{"id":2276,"date":"2026-06-11T01:00:00","date_gmt":"2026-06-11T04:00:00","guid":{"rendered":"https:\/\/sevenresiduosaude.com.br\/blog\/?p=2276"},"modified":"2026-06-11T01:00:00","modified_gmt":"2026-06-11T04:00:00","slug":"pgrss-clinica-medicina-cir-oncologica-cervical-ccc-wertheim-schauta-brachy-ctv-pap","status":"publish","type":"post","link":"https:\/\/sevenresiduosaude.com.br\/blog\/pgrss-clinica-medicina-cir-oncologica-cervical-ccc-wertheim-schauta-brachy-ctv-pap\/","title":{"rendered":"PGRSS cervical: CCC, Wertheim, brachy, Pap"},"content":{"rendered":"

A regula\u00e7\u00e3o brasileira de RSS \u00e9 frequentemente subaproveitada por gestores de cl\u00ednicas de cirurgia oncol\u00f3gica cervical que reduzem PGRSS a descarte de esp\u00e9culo e gaze<\/strong>. Em 2026, h\u00e1 um cen\u00e1rio desafiador \u2014 cl\u00ednicas de cir oncol\u00f3gica cervical<\/strong> + CCC carcinoma cervical colo \u00fatero escamoso 70%+adenoCa 25%+adenoescamoso 5%<\/strong> + HPV 16\/18 alto risco oncog\u00eanico 70-80% + 31\/33\/45\/52\/58 + Gardasil 9 vacina<\/strong> + Wertheim histerectomia radical Tipo III + Schauta vaginal + Querleu-Morrow A-D classification<\/strong> + PLND linfadenectomia p\u00e9lvica + para-a\u00f3rtica<\/strong> + brachy intracavit\u00e1ria HDR Iridium-192 cilindro+colpostat+tandem-and-ovoid Fletcher+CTV high-risk EMBRACE-II<\/strong> + Pap Papanicolaou screening + colposcopia + LEEP cone+cone cl\u00e1ssico<\/strong> + bevacizumab Avastin GOG 240 + cemiplimab Libtayo EMPOWER-Cervical 1 + pembrolizumab Keytruda KEYNOTE-826\/A18 + tisotumab vedotin Tivdak InnovativeBio CD-142 ADC + atezolizumab BEATcc<\/strong> geram fluxos heterog\u00eaneos de RSS Grupo A1 (CCC escamoso+adenoCa+adenoescamoso+neuroend\u00f3crino raro+sarcoma uterino+CIN cervical intraepithelial neoplasia I\/II\/III+HSIL high-grade squamous intraepithelial lesion+ASCUS atypical squamous cells + Pap+colposcopia+LEEP) + Grupo A4 (linfa p\u00e9lvica obturador+il\u00edaca interna externa primitiva+presacral + para-a\u00f3rtica at\u00e9 bifurca\u00e7\u00e3o a\u00f3rtica) + Grupo C (Iridium-192 brachy intracavit\u00e1ria HDR after-loading + Cesium-137 LDR cl\u00e1ssico + Y-90 SIRT met\u00e1stase hep\u00e1tica raro) + Grupo E (perfuro bi\u00f3psia colposc\u00f3pica direcionada + LEEP loop electrosurgical + cone cl\u00e1ssico+frio + curetagem endocervical ECC) + Lista C5 (cisplatina Platinol+carboplatina+paclitaxel+topotecan+gencitabina+5-FU+ifosfamida+vinorelbina+irinotecan+bevacizumab Avastin Genentech VEGF GOG 240+cemiplimab Libtayo Regeneron PD-1 EMPOWER-Cervical 1+pembrolizumab Keytruda Merck KEYNOTE-826 1L PD-L1+nivolumab Opdivo CheckMate-358+tisotumab vedotin Tivdak InnovativeBio Pfizer ADC tissue factor TF+atezolizumab Tecentriq Roche+balstilimab Agenus+dostarlimab Jemperli RUBY+Gardasil 9 Merck nonavalente+Cervarix bivalente GSK).<\/p>\n

Para o gestor que opera ou planeja cl\u00ednica de cir oncol\u00f3gica cervical, \u00e9 fundamental dimensionar PGRSS espec\u00edfico desde o in\u00edcio.<\/p>\n

