BOOK
Clinical Gynecologic Oncology E-Book
Philip J. DiSaia | William T. Creasman | Robert S Mannel | D. Scott McMeekin | David G Mutch
(2017)
Additional Information
Book Details
Abstract
The most readable, most comprehensive book in its field, Clinical Gynecologic Oncology, 9th Edition is the leading reference for diagnosis and treatment of gynecologic cancers – a must-have reference for improving outcomes and providing effective care. A "who’s who" list of contributing authors, under the editorial direction of Drs. Philip DiSaia and William Creasman, provides expert guidance on clinical presentations and management, now fully up to date with a brand-new design for faster, easier reference.
- Contains useful appendices covering staging, screening, nutritional therapy, toxicity criteria, blood component therapy, and radiation therapy.
- Covers hot topics such as multi-panel genetic testing, target therapies, sentinel node concept in endometrial cancer and vulvar cancer, and robotic surgery.
- Updates include new quick-reference features such as key point boxes with bulleted lists, highlighted key text, enhanced chapter outlines, and a brand-new design throughout.
- Includes up-to-date references and algorithms, making this text a comprehensive resource for clinical practice, personal study, and exam review.
- Helps you take advantage of the latest advances in early detection and improved treatment options for gynecologic cancers, especially uterine and cervical cancers.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Clinical Gynecologic Oncology | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Preface | ix | ||
| Acknowledgments | x | ||
| Table Of Contents | xi | ||
| 1 Preinvasive Disease of the Cervix | 1 | ||
| Outline | 1 | ||
| Key Points | 1 | ||
| Natural History | 1 | ||
| Epidemiology | 4 | ||
| Human Papillomavirus Vaccination | 5 | ||
| Screening | 6 | ||
| Core Principles for Managing Abnormal Screening Test Results | 9 | ||
| Managing Abnormal Cervical Cancer Screening Test Results | 12 | ||
| Managing Abnormal Results in Young Women | 12 | ||
| Unsatisfactory Cytology | 12 | ||
| Pap-Negative, Human Papillomavirus–Positive Women (Fig. 1.9) | 12 | ||
| Atypical Squamous Cells of Undetermined Significance (Fig. 1.10) | 13 | ||
| Low-Grade Squamous Intraepithelial Lesion (Fig. 1.11) | 13 | ||
| Atypical Squamous Cells, Cannot Exclude HSIL | 13 | ||
| High-Grade Squamous Intraepithelial Lesion | 15 | ||
| Atypical Glandular Cells | 15 | ||
| Endometrial Cells in Older Women | 15 | ||
| Postcolposcopy Management | 15 | ||
| Managing Women With No Lesion or CIN1 at Colposcopy (Fig. 1.12) | 15 | ||
| Managing Women With CIN2 or CIN3 (Fig. 1.13) | 16 | ||
| Treatment of Cervical Disease | 17 | ||
| Managing Abnormal Results During Pregnancy | 19 | ||
| Future Directions | 19 | ||
| Bibliography | 19.e1 | ||
| 2 Preinvasive Disease of the Vagina and Vulva and Related Disorders | 20 | ||
| Outline | 20 | ||
| Key Points | 20 | ||
| Embryology | 20 | ||
