Additional Information
Book Details
Abstract
Clinical Gynecologic Oncology, by Drs. Di Saia and Creasman, is the leading medical reference book geared toward helping you improve gynecologic cancer outcomes. You’ll see how to take advantage of the latest advances in early detection and improved treatment options for gynecologic cancers, especially uterine and cervical cancers, equipping you with the skills you need to provide effective and compassionate care for your patients.
- Easily identify and absorb key information with outlines beginning each chapter.
- Choose the best management plan for each patient using algorithms throughout the book.
- Stay at the forefront of your field thanks to new chapters on Genetic Counseling and Clinical Management of Inherited Disease; Molecular Genetics; and Minimally Invasive Surgery, plus sweeping updates covering all the latest advances.
- Find everything you need to face your daily challenges with appendices covering staging, screening, nutritional therapy, toxicity criteria, blood component therapy, and radiation therapy.
- Locate answers fast with a chapter organization based on cancer type and size.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Clinical Gynecologic Oncology | i | ||
| Copyright page | ii | ||
| Dedications | iii | ||
| Contributors | v | ||
| Preface | vii | ||
| Acknowledgments | ix | ||
| Table of Contents | xi | ||
| 1 Preinvasive Disease of the Cervix | 1 | ||
| Outline | 1 | ||
| Cervical Intraepithelial Neoplasia | 1 | ||
| Screening Guidelines | 1 | ||
| Epidemiology | 4 | ||
| Human Papillomavirus | 5 | ||
| Vaccines | 9 | ||
| HIV and Cervical Neoplasia | 10 | ||
| Natural History | 11 | ||
| Cytology | 13 | ||
| Pathology | 14 | ||
| Evaluation of an Abnormal Cervical Cytology | 15 | ||
| Atypical Squamous Cells | 15 | ||
| ASCUS | 15 | ||
| ASC-H | 16 | ||
| Low-Grade Squamous Intraepithelial Lesions | 17 | ||
| High-Grade Squamous Intraepithelial Lesions | 17 | ||
| Atypical Glandular Cells and Adenocarcinoma In Situ | 18 | ||
| Cervical Glandular Cell Abnormalities | 18 | ||
| Colposcopy | 19 | ||
| Treatment Options | 23 | ||
| Outpatient Management | 24 | ||
| Electrocautery | 24 | ||
| Cryosurgery | 25 | ||
| Laser surgery | 25 | ||
| Cold coagulator | 27 | ||
| Loop electrosurgical excision procedure | 27 | ||
| Conization of the cervix | 29 | ||
| Hysterectomy | 30 | ||
| Bibliography | 30.e1 | ||
| Epidemiology and Natural History | 30.e1 | ||
| Screening and Diagnosis | 30.e2 | ||
| Pathology and Cytology | 30.e3 | ||
| Management | 30.e4 | ||
| 2 Preinvasive Disease of the Vagina and Vulva and Related Disorders | 31 | ||
| Outline | 31 | ||
| Embryology | 31 | ||
| Examination and Treatment of the Female Exposed to Diethylstilbestrol | 33 | ||
| Non-Neoplastic Epithelial Disorders of the Vulva | 33 | ||
| Lichen Simplex Chronicus | 34 | ||
| Lichen Sclerosus | 35 | ||
| Lichen Planus | 37 | ||
| Diagnosis and Treatment | 37 | ||
| Lichen Simplex Chronicus | 37 | ||
| Lichen Sclerosus | 38 | ||
| Lichen Planus | 38 | ||
| Intraepithelial Neoplasia of the Vagina | 39 | ||
| Clinical Profile | 39 | ||
| Diagnosis | 40 | ||
| Management | 40 | ||
| Intraepithelial Neoplasia of the Vulva | 42 | ||
| Clinical Profile | 42 | ||
| Diagnosis | 43 | ||
| Pigmented Lesions | 45 | ||
| Management | 45 | ||
| Excision | 45 | ||
| Laser | 46 | ||
| Cavitational Ultrasonic Surgical Aspirator | 48 | ||
| Imiquimod | 48 | ||
| Bibliography | 49.e1 | ||
| Diethylstilbestrol-Related Genital Tract Anomalies | 49.e1 | ||
| Nonneoplastic Epithelial Disorders of the Vulva | 49.e1 | ||
| Intraepithelial Neoplasia of the Vagina | 49.e1 | ||
| Intraepithelial Neoplasia of the Vulva | 49.e2 | ||
| 3 Invasive Cervical Cancer | 51 | ||
| Outline | 51 | ||
| General Observations | 51 | ||
| Anatomy | 51 | ||
| Epidemiologic Studies | 52 | ||
| Clinical Profile | 52 | ||
| Human Papillomavirus | 53 | ||
| Prophylactic Vaccination | 53 | ||
| Quadravalent Vaccine | 54 | ||
| Bivalent Vaccine | 55 | ||
| Microinvasive Carcinoma of the Cervix | 56 | ||
| Clinical Profile of Invasive Cancer | 57 | ||
| Symptoms | 60 | ||
| Gross Appearance | 60 | ||
| Routes of Spread | 60 | ||
| Primary Group | 61 | ||
| Secondary Group | 61 | ||
| Glandular Tumors of the Cervix | 63 | ||
| Staging | 64 | ||
| International Federation of Gynecology and Obstetrics | 64 | ||
| Positron Emission Tomography | 65 | ||
| Surgical Staging | 68 | ||
| Treatment of Early-Stage Disease | 69 | ||
| Radical Abdominal Hysterectomy with Lymphadenectomy | 73 | ||
| Complications | 78 | ||
| Indications for Postoperative Adjuvant Therapy | 80 | ||
| Sexual Function | 82 | ||
| Nerve-Sparing Radical Hysterectomy | 82 | ||
| Sentinel Lymph Node Identification | 83 | ||
| Laparoscopic Radical Hysterectomy with Lymphadenectomy | 85 | ||
| Robotic-Assisted Laparoscopic Radical Hysterectomy with Lymphadenectomy | 86 | ||
| Fertility-Preserving Surgery for Early-Stage Tumors | 87 | ||
| Cervical Conization for Adenocarcinoma In Situ and Microinvasive Carcinoma | 87 | ||
| Vaginal Radical Trachelectomy with Laparoscopic Lymphadenectomy | 88 | ||
| Lateral Ovarian Transposition | 90 | ||
| Treatment of Locally Advanced Disease | 90 | ||
| Radiotherapy | 90 | ||
| Radium and Cesium Therapy | 91 | ||
| Interstitial Therapy | 93 | ||
| Extended Field Irradiation Therapy | 94 | ||
| Radiation and Chemotherapy | 95 | ||
| Neoadjuvant Chemotherapy | 99 | ||
| Suboptimal Treatment Situations | 99 | ||
| Neuroendocrine and Other Uncommon Tumors of the Cervix | 100 | ||
| Glassy Cell Carcinoma, Carcinosarcoma, Lymphoma, and Melanoma | 101 | ||
| Survival Results and Prognostic Factors for Early-Stage and Locally Advanced Disease | 102 | ||
| Recurrent and Advanced Carcinoma of the Cervix | 103 | ||
| Management and Prognosis | 107 | ||
| Surgical Therapy: Radical Hysterectomy | 107 | ||
| Pelvic Exenteration | 107 | ||
| Patient Selection | 109 | ||
| Morbidity and Mortality | 111 | ||
| Survival Results | 112 | ||
| Radiation | 112 | ||
| Chemotherapy | 114 | ||
| Targeted Therapies | 117 | ||
| Angiogenesis Inhibitors | 117 | ||
| Therapeutic HPV Vaccine | 119 | ||
| Bibliography | 119.e1 | ||
| General Observations | 119.e1 | ||
| Human Papillomavirus | 119.e1 | ||