Os 5 fluxos oncol\u00f3gicos cervicais<\/h2>\n

Em uma opera\u00e7\u00e3o de qualquer porte, o PGRSS cervical tem 5 fluxos.<\/p>\n\n\n\n\n\n\n\n\n\n
Fluxo<\/th>\nVolume<\/th>\nFrequ\u00eancia<\/th>\nParticularidade<\/th>\n<\/tr>\n<\/thead>\n
A1 CCC+CIN+HSIL+HPV<\/td>\n5-13 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nEscamoso 70%+adeno 25%<\/td>\n<\/tr>\n
A4 PLND+para-a\u00f3rtica<\/td>\n4-12 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nWertheim+Schauta<\/td>\n<\/tr>\n
C brachy HDR Ir-192<\/td>\n0,8-2,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nFletcher+CTV+CNEN<\/td>\n<\/tr>\n
E LEEP+cone+ECC<\/td>\n0,5-1,5 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nPap+colposcopia<\/td>\n<\/tr>\n
Lista C5 imuno+ADC<\/td>\n1,5-4,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nKEYNOTE-826+Tivdak<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

A soma t\u00edpica \u00e9 11,8-33,5 kg\/dia<\/strong> em cl\u00ednica cir oncol\u00f3gica cervical m\u00e9dia porte.<\/p>\n

A1 CCC + HPV alto risco + Pap+colposcopia: o est\u00e1gio cir\u00fargico+screening<\/h2>\n

A primeira camada do PGRSS cervical \u00e9 A1. Padr\u00e3o setorial inclui (a) CCC carcinoma cervical<\/strong> com escamoso 70% mais comum + adenoCa 25% + adenoescamoso 5% + HPV 16\/18 70-80% + 31\/33\/45\/52\/58 alto risco oncog\u00eanico + estadiamento FIGO 2018 IA1-IVB; (b) HPV alto risco<\/strong> com 16+18+31+33+35+39+45+51+52+56+58+59+66+68 high-risk + Gardasil 9 Merck nonavalente 6\/11\/16\/18\/31\/33\/45\/52\/58 + Cervarix bivalente GSK + 9-26 anos preferencial; (c) screening Pap Papanicolaou<\/strong> com citologia convencional+l\u00edquida ThinPrep Hologic+SurePath BD + co-test HPV + Brasil INCA recomenda\u00e7\u00e3o 25-64 anos + EUA USPSTF 21-65; (d) colposcopia + bi\u00f3psia direcionada + LEEP\/cone<\/strong> com colposc\u00f3pio Leisegang Karl Storz+Olympus + \u00e1cido ac\u00e9tico 5%+lugol Schiller + bi\u00f3psia 4mm punch + ECC endocervical curettage + LEEP loop electrosurgical excision procedure 0,2-0,7mm fio + cone cl\u00e1ssico bisturi+CO2 laser; (e) estadiamento FIGO 2018<\/strong> Tis carcinoma in situ + IA1<3mm + IA2 3-5mm + IB1<2cm + IB2 2-4cm + IB3>4cm + IIA<4cm\/>4cm + IIB parametrium + III parede p\u00e9lvica\/hidronefrose + IV vesical\/retal\/dist\u00e2ncia + CID C53.<\/p>\n

Cl\u00ednica com A1 cervical madura garante margem R0<\/strong> + previne recidiva regional<\/strong> + otimiza FIGO 2018+HPV+screening<\/strong>. Como discutimos no post sobre vulvovaginal<\/a>, A1 cervical \u00e9 base.<\/p>\n

A4 Wertheim histerectomia radical + Schauta vaginal + Querleu-Morrow + PLND: o est\u00e1gio cir\u00fargico<\/h2>\n

A segunda camada \u00e9 t\u00e9cnica. Padr\u00e3o setorial inclui (a) Wertheim Meigs histerectomia radical Tipo III<\/strong> com \u00fatero + parametrium completo + 1\/3 superior vagina + ureter + esvaziamento PLND p\u00e9lvico bilateral + ligadura \u00fatero-ovariana + parameterectomy; (b) Schauta vaginal<\/strong> com via vaginal + parametrium incompleta + paravaginal + alternativa Wertheim + tradi\u00e7\u00e3o Coelho-Brasil; (c) Querleu-Morrow classification A-D<\/strong> com A simple\/extrafascial + B modified radical + C radical + D laterally extended endopelvic resection + nerve-sparing C1\/C2 preservar plexo hipog\u00e1strico inferior; (d) fertility-sparing trachelectomy<\/strong> com Dargent vaginal + abdominal + radical trachelectomy + paciente desejo gestacional + IB1<2cm + cerclagem permanente; (e) PLND linfadenectomia p\u00e9lvica<\/strong> com obturador + il\u00edaca interna externa primitiva + presacral + 15-25 LN dissecados + sentinela SLN ICG indocyanine green + Tc-99m + para-a\u00f3rtica indica\u00e7\u00e3o IB3+IIA2+IIB+ + estadiamento FIGO 2018 incluiu imaging.<\/p>\n