| Examination and Treatment of Females Exposed to Diethylstilbestrol | 21 | ||
| Nonneoplastic Epithelial Disorders of the Vulva | 23 | ||
| Lichen Simplex Chronicus | 23 | ||
| Lichen Sclerosus | 24 | ||
| Lichen Planus | 25 | ||
| Diagnosis and Treatment | 26 | ||
| Lichen Simplex Chronicus | 26 | ||
| Lichen Sclerosus | 26 | ||
| Lichen Planus | 27 | ||
| Intraepithelial Neoplasia of the Vagina | 27 | ||
| Clinical Profile | 27 | ||
| Diagnosis | 28 | ||
| Management | 28 | ||
| Vulvar Intraepithelial Neoplasia | 30 | ||
| Clinical Profile | 30 | ||
| Diagnosis | 31 | ||
| Pigmented Lesions | 32 | ||
| Management | 33 | ||
| Excision | 33 | ||
| Laser | 34 | ||
| Cavitational Ultrasonic Surgical Aspirator | 35 | ||
| Imiquimod | 36 | ||
| Bibliography | 37.e1 | ||
| Diethylstilbestrol-Related Genital Tract Anomalies | 37.e1 | ||
| Nonneoplastic Epithelial Disorders of the Vulva | 37.e1 | ||
| Intraepithelial Neoplasia of the Vagina | 37.e1 | ||
| Intraepithelial Neoplasia of the Vulva | 37.e2 | ||
| 3 Invasive Cervical Cancer | 38 | ||
| Outline | 38 | ||
| Key Points | 38 | ||
| General Observations | 38 | ||
| Anatomy | 38 | ||
| Epidemiologic Studies | 39 | ||
| Clinical Profile | 39 | ||
| Microinvasive Carcinoma of the Cervix | 41 | ||
| 0–3 mm Invasion | 42 | ||
| 3–5 mm Invasion | 42 | ||
| Clinical Profile of Invasive Cancer | 44 | ||
| Symptoms | 46 | ||
| Gross Appearance | 46 | ||
| Routes of Spread | 47 | ||
| Primary Group | 47 | ||
| Secondary Group | 47 | ||
| Glandular Tumors of the Cervix | 49 | ||
| Staging | 50 | ||
| International Federation of Gynecology and Obstetrics | 50 | ||
| Positron Emission Tomography | 52 | ||
| Surgical Staging | 54 | ||
| Treatment of Early-Stage Disease | 55 | ||
| Radical Abdominal Hysterectomy With Lymphadenectomy | 58 | ||
| Complications | 64 | ||
| Indications for Postoperative Adjuvant Therapy | 65 | ||
| Sexual Function | 67 | ||
| Nerve-Sparing Radical Hysterectomy | 67 | ||
| Sentinel Lymph Node Identification | 69 | ||
| Laparoscopic Radical Hysterectomy With Lymphadenectomy | 70 | ||
| Robotic-Assisted Laparoscopic Radical Hysterectomy With Lymphadenectomy | 71 | ||
| Fertility-Preserving Surgery for Early-Stage Tumors | 72 | ||
| Cervical Conization for Adenocarcinoma in Situ and Microinvasive Carcinoma | 72 | ||
| Vaginal Radical Trachelectomy With Laparoscopic Lymphadenectomy | 73 | ||
| Lateral Ovarian Transposition | 75 | ||
| Treatment of Locally Advanced Disease | 75 | ||
| Radiotherapy | 75 | ||
| Intensity-Modulated Whole Pelvic Radiotherapy | 76 | ||
| Radium and Cesium Therapy | 77 | ||
| Interstitial Therapy | 79 | ||
| Extended-Field Irradiation Therapy | 79 | ||
| Radiation and Chemotherapy | 81 | ||
| Neoadjuvant Chemotherapy and Other Novel Treatment Approaches | 83 | ||
| Suboptimal Treatment Situations | 84 | ||
| Neuroendocrine and Other Uncommon Tumors of the Cervix | 85 | ||
| Glassy Cell Carcinoma, Carcinosarcoma, Lymphoma, and Melanoma | 86 | ||
| Survival Results and Prognostic Factors for Early-Stage and Locally Advanced Disease | 87 | ||
