{"id":3208,"date":"2021-12-03T07:44:27","date_gmt":"2021-12-03T07:44:27","guid":{"rendered":"https:\/\/www.cirurgiahpb.com.br\/?page_id=3208"},"modified":"2023-02-17T13:09:01","modified_gmt":"2023-02-17T13:09:01","slug":"patologias-do-figado","status":"publish","type":"page","link":"https:\/\/www.cirurgiahpb.com.br\/patologias-do-figado\/","title":{"rendered":"Patologias do F\u00edgado"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3208\" class=\"elementor elementor-3208\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6166631 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6166631\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b35b4ed\" data-id=\"b35b4ed\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-696e130 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"696e130\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-e2f49ed\" data-id=\"e2f49ed\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-53573ea\" data-id=\"53573ea\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-408f342 elementor-toc--minimized-on-tablet elementor-widget elementor-widget-table-of-contents\" data-id=\"408f342\" data-element_type=\"widget\" data-settings=\"{&quot;headings_by_tags&quot;:[&quot;h2&quot;,&quot;h3&quot;,&quot;h4&quot;],&quot;exclude_headings_by_selector&quot;:[],&quot;marker_view&quot;:&quot;bullets&quot;,&quot;icon&quot;:{&quot;value&quot;:&quot;far fa-circle&quot;,&quot;library&quot;:&quot;fa-regular&quot;},&quot;minimize_box&quot;:&quot;yes&quot;,&quot;minimized_on&quot;:&quot;tablet&quot;,&quot;hierarchical_view&quot;:&quot;yes&quot;,&quot;min_height&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"table-of-contents.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-toc__header\">\n\t\t\t<h2 class=\"elementor-toc__header-title\">\n\t\t\t\t\u00cdndice\t\t\t<\/h2>\n\t\t\t\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--expand\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__408f342\" aria-expanded=\"true\" aria-label=\"Open table of contents\"><i aria-hidden=\"true\" class=\"fas fa-chevron-down\"><\/i><\/div>\n\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--collapse\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__408f342\" aria-expanded=\"true\" aria-label=\"Close table of contents\"><i aria-hidden=\"true\" class=\"fas fa-chevron-up\"><\/i><\/div>\n\t\t\t\t\t<\/div>\n\t\t<div id=\"elementor-toc__408f342\" class=\"elementor-toc__body\">\n\t\t\t<div class=\"elementor-toc__spinner-container\">\n\t\t\t\t<i class=\"elementor-toc__spinner eicon-animation-spin eicon-loading\" aria-hidden=\"true\"><\/i>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f5089dd elementor-widget elementor-widget-spacer\" data-id=\"f5089dd\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9bedccb elementor-widget elementor-widget-heading\" data-id=\"9bedccb\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">F\u00cdGADO <\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5f65e5f elementor-widget elementor-widget-text-editor\" data-id=\"5f65e5f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Os n\u00f3dulos hep\u00e1ticos s\u00e3o tumores localizados no f\u00edgado. Eles podem ser malignos ou benignos. Em ambas as situa\u00e7\u00f5es, s\u00e3o pass\u00edveis de tratamento. <\/span><span style=\"font-weight: 400;\">A diferencia\u00e7\u00e3o entre os dois tipos \u00e9 fundamental, para permitir o adequado tratamento. <\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6200220 elementor-widget elementor-widget-heading\" data-id=\"6200220\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">NEOPLASIAS BENIGNAS<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-02d4386 elementor-widget elementor-widget-text-editor\" data-id=\"02d4386\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Os tumores hep\u00e1ticos benignos podem ser classificados de acordo com as suas<\/span> <span style=\"font-weight: 400;\">origens. <\/span><span style=\"font-weight: 400;\">\u00c9 importante diferenciar bem cada um deles, pois a maioria n\u00e3o requer tratamento, apenas em alguns casos espec\u00edficos, que s\u00e3o aqueles que causam sintomas ou que tem chance de transforma\u00e7\u00e3o maligna.\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Os mais comuns s\u00e3o hemangioma, hiperplasia nodular focal, adenoma e cistos.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b761925 elementor-widget elementor-widget-menu-anchor\" data-id=\"b761925\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"hemangioma\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d7184b1 elementor-widget elementor-widget-spacer\" data-id=\"d7184b1\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-747d0b9 elementor-widget elementor-widget-heading\" data-id=\"747d0b9\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Hemangioma hep\u00e1tico<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5b8ab35 elementor-widget elementor-widget-text-editor\" data-id=\"5b8ab35\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Hemangiomas Hep\u00e1ticos s\u00e3o os tumores hep\u00e1ticos benignos mais frequentes, sendo compostos de m\u00faltiplos vasos revestidos por uma \u00fanica camada de c\u00e9lulas endoteliais dentro de um estroma fibroso fino. A maioria dos pacientes com hemangioma n\u00e3o apresenta sintomas e tem o tumor identificado em exames de imagem na rotina ou durante investiga\u00e7\u00e3o cl\u00ednica para outras condi\u00e7\u00f5es. Os hemangiomas podem apresentar-se em diferentes tamanhos, \u00fanicos ou m\u00faltiplos. Os testes de fun\u00e7\u00e3o hep\u00e1tica, via de regra, s\u00e3o normais, a menos que haja uma complica\u00e7\u00e3o como trombose, hemorragia ou compress\u00e3o da \u00e1rvore biliar.\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Na grande maioria das vezes os hemangiomas permanecem est\u00e1veis ao longo do tempo e raramente pode ocorrer crescimento significativo. Ruptura espont\u00e2nea ou decorrente de trauma contuso s\u00e3o excepcionais.\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">O tratamento dos hemangiomas costuma ser conservador. N\u00e3o h\u00e1 consenso na literatura, a respeito da necessidade de acompanhamento cont\u00ednuo em tumores \u2264 5 cm. Aconselha-se controle semestral ou anual quando a les\u00e3o for maior que 5 cm. Para esses tumores, quando da aus\u00eancia de sintomas, o risco de hemorragia \u00e9 demasiado baixo para justificar a ressec\u00e7\u00e3o profil\u00e1tica. Os pacientes que t\u00eam dor ou sintomas sugestivos de compress\u00e3o extr\u00ednseca de estruturas adjacentes devem ser <\/span><span style=\"font-weight: 400;\">considerados para a ressec\u00e7\u00e3o cir\u00fargica, desde que outras causas dos sintomas tenham sido exclu\u00eddas . O uso de anticoncepcionais orais (ACO) ou outras terapias hormonais n\u00e3o est\u00e1 contraindicado em pacientes com hemangiomas.