| Prophylactic Vaccination | 119.e1 | ||
| Microinvasive Carcinoma of the Cervix | 119.e1 | ||
| Clinical Profile of Invasive Cancer | 119.e2 | ||
| Glandular Tumors of the Cervix | 119.e3 | ||
| Uncommon and Neuroendocrine Tumors of the Cervix | 119.e3 | ||
| Staging | 119.e4 | ||
| Treatment of Early-Stage Disease | 119.e4 | ||
| Survival Results and Prognostic Factors | 119.e8 | ||
| Postsurgical Adjuvant Therapy | 119.e9 | ||
| Radical Trachelectomy | 119.e9 | ||
| Nerve-Sparing Radical Hysterectomy | 119.e9 | ||
| Laparoscopic Radical Hysterectomy with Pelvic Lymphadenectomy | 119.e9 | ||
| Robotic-Assisted Laparoscopic Radical Hysterectomy with Pelvic Lymphadenectomy | 119.e10 | ||
| Recurrent and Advanced Carcinoma of the Cervix | 119.e10 | ||
| Locally Advanced Disease | 119.e11 | ||
| Recurrent/Metastatic/Persistent Disease | 119.e11 | ||
| Pelvic Recurrence After Suboptimal Surgery | 119.e12 | ||
| Pelvic Exenteration | 119.e12 | ||
| Nonepithelial Tumors of the Cervix (Sarcoma, Lymphoma, and Melanoma) | 119.e13 | ||
| 4 Endometrial Hyperplasia, Estrogen Therapy, and the Prevention of Endometrial Cancer | 121 | ||
| Outline | 121 | ||
| Clinical Presentation | 123 | ||
| Endometrial Hyperplasia: Pathologic Diagnostic Criteria | 124 | ||
| Management Decisions for Atypical Endometrial Hyperplasia | 126 | ||
| Management of Endometrial Hyperplasia without Atypia | 127 | ||
| Prevention of Endometrial Cancer | 128 | ||
| Benefits and Risks of Estrogen Replacement Therapy | 129 | ||
| Quality of Life, Vasomotor Symptoms, and Sexual Function | 129 | ||
| Breast Cancer | 130 | ||
| Osteoporosis | 130 | ||
| Colorectal Cancer | 132 | ||
| Cardiovascular Disease | 133 | ||
| Estrogen Replacement Therapy for Endometrial and Breast Cancer Survivors | 135 | ||
| Estrogen Replacement Therapy for the Endometrial Cancer Survivor | 135 | ||
| Hormonal Therapy for the Breast Cancer Survivor | 137 | ||
| Bibliography | 139.e1 | ||
| Clinical Presentation | 139.e1 | ||
| Endometrial Hyperplasia: Pathologic Diagnostic Criteria | 139.e1 | ||
| Management Decisions for Atypical Endometrial Hyperplasia | 139.e1 | ||
| Management of Endometrial Hyperplasia Without Atypia | 139.e2 | ||
| Prevention of Endometrial Cancer | 139.e2 | ||
| Estrogens and Endometrial Neoplasia | 139.e2 | ||
| Estrogen–Progestin Therapy | 139.e3 | ||
| Estrogens and Breast Cancer | 139.e3 | ||
| Benefits/Risks of Estrogen Replacement Therapy | 139.e5 | ||
| Estrogen Therapy for Endometrial and Breast Cancer Survivors | 139.e6 | ||
| 5 Adenocarcinoma of the Uterine Corpus | 141 | ||
| Outline | 141 | ||
| Incidence | 141 | ||
| Epidemiology | 141 | ||
| Diagnosis | 146 | ||
| Pathology | 149 | ||
| Tumor Grade | 154 | ||
| Prognostic Factors | 154 | ||
| Stage of Disease: Depth of Invasion, Cervical Involvement, Adnexal Involvement, and Nodal Metastasis | 155 | ||
| Tumor Grade | 158 | ||
| Lymphovascular Space Involvement | 158 | ||
| Tumor Size | 158 | ||
| Peritoneal Cytology | 158 | ||
| Molecular Indices | 159 | ||
| Hormone Receptors | 159 | ||
| Correlation of Multiple Prognostic Factors | 160 | ||
| Treatment | 161 | ||
| Surgical Management of Endometrial Cancer | 161 | ||
| Radiation Therapy | 166 | ||
| Chemotherapy | 168 | ||
| Drug Development | 168 | ||
| Advanced Disease | 168 | ||
| Adjuvant Therapy: High-Risk Disease | 169 | ||
| Hormones | 170 | ||
| Special Circumstances | 171 | ||
| Multiple Malignant Neoplasms | 171 | ||
| Serous Carcinoma | 172 | ||
| Follow-Up | 173 | ||
| Bibliography | 174.e1 | ||
| Incidence and epidemiology | 174.e1 | ||
| Screening And Diagnosis, Surgery, and Prognostic Factors | 174.e1 | ||
| Pathology | 174.e4 | ||
| Treatment and recurrence | 174.e4 | ||
| 6 Sarcoma of the Uterus | 175 | ||
| Outline | 175 | ||
| Classification | 175 | ||
| Incidence and Epidemiology | 176 | ||
| Carcinosarcoma | 177 | ||
| Clinical Profile | 177 | ||
| Surgical Management | 177 | ||
| Adjuvant Therapy | 179 | ||
| Management of Recurrent Disease | 180 | ||
| Leiomyosarcoma | 181 | ||
| Clinical Profile | 181 | ||
| Surgical Management | 183 | ||
| Adjuvant Therapy | 184 | ||
| Management of Recurrent Disease | 184 | ||
| Endometrial Stromal Sarcoma | 185 | ||
| Clinical Profile | 185 | ||
| Surgical Management | 186 | ||
| Adjuvant Therapy | 186 | ||
| Management of Recurrent Disease | 187 | ||
| Other Sarcomas | 187 | ||
| Bibliography | 187.e1 | ||
| Classification | 187.e1 | ||
| Incidence and Epidemiology | 187.e1 | ||
| Carcinosarcoma | 187.e1 | ||
| Leiomyosarcoma | 187.e2 | ||
| Endometrial stromal sarcoma | 187.e3 | ||
| Other Sarcoma | 187.e3 | ||
| 7 Gestational Trophoblastic Disease | 189 | ||
| Outline | 189 | ||
| Hydatidiform Mole | 190 | ||
| Epidemiology | 190 | ||
| Cytogenetics and Pathology | 191 | ||
| Presentation and Symptoms | 193 | ||
| Diagnosis | 194 | ||
| Evacuation | 195 | ||
| Risk Factors for Postmolar Gestational Trophoblastic Neoplasia | 196 | ||
| Postmolar Surveillance | 196 | ||
| Prophylactic Chemotherapy after Molar Evacuation | 197 | ||
| Coexistent Molar Pregnancy with a Normal Fetus | 197 | ||
| Gestational Trophoblastic Neoplasia | 198 | ||
| Diagnosis | 199 | ||
| “Phantom” Human Chorionic Gonadotropin | 201 | ||
| Pretherapy Evaluation | 201 | ||
| Classification and Staging | 203 | ||
| Treatment of Nonmetastatic and Low-Risk Metastatic Gestational Trophoblastic Neoplasia | 205 | ||
| High-Risk Metastatic Gestational Trophoblastic Neoplasia | 209 | ||
| Surgery | 211 | ||
| Radiation Therapy | 214 | ||
| Placental Site Trophoblastic Tumor | 216 | ||
| Other Considerations | 216 | ||
| Future Childbearing | 216 | ||
| Coexistence of Normal Pregnancy and Gestational Trophoblastic Neoplasia | 217 | ||
| Transplacental Fetal Metastases | 217 | ||
| Survivorship Issues after Successful Treatment of Gestational Trophoblastic Neoplasia | 217 | ||
| Bibliography | 218.e1 | ||
| Epidemiology and Risk Factors | 218.e1 | ||
| Moles | 218.e1 | ||
| Prophylactic chemotherapy | 218.e2 | ||
| Diagnosis of GTN | 218.e2 | ||
| Treatment | 218.e3 | ||
| Posttreatment Pregnancy | 218.e5 | ||
| Placental Site Tumors | 218.e5 | ||
| Other Considerations | 218.e5 | ||
| 8 Invasive Cancer of the Vulva | 219 | ||
| Outline | 219 | ||