| Recurrent and Advanced Carcinoma of the Cervix | 88 | ||
| Management and Prognosis | 92 | ||
| Surgical Therapy: Radical Hysterectomy | 92 | ||
| Pelvic Exenteration | 92 | ||
| Patient Selection | 93 | ||
| Morbidity and Mortality | 94 | ||
| Survival Results | 96 | ||
| Radiation | 97 | ||
| Chemotherapy | 98 | ||
| Targeted Therapies | 103 | ||
| Angiogenesis Inhibitors | 103 | ||
| Immunotherapy | 104 | ||
| Therapeutic Human Papillomavirus Vaccine | 104 | ||
| Human Papillomavirus–Targeted Tumor-Infiltrating T Cells | 104 | ||
| Bibliography | 104.e1 | ||
| General Observations | 104.e1 | ||
| Human Papillomavirus | 104.e1 | ||
| Microinvasive Carcinoma of the Cervix | 104.e1 | ||
| Clinical Profile of Invasive Cancer | 104.e2 | ||
| Glandular Tumors of the Cervix | 104.e3 | ||
| Uncommon and Neuroendocrine Tumors of the Cervix | 104.e3 | ||
| Staging | 104.e4 | ||
| Treatment of Early-Stage Disease | 104.e4 | ||
| Survival Results and Prognostic Factors | 104.e8 | ||
| Postsurgical Adjuvant Therapy | 104.e10 | ||
| Radical Trachelectomy | 104.e10 | ||
| Nerve-Sparing Radical Hysterectomy | 104.e10 | ||
| Laparoscopic Radical Hysterectomy With Pelvic Lymphadenectomy | 104.e10 | ||
| Robotic-Assisted Laparoscopic Radical Hysterectomy With Pelvic Lymphadenectomy | 104.e10 | ||
| Recurrent and Advanced Carcinoma of the Cervix | 104.e10 | ||
| Locally Advanced Disease | 104.e12 | ||
| Recurrent/Metastatic/Persistent Disease | 104.e12 | ||
| Pelvic Recurrence After Suboptimal Surgery | 104.e13 | ||
| Pelvic Exenteration | 104.e14 | ||
| Nonepithelial Tumors of the Cervix (Sarcoma, Lymphoma, and Melanoma) | 104.e15 | ||
| 4 Endometrial Hyperplasia, Estrogen Therapy, and the Prevention of Endometrial Cancer | 105 | ||
| Outline | 105 | ||
| Key Points | 105 | ||
| Introduction | 105 | ||
| Clinical Presentation | 107 | ||
| Endometrial Hyperplasia: Pathologic Diagnostic Criteria | 107 | ||
| Management Decisions for Atypical Endometrial Hyperplasia (Endometrial Intraepithelial Neoplasia) | 109 | ||
| Management of Endometrial Hyperplasia Without Atypia | 110 | ||
| Prevention of Endometrial Cancer | 111 | ||
| Benefits and Risks of Estrogen Replacement Therapy | 112 | ||
| Quality of Life, Vasomotor Symptoms, and Sexual Function | 112 | ||
| Osteoporosis | 113 | ||
| Colorectal Cancer | 114 | ||
| Cardiovascular Disease | 115 | ||
| Estrogen Replacement Therapy for Endometrial and Breast Cancer Survivors | 117 | ||
| Estrogen Replacement Therapy for Endometrial Cancer Survivors | 117 | ||
| Hormonal Therapy for Breast Cancer Survivors | 118 | ||
| Bibliography | 120.e1 | ||
| Clinical Presentation | 120.e1 | ||
| Endometrial Hyperplasia: Pathologic Diagnostic Criteria | 120.e1 | ||
| Management | 120.e2 | ||
| Management of Endometrial Hyperplasia Without Atypia | 120.e2 | ||
| Prevention of Endometrial Cancer | 120.e2 | ||
| Estrogens and Endometrial Neoplasia | 120.e2 | ||
| Estrogen–Progestin Therapy | 120.e3 | ||
| Estrogens and Breast Cancer | 120.e4 | ||