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-641aead elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"641aead\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.cirurgiahpb.com.br\/#figado\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-arrow-left\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Voltar para a p\u00e1gina inicial<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b6aa68f elementor-widget elementor-widget-menu-anchor\" data-id=\"b6aa68f\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"hiperplasia\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3ef9900 elementor-widget elementor-widget-spacer\" data-id=\"3ef9900\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-43587c5 elementor-widget elementor-widget-heading\" data-id=\"43587c5\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Hiperplasia nodular focal \n<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c74bb00 elementor-widget elementor-widget-text-editor\" data-id=\"c74bb00\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">A Hiperplasia Nodular Focal (HNF) \u00e9 uma les\u00e3o benigna, a hip\u00f3tese mais aceita atualmente \u00e9 que seja uma resposta hiperpl\u00e1sica associada \u00e0 les\u00e3o vascular de uma art\u00e9ria an\u00f4mala, localizada no seu interior. A HNF \u00e9 o segundo tumor benigno mais frequente, sendo tamb\u00e9m mais comum nas mulheres na faixa entre 20 e 60 anos. S\u00e3o assintom\u00e1ticos em 70% a 90% dos casos e seu achado \u00e9 incidental nos exames de imagem. Sua associa\u00e7\u00e3o com horm\u00f4nios \u00e9 controversa, n\u00e3o havendo indica\u00e7\u00e3o de parar o uso de anticoncepcionais quando for diagnosticado. A cl\u00e1ssica cicatriz central e outras caracter\u00edsticas ao exame de imagem possibilitam diagn\u00f3stico seguro na maioria dos pacientes. Al\u00e9m de comumente n\u00e3o causar sintomas, n\u00e3o costuma apresentar complica\u00e7\u00f5es como sangramento e nem evoluir para maligniza\u00e7\u00e3o.\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">O tratamento com cirurgia \u00e9 recomendado apenas quando h\u00e1 sintomas, d\u00favidas no diagn\u00f3stico apesar dos exames, ou quando h\u00e1 suspeita de ser um adenoma, que tem mais risco de maligniza\u00e7\u00e3o ou de ter complica\u00e7\u00f5es.\u00a0<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-aafcc22 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"aafcc22\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.cirurgiahpb.com.br\/#figado\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-arrow-left\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Voltar para a p\u00e1gina inicial<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6ab7da4 elementor-widget elementor-widget-menu-anchor\" data-id=\"6ab7da4\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"adenoma\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-71b7d9b elementor-widget elementor-widget-spacer\" data-id=\"71b7d9b\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e591898 elementor-widget elementor-widget-heading\" data-id=\"e591898\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Adenoma hep\u00e1tico \n<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5b23b8d elementor-widget elementor-widget-text-editor\" data-id=\"5b23b8d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Adenoma hepatocelular \u00e9 a terceira neoplasia benigna do f\u00edgado mais prevalente. Ocorrem mais frequentemente em mulheres na idade f\u00e9rtil entre 20 e 44 anos. Tradicionalmente est\u00e3o relacionados com o uso de anticoncepcionais orais contendo estrog\u00eanios. Neste cen\u00e1rio, a incid\u00eancia \u00e9 estimada ser 30 vezes maior do que entre as que n\u00e3o fazem uso destes medicamentos e apresenta rela\u00e7\u00e3o direta com a dose e o tempo de uso. A suspens\u00e3o dos anticoncepcionais pode promover a regress\u00e3o da les\u00e3o. O Adenoma tamb\u00e9m tem sido associado ao uso de esteroides anabolizantes, doen\u00e7as gen\u00e9ticas como as de dep\u00f3sito do Glicog\u00eanio tipo I e III e mais recentemente vem sendo associado \u00e0 s\u00edndrome metab\u00f3lica e obesidade. Os adenomas em geral s\u00e3o assintom\u00e1ticos e t\u00eam bom progn\u00f3stico, mas podem <\/span><span style=\"font-weight: 400;\">apresentar complica\u00e7\u00f5es como o sangramento e a transforma\u00e7\u00e3o maligna. O adenoma costuma ser encontrado durante os exames por queixas de dor abdominal ou, ent\u00e3o, como achado incidental em exames de rotina.\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">O controle de n\u00f3dulos sem indica\u00e7\u00e3o cir\u00fargica deve ser realizado por m\u00e9todos de imagem com contraste. <\/span><span style=\"font-weight: 400;\">Como na maioria dos casos o adenoma tem menos de 5 cm<\/span> <span style=\"font-weight: 400;\">e, por isso, baixo risco de ser c\u00e2ncer e de ter complica\u00e7\u00f5es como hemorragia ou<\/span> <span style=\"font-weight: 400;\">ruptura, n\u00e3o precisa de tratamento e pode simplesmente ser acompanhado com<\/span> <span style=\"font-weight: 400;\">exames regulares.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Quando diagnosticado em mulheres, os adenomas com mais de 5 cm, por ter maior<\/span> <span style=\"font-weight: 400;\">risco de complica\u00e7\u00f5es ou de virar c\u00e2ncer, tem indica\u00e7\u00e3o de remo\u00e7\u00e3o cir\u00fargica.<\/span> <span style=\"font-weight: 400;\">Quando diagnosticado em homens, os adenomas tem maior risco de transforma\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">maligna e por esse motivo tem indica\u00e7\u00e3o de remo\u00e7\u00e3o cir\u00fargica independente do<\/span> <span style=\"font-weight: 400;\">tamanho.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e3ff837 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"e3ff837\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.cirurgiahpb.com.br\/#figado\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-arrow-left\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Voltar para a p\u00e1gina inicial<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-83e1706 elementor-widget elementor-widget-menu-anchor\" data-id=\"83e1706\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"cistos\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-223d55e elementor-widget elementor-widget-spacer\" data-id=\"223d55e\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3195913 elementor-widget elementor-widget-heading\" data-id=\"3195913\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Cistos <\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-504e2f0 elementor-widget elementor-widget-text-editor\" data-id=\"504e2f0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Les\u00f5es c\u00edsticas do f\u00edgado s\u00e3o les\u00f5es cong\u00eanitas que resultam da dilata\u00e7\u00e3o progressiva de micro-hamartomas biliares, sem comunica\u00e7\u00e3o com a \u00e1rvore biliar. Sua preval\u00eancia varia de 1,6% a 18% da popula\u00e7\u00e3o. As principais les\u00f5es c\u00edsticas do f\u00edgado s\u00e3o os cistos simples, os cistos hid\u00e1ticos, a doen\u00e7a polic\u00edstica do f\u00edgado, o cistadenoma e o cistadenocarcinoma. A maioria n\u00e3o provoca sintomas ou problemas de sa\u00fade. Eles s\u00e3o detectados acidentalmente por exames de diagn\u00f3stico por imagem. Ocasionalmente, se os cistos forem muito grandes, eles podem comprimir outros \u00f3rg\u00e3os e\/ou causar dor. Nesses casos, pode ser indicado um procedimento cir\u00fargico.\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">A grande maioria destas les\u00f5es s\u00e3o cistos simples, ou seja, tem car\u00e1ter benigno, entretanto n\u00e3o se pode deixar de avaliar a possibilidade de les\u00f5es pr\u00e9-malignas ou malignas como cistadenoma e cistadenocarcinoma.