| Invasive Squamous Cell Carcinoma | 220 | ||
| Histology | 220 | ||
| Clinical Presentation and Diagnosis | 220 | ||
| Location and Spread Pattern | 221 | ||
| Staging | 224 | ||
| Management | 226 | ||
| Technique of Radical Vulvectomy | 228 | ||
| Morbidity Associated with Treatment of Vulvar Carcinoma | 232 | ||
| Survival Results | 234 | ||
| Tolerance of the Elderly Patient to Therapy | 235 | ||
| Recurrence | 235 | ||
| Early Vulvar Carcinoma | 236 | ||
| Paget’s Disease | 236 | ||
| Clinical and Histologic Features | 237 | ||
| Clinical Course and Management | 238 | ||
| Melanoma | 239 | ||
| Sarcoma | 242 | ||
| Bartholin Gland Carcinoma | 243 | ||
| Basal Cell Carcinoma | 244 | ||
| Bibliography | 244.e1 | ||
| Invasive Squamous Cell Carcinoma | 244.e1 | ||
| Early Vulvar Carcinoma | 244.e3 | ||
| Paget’s Disease | 244.e3 | ||
| Melanoma | 244.e4 | ||
| Sarcoma | 244.e4 | ||
| Bartholin Gland Carcinoma | 244.e4 | ||
| Basal Cell Carcinoma | 244.e4 | ||
| 9 Invasive Cancer of the Vagina | 245 | ||
| Outline | 245 | ||
| Squamous Cell Carcinoma of the Vagina | 245 | ||
| Epidemiology | 245 | ||
| Screening | 246 | ||
| Signs and Symptoms | 247 | ||
| Diagnostic Considerations | 247 | ||
| PET/CT and Vaginal Cancer | 248 | ||
| Sentinel Lymph Node Dissection | 248 | ||
| Staging | 248 | ||
| Patterns of Spread | 248 | ||
| Prognostic Features | 250 | ||
| Management | 251 | ||
| Prevention | 251 | ||
| Stage 0 and I | 251 | ||
| Stage II to IVa | 252 | ||
| Chemotherapy | 253 | ||
| Special Considerations | 253 | ||
| Survival and Recurrence | 253 | ||
| Rare Histologies | 254 | ||
| Adenocarcinoma/Clear Cell Adenocarcinoma | 254 | ||
| Recurrent Adenocarcinoma | 256 | ||
| Malignant Melanoma | 257 | ||
| Sarcoma | 258 | ||
| Endodermal Sinus Tumor | 259 | ||
| Special Considerations | 259 | ||
| Bibliography | 259.e1 | ||
| Squamous Cell Carcinoma | 259.e1 | ||
| Adenocarcinoma/Clear Cell Adenocarcinoma | 259.e2 | ||
| Malignant Melanoma | 259.e3 | ||
| Sarcoma | 259.e3 | ||
| Endodermal Sinus Tumor | 259.e3 | ||
| 10 The Adnexal Mass | 261 | ||
| Outline | 261 | ||
| The Adnexal Mass | 261 | ||
| Evaluative Approach | 261 | ||
| Classifying the Mass | 262 | ||
| OVA1 Test | 264 | ||
| HE4 | 264 | ||
| Multimodality Approach | 264 | ||
| Differential Diagnosis | 264 | ||
| Extraovarian Adnexal Masses | 265 | ||
| Uterine Masses | 265 | ||
| Tubal Masses | 266 | ||
| Adnexal Masses of Nongynecologic Origin | 266 | ||
| Bowel | 266 | ||
| Ovarian Masses | 266 | ||
| Functional Cysts | 266 | ||
| Endometriotic Cysts | 267 | ||
| Benign Ovarian Neoplasms | 268 | ||
| Serous Cystadenoma | 268 | ||
| Mucinous Cystadenoma | 269 | ||
| Dermoid Cyst (Benign Cystic Teratoma) | 270 | ||
| Fibroma | 270 | ||
| Brenner Tumor | 271 | ||
| Management of the Adnexal Mass | 272 | ||
| Observation versus Surgery | 272 | ||
| Minimally Invasive Surgery for Adnexal Masses | 273 | ||
| Special Circumstances | 274 | ||
| Adnexal Masses in Childhood | 274 | ||
| Postmenopausal Ovary | 275 | ||
| Borderline Malignant Epithelial Ovarian Neoplasms | 277 | ||
| Fertility Preservation | 280 | ||
| Cyst Rupture/Spill of Tumor | 281 | ||
| Prophylactic versus Risk-Reducing Oophorectomy | 282 | ||
| Bibliography | 283.e1 | ||
| Adnexal Mass | 283.e1 | ||
| Benign Ovarian Tumors | 283.e1 | ||
| Adnexal Masses in Childhood | 283.e2 | ||
| Palpable or Enlarged Postmenopausal Ovary | 283.e2 | ||
| Scan-Detected Masses | 283.e2 | ||
| Borderline Malignant Epithelial Ovarian Neoplasms | 283.e3 | ||
| Management of Early Ovarian Cancer in Young Women | 283.e3 | ||
| Spill of Tumor | 283.e4 | ||
| Prophylactic Oophorectomy | 283.e4 | ||
| 11 Epithelial Ovarian Cancer | 285 | ||
| Outline | 285 | ||
| Classification | 285 | ||
| Incidence, Epidemiology, and Etiology | 286 | ||
| Familial Ovarian Cancer | 290 | ||
| Signs, Symptoms, and Attempts at Early Detection (Screening) | 292 | ||
| Diagnostic Techniques and Staging | 295 | ||
| Therapeutic Options for Primary Treatment | 299 | ||
| Borderline Malignant Epithelial Neoplasms | 299 | ||
| Treatment of Malignant Epithelial Neoplasms | 300 | ||
| Stages Ia, Ib, and Ic | 301 | ||
| Stages IIa, IIb, and IIc | 303 | ||
| Stage III | 303 | ||
| Stage IV | 304 | ||
| Maximal Surgical Effort | 304 | ||
| Role of Radiation Therapy | 310 | ||
| Radioisotopes | 312 | ||
| Chemotherapy | 312 | ||
| Clinical Trials | 312 | ||
| Dose-Intense Chemotherapy | 314 | ||
| Immunochemotherapy | 315 | ||
| Intraperitoneal Chemotherapy | 316 | ||
| Extraovarian Peritoneal Serous Papillary Carcinoma | 317 | ||
| Small Cell Carcinoma of the Ovary | 319 | ||
| Follow-Up Techniques and Treatment of Recurrences | 319 | ||
| Second-Look Operation (Reassessment Surgery) | 319 | ||
| Use of CA-125 Levels and Other Tumor Markers | 320 | ||
| Radiographic Imaging | 321 | ||
| Maintenance Therapy | 321 | ||
| Chemotherapy for Recurrent Disease and Targeted Therapies | 322 | ||
| Targeted Therapy | 324 | ||
| Surgery for Recurrent Disease | 325 | ||
| Rehabilitation | 326 | ||
| Conclusions on Management | 326 | ||
| Current Areas of Research | 328 | ||
| Bibliography | 328.e1 | ||
| Incidence, Epidemiology, and Etiology | 328.e1 | ||
| Signs, Symptoms, and Attempts at Early Detection (Screening) | 328.e2 | ||
| Borderline Malignant Epithelial Neoplasms | 328.e3 | ||
| Treatment of Malignant Epithelial Neoplasms | 328.e3 | ||
| Maximal Surgical Effort | 328.e5 | ||
| Role of Radiation Therapy and Radioisotopes | 328.e6 | ||
| Chemotherapy | 328.e7 | ||
| Intraperitoneal Chemotherapy | 328.e9 | ||
| Extraovarian Peritoneal Serous Papillary Carcinoma | 328.e10 | ||
| Small Cell Carcinoma of the Ovary | 328.e10 | ||
| Second-Look Operation (Reassessment Surgery) | 328.e10 | ||
| Use of CA-125 Levels | 328.e10 | ||
| Radiographic Imaging | 328.e11 | ||
| Maintenance Therapy | 328.e11 | ||
| Chemotherapy for Recurrent Disease and Targeted Therapies | 328.e11 | ||
| Surgery for Recurrent Disease | 328.e12 | ||
| 12 Germ Cell, Stromal, and Other Ovarian Tumors | 329 | ||
| Outline | 329 | ||
| Germ Cell Tumors | 329 | ||
| Classification | 329 | ||
| Clinical Profile | 330 | ||
| Staging | 331 | ||
| Treatment Options | 332 | ||
| Surgery | 332 | ||
| Surveillance for Stage I Tumors | 333 | ||
