DESAFIOS NO TRATAMENTO DO CÂNCER DE VAGINA: PRESERVAÇÃO FUNCIONAL E CONTROLE ONCOLÓGICO
DOI:
https://doi.org/10.56238/arev8n2-018Palavras-chave:
Neoplasias Vaginais, Papillomavirus Humano, Braquiterapia, Qualidade de Vida, Saúde da Mulher, Estenose VaginalResumo
O câncer vaginal primário é uma neoplasia ginecológica rara, associada principalmente à infecção persistente pelo papilomavírus humano de alto risco, cujo manejo clínico é desafiador devido à complexidade anatômica, ao impacto funcional dos tratamentos e à ausência de diretrizes terapêuticas bem estabelecidas. Com isso, este estudo teve como objetivo revisar as estratégias diagnósticas e terapêuticas atuais, com foco no equilíbrio entre controle oncológico e preservação funcional. Trata-se de uma revisão narrativa da literatura, realizada a partir de busca na base PubMed, incluindo estudos publicados nos últimos dez anos relacionados ao diagnóstico e tratamento do câncer vaginal. Os achados demonstram que o diagnóstico depende da confirmação histopatológica e do uso complementar de métodos de imagem para adequado estadiamento e planejamento terapêutico. O tratamento deve ser individualizado, considerando o estágio da doença, características tumorais e condições clínicas da paciente. A radioterapia representa o principal pilar terapêutico, especialmente em estágios avançados, enquanto cirurgia, laser CO₂ e terapias menos invasivas são indicadas em casos selecionados.
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Referências
ADAMS, T. S. et al. Cancer of the vagina: 2021 update. International Journal of Gynecology & Obstetrics, v. 155, n. S1, p. 19-27, 2021. DOI: https://doi.org/10.1002/ijgo.13867
ADAMS TS, MALULEKE JC, CUELLO MA. Cancer of the vagina: 2025 update. Int J Gynaecol Obstet. 2025 Sep;171 Suppl 1(Suppl 1):48-59. doi: 10.1002/ijgo.70325. Epub 2025 Jul 9. PMID: 40631450; PMCID: PMC12411808. DOI: https://doi.org/10.1002/ijgo.70325
AKEFLO L, ELMERSTIG E, BERGMARK K, DUNBERGER G. Barriers to and strategies for dealing with vaginal dilator therapy – Female pelvic cancer survivors’ experiences: A qualitative study. European Journal of Oncology Nursing, Volume 62 (2023), 102252. https://doi.org/10.1016/j.ejon.2022.102252 DOI: https://doi.org/10.1016/j.ejon.2022.102252
AUL, A. et al. Guidelines for the prevention and diagnosis of vaginal and vulvar cancers: A systematic review. Critical Reviews in Oncology/Hematology, v. 216, p. 104970, 2025. DOI: https://doi.org/10.1016/j.critrevonc.2025.104970
CHOEKOE, J. et al. Cancer of the vagina: 2025 update. International Journal of Gynecology & Obstetrics, 2025.
JHINGRAN, A. Updates in the treatment of vaginal cancer. International Journal of Gynecological Cancer, v. 32, n. 3, p. 344-351, 2022. DOI: https://doi.org/10.1136/ijgc-2021-002517
KULKARNI A, DOGRA N, ZIGRAS T. Innovations in the Management of Vaginal Cancer. Curr Oncol. 2022 Apr 27;29(5):3082-3092. doi: 10.3390/curroncol29050250. PMID: 35621640; PMCID: PMC9139564. DOI: https://doi.org/10.3390/curroncol29050250
LIU, Y. et al. HiPorfin photodynamic therapy for vaginal high-grade squamous intraepithelial lesion. Archives of Gynecology and Obstetrics, v. 310, p. 1197-1205, 2024. DOI: https://doi.org/10.1007/s00404-024-07600-4
NAUMANN, R. W. et al. Safety and Efficacy of Nivolumab Monotherapy in Recurrent or Metastatic Cervical, Vaginal, or Vulvar Carcinoma: Results From the Phase I/II CheckMate 358 Trial. Journal of Clinical Oncology, v. 37, n. 31, p. 2825-2834, 2019. DOI: https://doi.org/10.1200/JCO.19.00739
NOGUEIRA-RODRIGUES, A. et al. Comprehensive management of vulvovaginal cancers. CA: A Cancer Journal for Clinicians, 2025. DOI: https://doi.org/10.3322/caac.70014
WEI, J. et al. Comprehensive evaluation of vaginal intraepithelial neoplasia development after hysterectomy: insights into diagnosis and treatment strategies. Archives of Gynecology and Obstetrics, v. 310, p. 1-10, 2024. DOI: https://doi.org/10.1007/s00404-024-07530-1
SCHNÜRCH, Hans-Georg et al. Diagnosis, therapy and follow-up of vaginal cancer and its precursors. Guideline of the DGGG and the DKG (S2k-Level, AWMF Registry No. 032/042, October 2018). Geburtshilfe und Frauenheilkunde, v. 79, n. 10, p. 1060-1078, 2019. DOI: https://doi.org/10.1055/a-0919-4959
BOGANI, Giorgio et al. LASER treatment for women with high‐grade vaginal intraepithelial neoplasia: A propensity‐matched analysis on the efficacy of ablative versus excisional procedures. Lasers in surgery and medicine, v. 50, n. 9, p. 933-939, 2018. DOI: https://doi.org/10.1002/lsm.22941
FIASCONE, Stephen; VITONIS, Allison F.; FELDMAN, Sarah. Topical 5-fluorouracil for women with high-grade vaginal intraepithelial neoplasia. Obstetrics & Gynecology, v. 130, n. 6, p. 1237-1243, 2017. DOI: https://doi.org/10.1097/AOG.0000000000002311
DODGE, Jeffrey A. et al. Clinical features and risk of recurrence among patients with vaginal intraepithelial neoplasia. Gynecologic oncology, v. 83, n. 2, p. 363-369, 2001. DOI: https://doi.org/10.1006/gyno.2001.6401
TAINIO, Karoliina et al. Randomised trial on treatment of vaginal intraepithelial neoplasia—Imiquimod, laser vaporisation and expectant management. International journal of cancer, v. 139, n. 10, p. 2353-2358, 2016. DOI: https://doi.org/10.1002/ijc.30275
TRANOULIS, A. et al. Efficacy of 5% imiquimod for the treatment of Vaginal intraepithelial neoplasia—A systematic review of the literature and a meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, v. 218, p. 129-136, 2017. DOI: https://doi.org/10.1016/j.ejogrb.2017.09.020
PERROTTA, Myriam et al. Use of CO2 laser vaporization for the treatment of high-grade vaginal intraepithelial neoplasia. Journal of lower genital tract disease, v. 17, n. 1, p. 23-27, 2013. DOI: https://doi.org/10.1097/LGT.0b013e318259a3ec