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2cf0891 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"2cf0891\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.cirurgiahpb.com.br\/#figado\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-arrow-left\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Voltar para a p\u00e1gina inicial<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5cd2d7d elementor-widget elementor-widget-spacer\" data-id=\"5cd2d7d\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e2ef0f3 elementor-widget elementor-widget-heading\" data-id=\"e2ef0f3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">NEOPLASIAS MALIGNAS<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f89fdf5 elementor-widget elementor-widget-text-editor\" data-id=\"f89fdf5\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Os tumores malignos do f\u00edgado podem ser divididos basicamente em dois tipos, os <\/span><b>tumores prim\u00e1rios <\/b><span style=\"font-weight: 400;\">cuja origem ocorre no pr\u00f3prio f\u00edgado e os <\/span><b>tumores secund\u00e1rios <\/b><span style=\"font-weight: 400;\">tamb\u00e9m chamados de met\u00e1stases hep\u00e1ticas, estes originados de tumores em outros locais. <\/span><span style=\"font-weight: 400;\">Dentre os <\/span><b>tumores prim\u00e1rios<\/b><span style=\"font-weight: 400;\">,<\/span> <span style=\"font-weight: 400;\">aqueles iniciados no<\/span> <span style=\"font-weight: 400;\">f\u00edgado, o mais comum \u00e9 o hepatocarcinoma ou carcinoma hepatocelular. Existem<\/span> <span style=\"font-weight: 400;\">tamb\u00e9m o colangiocarcinoma (originado nos dutos biliares do f\u00edgado), o<\/span> <span style=\"font-weight: 400;\">angiossarcoma (c\u00e2ncer raro que se origina nos vasos sangu\u00edneos do f\u00edgado) e o<\/span> <span style=\"font-weight: 400;\">hepatoblastoma, tumor maligno raro que atinge rec\u00e9m-nascidos e crian\u00e7as nos<\/span> <span style=\"font-weight: 400;\">primeiros anos de vida, dentre outros. Dentre os <\/span><b>tumores secund\u00e1rios<\/b><span style=\"font-weight: 400;\">,<\/span> <span style=\"font-weight: 400;\">os que<\/span> <span style=\"font-weight: 400;\">mais comumente enviam met\u00e1stases de forma isolada para o f\u00edgado s\u00e3o os tumores<\/span> <span style=\"font-weight: 400;\">originados no intestino grosso e reto. Por\u00e9m, qualquer tumor pode enviar met\u00e1stase<\/span> <span style=\"font-weight: 400;\">para o f\u00edgado, devendo ser considerada a avalia\u00e7\u00e3o do cirurgi\u00e3o para remo\u00e7\u00e3o.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-353eb18 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"353eb18\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.cirurgiahpb.com.br\/#malignas\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-arrow-left\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Voltar para a p\u00e1gina inicial<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-651ebb3 elementor-widget elementor-widget-menu-anchor\" data-id=\"651ebb3\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"carcinoma\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6f13647 elementor-widget elementor-widget-heading\" data-id=\"6f13647\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Tumores Prim\u00e1rios do F\u00edgado<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-75c555d elementor-widget elementor-widget-heading\" data-id=\"75c555d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Carcinoma Hepatocelular (CHC) \n<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bba3d2e elementor-widget elementor-widget-text-editor\" data-id=\"bba3d2e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">O carcinoma hepatocelular ocorre na maioria das vezes em um f\u00edgado previamente<\/span> <span style=\"font-weight: 400;\">doente. \u00c9 raro o aparecimento de CHC em f\u00edgado sadio, representando menos de<\/span> <span style=\"font-weight: 400;\">10% dos casos<\/span><b>.<\/b> <span style=\"font-weight: 400;\">Cerca de 50% dos pacientes com hepatocarcinoma apresentam<\/span> <span style=\"font-weight: 400;\">cirrose hep\u00e1tica, doen\u00e7a grave associada ao alcoolismo ou \u00e0 hepatite cr\u00f4nica. No<\/span> <span style=\"font-weight: 400;\">Brasil, a rela\u00e7\u00e3o entre infec\u00e7\u00e3o pelos v\u00edrus B e C da hepatite, alcoolismo cr\u00f4nico e o<\/span> <span style=\"font-weight: 400;\">aparecimento do CHC t\u00eam sido apontada por v\u00e1rios autores. A dura\u00e7\u00e3o da<\/span> <span style=\"font-weight: 400;\">hepatopatia contribui para o surgimento da doen\u00e7a, com aumento do risco ap\u00f3s 20<\/span> <span style=\"font-weight: 400;\">anos de evolu\u00e7\u00e3o.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Cirrose alco\u00f3lica e hepatite s\u00e3o as principais doen\u00e7as de f\u00edgado que levam ao<\/span> <span style=\"font-weight: 400;\">aparecimento do carcinoma hepatocelular. Por isso, \u00e9 muito importante que se fa\u00e7a<\/span> <span style=\"font-weight: 400;\">o acompanhamento correto com o hepatologista, quando existe risco de<\/span> <span style=\"font-weight: 400;\">desenvolver essas doen\u00e7as, de forma a diminuir as chances de c\u00e2ncer.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Assim, se a pessoa tiver:<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><ul><li><span style=\"font-weight: 400;\"> Hist\u00f3rico de transfus\u00f5es de sangue;<\/span><\/li><li><span style=\"font-weight: 400;\"> Tatuagens;<\/span><\/li><li><span style=\"font-weight: 400;\"> Uso de drogas injet\u00e1veis;<\/span><\/li><li><span style=\"font-weight: 400;\"> Consumo de \u00e1lcool;<\/span><\/li><li><span style=\"font-weight: 400;\"> Hist\u00f3ria na fam\u00edlia de doen\u00e7a hep\u00e1tica cr\u00f4nica como cirrose.<\/span><\/li><\/ul><p><span style=\"font-weight: 400;\">Poder\u00e1 ter risco de desenvolver doen\u00e7a do f\u00edgado e\/ou c\u00e2ncer, sendo recomendado<\/span> <span style=\"font-weight: 400;\">recorrer a um hepatologista para avaliar as chances de ter doen\u00e7a hep\u00e1tica e iniciar<\/span> <span style=\"font-weight: 400;\">o tratamento adequado, se necess\u00e1rio.<\/span> <\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-337a8aa elementor-widget elementor-widget-heading\" data-id=\"337a8aa\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Quadro Cl\u00ednico<\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d5afa3e elementor-widget elementor-widget-text-editor\" data-id=\"d5afa3e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">O CHC se apresenta com ampla gama de manifesta\u00e7\u00f5es cl\u00ednicas. A<\/span> <span style=\"font-weight: 400;\">maioria dos pacientes apresenta dor abdominal superior mal definida, que pode<\/span> <span style=\"font-weight: 400;\">irradiar-se para o ombro direito quando o tumor situa-se no lado direito do f\u00edgado;<\/span> <span style=\"font-weight: 400;\">massa ou irregularidades palp\u00e1veis; emagrecimento progressivo; perda do apetite;<\/span> <span style=\"font-weight: 400;\">adinamia e icter\u00edcia (amarel\u00e3o na pele). \u00c9 caracter\u00edstica a descompensa\u00e7\u00e3o de uma<\/span> <span style=\"font-weight: 400;\">hepatopatia pr\u00e9-existente, com aumento da ascite, hemorragia digestiva,<\/span> <span style=\"font-weight: 400;\">encefalopatia e esplenomegalia. Na avalia\u00e7\u00e3o inicial do paciente com suspeita de<\/span> <span style=\"font-weight: 400;\">CHC faz-se necess\u00e1rio avaliar a presen\u00e7a de neoplasia, hepatopatias cr\u00f4nicas<\/span> <span style=\"font-weight: 400;\">associadas e ressecabilidade. Para isso tem-se \u00e0 disposi\u00e7\u00e3o testes de fun\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">hep\u00e1tica, sorologias e exames de imagem. Complementa-se o diagn\u00f3stico com a<\/span> <span style=\"font-weight: 400;\">dosagem de marcadores tumorais que s\u00e3o exames de sangue que auxiliam no<\/span> <span style=\"font-weight: 400;\">entendimento da doen\u00e7a.