| Second-Look Laparotomy | 333 | ||
| Radiation Therapy | 333 | ||
| Chemotherapy | 334 | ||
| Recurrences in Germ Cell Cancer | 334 | ||
| Treatment Toxicity | 335 | ||
| Dysgerminoma | 335 | ||
| Endodermal Sinus Tumor (Yolk Sac Tumor) | 338 | ||
| Embryonal Carcinoma | 340 | ||
| Polyembryoma | 341 | ||
| Choriocarcinoma | 341 | ||
| Mixed Germ Cell Tumors | 342 | ||
| Teratoma | 342 | ||
| Mature Cystic Teratoma | 342 | ||
| Mature Solid Teratoma | 343 | ||
| Immature Teratoma | 343 | ||
| Monodermal or Highly Specialized Teratomas | 345 | ||
| Tumors of Germ Cell and Sex Cord Derivation | 346 | ||
| Gonadoblastoma | 346 | ||
| Mixed Germ Cell–Sex Cord Stromal Tumors | 346 | ||
| Tumors Derived From Special Gonadal Stroma | 347 | ||
| Classification, Clinical Profile, and Staging | 347 | ||
| Treatment | 347 | ||
| Granulosa–Stromal Cell Tumors | 348 | ||
| Thecomas | 351 | ||
| Fibromas and Sclerosing Stromal Cell Tumors | 351 | ||
| Sertoli–Leydig Cell Tumors | 352 | ||
| Sex Cord Tumor with Annular Tubules | 353 | ||
| Gynandroblastoma | 353 | ||
| Steroid Cell Neoplasms | 353 | ||
| Tumors Derived From Nonspecific Mesenchyme | 354 | ||
| Malignant Lymphoma | 354 | ||
| Metastatic Tumors to the Ovary | 354 | ||
| Malignant Ovarian Tumors in Children | 355 | ||
| Bibliography | 356.e1 | ||
| Germ Cell Tumors | 356.e1 | ||
| Tumor of Germ Cell and Sex Cord Derivation | 356.e3 | ||
| Tumors Derived from Special Gonadal Stroma | 356.e3 | ||
| Other Ovarian Tumors | 356.e4 | ||
| Malignant Ovarian Tumors in Children | 356.e5 | ||
| 13 Fallopian Tube Cancer | 357 | ||
| Outline | 357 | ||
| Incidence and Epidemiology | 357 | ||
| Molecular Biology and Genetics | 358 | ||
| Hereditary Cancer | 359 | ||
| Carcinoma in Situ | 360 | ||
| Invasive Carcinoma | 361 | ||
| Signs and Symptoms | 361 | ||
| Diagnosis | 362 | ||
| Therapy | 364 | ||
| Prognosis | 367 | ||
| Sarcomas and Other Tumors | 368 | ||
| Bibliography | 368.e1 | ||
| Incidence and Epidemiology | 368.e1 | ||
| Molecular Biology and Genetics | 368.e1 | ||
| Hereditary Cancer | 368.e1 | ||
| Carcinoma in Situ | 368.e2 | ||
| Invasive Carcinoma | 368.e2 | ||
| Sarcomas and Other Tumors | 368.e4 | ||
| 14 Breast Diseases | 369 | ||
| Outline | 369 | ||
| Anatomy of the Breast | 370 | ||
| Embryology and Development of the Breast | 372 | ||
| Pregnancy and Breast Feeding | 372 | ||
| Benign Breast Conditions | 372 | ||
| Fibrocystic Changes | 372 | ||
| Proliferative Changes | 373 | ||
| Sclerosing Lesions | 373 | ||
| Fibroadenoma | 374 | ||
| Phyllodes Tumor | 374 | ||
| Adenoma | 374 | ||
| Superficial Thrombophlebitis | 375 | ||
| Mastitis | 375 | ||
| Duct Ectasia | 375 | ||
| Fat Necrosis | 375 | ||
| Nipple Discharge | 376 | ||
| Unilateral, Spontaneous Nipple Discharge | 376 | ||
| History and Physical Examination | 376 | ||
| Mammography | 379 | ||
| Screening Interval | 379 | ||
| Breast Imaging Reporting and Data System | 380 | ||
| Diagnostic Mammography | 381 | ||
| Mammographic Lesions | 381 | ||
| Microcalcifications | 381 | ||
| Breast Ultrasound and Magnetic Resonance Imaging | 381 | ||
| Digital Mammography | 382 | ||
| Diagnostic Evaluation | 382 | ||
| Palpable Mass | 382 | ||
| Fine-Needle Aspiration or Biopsy | 383 | ||
| Needle Localization and Excision | 383 | ||
| Image-Guided Percutaneous Breast Biopsy | 383 | ||
| Stereotactic Biopsy | 384 | ||
| Ultrasound-Guided Biopsy | 384 | ||
| Tissue-Acquisition Devices | 384 | ||
| Surgical Excision/Breast Biopsy | 384 | ||
| Epidemiology of Breast Cancer | 385 | ||
| Risk Factors and Assessment | 385 | ||
| Age | 385 | ||
| Family History | 385 | ||
| Personal History | 385 | ||
| Reproductive History | 385 | ||
| Exogenous Hormone Use | 386 | ||
| Prior Exposure to Radiation Therapy | 387 | ||
| Other Factors | 387 | ||
| Relative Risk | 387 | ||
| BRCA1 and BRCA2 | 387 | ||
| Natural History | 388 | ||
| Pathology | 388 | ||
| Ductal Carcinoma in Situ | 388 | ||
| Paget’s Disease | 389 | ||
| Lobular Carcinoma in Situ | 389 | ||
| Invasive Duct Carcinoma | 389 | ||
| Infiltrating Lobular Carcinoma | 389 | ||
| Inflammatory Carcinoma | 389 | ||
| Metastases from Extramammary Tumors | 389 | ||
| Biologic Markers and Prognostic Factors | 389 | ||
| Axillary Lymph Node Status | 389 | ||
| Tumor Size | 390 | ||
| Histologic Grade | 390 | ||
| Molecular Profiling | 390 | ||
| ERs/PRs | 390 | ||
| HER2/neu | 390 | ||
| p53 | 390 | ||
| Staging of Breast Cancer Using the Tumor–Node–Metastasis System | 390 | ||
| Treatment of Breast Cancer | 390 | ||
| Surgery | 390 | ||
| Mastectomy | 390 | ||
| Breast-Conservation Therapy | 392 | ||
| Patient Selection | 394 | ||
| Management of the Axilla | 394 | ||
| Sentinel Lymph Node Biopsy | 395 | ||
| Adjuvant Therapy | 396 | ||
| Node-Positive Breast Cancer | 397 | ||
| Estrogen Receptor-Positive Breast Cancer | 398 | ||
| Ovarian Ablation | 398 | ||
| Tamoxifen | 399 | ||
| Aromatase Inhibitors | 399 | ||
| Gene Expression Assays | 400 | ||
| Metastatic Disease | 400 | ||
| High-Dose Chemotherapy | 400 | ||
| Neoadjuvant Chemotherapy | 400 | ||
| Radiation Therapy | 400 | ||
| Breast Reconstruction | 401 | ||
| Special Issues | 401 | ||
| Hereditary Breast Cancer | 401 | ||
| Pathologic Features | 401 | ||
| Stage | 401 | ||
| Treatment | 401 | ||
| Chemoprevention | 402 | ||
| Surveillance versus Prophylactic Surgery in High-Risk Patients | 403 | ||
| Conclusions | 403 | ||
| Bibliography | 403.e1 | ||
| Introduction | 403.e1 | ||
| Anatomy of the Breast | 403.e1 | ||
| Embryology and Development of the Breast | 403.e1 | ||
| Fibroadenoma | 403.e1 | ||
| History and Physical Examination | 403.e1 | ||
| Breast Ultrasound and Magnetic Resonance Imaging | 403.e1 | ||
| Mammography | 403.e1 | ||
| Diagnostic Evaluation | 403.e2 | ||
| Epidemiology of Breast Cancer | 403.e2 | ||
| Risk Factors and Assessment | 403.e2 | ||
| Relative Risk | 403.e2 | ||
| BRCA1 and BRCA2 | 403.e2 | ||
| Pathology | 403.e2 | ||
| Treatment of Breast Cancer | 403.e2 | ||
| Sentinel Lymph Node Biopsy | 403.e2 | ||
| Adjuvant Therapy | 403.e2 | ||
| Node-Positive Breast Cancer | 403.e2 | ||
| Aromatase Inhibitors | 403.e3 | ||
| Metastatic Disease | 403.e3 | ||
| Special Issues | 403.e3 | ||
| Stage | 403.e3 | ||
