043e\u043a\u043e\u043b \u201c\u0410\u043b\u0433\u043e\u0440\u0438\u0442\u043c\u044b \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u0438 \u043b\u0435\u0447\u0435\u043d\u0438\u044f \u0437\u043b\u043e\u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u0445 \u043d\u043e\u0432\u043e\u043e\u0431\u0440\u0430\u0437\u043e\u0432\u0430\u043d\u0438\u0439\u201d \u041c\u0417 \u0420\u0411 \u043e\u0442 06.07.2018\u0433.)<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">7.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>A. N. Sencha. Ultrassonografia da mama. Passo a passo. Do simples ao complexo. (\u0410.\u00a0\u041d. \u0421\u0435\u043d\u0447\u0430. \u0423\u043b\u044c\u0442\u0440\u0430\u0437\u0432\u0443\u043a\u043e\u0432\u043e\u0435 \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435 \u043c\u043e\u043b\u043e\u0447\u043d\u044b\u0445 \u0436\u0435\u043b\u0435\u0437. \u0428\u0430\u0433 \u0437\u0430 \u0448\u0430\u0433\u043e\u043c. \u041e\u0442 \u043f\u0440\u043e\u0441\u0442\u043e\u0433\u043e \u043a \u0441\u043b\u043e\u0436\u043d\u043e\u043c\u0443.) \\[Livro em russo] 2\u00aa edi\u00e7\u00e3o.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">8.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>A.\u00a0N.\u00a0Sencha, Yu.\u00a0V.\u00a0Bikeev. Exame ultrassonogr\u00e1fico das gl\u00e2ndulas mam\u00e1rias. Atlas. (\u0421\u0435\u043d\u0447\u0430 \u0410.\u00a0\u041d., \u0411\u0438\u043a\u0435\u0435\u0432 \u042e.\u00a0\u0412. \u0423\u043b\u044c\u0442\u0440\u0430\u0437\u0432\u0443\u043a\u043e\u0432\u043e\u0435 \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435 \u043c\u043e\u043b\u043e\u0447\u043d\u044b\u0445 \u0436\u0435\u043b\u0435\u0437. \u0410\u0442\u043b\u0430\u0441.) \\[Book in Russian]<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">9.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>S. K. Ternovoy, A. B. Abduraimov. Radiation mammology. (\u0421.\u00a0\u041a. \u0422\u0435\u0440\u043d\u043e\u0432\u043e\u0439, \u0410.\u00a0\u0411. \u0410\u0431\u0434\u0443\u0440\u0430\u0438\u043c\u043e\u0432. \u041b\u0443\u0447\u0435\u0432\u0430\u044f \u043c\u0430\u043c\u043c\u043e\u043b\u043e\u0433\u0438\u044f.) \\[Livro em russo]<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">10.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Organiza\u00e7\u00e3o Mundial de Sa\u00fade. C\u00e2ncer de mama. [Internet].<\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/breast-cancer#:~:text=Overview,producing%20lobules%20of%20the%20breast<\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">11.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>C\u00e2ncer de mama. Gopal Menon; Fadi M. Alkabban; Troy Ferguson. [Internet].<\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482286\/ <\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">12.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>C\u00e2ncer de mama (est\u00e1gios). [Internet]. <\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/radiopaedia.org\/articles\/breast-cancer-staging-1 <\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">13.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Pathology Outlines. [Internet]. <\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/www.pathologyoutlines.com\/breast.html <\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">14.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Doen\u00e7a de Paget mam\u00e1ria. Muhammad Yasir; Myra Khan; Sarah Lotfollahzadeh. [Internet].<\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK563228\/<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sources-expand-button-wrapper\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>O c\u00e2ncer de mama \u00e9 a neoplasia maligna mais comumente diagnosticada e a segunda causa mais comum de morte por c\u00e2ncer em mulheres. Entre os homens, esse tumor \u00e9 extremamente raro (0,5 a 1% do total de casos). Segundo a OMS, em 2022, o c\u00e2ncer de mama foi diagnosticado em 2,3 milh\u00f5es de mulheres em [&hellip;]<\/p>\n","protected":false},"author":9,"featured_media":0,"template":"","diseases_category":[352],"class_list":["post-2158","diseases_post","type-diseases_post","status-publish","hentry","diseases_category-oncologia"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.0 (Yoast SEO v26.5) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>C\u00e2ncer de mama: sintomas, causas, est\u00e1gios, tratamento e progn\u00f3stico<\/title>\n<meta name=\"description\" content=\"C\u00e2ncer de mama: causas, apresenta\u00e7\u00e3o cl\u00ednica, classifica\u00e7\u00e3o dos tumores malignos da mama e m\u00e9todos modernos de diagn\u00f3stico e tratamento.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta 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