<br \/><br \/><strong> Alfa-fetoprote\u00edna (AFP):<\/strong> A eleva\u00e7\u00e3o deste marcador \u00e9<\/span> <span style=\"font-weight: 400;\">encontrada na maior parte dos casos em tumores com mais de 5 cm de di\u00e2metro. A<\/span> <span style=\"font-weight: 400;\">AFP est\u00e1 acima de 20 ng\/mL em cerca de 60% a 95% dos CHC, mas somente<\/span> <span style=\"font-weight: 400;\">valores maiores 500 ng\/mL podem ser considerados espec\u00edficos de CHC. Isto se<\/span> <span style=\"font-weight: 400;\">deve ao fato de que outras afec\u00e7\u00f5es podem alterar o valor da AFP, como tumores<\/span> <span style=\"font-weight: 400;\">de c\u00e9lulas germinativas e muitas condi\u00e7\u00f5es n\u00e3o neopl\u00e1sicas incluindo cirrose,<\/span> <span style=\"font-weight: 400;\">necrose hep\u00e1tica maci\u00e7a, hepatite cr\u00f4nica, gravidez normal, sofrimento ou morte<\/span> <span style=\"font-weight: 400;\">fetal, e defeitos do tubo neural fetal, como anencefalia e espinha b\u00edfida. A AFP \u00e9<\/span> <span style=\"font-weight: 400;\">tamb\u00e9m empregada para o seguimento dos pacientes tratados por ressec\u00e7\u00e3o ou<\/span> <span style=\"font-weight: 400;\">abla\u00e7\u00e3o, pois como a regenera\u00e7\u00e3o do f\u00edgado normal n\u00e3o produz este marcador, um<\/span> <span style=\"font-weight: 400;\">valor persistentemente elevado sugere doen\u00e7a residual, e no caso de uma eleva\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">s\u00fabita ap\u00f3s um per\u00edodo de normaliza\u00e7\u00e3o dos n\u00edveis s\u00e9ricos, pode indicar recidiva da<\/span> <span style=\"font-weight: 400;\">doen\u00e7a.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d49c8f1 elementor-widget elementor-widget-heading\" data-id=\"d49c8f1\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Tratamento<\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-df40281 elementor-widget elementor-widget-text-editor\" data-id=\"df40281\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Tendo realizado o diagnostico de CHC, tem-se em m\u00e3os algumas<\/span> <span style=\"font-weight: 400;\">modalidades terap\u00eauticas poss\u00edveis de serem realizadas. Estas podem ser<\/span> <span style=\"font-weight: 400;\">cir\u00fargicas, e incluem a ressec\u00e7\u00e3o e o transplante, a abla\u00e7\u00e3o percut\u00e2nea por<\/span> <span style=\"font-weight: 400;\">radiofrequ\u00eancia ou alcooliza\u00e7\u00e3o e a quimioterapia, sist\u00eamica ou regional. A sele\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">da modalidade de tratamento vai depender dos seguintes fatores : <br \/><br \/>1. Avalia\u00e7\u00e3o do<\/span> <span style=\"font-weight: 400;\">tumor: tamanho, n\u00famero de n\u00f3dulos e localiza\u00e7\u00e3o; <br \/>2. Fun\u00e7\u00e3o hep\u00e1tica: presen\u00e7a ou<\/span> <span style=\"font-weight: 400;\">n\u00e3o de press\u00e3o da veia porta aumentada (hipertens\u00e3o portal). <br \/>3. Condi\u00e7\u00e3o geral:<\/span> <span style=\"font-weight: 400;\">avalia-se a idade, fun\u00e7\u00e3o card\u00edaca e pulmonar e outras comorbidades.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">As a\u00e7\u00f5es terap\u00eauticas ser\u00e3o expostas de acordo com esta avalia\u00e7\u00e3o, dividindo os<\/span> <span style=\"font-weight: 400;\">pacientes com CHC em oper\u00e1veis e inoper\u00e1veis. Pacientes oper\u00e1veis Doen\u00e7a<\/span> <span style=\"font-weight: 400;\">Ressec\u00e1vel: hepatectomia parcial com margens negativas ou transplante hep\u00e1tico<\/span> <span style=\"font-weight: 400;\">(somente em pacientes selecionados). A ressec\u00e7\u00e3o hep\u00e1tica \u00e9 o tratamento de<\/span> <span style=\"font-weight: 400;\">escolha em pacientes n\u00e3o cirr\u00f3ticos. O tratamento dos pacientes, se bem<\/span> <span style=\"font-weight: 400;\">selecionados \u2013 presen\u00e7a de tumor assintom\u00e1tico e boa fun\u00e7\u00e3o hep\u00e1tica \u2013 pode<\/span> <span style=\"font-weight: 400;\">atingir sobrevida em cinco anos de at\u00e9 70%. Recidivas tumorais podem ocorrer,<\/span> <span style=\"font-weight: 400;\">chegando a 50% dos casos em tr\u00eas anos, apesar da sele\u00e7\u00e3o adequada.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Os principais fatores progn\u00f3sticos s\u00e3o:<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><ul><li><span style=\"font-weight: 400;\"> Tamanho do tumor;<\/span><\/li><li><span style=\"font-weight: 400;\"> N\u00famero de n\u00f3dulos tumorais e presen\u00e7a de n\u00f3dulos sat\u00e9lites;<\/span><\/li><li><span style=\"font-weight: 400;\"> Presen\u00e7a e invas\u00e3o de c\u00e1psula;<\/span><\/li><li><span style=\"font-weight: 400;\"> Ocorr\u00eancia de cirrose associada;<\/span><\/li><li><span style=\"font-weight: 400;\"> Exist\u00eancia de \u00eambolos tumorais.<br \/><br \/><\/span><\/li><\/ul><p><span style=\"font-weight: 400;\">Atualmente empregam-se t\u00e9cnicas que visam aumentar a taxa de ressecabilidade e<\/span> <span style=\"font-weight: 400;\">radicalidade. A emboliza\u00e7\u00e3o portal 4 a 6 semanas antes da cirurgia resulta em<\/span> <span style=\"font-weight: 400;\">atrofia da \u00e1rea a ser tratada e hipertrofia do par\u00eanquima restante. Em f\u00edgados<\/span> <span style=\"font-weight: 400;\">cirr\u00f3ticos a hipertrofia pode ser insuficiente ou n\u00e3o ocorrer, conforme o grau de<\/span> <span style=\"font-weight: 400;\">fibrose. A quimioemboliza\u00e7\u00e3o tamb\u00e9m pode reduzir o volume tumoral, permitindo<\/span> <span style=\"font-weight: 400;\">melhores margens.<\/span><\/p><p><span style=\"font-weight: 400;\">Transplante hep\u00e1tico deve ser considerado para pacientes cirr\u00f3ticos com n\u00f3dulo<\/span> <span style=\"font-weight: 400;\">\u00fanico (at\u00e9 5 cm) ou at\u00e9 tr\u00eas n\u00f3dulos menores (at\u00e9 3 cm). O transplante hep\u00e1tico<\/span> <span style=\"font-weight: 400;\">oferece a possibilidade de cura do tumor em conjunto com a doen\u00e7a hep\u00e1tica<\/span> <span style=\"font-weight: 400;\">subjacente. O n\u00famero insuficiente de doadores limita o benef\u00edcio dessa terapia, j\u00e1<\/span> <span style=\"font-weight: 400;\">que o tempo de espera ideal deve ser de at\u00e9 seis meses.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c9f7351 elementor-widget elementor-widget-heading\" data-id=\"c9f7351\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Pacientes inoper\u00e1veis<\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6a7fb0b elementor-widget elementor-widget-text-editor\" data-id=\"6a7fb0b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Para os pacientes sem indica\u00e7\u00e3o cir\u00fargica, devido ao<\/span> <span style=\"font-weight: 400;\">comprometimento da fun\u00e7\u00e3o hep\u00e1tica, multiplicidade ou bilateralidade dos focos<\/span> <span style=\"font-weight: 400;\">tumorais, existe a op\u00e7\u00e3o de tratamentos percut\u00e2neos, que incluem a inje\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">percut\u00e2nea de \u00e1lcool (IPA), a abla\u00e7\u00e3o por radiofrequ\u00eancia (RFA), a crioabla\u00e7\u00e3o e a<\/span> <span style=\"font-weight: 400;\">quimioterapia.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-05a3a6a elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"05a3a6a\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.cirurgiahpb.com.br\/#tumoresmalignos\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-arrow-left\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Voltar para a p\u00e1gina inicial<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-aa67ff2 elementor-widget elementor-widget-menu-anchor\" data-id=\"aa67ff2\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"colangio\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-15451b3 elementor-widget elementor-widget-spacer\" data-id=\"15451b3\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-116bec3 elementor-widget elementor-widget-heading\" data-id=\"116bec3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Colangiocarcinoma \n<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ad00e05 elementor-widget elementor-widget-text-editor\" data-id=\"ad00e05\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Os tumores do trato biliar s\u00e3o respons\u00e1veis por menos de 1% de todos os tumores<\/span> <span style=\"font-weight: 400;\">em geral e representam em torno de 10-20% dos tumores prim\u00e1rios do f\u00edgado. S\u00e3o<\/span> <span style=\"font-weight: 400;\">mais comuns ap\u00f3s os 65 anos, com um leve predom\u00ednio no sexo masculino,<\/span> <span style=\"font-weight: 400;\">enquanto os tumores de ves\u00edcula biliar t\u00eam uma leve tend\u00eancia a acometer mais<\/span> <span style=\"font-weight: 400;\">pacientes do sexo feminino.