| Chemoprevention | 403.e3 | ||
| Surveillance vs Prophylactic Surgery in High-Risk Patients | 403.e3 | ||
| 15 Cancer in Pregnancy | 405 | ||
| Outline | 405 | ||
| Background and Epidemiology Of Cancer In Pregnancy | 405 | ||
| The More Common Solid Tumors in Pregnancy | 407 | ||
| Cervical Cancer | 407 | ||
| Human Papillomavirus in Pregnancy | 407 | ||
| Evaluation of the Papanicolaou Smear in Pregnancy | 408 | ||
| The Performance of Colposcopy in Pregnancy | 408 | ||
| The Natural History of Cervical Intraepithelial Neoplasia in Pregnancy | 409 | ||
| Conization and Related Procedures in Pregnancy | 410 | ||
| Management of Cervical Intraepithelial Neoplasia in Pregnancy | 411 | ||
| Management of Squamous Cell Abnormalities | 411 | ||
| Management of Glandular Cell Abnormalities | 412 | ||
| Intrapartum Hysterectomy | 413 | ||
| Invasive Cervical Cancer | 413 | ||
| Microinvasive Disease | 414 | ||
| Cesarean–Radical Hysterectomy with Pelvic Lymphadenectomies | 415 | ||
| Radical Trachelectomy with Lymphadenectomy | 415 | ||
| Whole-Pelvis Radiotherapy with Intracavitary Brachytherapy | 416 | ||
| Episiotomy Site Recurrence | 416 | ||
| Planned Delay of Therapy | 417 | ||
| Neoadjuvant Chemotherapy in Pregnancy | 417 | ||
| Prognosis for Patients with Cervical Cancer in Pregnancy | 419 | ||
| Obstetric Outcomes | 420 | ||
| Ovarian Cancer | 420 | ||
| Asymptomatic Adnexal Masses | 421 | ||
| Laparoscopic Management of the Ovarian Mass | 421 | ||
| Ovarian Masses Specific to Pregnancy | 423 | ||
| Histologic Types of Ovarian Tumors | 423 | ||
| Borderline Ovarian Tumors | 423 | ||
| Frankly Malignant Ovarian Tumors | 424 | ||
| Malignant Germ Cell Tumors in Pregnancy | 424 | ||
| Dysgerminoma in Pregnancy | 425 | ||
| Sex Cord–Stromal Tumors in Pregnancy | 426 | ||
| Chemotherapy for Nonepithelial Ovarian Cancer During Pregnancy | 427 | ||
| Epithelial Ovarian Cancer in Pregnancy | 427 | ||
| Chemotherapy for Epithelial Ovarian Cancer During Pregnancy | 428 | ||
| Other Types of Malignant Ovarian Tumors | 429 | ||
| Summary of the Adnexal Mass and Ovarian Cancer in Pregnancy | 429 | ||
| Breast Cancer | 429 | ||
| Presentation | 430 | ||
| Evaluation | 430 | ||
| Surgical Management | 432 | ||
| Sentinel Lymph Node Identification | 432 | ||
| Breast Reconstruction | 432 | ||
| Adjuvant Therapy | 433 | ||
| Neoadjuvant/Adjuvant Chemotherapy for PABC | 434 | ||
| Chemotherapy for Metastatic Breast Cancer | 434 | ||
| HER2/Neu Targeted Agents in Pregnancy | 434 | ||
| Hormonal Treatments for PABC | 435 | ||
| Prognosis of PABC | 435 | ||
| Lactation | 435 | ||
| Hormonal Considerations: Pregnancy Preceding Breast Cancer | 436 | ||
| Protective Effect of Human Chorionic Gonadotropin | 436 | ||
| Recent Antecedent Pregnancy | 436 | ||
| Breast Feeding | 437 | ||
| Hormonal Considerations: Pregnancy Coincident with Breast Cancer | 437 | ||
| Estrogen-Receptor and Progesterone-Receptor Status | 437 | ||
| Pregnancy Termination | 437 | ||
| Tamoxifen | 438 | ||
| Hormonal Considerations: Pregnancy Following Breast Cancer | 438 | ||
| Prophylactic Oophorectomy | 439 | ||
| Survival Among Patients with Pregnancy-Associated Breast Cancer | 439 | ||
| Evaluation and Therapeutic Modalities | 440 | ||
| Anesthesia and Surgery in the Pregnant Patient | 440 | ||
| Anesthesia | 440 | ||
| Surgery | 440 | ||
| Laparotomy | 441 | ||
| Laparoscopy | 441 | ||
| Diagnostic and Therapeutic Radiation in Pregnancy | 442 | ||
| Radiobiology | 442 | ||
| Radiation-Induced Anomalies | 442 | ||
| Diagnostic Radiology | 443 | ||
| Ionizing Radiation | 444 | ||
| Nonionizing Radiation | 444 | ||
| Radionuclides | 444 | ||
| Radiation Therapy | 445 | ||
| Radiation-Induced Carcinogenesis | 445 | ||
| Genetic Damage and Infertility | 446 | ||
| Chemotherapy | 446 | ||
| Teratology and Embryology | 446 | ||
| Transplacental Studies | 447 | ||
| Classes of Antineoplastic Agents | 448 | ||
| Antimetabolites | 448 | ||
| Alkylators | 448 | ||
| Anthracycline and Antitumor Antibiotics | 448 | ||
| Plant Alkaloids | 449 | ||
| Taxanes | 449 | ||
| Platinum Analogs | 449 | ||
| Pharmacokinetics, Sublethal Fetal Effects, and Maternal Risks | 449 | ||
| Estimating the Stillbirth Rate | 450 | ||
| Occupational Exposure | 450 | ||
| Recommendations on the Use of Chemotherapy During Pregnancy | 450 | ||
| Timing of Delivery | 452 | ||
| Breast Feeding | 452 | ||
| Long-Term Neonatal Follow-up | 452 | ||
| Supportive Therapy | 452 | ||
| Serum Tumor Markers in Pregnancy | 453 | ||
| Hematologic Malignancies in Pregnancy | 454 | ||
| Leukemia | 454 | ||
| Leukemia in Pregnancy | 455 | ||
| Chemotherapy for Acute Leukemia in Pregnancy | 455 | ||
| Acute Myeloid Leukemia | 456 | ||
| Acute Lymphoblastic Leukemia | 456 | ||
| Acute Promyelocytic Leukemia | 456 | ||
| Management of Chronic Leukemia | 457 | ||
| Chronic Myeloid Leukemia | 457 | ||
| Hairy Cell Leukemia, Multiple Myeloma, and Chronic Lymphocytic Leukemia | 458 | ||
| Hodgkin Disease | 458 | ||
| Hodgkin Disease in Pregnancy | 459 | ||
| Management of Hodgkin Disease in Pregnancy | 459 | ||
| Non-Hodgkin Lymphoma | 462 | ||
| Non-Hodgkin Lymphoma in Pregnancy | 462 | ||
| Other Tumors in Pregnancy | 464 | ||
| Melanoma | 464 | ||
| Staging of Melanoma | 464 | ||
| Melanoma in Pregnancy | 464 | ||
| Historical Series of Melanoma in Pregnancy | 465 | ||
| Contemporary Studies of Melanoma in Pregnancy | 465 | ||
| Management of Melanoma in Pregnancy | 466 | ||
| Melanoma Metastatic to the Products of Conception | 467 | ||
| Thyroid Cancer | 467 | ||
| Thyroid Cancer in Pregnancy | 468 | ||
| The Undifferentiated Lesion | 468 | ||
| Prognosis Among Pregnant Women with Thyroid Cancer | 468 | ||
| Rare Gynecologic Malignancies in Pregnancy | 470 | ||
| Vulvar Cancer | 470 | ||
| Historical Series of Vulvar Cancer in Pregnancy | 470 | ||
| Management of Vulvar Cancer in Pregnancy | 470 | ||
| Primary Invasive Vaginal Tumors | 471 | ||
| Endometrial Cancer | 472 | ||
| Fallopian Tube Cancer | 472 | ||
| Trophoblastic Tumors of the Fallopian Tube: “Ectopic” Pregnancy | 473 | ||
| Placental and Fetal Tumors | 473 | ||
| Complete Hydatidiform Mole with Coexistent Fetus | 474 | ||
| Placental and Fetal Metastases | 475 | ||
| Primary Fetal Tumors | 476 | ||