Cl\u00ednica com A4 Wertheim+PLND madura escala R0 90+%<\/strong> + escala fertility-sparing IB1<2cm<\/strong> + escala SLN sentinela ICG mapeamento<\/strong>. Conex\u00e3o com vulvovaginal IFL<\/a>.<\/p>\n

Brachy HDR Iridium-192 + RT EBRT + KEYNOTE-826 + Tivdak ADC + RUBY dostarlimab: o est\u00e1gio radio+sist\u00eamico+targeted<\/h2>\n

A terceira camada \u00e9 brachy+sist\u00eamico+targeted. Padr\u00e3o setorial inclui (a) brachy intracavit\u00e1ria HDR Iridium-192<\/strong> com cilindro vaginal + colpostat + tandem-and-ovoid Fletcher + CTV high-risk EMBRACE-II + ICRU-89 dosimetria 3D + 28-30 Gy HDR 4-6 fra\u00e7\u00f5es + EBRT preop 45-50 Gy\/25 + IGRT image-guided + IMRT intensity-modulated; (b) RT preop+p\u00f3s-op definitivo<\/strong> com 50,4 Gy em 28 fra\u00e7\u00f5es + boost 14-19 Gy + cisplatina Platinol concomitante 40 mg\/m\u00b2 weekly RTOG 90-01 + GOG 120 + KEYNOTE-A18 RT+pembrolizumab + ENGOT-cx11; (c) bevacizumab Avastin GOG 240 1L mestast\u00e1tico<\/strong> com + paclitaxel\/topotecan\/cisplatina + carboplatina+paclitaxel + OS 17m vs 13,3m placebo HR 0,71 + cemiplimab Libtayo Regeneron EMPOWER-Cervical 1 PD-1 2L OS 12,0 vs 8,5m chemo HR 0,69; (d) KEYNOTE-826\/A18 pembrolizumab Keytruda 1L 2L<\/strong> + chemo+bevacizumab PD-L1 CPS\u22651 + KEYNOTE-A18 add to RT-cisplatin definitive + tisotumab vedotin Tivdak InnovativeBio Pfizer tissue factor TF ADC innovaTV-204 ORR 24% 2L+; (e) outras mol\u00e9culas<\/strong> atezolizumab BEATcc + balstilimab Agenus + dostarlimab Jemperli GSK RUBY-1 PD-1 + nivolumab CheckMate-358 + larotrectinib NTRK Lista C5.<\/p>\n

Cl\u00ednica com brachy+KEYNOTE-826+Tivdak+RUBY madura escala brachy CTV-high risk EMBRACE-II OS 5y 70+%<\/strong> + escala KEYNOTE-A18 RT+pembro PFS HR 0,70<\/strong> + escala Tivdak ORR 24% 2L+<\/strong>. Conex\u00e3o com Lista C5<\/a>.<\/p>\n

Tr\u00eas perfis de PGRSS por capacidade cervical<\/h2>\n

Cl\u00ednica cervical s\u00f3 A1.<\/strong> 1 fluxo. Custo mensal R$ 9.000-26.000<\/strong> mas perda de A4+brachy+E+sist\u00eamico.<\/p>\n

Cl\u00ednica cervical A1 + A4 + brachy.<\/strong> 3 fluxos. Custo mensal R$ 22.000-54.000<\/strong>, captura cirurgia + radio.<\/p>\n

Cl\u00ednica cervical 5 fluxos completos.<\/strong> A1+A4+brachy+E+sist\u00eamico + integra\u00e7\u00e3o com servi\u00e7os hospitalares<\/a>. Custo mensal R$ 40.000-95.000<\/strong>, efic\u00e1cia 95%, ROI 800-2.500% via captura completa cervical + KEYNOTE-826+A18 + Tivdak ADC + Wertheim+brachy CTV-HR.<\/p>\n

Os tr\u00eas erros que aparecem em cir oncol\u00f3gica cervical<\/h2>\n

O primeiro \u00e9 a subdimensionamento brachy Iridium-192 CNEN-NN-3.05<\/strong>. Sem dosimetria 3D ICRU-89 + EMBRACE-II CTV high-risk + after-loading + IPEN\/CNEN = n\u00e3o-conformidade radioativa + risco multa + zero compliance prote\u00e7\u00e3o radiol\u00f3gica.<\/p>\n