<br \/><br \/>Colangiocarcinoma, tamb\u00e9m conhecido como c\u00e2ncer<\/span> <span style=\"font-weight: 400;\">de vias biliares, \u00e9 uma forma de c\u00e2ncer que se forma nos ductos biliares. O<\/span> <span style=\"font-weight: 400;\">colangiocarcinoma pode afetar qualquer \u00e1rea dos ductos biliares, dentro ou fora do<\/span> <span style=\"font-weight: 400;\">f\u00edgado. Os tumores que ocorrem nos ductos biliares dentro do f\u00edgado s\u00e3o referidos<\/span> <span style=\"font-weight: 400;\">como <\/span><i><span style=\"font-weight: 400;\">intra-hep\u00e1ticos<\/span><\/i><span style=\"font-weight: 400;\">,<\/span> <span style=\"font-weight: 400;\">os que ocorrem nos ductos fora do \u00f3rg\u00e3o s\u00e3o <\/span><i><span style=\"font-weight: 400;\">extra-hep\u00e1ticos<\/span><\/i> <span style=\"font-weight: 400;\">e os tumores que ocorrem no local onde os ductos biliares saem do f\u00edgado podem<\/span> <span style=\"font-weight: 400;\">ser referidos como <\/span><i><span style=\"font-weight: 400;\">peri-hilares<\/span><\/i><span style=\"font-weight: 400;\">.<\/span> <span style=\"font-weight: 400;\">Um colangiocarcinoma ocorrendo na jun\u00e7\u00e3o onde os<\/span> <span style=\"font-weight: 400;\">ductos hep\u00e1ticos esquerdo e direito se encontram para formar o ducto hep\u00e1tico<\/span> <span style=\"font-weight: 400;\">comum pode ser referido de forma epon\u00edmica como um tumor de Klatskin.<\/span> <span style=\"font-weight: 400;\">Baseando-se na localiza\u00e7\u00e3o anat\u00f4mica, podem ser classificados como<\/span> <span style=\"font-weight: 400;\">intra-hep\u00e1tico (CCAi, 10%), perihilar (CCAp, &gt; 70%) ou distal (CCAd, 25%). Os<\/span> <span style=\"font-weight: 400;\">CCAi podem ocorrer em um f\u00edgado normal ou com doen\u00e7a de base.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Os sintomas da doen\u00e7a podem incluir dor abdominal, pele amarelada, perda de<\/span> <span style=\"font-weight: 400;\">peso, prurido generalizado e febre. Tamb\u00e9m podem ocorrer fezes esbranqui\u00e7adas<\/span> <span style=\"font-weight: 400;\">ou urina escura. Os fatores de risco incluem colangite esclerosante prim\u00e1ria (uma<\/span> <span style=\"font-weight: 400;\">doen\u00e7a inflamat\u00f3ria dos ductos biliares), colite ulcerativa, cirrose, hepatite C, <\/span><span style=\"font-weight: 400;\">hepatite B, infec\u00e7\u00e3o por certos parasitas de f\u00edgado e algumas malforma\u00e7\u00f5es<\/span> <span style=\"font-weight: 400;\">cong\u00eanitas do \u00f3rg\u00e3o. No entanto, a maioria das pessoas n\u00e3o possui fatores de risco<\/span> <span style=\"font-weight: 400;\">identific\u00e1veis. Suspeita-se do diagn\u00f3stico com base em uma combina\u00e7\u00e3o de<\/span> <span style=\"font-weight: 400;\">exames de sangue, imagiologia m\u00e9dica, endoscopia e, \u00e0s vezes, explora\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">cir\u00fargica. A doen\u00e7a \u00e9 confirmada pelo exame de c\u00e9lulas do tumor em microsc\u00f3pio.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Nos est\u00e1gios iniciais usualmente os pacientes s\u00e3o assintom\u00e1ticos. Nos est\u00e1gios<\/span> <span style=\"font-weight: 400;\">mais avan\u00e7ados os pacientes podem apresentar sintomas como perda de <\/span><span style=\"font-weight: 400;\">peso,<\/span> <span style=\"font-weight: 400;\">mal-estar, desconforto abdominal, icter\u00edcia, hepatomegalia e at\u00e9 massa<\/span> <span style=\"font-weight: 400;\">abdominal palp\u00e1vel. A obstru\u00e7\u00e3o biliar raramente ocorre nos CCAi, sendo<\/span> <span style=\"font-weight: 400;\">frequentemente o primeiro sintoma nos perihilares e distais.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Nos casos de CCAi, \u00e9 usual a apresenta\u00e7\u00e3o de uma massa hep\u00e1tica, em<\/span> <span style=\"font-weight: 400;\">exames de imagem.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">As indica\u00e7\u00f5es f\u00edsicas mais comuns de colangiocarcinoma s\u00e3o testes de fun\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">hep\u00e1tica anormais (amarelecimento dos olhos e da pele que ocorre quando os<\/span> <span style=\"font-weight: 400;\">ductos biliares s\u00e3o bloqueados pelo tumor), icter\u00edcia, dor abdominal (30%\u201350%),<\/span> <span style=\"font-weight: 400;\">prurido generalizado (66%), perda de peso (30%\u201350%), febre (at\u00e9 20%) e<\/span> <span style=\"font-weight: 400;\">altera\u00e7\u00f5es na cor das fezes ou da urina.<br \/><br \/>At\u00e9 certo ponto, os sintomas dependem da<\/span> <span style=\"font-weight: 400;\">localiza\u00e7\u00e3o do tumor: pacientes com colangiocarcinoma nos ductos biliares<\/span> <span style=\"font-weight: 400;\">extra-hep\u00e1ticos (fora do f\u00edgado) s\u00e3o mais propensos a ter icter\u00edcia, enquanto<\/span> <span style=\"font-weight: 400;\">aqueles com tumores dos ductos biliares dentro do f\u00edgado mais frequentemente t\u00eam<\/span> <span style=\"font-weight: 400;\">dor sem icter\u00edcia.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ecc4531 elementor-widget elementor-widget-heading\" data-id=\"ecc4531\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Exames <\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3a0aa07 elementor-widget elementor-widget-text-editor\" data-id=\"3a0aa07\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">N\u00e3o h\u00e1 exames de sangue espec\u00edficos que possam<\/span> <span style=\"font-weight: 400;\">diagnosticar o colangiocarcinoma por si s\u00f3. Os n\u00edveis s\u00e9ricos de ant\u00edgeno<\/span> <span style=\"font-weight: 400;\">carcinoembrion\u00e1rio e CA19-9 s\u00e3o frequentemente elevados, mas n\u00e3o s\u00e3o sens\u00edveis<\/span> <span style=\"font-weight: 400;\">ou espec\u00edficos o suficiente para serem usados como ferramenta geral de triagem.<\/span> <span style=\"font-weight: 400;\">No entanto, eles podem ser \u00fateis em conjunto com m\u00e9todos de imagem no apoio a<\/span> <span style=\"font-weight: 400;\">um diagn\u00f3stico suspeito de colangiocarcinoma.<\/span><\/p><p><span style=\"font-weight: 400;\">As caracter\u00edsticas do exame de imagem s\u00e3o frequentemente sugestivas do<\/span> <span style=\"font-weight: 400;\">diagn\u00f3stico, mas n\u00e3o definitivas. A bi\u00f3psia hep\u00e1tica eventualmente pode auxiliar na<\/span> <span style=\"font-weight: 400;\">decis\u00e3o. Em pacientes com proposta de ressec\u00e7\u00e3o prim\u00e1ria da les\u00e3o n\u00e3o existe a<\/span> <span style=\"font-weight: 400;\">necessidade de confirma\u00e7\u00e3o histol\u00f3gica antes do procedimento.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Exames como tomografia computadorizada de abd\u00f4men, resson\u00e2ncia magn\u00e9tica,<\/span> <span style=\"font-weight: 400;\">resson\u00e2ncia magn\u00e9tica com colangiopancreatografia podem ser \u00fateis no racioc\u00ednio<\/span> <span style=\"font-weight: 400;\">diagn\u00f3stico e plano terap\u00eautico.