Gynecologic Cancer (eBook)

CONTENTS 12
FOREWORD --- Maurie Markman, 8
PREFACE 9
CONTRIBUTORS 14
1 MULTIDISCIPLINARY CARE OF PATIENTS WITH GYNECOLOGIC CANCER S --- David M. Gershenson, John J. Kavanagh, Patricia J. Eifel, and Elvio G. Silva 17
Chapter Overview 17
Introduction 17
Organization of Multidisciplinary Clinical Trial Research 18
Gynecologic Oncology Multidisciplinary Planning Conference 19
Gynecologic Oncology Multidisciplinary Planning Clinic 19
Gynecologic Cancer Practice Guidelines 20
2 PREVENTION AND EARLY DETECTION OF ENDOMETRIAL AND OVARIAN CANCERS --- Karen H. Lu 28
Chapter Overview 28
Introduction 29
Endometrial Cancer 29
Prevention for Women at Average Risk 29
Prevention and Screening for Women with Lynch Syndrome 29
Prevention and Screening for Women Taking Tamoxifen 30
Prevention and Screening for Obese Women 31
Ovarian Cancer 31
Prevention and Screening for Women with Hereditary Breast-Ovarian Cancer Syndrome 32
Summary 34
3 PREINVASIVE DISEASE OF THE LOWER GENITAL TRACT --- Andrea Milbourne and Michele Follen 36
Chapter Overview 36
INTRODUCTION 37
EVALUATION OF PATIENTS WITH AN ABNORMAL PAP TEST RESULT 37
EVALUATION OF SPECIAL CASES 40
CONCLUSION 43
4 SELECTED TOPICS IN GYNECOLOGIC PATHOLOGY --- Anais Malpica, Michael T. Deavers, and Elvio G. Silva 46
Chapter Overview 46
Vulvar Intraepithelial Neoplasia, Simplex Type 47
P16 IN CERVICAL INTRAEPITHELIAL NEOPLASIA 48
LARGE CELL NEUROENDOCRINE CARCINOMA OF THE CERVIX 49
Endocervical Adenocarcinoma Versus Endometrial Adenocarcinoma 51
ENDOMETRIAL HYPERPLASIA AND CARCINOMA 53
DEDIFFERENTIATED ENDOMETRIOID ADENOCARCINOMA 54
GRADING OF OVARIAN SEROUS CARCINOMA 56
INVASIVE IMPLANTS OF OVARIAN SEROUS BORDERLINE TUMORS 57
MUCINOUS TUMORS OF THE OVARY 58
CELLULAR FIBROMA OF THE OVARY 60
5 IMAGING OF GYNECOLOGIC MALIGNANCIES --- Revathy Iyer 65
Chapter Overview 65
Introduction 66
Imaging Modalities 67
Cervical Cancer 69
Endometrial Cancer 71
Ovarian Cancer 73
Lymphadenopathy 76
Suggested Readings 77
6 CONTEMPORARY TREATMENT OF VAGINAL AND VULVAR CANCERS --- Patricia J. Eifel and Thomas W. Burke 80
Chapter Overview 80
Introduction 81
Epidemiology 82
Anatomy and Patterns of Spread 82
Clinical Evaluation and Staging 84
Prognostic Factors 85
Treatment of Vaginal Carcinomas 87
Treatment of Vulvar Carcinomas 93
Suggested Readings 100
7 TREATMENT OF EARLY CERVICAL CANCER --- Charles F. Levenback 103
Chapter Overview 103
Introduction 104
Clinical Presentation 104
History and Physical Examination 105
Staging 105
Impact of Histologic Subtype on Treatment Planning 108
Treatment Recommendations for Microinvasive Cervical Cancer 109
Treatment Recommendations for Stage IB1 Disease: Surgery Versus Radiotherapy 110
Treatment Recommendations for Stage IB2 Disease 113
Radical Hysterectomy for Early Cervical Cancer 113
Suggested Readings 116
8 TREATMENT OF LOCALLY ADVANCED CERVICAL CANCER --- Anuja Jhingran, Patricia J. Eifel, and Pedro T. Ramirez 118
Chapter Overview 118
Introduction 119
Clinical Evaluation 119
General Treatment Approach 120
Radiation Therapy Technique 124
Para-aortic Radiation Therapy 131
Treatment of Stage IVA Disease 134
Treatment of Locally Recurrent Disease 134
Treatment of Stage IVB Disease at Presentation or Recurrence 136
Complications of Radiation Therapy 137
Suggested Readings 139
9 UTERINE SARCOMAS --- Lois M. Ramondetta, Diane C. Bodurka, Michael T. Deavers, and Anuja Jhingran 141