| Benefits of Estrogen Replacement Therapy | 120.e5 | ||
| How to Use Estrogens | 120.e6 | ||
| 5 Adenocarcinoma of the Uterine Corpus | 121 | ||
| Outline | 121 | ||
| Key Points | 121 | ||
| Incidence | 121 | ||
| Epidemiology | 121 | ||
| Diagnosis | 125 | ||
| Pathology | 128 | ||
| Tumor Grade | 132 | ||
| Prognostic Factors | 132 | ||
| Stage of Disease: Depth of Invasion, Cervical Involvement, Adnexal Involvement, and Nodal Metastasis | 133 | ||
| Tumor Grade | 136 | ||
| Lymphovascular Space Involvement | 136 | ||
| Tumor Size | 136 | ||
| Peritoneal Cytology | 137 | ||
| Molecular Indices | 137 | ||
| Hormone receptors. | 137 | ||
| Correlation of Multiple Prognostic Factors | 138 | ||
| Treatment | 139 | ||
| Surgical Management of Endometrial Cancer | 139 | ||
| Radiation Therapy | 143 | ||
| Chemotherapy | 145 | ||
| Drug Development | 145 | ||
| Advanced Disease | 146 | ||
| Adjuvant Therapy: High-Risk Disease | 146 | ||
| Hormones | 147 | ||
| Special Circumstances | 148 | ||
| Multiple Malignant Neoplasms | 148 | ||
| Uterine Papillary Serous Carcinoma | 149 | ||
| Carcinosarcoma | 150 | ||
| Clinical profile. | 150 | ||
| Surgical management. | 150 | ||
| Adjuvant Therapy | 152 | ||
| Management of Recurrent Disease | 153 | ||
| Follow-Up | 154 | ||
| Bibliography | 154.e1 | ||
| Incidence and Epidemiology | 154.e1 | ||
| Screening and Diagnosis, Surgery, and Prognostic Factors | 154.e1 | ||
| Pathology | 154.e4 | ||
| Treatment and Recurrence | 154.e5 | ||
| Carcinosarcoma | 154.e8 | ||
| 6 Sarcoma of the Uterus | 155 | ||
| Outline | 155 | ||
| Key Points | 155 | ||
| Classification | 155 | ||
| Incidence and Epidemiology | 155 | ||
| Leiomyosarcoma | 156 | ||
| Clinical Profile | 156 | ||
| Surgical Management | 157 | ||
| Adjuvant Therapy | 158 | ||
| Management of Recurrent Disease | 159 | ||
| Endometrial Stromal Sarcoma | 160 | ||
| Clinical Profile | 160 | ||
| Surgical Management | 161 | ||
| Adjuvant Therapy | 161 | ||
| Management of Recurrent Disease | 161 | ||
| Other Sarcomas | 161 | ||
| Bibliography | 162.e1 | ||
| Classification | 162.e1 | ||
| Incidence and Epidemiology | 162.e1 | ||
| Leiomyosarcoma | 162.e1 | ||
| Endometrial Stromal Sarcoma | 162.e2 | ||
| Other Sarcomas | 162.e2 | ||
| 7 Gestational Trophoblastic Disease | 163 | ||
| Outline | 163 | ||
| Key Points | 163 | ||
| Hydatidiform Mole | 164 | ||
| Epidemiology | 164 | ||
| Cytogenetics and Pathology | 165 | ||
| Presentation and Symptoms | 166 | ||
| Diagnosis | 167 | ||
| Evacuation | 168 | ||
| Risk Factors for Postmolar Gestational Trophoblastic Neoplasia | 170 | ||
| Postmolar Surveillance | 170 | ||
| Prophylactic Chemotherapy After Molar Evacuation | 171 | ||
| Coexistent Molar Pregnancy With a Normal Fetus | 171 | ||
| Gestational Trophoblastic Neoplasia | 172 | ||
| Diagnosis | 172 | ||
| “Phantom” Human Chorionic Gonadotropin | 174 | ||
| The “Hook Effect” | 174 | ||
| Pretherapy Evaluation | 174 | ||
| Classification and Staging | 176 | ||