<\/span> <\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-22b8fd5 elementor-widget elementor-widget-heading\" data-id=\"22b8fd5\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Tratamentos<\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4f0b51b elementor-widget elementor-widget-text-editor\" data-id=\"4f0b51b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">O tratamento cir\u00fargico varia de acordo com a localiza\u00e7\u00e3o de origem do tumor. <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\"><strong>CCAi<\/strong>: a cirurgia radical com completa remo\u00e7\u00e3o da doen\u00e7a com margens<\/span> <span style=\"font-weight: 400;\">microsc\u00f3picas negativas (R0) e preserva\u00e7\u00e3o de um adequado volume<\/span> <span style=\"font-weight: 400;\">remanescente \u00e9 o objetivo. O transplante hep\u00e1tico ainda \u00e9 controverso, n\u00e3o<\/span> <span style=\"font-weight: 400;\">havendo indica\u00e7\u00e3o fora de estudos controlados. A remo\u00e7\u00e3o de linfonodos<\/span> <span style=\"font-weight: 400;\">clinicamente suspeitos \u00e9 mandat\u00f3ria. Estudos t\u00eam demonstrado que a presen\u00e7a de<\/span> <span style=\"font-weight: 400;\">doen\u00e7a nodal \u00e9 um poderoso preditor de sobrevida. Segundo guidelines europeus e<\/span> <span style=\"font-weight: 400;\">americanos, dado esse forte papel progn\u00f3stico, a linfadenectomia deve ser<\/span> <span style=\"font-weight: 400;\">fortemente considerada no momento da cirurgia de todos os CCA. <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\"><strong>CCAp (Klatskin)<\/strong>: A drenagem biliar pr\u00e9-operat\u00f3ria n\u00e3o \u00e9 recomendada de rotina,<\/span> <span style=\"font-weight: 400;\">devendo ser discutida em equipe multidisciplinar, levando-se em considera\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">comorbidades, n\u00edveis de bilirrubinas e estado nutricional. Devido \u00e0 localiza\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">anat\u00f4mica do ducto esquerdo (mais alongado antes da segmenta\u00e7\u00e3o) usualmente a<\/span> <span style=\"font-weight: 400;\">cirurgia \u00e9 uma hepatectomia direita estendida para o segmento IV, incluindo o I, o<\/span> <span style=\"font-weight: 400;\">que usualmente requer emboliza\u00e7\u00e3o portal (nesse caso deve-se drenar a via biliar<\/span> <span style=\"font-weight: 400;\">do lado que fica antes). A ressec\u00e7\u00e3o vascular do hilo \u00e9 poss\u00edvel, por\u00e9m afeta o<\/span> <span style=\"font-weight: 400;\">progn\u00f3stico. Transplante hep\u00e1tico nos casos de doen\u00e7a irressec\u00e1vel tem sido<\/span> <span style=\"font-weight: 400;\">explorado em um contexto multidisciplinar com restritos crit\u00e9rios de sele\u00e7\u00e3o e<\/span> <span style=\"font-weight: 400;\">associado \u00e0 terapia neoadjuvante. A \u00fanica situa\u00e7\u00e3o em que a ressec\u00e7\u00e3o hep\u00e1tica<\/span> <span style=\"font-weight: 400;\">pode n\u00e3o ser requerida no CCAp \u00e9 no tipo I, pela classifica\u00e7\u00e3o de Bismuth-Corlette,<\/span> <span style=\"font-weight: 400;\">ou seja, tumores no 1\/3 m\u00e9dio do col\u00e9doco.<\/span><\/p><p><span style=\"font-weight: 400;\"><strong>CCAd<\/strong>: requer a remo\u00e7\u00e3o da cabe\u00e7a pancre\u00e1tica por meio de uma<\/span> <span style=\"font-weight: 400;\">duodenopancreatectomia cef\u00e1lica com extens\u00e3o da ressec\u00e7\u00e3o do ducto biliar at\u00e9 a<\/span> <span style=\"font-weight: 400;\">regi\u00e3o perihilar e linfadenectomia regional.<br \/><\/span><\/p><p><span style=\"font-weight: 400;\"><strong>Terapias locorregionais<\/strong>: As terapias locorregionais s\u00e3o consideradas nos casos de<\/span> <span style=\"font-weight: 400;\">tumores irressec\u00e1veis e com o objetivo de aliviar sintomas, podendo ter efeito<\/span> <span style=\"font-weight: 400;\">positivo na sobrevida. Por\u00e9m, poucos estudos t\u00eam avaliado a efic\u00e1cia dessas<\/span> <span style=\"font-weight: 400;\">terapias at\u00e9 o momento. A radioterapia tem sido recomendada para al\u00edvio parcial ou<\/span> <span style=\"font-weight: 400;\">completo da dor e da obstru\u00e7\u00e3o biliar nos casos de CCAi irressec\u00e1vel.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\"><strong>Terapias sist\u00eamicas<\/strong>: As altas taxas de recorr\u00eancia local e distante, ap\u00f3s a<\/span> <span style=\"font-weight: 400;\">ressec\u00e7\u00e3o, justificam a considera\u00e7\u00e3o de terapia com quimioterapia em alguns casos<\/span> <span style=\"font-weight: 400;\">ap\u00f3s a cirurgia. Em uma metan\u00e1lise recente, quimioterapia adjuvante ou<\/span> <span style=\"font-weight: 400;\">quimiorradioterapia parecem oferecer benef\u00edcio aos pacientes com linfonodos<\/span> <span style=\"font-weight: 400;\">positivos ou com margens comprometidas (R1).<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\"><strong>Tratamento da doen\u00e7a avan\u00e7ada ou metast\u00e1tica<\/strong>: tratamento com quimioterapia (Gencitabina e cisplatina) se mant\u00eam como tratamento padr\u00e3o de primeira linha para colangiocarcinoma avan\u00e7ado. <br \/><\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-94fab49 elementor-widget elementor-widget-heading\" data-id=\"94fab49\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Tumores secund\u00e1rios do f\u00edgado: Met\u00e1stases <\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1ecc12a elementor-widget elementor-widget-text-editor\" data-id=\"1ecc12a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Tumores metast\u00e1ticos (secund\u00e1rios) do f\u00edgado s\u00e3o mais comuns que os tumores<\/span> <span style=\"font-weight: 400;\">hep\u00e1ticos prim\u00e1rios e s\u00e3o, por vezes, as primeiras manifesta\u00e7\u00f5es cl\u00ednicas de<\/span> <span style=\"font-weight: 400;\">c\u00e2nceres origin\u00e1rios em outros \u00f3rg\u00e3os. O f\u00edgado \u00e9 um lugar comum para o<\/span> <span style=\"font-weight: 400;\">surgimento de met\u00e1stases, oriundas de c\u00e2ncer em qualquer parte do corpo,<\/span> <span style=\"font-weight: 400;\">principalmente quando existe algum tipo de c\u00e2ncer no sistema digestivo, como<\/span> <span style=\"font-weight: 400;\">intestino grosso, reto, est\u00f4mago ou p\u00e2ncreas. O tipo secund\u00e1rio mais<\/span> <span style=\"font-weight: 400;\">frequentemente encontrado de forma isolada no f\u00edgado \u00e9 decorrente de tumor<\/span> <span style=\"font-weight: 400;\">maligno no intestino grosso ou no reto. Tamb\u00e9m podem ocorrer met\u00e1stases de<\/span> <span style=\"font-weight: 400;\">tumores neuroendocrinos. E por \u00faltimo, quando n\u00e3o se tratar de tumores de c\u00f3lon, <\/span><span style=\"font-weight: 400;\">nem de tumores neuroendocrinos, s\u00e3o os chamados tumores n\u00e3o-colorretais, n\u00e3o<\/span> <span style=\"font-weight: 400;\">neuroendocrinos, ou seja, todos os outros tumores.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Algumas vezes a pessoa pode n\u00e3o ter qualquer sintoma quando descobre o c\u00e2ncer<\/span><span style=\"font-weight: 400;\"> j<\/span><span style=\"font-weight: 400;\">\u00e1 metastatizado, outras vezes sintomas pouco espec\u00edficos como como dor<\/span> <span style=\"font-weight: 400;\">abdominal, mal estar, fraqueza e perda de peso sem motivo aparente poder\u00e3o ser o<\/span> <span style=\"font-weight: 400;\">\u00fanico ind\u00edcio de um c\u00e2ncer.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9cb7eec elementor-widget elementor-widget-heading\" data-id=\"9cb7eec\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Quando suspeitar?