Chapter Overview 142
Introduction 142
Uterine Malignant Mixed Müllerian Tumors 143
Epidemiology and Tumor Features 143
Surgical Treatment 144
Pathologic Evaluation 145
Radiation Therapy 146
Chemotherapy 147
Hormonal Therapy 148
Treatment Summary 148
Leiomyosarcoma 148
Endometrial Stromal Sarcoma 153
Undifferentiated Sarcomas 157
Adenosarcoma 157
Summary 159
Suggested Readings 160
10 TREATMENT OFENDOMETRIAL CANCER --- Lois M. Ramondetta, Thomas W. Burke, Russell Broaddus, and Anuja Jhingran 164
Chapter Overview 164
Introduction 165
Epidemiology 165
Pretreatment Evaluation 166
Surgical Treatment 168
Surgical Staging 169
Tumor Features 170
Pathologic Evaluation of the Hysterectomy Specimen 172
Adjuvant Treatme 173
Treatment of Residual Disease 177
Treatment of Recurrent Disease 182
Hormone Replacement Therapy 185
Suggested Readings 186
11 SURGERY FOR OVARIANCANCER --- Judith K. Wolf and J. Taylor Wharton 191
Chapter Overview 191
Introduction 192
Exploratory Laparotomy and Primary Tumor Debulking 192
Interval Debulking Surgery 197
Second-Look Surgery 198
Secondary Tumor Debulking 199
Surgery for Palliation 200
Summary 202
Suggested Readings 202
12 CHEMOTHERAPY FOR EPITHELIAL OVARIAN CANCER --- Michele L. Donato, Xipeng Wang, John J. Kavanagh, and David M. Gershenson 204
Chapter Overview 204
Introduction 205
Primary Chemotherapy 206
Neoadjuvant Chemotherapy 208
Intraperitoneal Chemotherapy 210
Consolidation Therapy 211
Therapeutic Strategies for Recurrent Ovarian Cancer 212
Suggested Readings 219
13 TREATMENT OF RARE OVARIAN MALIGNANCIES --- Jubilee Brown and David M. Gershenson 223
Chapter Overview 223
Introduction 224
Sex Cord–Stromal Tumors 225
General Treatment Guidelines 225
Disease-Specific Considerations 228
Germ Cell Tumors 231
Ovarian Tumors of Low Malignant Potential 237
Clinical and Pathologic Characteristics 237
Guidelines for Therapy 238
Other Uncommon Ovarian Tumors 239
Suggested Readings 240
14 GESTATIONAL TROPHOBLASTIC DISEASE --- Hui T. See, Ralph S. Freedman, Andrzej P. Kudelka, and John J. Kavanagh 242
Chapter Overview 242
Introduction 243
Epidemiology 244
Pathology 245
Clinical Presentation 246
Diagnosis 247
Staging and Prognosticating Systems 248
Treatment 249
GTTs Coexisting with Normal Pregnancies 255
Follow-up 255
Suggested Readings 258
15 FERTILITY-SPARING OPTIONS FOR TREATMENT OF WOMEN WITH GYNECOLOGIC CANCERS --- Pedro T. Ramirez 260
Chapter Overview 260
Cervix 261
Uterus 265
Ovary 267
Ovarian Cryopreservation and Transplantation 272
Conclusion 273
Suggested Readings 275
16 QUALITY OF LIFE AND SEXUAL FUNCTIONING --- Diane C. Bodurka and Charlotte C. Sun 277
Chapter Overview 277
Introduction 278
Measuring Quality of Life 278
Treatment-Related Side Effects 279
Psychosocial Concerns 282
Spirituality 282
Sexual Functioning 283
Complementary and Alternative Medicine 285
Palliative Chemotherapy 286
Palliative Surgery 287
Support Services 288
End-of-Life Issues 290
Acknowledgment 292
Suggested Readings 292
17 PALLIATIVE CARE FOR GYNECOLOGIC MALIGNANCIES --- Florian Strasser, Michael W. Bevers, and Eduardo Bruera 295
Chapter Overview 296
Introduction 296
Palliative Care Assessment 297
Management of Selected Symptoms and Syndromes in Patients with Advanced Cancer 302
Management of Syndromes Specific to Gynecologic Cancer 312
Talking About Cancer 315
Suggested Readings 318
INDEX 320