| Treatment of Nonmetastatic and Low-Risk Metastatic Gestational Trophoblastic Neoplasia | 178 | ||
| High-Risk Metastatic Gestational Trophoblastic Neoplasia | 181 | ||
| Surgery | 183 | ||
| Radiation Therapy | 186 | ||
| Placental Site Trophoblastic Tumor | 187 | ||
| Epithelioid Trophoblastic Tumor | 187 | ||
| Other Considerations | 188 | ||
| Future Childbearing | 188 | ||
| Coexistence of Normal Pregnancy and Gestational Trophoblastic Neoplasia | 188 | ||
| Transplacental Fetal Metastases | 188 | ||
| Survivorship Issues After Successful Treatment of Gestational Trophoblastic Neoplasia | 189 | ||
| Bibliography | 189.e1 | ||
| Epidemiology and Risk Factors | 189.e1 | ||
| Moles | 189.e1 | ||
| Prophylactic Chemotherapy | 189.e2 | ||
| Diagnosis of Gestational Trophoblastic Neoplasia | 189.e2 | ||
| Treatment | 189.e2 | ||
| Posttreatment Pregnancy | 189.e4 | ||
| Placental Site Tumors | 189.e5 | ||
| Other Considerations | 189.e5 | ||
| 8 Invasive Cancer of the Vulva | 190 | ||
| Outline | 190 | ||
| Key Points | 190 | ||
| Invasive Squamous Cell Carcinoma | 191 | ||
| Histology | 191 | ||
| Clinical Presentation and Diagnosis | 191 | ||
| Location and Spread Pattern | 192 | ||
| Staging | 195 | ||
| Sentinel Lymph Node Biopsy | 196 | ||
| Sentinel nodes | 199 | ||
| Management | 199 | ||
| Technique of Radical Vulvectomy | 201 | ||
| Morbidity Associated With Treatment of Vulvar Carcinoma | 205 | ||
| Survival Results | 207 | ||
| Tolerance of the Elderly Patients to Therapy | 208 | ||
| Recurrence | 208 | ||
| Early Vulvar Carcinoma | 208 | ||
| Paget Disease | 209 | ||
| Clinical and Histologic Features | 209 | ||
| Clinical Course and Management | 210 | ||
| Melanoma | 212 | ||
| Sarcoma | 215 | ||
| Bartholin Gland Carcinoma | 215 | ||
| Basal Cell Carcinoma | 216 | ||
| Bibliography | 216.e1 | ||
| Invasive Squamous Cell Carcinoma | 216.e1 | ||
| Sentinel Nodes | 216.e3 | ||
| Early Vulvar Carcinoma | 216.e4 | ||
| Paget Disease | 216.e4 | ||
| Melanoma | 216.e5 | ||
| Sarcoma | 216.e5 | ||
| Bartholin Gland Carcinoma | 216.e5 | ||
| Basal Cell Carcinoma | 216.e6 | ||
| 9 Invasive Cancer of the Vagina | 217 | ||
| Outline | 217 | ||
| Key Points | 217 | ||
| Squamous Cell Carcinoma of the Vagina | 217 | ||
| Epidemiology | 217 | ||
| Screening | 218 | ||
| Signs and Symptoms | 219 | ||
| Diagnostic Considerations | 219 | ||
| Staging | 219 | ||
| Patterns of Spread | 221 | ||
| Imaging and Vaginal Cancer | 221 | ||
| Sentinel Lymph Node Dissection | 221 | ||
| Prognostic Features | 221 | ||
| Management | 222 | ||
| Prevention | 222 | ||
| Stage 0 and I | 223 | ||
| Stage II to IVa | 223 | ||
| Chemotherapy | 224 | ||
| Special Considerations | 224 | ||
| Survival and Recurrence | 224 | ||
| Rare Histologies | 226 | ||
| Adenocarcinoma and Clear Cell Adenocarcinoma | 226 | ||
| Recurrent Adenocarcinoma | 227 | ||
| Malignant Melanoma | 228 | ||
| Sarcoma | 229 | ||
| Endodermal Sinus Tumor | 229 | ||
| Special Considerations | 230 | ||
| Bibliography | 230.e1 | ||
| Squamous Cell Carcinoma | 230.e1 | ||