<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8aa7537 elementor-widget elementor-widget-text-editor\" data-id=\"8aa7537\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Quando a pessoa tem sintomas como incha\u00e7o abdominal,<\/span> <span style=\"font-weight: 400;\">sangramento intestinal, olhos e pele amarelada ou perda de peso sem motivo, \u00e9<\/span> <span style=\"font-weight: 400;\">poss\u00edvel que exista alguma doen\u00e7a, e deve ser investigada. Por vezes os sintomas<\/span> <span style=\"font-weight: 400;\">s\u00e3o pouco espec\u00edficos, como fraqueza e perda de peso sem motivo, mas poder\u00e3o<\/span> <span style=\"font-weight: 400;\">ser o \u00fanico ind\u00edcio de um c\u00e2ncer. Assim, quando a pessoa tem este tipo de queixas,<\/span> <span style=\"font-weight: 400;\">deve recorrer ao m\u00e9dico e fazer uma avalia\u00e7\u00e3o adequada, com alguns exames para<\/span> <span style=\"font-weight: 400;\">tentar entender a origem do problema e, a partir da\u00ed, indicar o tratamento mais<\/span> <span style=\"font-weight: 400;\">correto.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">O tratamento de uma met\u00e1stase no f\u00edgado ser\u00e1 de acordo com o tipo de c\u00e2ncer que<\/span> <span style=\"font-weight: 400;\">a originou. Em geral, o tratamento envolve quimioterapia paliativa. Por\u00e9m, existem<\/span> <span style=\"font-weight: 400;\">casos em que o tratamento \u00e9 cir\u00fargico e pode ser curativo.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">A bi\u00f3psia hep\u00e1tica guiada por imagem fornece o diagn\u00f3stico definitivo e \u00e9 realizada<\/span> <span style=\"font-weight: 400;\">se os demais estudos forem equivocados ou insuficientes, ou ainda se a informa\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">histol\u00f3gica (p. ex., o tipo histol\u00f3gico no caso de met\u00e1stases hep\u00e1ticas) puder<\/span> <span style=\"font-weight: 400;\">determinar o plano de tratamento.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c57d939 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"c57d939\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.cirurgiahpb.com.br\/#tumoresmalignos\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-arrow-left\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Voltar para a p\u00e1gina inicial<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-afa59f5 elementor-widget elementor-widget-menu-anchor\" data-id=\"afa59f5\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"colorretal\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-be42e90 elementor-widget elementor-widget-spacer\" data-id=\"be42e90\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ca8eb60 elementor-widget elementor-widget-heading\" data-id=\"ca8eb60\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Met\u00e1tases de origem colorretal<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-033d7cb elementor-widget elementor-widget-text-editor\" data-id=\"033d7cb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">O tipo secund\u00e1rio mais frequentemente<\/span> <span style=\"font-weight: 400;\">encontrado de forma isolada no f\u00edgado \u00e9 decorrente de tumor maligno no intestino<\/span> <span style=\"font-weight: 400;\">grosso ou no reto, s\u00e3o as chamadas met\u00e1stases de origem colorretal. <\/span><span style=\"font-weight: 400;\">O tratamento<\/span> <span style=\"font-weight: 400;\">depende da extens\u00e3o da doen\u00e7a metast\u00e1tica. Com met\u00e1stases solit\u00e1rias ou em<\/span> <span style=\"font-weight: 400;\">pequeno n\u00famero, localizadas apenas no f\u00edgado, a cirurgia para remo\u00e7\u00e3o pode ser<\/span> <span style=\"font-weight: 400;\">realizada. Em se tratando de c\u00e2ncer colorretal, a ressec\u00e7\u00e3o cir\u00fargica pode prolongar<\/span> <span style=\"font-weight: 400;\">a sobrevida ou at\u00e9 mesmo curar a doen\u00e7a. Dependendo das caracter\u00edsticas do <\/span><span style=\"font-weight: 400;\">tumor prim\u00e1rio e das met\u00e1stases, quimioterapia sist\u00eamica reduz a massa tumoral e<\/span> <span style=\"font-weight: 400;\">pode ser associada a ressec\u00e7\u00e3o cir\u00fargica.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Nesses casos, a met\u00e1stases pode ser diagnosticada ao mesmo tempo que o tumor<\/span> <span style=\"font-weight: 400;\">origin\u00e1rio ou at\u00e9 mesmo muitos meses depois do tratamento do tumor colorretal.<\/span> <span style=\"font-weight: 400;\">Dependendo do momento do diagn\u00f3stico tem-se diferentes op\u00e7\u00f5es de tratamento. \u00c9<\/span> <span style=\"font-weight: 400;\">importante que o paciente seja tratado por uma equipe multidisciplinar, ou seja,<\/span> <span style=\"font-weight: 400;\">v\u00e1rios especialistas se re\u00fanem para analisar o caso e tomar a melhor decis\u00e3o, de<\/span> <span style=\"font-weight: 400;\">forma individualizada, somando-se o conhecimento de cada especialista. Existem<\/span> <span style=\"font-weight: 400;\">v\u00e1rias op\u00e7\u00f5es de tratamento. Pode-se operar primeiro o tumor origin\u00e1rio do<\/span> <span style=\"font-weight: 400;\">intestino, depois fazer quimioterapia e depois operar a met\u00e1stases. Pode-se inverter<\/span> <span style=\"font-weight: 400;\">e operar primeiro a met\u00e1stase, depois a quimio e depois o tumor origin\u00e1rio do c\u00f3lon.<\/span> <span style=\"font-weight: 400;\">A op\u00e7\u00e3o de tratar primeiro a met\u00e1stase e depois o tumor origin\u00e1rio do intestino \u00e9<\/span> <span style=\"font-weight: 400;\">uma op\u00e7\u00e3o mais recentemente proposta pela literatura e tem apresentado \u00f3timos<\/span> <span style=\"font-weight: 400;\">resultados. Em alguns casos a alternativa \u00e9 a quimioterapia sist\u00eamica, sem<\/span> <span style=\"font-weight: 400;\">ressec\u00e7\u00e3o cir\u00fargica ou radioterapia ou at\u00e9 mesmo quimioterapia isoladamente.<\/span> <span style=\"font-weight: 400;\">Sempre se deve ter em mente que a decis\u00e3o sobre o melhor tratamento a ser<\/span> <span style=\"font-weight: 400;\">proposto deve ser tomada por uma equipe multidisciplinar e de forma<\/span> <span style=\"font-weight: 400;\">individualizada, ou seja, cada paciente deve ser analisado detalhadamente para se<\/span> <span style=\"font-weight: 400;\">chegar ao melhor tratamento para aquele indiv\u00edduo.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d457268 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"d457268\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.cirurgiahpb.com.br\/#tumoresmalignos\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-arrow-left\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Voltar para a p\u00e1gina inicial<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-80beef4 elementor-widget elementor-widget-menu-anchor\" data-id=\"80beef4\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"neuroendo\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8e67e9a elementor-widget elementor-widget-spacer\" data-id=\"8e67e9a\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ca8230e elementor-widget elementor-widget-heading\" data-id=\"ca8230e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Met\u00e1stases de origem neuroend\u00f3crina<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a288010 elementor-widget elementor-widget-text-editor\" data-id=\"a288010\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Os tumores neuroend\u00f3crinos<\/span> <span style=\"font-weight: 400;\">frequentemente enviam met\u00e1stases para o f\u00edgado. Nesses casos, deve ser realizada<\/span> <span style=\"font-weight: 400;\">uma avalia\u00e7\u00e3o meticulosa, no sentido de identificar quais os \u00f3rg\u00e3os est\u00e3o<\/span> <span style=\"font-weight: 400;\">envolvidos. Quando o tumor que originou a met\u00e1stase j\u00e1 tiver sido tratado, e<\/span> <span style=\"font-weight: 400;\">nenhum outro \u00f3rg\u00e3o apresentar met\u00e1stases, apenas o f\u00edgado, nesses casos existe<\/span> <span style=\"font-weight: 400;\">possibilidade de tratamento cir\u00fargico. O tratamento cir\u00fargico pode ser por ressec\u00e7\u00e3o<\/span> <span style=\"font-weight: 400;\">(remo\u00e7\u00e3o cir\u00fargica das les\u00f5es) ou por transplante hep\u00e1tico. Cada caso deve ser<\/span> <span style=\"font-weight: 400;\">estudado por uma equipe multidisciplinar, ou seja, profissionais de diferentes \u00e1reas<\/span> <span style=\"font-weight: 400;\">(cirurgi\u00f5es, oncologistas, radiologistas, hepatologistas, radioterapeutas) que se<\/span> <span style=\"font-weight: 400;\">re\u00fanem para discutir cada caso, e, especialmente, que envolva profissionais<\/span> <span style=\"font-weight: 400;\">treinados em cirurgias do f\u00edgado.