| Bibliography | 477.e1 | ||
| Background and Epidemiology | 477.e1 | ||
| Cervical Cancer in Pregnancy | 477.e1 | ||
| Ovarian Cancer in Pregnancy | 477.e2 | ||
| Breast Cancer in Pregnancy | 477.e3 | ||
| Anesthesia and Surgery | 477.e5 | ||
| Diagnostic and Therapeutic Radiation | 477.e5 | ||
| Chemotherapy | 477.e5 | ||
| Tumor Markers | 477.e6 | ||
| Hematologic Malignancies in Pregnancy | 477.e6 | ||
| Melanoma in Pregnancy | 477.e7 | ||
| Thyroid Cancer in Pregnancy | 477.e7 | ||
| Vulvar Cancer in Pregnancy | 477.e7 | ||
| Primary Invasive Vaginal Cancer in Pregnancy | 477.e7 | ||
| Endometrial Cancer in Pregnancy | 477.e8 | ||
| Fallopian Tube Cancer in Pregnancy | 477.e8 | ||
| Twin Pregnancy with Coexisting Complete Mole and Fetus | 477.e8 | ||
| Maternal Malignancy Metastatic to the Products of Conception | 477.e8 | ||
| 16 Complications of Disease and Therapy | 479 | ||
| Outline | 479 | ||
| Disease–Oriented Complications | 479 | ||
| Hemorrhage | 479 | ||
| Urinary Tract Complications | 480 | ||
| Ureteral Obstruction | 480 | ||
| Urinary Tract Fistulas | 481 | ||
| Gastrointestinal Obstruction | 482 | ||
| Gastrointestinal Fistulas | 483 | ||
| Venous Thromboembolic Complications | 483 | ||
| Risk Factors | 484 | ||
| Prophylactic Methods | 484 | ||
| Low-Dose Heparin | 484 | ||
| Low Molecular Weight Heparins | 485 | ||
| Mechanical Methods | 485 | ||
| Graduated Compression Stockings. | 485 | ||
| External Pneumatic Compression. | 485 | ||
| Integrating Evidence and Experience | 486 | ||
| Combination Prophylaxis | 486 | ||
| Management of Deep Venous Thrombosis and Pulmonary Embolism | 486 | ||
| Diagnosis of Deep Venous Thrombosis | 486 | ||
| Doppler Ultrasound. | 487 | ||
| Venogram. | 487 | ||
| Magnetic Resonance Venography. | 487 | ||
| Treatment of Deep Venous Thrombosis | 487 | ||
| Unfractionated Heparin. | 487 | ||
| Low Molecular Weight Heparin. | 487 | ||
| Oral Anticoagulants: Warfarin | 488 | ||
| Diagnosis of Pulmonary Embolism | 488 | ||
| Superior Vena Cava Syndrome | 489 | ||
| Biliary Obstruction | 489 | ||
| Treatment-Related Complications | 489 | ||
| Surgical | 489 | ||
| Intraoperative and Postoperative Hemorrhage | 489 | ||
| Intraoperative Management of Vascular Complications | 489 | ||
| Hypogastric (Internal Iliac) Artery Ligation | 490 | ||
| Management of Shock | 491 | ||
| Central Monitoring | 491 | ||
| Intraoperative Genitourinary Injuries | 492 | ||
| Postoperative Urinary Tract Injury | 493 | ||
| Bladder Dysfunction After Radical Surgery | 495 | ||
| Intraoperative Gastrointestinal Injuries | 495 | ||
| Postoperative Gastrointestinal Complications | 496 | ||
| Ileus | 496 | ||
| Small Bowel Obstruction | 497 | ||
| Colonic Obstruction | 498 | ||
| Diarrhea | 498 | ||
| Fistula | 499 | ||
| Lymphocysts | 499 | ||
| Postoperative Infections | 500 | ||
| Urinary Tract Infections | 500 | ||
| Pulmonary Infections | 501 | ||
| Wound Infections | 501 | ||
| Intraabdominal and Pelvic Abscess | 502 | ||
| Necrotizing Fasciitis | 502 | ||
| Obesity | 504 | ||
| Incidence and Definition | 504 | ||
| Postoperative Complications and Management | 504 | ||
| The Elderly Patient | 504 | ||
| Radiation Therapy | 505 | ||
| Gastrointestinal Complications | 506 | ||
| Acute Complications | 506 | ||
| Chronic Conditions | 506 | ||
| Urologic Complications | 510 | ||
| Chemotherapy | 510 | ||
| Myelodysplastic Syndrome and Acute Nonlymphocytic Leukemia | 510 | ||
| Neurotoxicity | 512 | ||
| Cardiac Toxicity | 512 | ||
| Pulmonary Toxicity | 512 | ||
| Bibliography | 513.e1 | ||
| Hemorrhage | 513.e1 | ||
| Genitourinary Tract | 513.e1 | ||
| Gastrointestinal Tract | 513.e1 | ||
| Venous Thromboembolism | 513.e2 | ||
| Postoperative Infections | 513.e3 | ||
| Surgical Complications | 513.e3 | ||
| Lymphocysts | 513.e3 | ||
| Sepsis | 513.e4 | ||
| Drug-Related Complications | 513.e4 | ||
| The Elderly Patient | 513.e4 | ||
| Invasive Hemodynamic Monitoring | 513.e5 | ||
| Complications of Radiation Therapy | 513.e5 | ||
| 17 Basic Principles of Chemotherapy | 515 | ||
| Outline | 515 | ||
| Historical Overview | 515 | ||
| General Principles | 516 | ||
| Cell Cycle Control and Growth Kinetics | 516 | ||
| Dynamics of Chemotherapy | 520 | ||
| Pharmacologic Principles | 521 | ||
| Drug Interactions | 522 | ||
| Drug Resistance | 522 | ||
| Calculation of Dosage | 523 | ||
| Jelliffe Method | 524 | ||
| Cockroft–Gault Method | 524 | ||
| Calvert Formula | 524 | ||
| Categories of Drugs in Current Use (Table 17-7) | 525 | ||
| Alkylating Agents | 525 | ||
| Antimetabolites | 531 | ||
| Antitumor Antibiotics | 531 | ||
| Agents Derived from Plants | 531 | ||
| Hormonal Agents | 531 | ||
| Targeted Therapies/Immunotherapy | 531 | ||
| Drug Toxicity | 532 | ||
| Hematologic Toxicity | 532 | ||
| Growth Factor Therapy | 533 | ||
| Granulocyte Stimulating Therapy | 533 | ||
| Erythrocyte Stimulating Therapy | 533 | ||
| Platelet Stimulating Therapy | 534 | ||
| Gastrointestinal Toxicity | 534 | ||
| Skin Reactions | 535 | ||
| Hypersensitivity | 536 | ||
| Hepatic Toxicity | 536 | ||
| Pulmonary Toxicity | 536 | ||
| Cardiac Toxicity | 536 | ||
| Renal Toxicity | 536 | ||
| Genitourinary Toxicity | 537 | ||
| Neurologic Toxicity | 537 | ||
| Gonadal Dysfunction | 537 | ||
| Supportive Care | 537 | ||
| Evaluation of New Agents | 537 | ||
| Phase I | 537 | ||
| Phase II | 537 | ||
| Phase III | 538 | ||
| Bibliography (Key References indicated with*) | 538.e1 | ||
| Historical overview | 538.e1 | ||
| Drug resistance | 538.e1 | ||
| Calculation of dosage | 538.e1 | ||
| Drug toxicity | 538.e1 | ||
| 18 Targeted Therapy and Molecular Genetics | 539 | ||
| Outline | 539 | ||
| Targeted Therapy | 539 | ||
| Foundation of Targeted Therapy | 540 | ||
| Targeted Agents | 540 | ||
| Angiogenesis | 542 | ||
| Vegfs and Vegf Receptors | 542 | ||
| Agents Targeting VEGF | 543 | ||
| Bevacizumab | 543 | ||
| Ovarian Cancer | 543 | ||
| Uterine Cancer | 545 | ||
| Cervical Cancer | 545 | ||
| VEGF-Trap (Aflibercept) | 545 | ||
| Agents Targeting VEGF Receptors | 546 | ||
| IMC-1121B (Ramucirumab) | 546 | ||
| AZD2171 (Cediranib) | 546 | ||
| Agents Targeting Multiple VEGF-Related Molecules | 546 | ||
| Sunitinib | 546 | ||
| Pazopanib | 547 | ||