O segundo \u00e9 a mistura A1 CCC + CIN + HSIL + HPV<\/strong>. Confunde rastreabilidade etiologia HPV alto risco oncog\u00eanico + impossibilita screening Pap+colposcopia+LEEP padronizado + risco subdiagn\u00f3stico precoce.<\/p>\n

O terceiro \u00e9 a falta de protocolo Gardasil 9 vacina\u00e7\u00e3o universal<\/strong>. Sem vacina\u00e7\u00e3o 9-26 anos preferencial + INCA recomenda\u00e7\u00e3o Brasil + zero preven\u00e7\u00e3o prim\u00e1ria HPV = sustenta carga doen\u00e7a + zero erradica\u00e7\u00e3o WHO 2030.<\/p>\n

A regula\u00e7\u00e3o de PGRSS cervical no Brasil est\u00e1 em fase de moderniza\u00e7\u00e3o t\u00e9cnica acelerada com cir oncol\u00f3gica preservadora como prioridade. As institui\u00e7\u00f5es que estruturam fluxos completos desde o in\u00edcio \u2014 alinhadas com PGRSS cl\u00ednicas especializadas<\/a> \u2014 atravessam o crescimento sem solavanco. Para gestores que precisam alinhar com gest\u00e3o paralela industrial, o portal Seven Res\u00edduos sobre servi\u00e7os completos<\/a> traz a perspectiva integrada. A INCA C\u00e2ncer Colo \u00datero<\/a> \u00e9 refer\u00eancia t\u00e9cnica nacional.<\/p>\n

Solicite cota\u00e7\u00e3o PGRSS cervical 5 fluxos oncol\u00f3gicos<\/a><\/strong> \u2014 cap\u00edtulo dedicado a A1 CCC escamoso 70%+adenoCa 25%+adenoescamoso+neuroend\u00f3crino+sarcoma uterino+HPV 16\/18 alto risco 70-80%+31\/33\/45\/52\/58+Gardasil 9 Merck+Cervarix GSK+screening Pap citologia ThinPrep Hologic+SurePath BD+co-test HPV+colposcopia+LEEP+cone+ECC+CIN I\/II\/III+HSIL+ASCUS+FIGO 2018+CID C53, A4 Wertheim Meigs Tipo III+Schauta vaginal+Querleu-Morrow A-D nerve-sparing C1\/C2+Dargent fertility-sparing trachelectomy+PLND obturador+il\u00edaca+presacral+15-25 LN+SLN sentinela ICG+Tc-99m+para-a\u00f3rtica IB3+IIA2+IIB, C brachy intracavit\u00e1ria HDR Iridium-192+cilindro+colpostat+tandem-and-ovoid Fletcher+CTV-HR EMBRACE-II+ICRU-89+EBRT 50,4 Gy\/28+boost 14-19 Gy+cisplatina concomitante RTOG 90-01+IMRT+IGRT+Cesium-137 LDR+CNEN-NN-3.05, E LEEP loop electrosurgical+cone cl\u00e1ssico bisturi+CO2 laser+ECC endocervical curettage+colposc\u00f3pio Leisegang+Olympus+\u00e1cido ac\u00e9tico+lugol Schiller+bi\u00f3psia 4mm punch, Lista C5 cisplatina Platinol+carboplatina+paclitaxel+topotecan+ifosfamida+vinorelbina+bevacizumab Avastin Genentech GOG 240 OS 17m+cemiplimab Libtayo Regeneron EMPOWER-Cervical 1 OS 12,0m+pembrolizumab Keytruda KEYNOTE-826 1L+KEYNOTE-A18 RT+atezolizumab Tecentriq BEATcc+balstilimab Agenus+dostarlimab Jemperli GSK RUBY-1+tisotumab vedotin Tivdak InnovativeBio Pfizer tissue factor TF ADC innovaTV-204 ORR 24%+nivolumab CheckMate-358+larotrectinib NTRK.<\/p>\n","protected":false},"excerpt":{"rendered":"

PGRSS oncologia cervical: CCC + Wertheim + brachy + Pap. Veja.<\/p>\n","protected":false},"author":3,"featured_media":2275,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[3019,3109,2712,2832],"class_list":["post-2276","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance-legislacao","tag-brachy","tag-cervical","tag-cirurgia-oncologica","tag-wertheim"],"_links":{"self":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2276","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/comments?post=2276"}],"version-history":[{"count":1,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2276\/revisions"}],"predecessor-version":[{"id":4361,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2276\/revisions\/4361"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media\/2275"}],"wp:attachment":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media?parent=2276"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/categories?post=2276"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/tags?post=2276"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}