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b9a1cb9 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"b9a1cb9\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.cirurgiahpb.com.br\/#tumoresmalignos\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-arrow-left\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Voltar para a p\u00e1gina inicial<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0d4db83 elementor-widget elementor-widget-menu-anchor\" data-id=\"0d4db83\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"ncnne\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0735789 elementor-widget elementor-widget-spacer\" data-id=\"0735789\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fbd978e elementor-widget elementor-widget-heading\" data-id=\"fbd978e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Met\u00e1stases de origem N\u00e3o-colorretal, N\u00e3o-neuroendocrina (NCNNE)<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b09f5a0 elementor-widget elementor-widget-text-editor\" data-id=\"b09f5a0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Quando<\/span> <span style=\"font-weight: 400;\">se tratar de met\u00e1stases que n\u00e3o se originaram de tumor do c\u00f3lon, nem de tumores<\/span> <span style=\"font-weight: 400;\">neuroendocrinos, s\u00e3o as chamadas met\u00e1stases hep\u00e1ticas de tumores<\/span> <span style=\"font-weight: 400;\">n\u00e3o-colorretais, n\u00e3o neuroendocrinos, ou seja, todos os outros tumores.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">Nesses casos, deve ser realizada uma avalia\u00e7\u00e3o meticulosa, no sentido de<\/span> <span style=\"font-weight: 400;\">identificar quais os \u00f3rg\u00e3os est\u00e3o envolvidos. Quando o tumor que originou a<\/span> <span style=\"font-weight: 400;\">met\u00e1stase j\u00e1 tiver sido tratado, e nenhum outro \u00f3rg\u00e3o apresentar met\u00e1stases,<\/span> <span style=\"font-weight: 400;\">apenas o f\u00edgado, nesses casos existe possibilidade de tratamento cir\u00fargico. O papel<\/span> <span style=\"font-weight: 400;\">da ressec\u00e7\u00e3o hep\u00e1tica em casos de met\u00e1stases n\u00e3o colorretais, n\u00e3o<\/span> <span style=\"font-weight: 400;\">neuroend\u00f3crinas permanece mal definido, embora as taxas de sobrevida dos<\/span> <span style=\"font-weight: 400;\">pacientes operados chegam a 42% em 5 anos tenham sido relatadas. O grande<\/span> <span style=\"font-weight: 400;\">desafio \u00e9 estabelecer quais os pacientes devem ser ressecados. V\u00e1rios fatores<\/span> <span style=\"font-weight: 400;\">foram identificados para definir melhor as indica\u00e7\u00f5es cir\u00fargicas, incluindo aqueles<\/span> <span style=\"font-weight: 400;\">associados ao tumor prim\u00e1rio, \u00e0s met\u00e1stases hep\u00e1ticas e aos resultados cir\u00fargicos<\/span> <span style=\"font-weight: 400;\">institucionais. Cada caso deve ser estudado por uma equipe multidisciplinar, ou<\/span> <span style=\"font-weight: 400;\">seja, profissionais de diferentes \u00e1reas (cirurgi\u00f5es, oncologistas, radiologistas,<\/span> <span style=\"font-weight: 400;\">hepatologistas, radioterapeutas) que se re\u00fanem para discutir cada caso, e,<\/span> <span style=\"font-weight: 400;\">especialmente, que envolva profissionais treinados em cirurgias do f\u00edgado.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-604e720 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"604e720\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.cirurgiahpb.com.br\/#tumoresmalignos\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-arrow-left\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Voltar para a p\u00e1gina inicial<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e275eea elementor-widget elementor-widget-spacer\" data-id=\"e275eea\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-af51dba elementor-widget elementor-widget-heading\" data-id=\"af51dba\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Refer\u00eancias<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f0a723f elementor-widget elementor-widget-text-editor\" data-id=\"f0a723f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">&#8211; Diagnostico e tratamento de n\u00f3dulos hep\u00e1ticos benignos Recomenda\u00e7\u00f5es da<\/span> <span style=\"font-weight: 400;\">Sociedade Brasileira de Hepatologia &#8211; SBH<\/span> <span style=\"font-weight: 400;\">https:\/\/sbhepatologia.org.br\/pdf\/recomendacoes_nodulos_hepaticos_2.pdf<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">&#8211; Carcinoma hepatocelular: um panorama cl\u00ednico. Rev Bras Clin Med,<\/span> <span style=\"font-weight: 400;\">2010;8:59-67<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">&#8211; ESMO consensus guidelines for the management of patients with metastatic<\/span> <span style=\"font-weight: 400;\">colorectal cancer. Annals of Oncology 27: 1386\u20131422, 2016<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">&#8211; Diretrizes Oncol\u00f3gicas: Colangiocarcinoma. <\/span><span style=\"font-weight: 400;\">Lucchese AM, Oliveira AF,<\/span> <span style=\"font-weight: 400;\">Laporte GA, Kalil AN, Santos MTM, SSouza e Silva JT, Correa TS. In:<\/span><\/p><p><span style=\"font-weight: 400;\">https:\/\/diretrizesoncologicas.com.br\/wp-content\/uploads\/2018\/10\/Diretrizes-on<\/span> <span style=\"font-weight: 400;\">col%C3%B3gicas-2_Parte15.pdf<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p><p><span style=\"font-weight: 400;\">&#8211; Neoadjuvant chemotherapy response influences outcomes in non-colorectal,<\/span> <span style=\"font-weight: 400;\">non-neuroendocrine liver metastases. A. M. Lucchese1,2 , A. N. Kalil2, A.<\/span> <span style=\"font-weight: 400;\">Ruiz1, V. Karam1, O. Ciacio1, G. Pittau1, D. Castaing1, D. Cherqui1, A. Sa<\/span> <span style=\"font-weight: 400;\">Cunha1, E. Vibert1 and R. Adam1<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-6a79e54\" data-id=\"6a79e54\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u00cdndice F\u00cdGADO Os n\u00f3dulos hep\u00e1ticos s\u00e3o tumores localizados no f\u00edgado. Eles podem ser malignos ou benignos. Em ambas as situa\u00e7\u00f5es, s\u00e3o pass\u00edveis de tratamento. A diferencia\u00e7\u00e3o entre os dois tipos \u00e9 fundamental, para permitir o adequado tratamento. NEOPLASIAS BENIGNAS Os tumores hep\u00e1ticos benignos podem ser classificados de acordo com as suas origens. \u00c9 importante diferenciar [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Patologias do F\u00edgado - Cirurgia HPB<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.cirurgiahpb.com.br\/patologias-do-figado\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Patologias do F\u00edgado - Cirurgia HPB\" \/>\n<meta property=\"og:description\" content=\"\u00cdndice F\u00cdGADO Os n\u00f3dulos hep\u00e1ticos s\u00e3o tumores localizados no f\u00edgado. 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