| Vatalanib (PTK787) | 547 | ||
| Brivanib | 547 | ||
| BIBF-1120 (Intedanib) | 547 | ||
| Vascular Disrupting Agents | 548 | ||
| Vadimezan (ASA404/DMXAA) | 548 | ||
| Fosbretabulin (Combretastatin A4); Ombrabulin (AVE8062) | 548 | ||
| Other Anti-Angiogenic Agents | 548 | ||
| Thalidomide | 548 | ||
| Phosphatidylinositol-3-Kinase/AKT Pathway | 548 | ||
| Agents Targeting mTOR (Rapalogues) | 549 | ||
| Temsirolimus (CC1-779) | 549 | ||
| Everolimus (RAD001) | 550 | ||
| Ridaforolimus (AP23573; MK-8669) | 550 | ||
| Agents Targeting AKT | 550 | ||
| Agents Targeting PI3K | 550 | ||
| Combination Agents | 551 | ||
| Epidermal Growth Factor Receptor Pathway | 551 | ||
| Small Molecule Inhibitors Targeting EGFR | 551 | ||
| Gefitinib | 551 | ||
| Erlotinib | 552 | ||
| Monoclonal Antibodies Targeting EGFR | 552 | ||
| Cetuximab | 552 | ||
| Trastuzumab | 553 | ||
| Pertuzumab | 553 | ||
| Matuzumab | 553 | ||
| Combination Agents | 553 | ||
| Lapatinib | 553 | ||
| Poly-ADP-Ribose Polymerase Pathway | 553 | ||
| Olaparib | 554 | ||
| Multipathway Targeted Agents | 554 | ||
| Sorafenib | 554 | ||
| Vandetanib | 555 | ||
| Imatinib | 555 | ||
| Dasatinib | 555 | ||
| Cabozantinib (XL-184) | 555 | ||
| Other Targets of Interest | 555 | ||
| Angiopoietin (Ang)/Tie-2 | 555 | ||
| Aurora Kinase | 556 | ||
| Delta-Like 4 (DII4)/Notch | 556 | ||
| Folate Receptor Alpha | 556 | ||
| EC-145 | 556 | ||
| Histone Acetyltransferases and Histone Deacetylases | 556 | ||
| Platelet-Derived Growth Factor | 557 | ||
| Unique Toxicities of Targeted Therapy | 557 | ||
| Hypertension | 557 | ||
| Reverse Protein Leukoencephalopathy (RPLS) | 558 | ||
| Cardiotoxicity | 558 | ||
| Renal Toxicity | 558 | ||
| Thromboembolic Events | 558 | ||
| Gastrointestinal Perforation and Fistula | 558 | ||
| Cutaneous Complications | 559 | ||
| Metabolic Abnormalities | 559 | ||
| Special Considerations for Targeted Therapies | 560 | ||
| Conclusions | 560 | ||
| Acknowledgments | 560 | ||
| Bibliography | 560.e1 | ||
| Targeted Therapy/Targeted Agents | 560.e1 | ||
| Angiogenesis | 560.e1 | ||
| Phosphatidylionositol-3-Kinase (PI3K) and AKT Pathway | 560.e3 | ||
| Epidermal Growth Factor Receptor Pathway | 560.e3 | ||
| Poly-ADP-Ribose Polymerase Pathway | 560.e4 | ||
| Combination Therapies | 560.e4 | ||
| Other Targets of Interest | 560.e5 | ||
| Unique Toxicities of Targeted Therapy | 560.e5 | ||
| Special Considerations for Targeted Therapies | 560.e6 | ||
| 19 Genes and Cancer: | 561 | ||
| Outline | 561 | ||
| Genetic Alterations in Cancer | 563 | ||
| Mechanisms of Human Gene Mutation | 565 | ||
| Single Base Pair Substitutions and Point Mutations | 566 | ||
| Larger Deletions | 568 | ||
| Insertions | 569 | ||
| Duplications | 569 | ||
| Inversions | 569 | ||
| Translocations | 569 | ||
| Cancer Epigenetics | 570 | ||
| Genomic Imprinting and Cancer | 570 | ||
| Genetic Alterations that Cause Cancer | 571 | ||
| Oncogenes | 571 | ||
| Tumor Suppressor Genes | 573 | ||
| Apoptosis | 575 | ||
| Mismatch Repair Defects | 576 | ||
| Telomerase | 577 | ||
| Clinically Relevant Hereditary Syndromes | 578 | ||
| Familial Breast and Ovarian Cancer (BRCA1 and BRCA2) | 579 | ||
| Lynch Syndrome or Hereditary Nonpolyposis Colon Cancer | 581 | ||
| Other Inherited Diseases Relevant to Gynecology | 587 | ||
| Peutz-Jeghers Syndrome | 587 | ||
| Cowden Syndrome | 588 | ||
| Li-Fraumini Syndrome | 589 | ||
| Counseling, Testing, and Risk Assessment for Hereditary Cancers | 589 | ||
| Ovarian Cancer (BRCA1 and BRCA2) | 589 | ||
| Ordering the Tests | 590 | ||
| Interpreting the Test Results | 590 | ||
| Lynch Syndrome (Hereditary Nonpolyposis Colon Cancer) | 591 | ||
| Legal Aspects of Genetic Testing | 592 | ||
| Conclusion | 593 | ||
| Glossary | 594 | ||
| Bibliography | 596.e1 | ||
| Introduction | 596.e1 | ||
| Genetic Alterations in Cancer | 596.e1 | ||
| Oncogenes and Tumor Suppressor Genes | 596.e1 | ||
| Mismatch Repair Defects | 596.e2 | ||
| Telomerase | 596.e2 | ||
| Clinically Relevant Inherited Cancers | 596.e2 | ||
| Clinically Relevant Genetic Cancers for the Gynecologists | 596.e3 | ||
| Lynch Syndrome or HNPCC | 596.e3 | ||
| Other Hereditary Syndromes | 596.e4 | ||
| Peutz-Jehgers Syndrome | 596.e4 | ||
| Cowden Syndrome | 596.e4 | ||
| Li-Fraumini Syndrome | 596.e5 | ||
| Risk Assessment for Hereditary Cancers and Counseling | 596.e5 | ||
| Lynch Syndrome (HNPCC) or Mismatch Repair Defects | 596.e5 | ||
| Medical Legal Issues Associated with Genetic Testing | 596.e6 | ||
| 20 Palliative Care and Quality of Life | 597 | ||
| Outline | 597 | ||
| Evolution of Palliative Care | 597 | ||
| Quality of Life in Gynecologic Cancers | 599 | ||
| Quality of Life in Ovarian Cancer | 599 | ||
| Quality of Life in Cervical Cancer | 601 | ||
| Quality of Life in Endometrial Cancer | 602 | ||
| Management of Common Physical Symptoms | 602 | ||
| Fatigue | 603 | ||
| Pain | 607 | ||
| Nausea and Vomiting | 616 | ||
| Diarrhea and Constipation | 619 | ||
| Cachexia and Malnutrition | 620 | ||
| Psychosocial and Spiritual Needs of Patients and Families | 620 | ||
| Strategies for Breaking Bad News and Preserving Hope | 620 | ||
| Management of Psychosocial and Spiritual Distress | 622 | ||
| Quality of Life Issues in Advanced and Recurrent Ovarian Cancer | 623 | ||
| Pleural Effusion | 623 | ||
| Small Bowel Obstruction | 623 | ||
| Ascites | 624 | ||
| Role of Palliative Surgical Procedures | 625 | ||
| Quality of Life Issues in Advanced and Recurrent Uterine AND Cervical Cancer | 625 | ||
| Ureteral Obstruction | 625 | ||
| Fistula | 626 | ||
| Sexual Dysfunction | 626 | ||
| Anxiety and Depression | 627 | ||
| End-of-Life Decision-Making | 627 | ||
| Patient Benefit | 627 | ||
| Patient Self-Determination | 627 | ||
| Legal Developments That Bear on End-of-Life Decision-Making | 627 | ||
| Surrogate Decision-Making | 628 | ||
| Futility | 628 | ||
| Hospice | 629 | ||
| Bibliography | 630.e1 | ||
| Evolution of Palliative Care | 630.e1 | ||
| Quality of Life | 630.e1 | ||
| Management of Common Physical Symptoms | 630.e1 | ||
| Fatigue | 630.e1 | ||
| National Comprehensive Cancer Network Fatigue | 630.e1 | ||
| Pain | 630.e2 | ||
| Nausea and Vomiting | 630.e2 | ||
| Diarrhea and Constipation | 630.e3 | ||
| Cachexia and Malnutrition | 630.e3 | ||
| Strategies for Breaking Bad News and Preserving Hope | 630.e3 | ||
| Management of Psychosocial and Spiritual Distress | 630.e3 | ||
| Pleural Effusion | 630.e4 | ||
| Small Bowel Obstruction | 630.e4 | ||
| Ascites | 630.e4 | ||
| Role of Palliative Surgical Procedures | 630.e4 | ||
| Ureteral Obstruction | 630.e4 | ||
| Fistula | 630.e4 | ||
| Sexual Dysfunction | 630.e5 | ||
| Anxiety and Depression | 630.e5 | ||
| End-of-Life Decision-Making | 630.e5 | ||
| Futility | 630.e5 | ||
| Hospice | 630.e5 | ||
| 21 Role of Minimally Invasive Surgery in Gynecologic Malignancies | 631 | ||
| Outline | 631 | ||
| Laparoscopic Surgery in Gynecologic Oncology | 631 | ||
| Laparoscopic Surgical Staging of Gynecologic Malignancies | 632 | ||
| Robotic Surgery in Gynecologic Malignancies | 632 | ||
| Minimally Invasive Surgery Learning Curve | 632 | ||
| Minimally Invasive Surgical Technique | 633 | ||
| Applications of Minimally Invasive Surgery in Gynecologic Oncology | 637 | ||
| Cervical Cancer | 637 | ||
| Early-stage cervical cancer—radical hysterectomy | 637 | ||
| Early-stage cervical cancer—fertility-sparing surgery | 638 | ||
| Advanced-stage cervical cancer—surgical staging | 639 | ||
| Endometrial Cancer | 640 | ||
| Laparoscopy | 640 | ||
| Robotics | 642 | ||
| Adnexal Mass | 643 | ||
| Minimally invasive surgery management | 644 | ||
| Ovarian Cancer | 645 | ||
| Diagnosis of ovarian cancer | 645 | ||
| Ovarian cyst rupture | 646 | ||
| Early-stage ovarian cancer | 646 | ||
| Advanced ovarian cancer | 647 | ||
| Complications of Laparoscopic Surgery | 647 | ||
| Port-Site Recurrences | 648 | ||
| Conclusions | 649 | ||
| Bibliography | 649.e1 | ||
| Minimally Invasive Surgery in Gynecologic Oncology | 649.e1 | ||
| Minimally Invasive Surgery Surgical Technique | 649.e1 | ||
| Laparoscopy in Cervical Cancer | 649.e2 | ||
| Laparoscopy in Endometrial Cancer | 649.e4 | ||
| Laparoscopic Management of Adnexal Mass | 649.e5 | ||
| Laparoscopy in Ovarian Cancer | 649.e7 | ||
| Complications | 649.e8 | ||
| 22 Epidemiology of Commonly Used Statistical Terms and Analysis of Clinical Studies | 651 | ||
| Outline | 651 | ||
| Epidemiology | 651 | ||
| Evidence-Based Medicine | 651 | ||
| Measures in Epidemiology | 652 | ||
| Analysis of Clinical Trials | 654 | ||
| Types of Clinical Trials | 655 | ||
| Evaluation of Clinical Trials | 656 | ||
| Placebo Treatment Groups | 656 | ||
| Controls Used in Clinical Trials | 657 | ||
| Studies of Therapy | 657 | ||
| Blinding | 657 | ||
| When to Stop a Clinical Trial | 657 | ||
| Bibliography | 658.e1 | ||
| 23 Basic Principles in Gynecologic Radiotherapy | 659 | ||
| Outline | 659 | ||
| Introduction to Electromagnetic Radiation | 659 | ||
| Radiation Units | 661 | ||
| Radiation Physics | 661 | ||
| Energy Deposition | 661 | ||
| Sources of Radiation | 662 | ||
| Photon Interactions | 662 | ||
| Radioactive Decay | 663 | ||
| Inverse Square Law | 663 | ||
| Depth Dose Characteristics of Radiation | 663 | ||
| Radiobiology | 664 | ||
| Structural Changes | 665 | ||
| Radiosensitivity | 665 | ||
| Radiosensitizers, Hypoxic Cell Sensitizers, and Radioprotectors | 668 | ||
| Genetic Effects | 669 | ||
| Fetal Effects | 670 | ||
| Principles of Clinical Radiation Therapy | 670 | ||
| External Beam Radiation (Teletherapy) | 671 | ||
| Local Radiation (Brachytherapy) | 671 | ||
| Normal Tissue Tolerance | 671 | ||
| Pelvic Organ Tolerance | 673 | ||
| Long-Term Effects | 675 | ||
| New Radiation Modalities | 676 | ||
| Protons | 676 | ||
| Electrons | 676 | ||
| Fast Neutrons | 676 | ||
| Negative Pi Mesons and Other Heavy Ions | 676 | ||
| New Radiation Delivery Technology | 676 | ||
| Intraoperative Radiation | 676 | ||
| Hyperthermia | 677 | ||
| Three-Dimensional Conformal Radiation Therapy | 677 | ||
| Intensity Modulated Radiation Therapy | 677 | ||
| Stereotactic Radiotherapy | 679 | ||
| Immune-Tagged Radiation Therapy | 679 | ||
| Glossary | 679 | ||
| Bibliography | 680.e1 | ||
| Radiation Physics | 680.e1 | ||
| Radiobiology | 680.e1 | ||
| Principles of Clinical Radiation Therapy | 680.e2 | ||
| New Radiation Modalities | 680.e2 | ||
| New Radiation Delivery Technology | 680.e2 | ||
| Appendices | 681 | ||
| Online Appendix A Staging: Staging of Cancer at Gynecologic Sites | 681 | ||
| Cervix Uteri, Corpus Uteri, Ovary, Vagina, Vulva, Gestational Trophoblastic Tumors, and Fallopian Tube | 681 | ||
| Appendix A Staging: Staging of Cancer at Gynecologic Sites | e1 | ||
| Cervix Uteri, Corpus Uteri, Ovary, Vagina, Vulva, Gestational Trophoblastic Tumors, and Fallopian Tube | e1 | ||
| Anatomy and Classification by Sites of Malignant Tumors of the Female Pelvis | e1 | ||
| Cervix Uteri | e1 | ||
| 1.0 Anatomy | e1 | ||
| 2.0 Rules for Classification | e1 | ||
| 3.0 Staging Classification | e2 | ||
| Notes About the Staging | e2 | ||
| Histopathology | e3 | ||
| Histopathologic Types | e3 | ||
| Histopathologic Grade | e3 | ||
| Stage Grouping for the Cervix | e3 | ||
| Corpus | e3 | ||
| 1.0 Anatomy | e3 | ||
| 2.0 Rules for Classification | e3 | ||
| 3.0 Surgical Staging Classification | e3 | ||
| 4.0 Notes About the Staging | e4 | ||
| Notes on Pathologic Grading | e4 | ||
| Rules Related to Staging | e4 | ||
| 5.0 Histopathology | e4 | ||
| Stage Grouping for Uterus | e4 | ||
| Uterine Sarcoma | e4 | ||
| Staging of uterine sarcomas (leiomyosarcomas, endometrial stromal sarcomas, and adenosarcomas). | e4 | ||
| Endometrial stromal sarcomas (3) | e5 | ||
| Adenosarcomas | e5 | ||
| Carcinosarcomas (5) | e5 | ||
| Ovary | e5 | ||
| 1.0 Anatomy | e5 | ||
| 2.0 Rules for Classification | e5 | ||
| 3.0 Staging Classification | e6 | ||
| 4.0 Histopathology | e6 | ||
| Stage Grouping for Ovary | e7 | ||
| Histopathologic Grade (G) | e7 | ||
| Vagina | e7 | ||
| Classification by Site | e7 | ||
| Index | 692 | ||
| A | 692 | ||
| B | 692 | ||
| C | 693 | ||
| D | 696 | ||
| E | 697 | ||
| F | 697 | ||
| G | 698 | ||
| H | 699 | ||
| I | 699 | ||
| J | 700 | ||
| K | 700 | ||
| L | 700 | ||
| M | 701 | ||
| N | 701 | ||
| O | 702 | ||
| P | 703 | ||
| Q | 705 | ||
| R | 705 | ||
| S | 706 | ||
| T | 706 | ||
| U | 707 | ||
| V | 707 | ||
| W | 708 | ||
| X | 708 | ||
| Y | 708 |