| Adenocarcinoma and Clear Cell Adenocarcinoma | 230.e3 | ||
| Malignant Melanoma | 230.e3 | ||
| Sarcoma | 230.e3 | ||
| Endodermal Sinus Tumor | 230.e4 | ||
| 10 Adnexal Masses | 231 | ||
| Outline | 231 | ||
| Key Points | 231 | ||
| Adnexal Masses | 231 | ||
| Evaluative Approach | 231 | ||
| Classifying the Mass | 232 | ||
| OVA1 Test | 233 | ||
| HE4 | 234 | ||
| Multimodality Approach | 234 | ||
| Differential Diagnosis | 234 | ||
| Extraovarian Adnexal Masses | 234 | ||
| Uterine Masses | 235 | ||
| Tubal Masses | 235 | ||
| Adnexal Masses of Nongynecologic Origin | 236 | ||
| Bowel | 236 | ||
| Ovarian Masses | 236 | ||
| Functional Cysts | 236 | ||
| Endometriotic Cysts | 237 | ||
| Benign Ovarian Neoplasms | 237 | ||
| Serous Cystadenoma | 237 | ||
| Mucinous Cystadenoma | 238 | ||
| Dermoid Cyst (Benign Cystic Teratoma) | 239 | ||
| Fibroma | 240 | ||
| Brenner Tumor | 240 | ||
| Management of Adnexal Masses | 241 | ||
| Observation versus Surgery | 241 | ||
| Minimally Invasive Surgery for Adnexal Masses | 242 | ||
| Special Circumstances | 243 | ||
| Adnexal Masses in Childhood | 243 | ||
| Postmenopausal Ovary | 244 | ||
| Borderline Malignant Epithelial Ovarian Neoplasms | 246 | ||
| Fertility Preservation | 249 | ||
| Cyst Rupture or Spill of Tumor | 250 | ||
| Prophylactic versus Risk-Reducing Oophorectomy | 250 | ||
| Bibliography | 252.e1 | ||
| Adnexal Masses | 252.e1 | ||
| Benign Ovarian Tumors | 252.e1 | ||
| Adnexal Masses in Childhood | 252.e2 | ||
| Palpable or Enlarged Postmenopausal Ovary | 252.e2 | ||
| Scan-Detected Masses | 252.e3 | ||
| Borderline Malignant Epithelial Ovarian Neoplasms | 252.e3 | ||
| Management of Early Ovarian Cancer in Young Women | 252.e4 | ||
| Spill of Tumor | 252.e4 | ||
| Prophylactic Oophorectomy | 252.e4 | ||
| 11 Epithelial Ovarian Cancer | 253 | ||
| Outline | 253 | ||
| Key Points | 253 | ||
| Classification | 253 | ||
| Incidence, Epidemiology, and Etiology | 254 | ||
| Familial Ovarian Cancer | 257 | ||
| Signs, Symptoms, and Attempts at Early Detection (Screening) | 259 | ||
| Diagnostic Techniques and Staging | 262 | ||
| Therapeutic Options for Primary Treatment | 262 | ||
| Borderline Malignant Epithelial Neoplasms | 262 | ||
| Treatment of Malignant Epithelial Neoplasms | 263 | ||
| Stages IA, IB, and IC | 266 | ||
| Stages IIA, IIB, and IIC | 269 | ||
| Stage III | 269 | ||
| Stage IV | 269 | ||
| Maximal Surgical Effort | 270 | ||
| Role of Radiation Therapy | 274 | ||
| Radioisotopes | 275 | ||
| Chemotherapy | 275 | ||
| Clinical Trials | 275 | ||
| Dose-intense Chemotherapy | 277 | ||
| Immunotherapy | 278 | ||
| Intraperitoneal Chemotherapy | 278 | ||
| Extraovarian Peritoneal Serous Papillary Carcinoma | 279 | ||
| Small Cell Carcinoma of the Ovary | 280 | ||
| Follow-Up Techniques and Treatment of Recurrences | 281 | ||
| Use of CA-125 Levels and Other Tumor Markers | 281 | ||
| Radiographic Imaging | 282 | ||
| Maintenance Therapy | 282 | ||
| Chemotherapy for Recurrent Disease and Targeted Therapies | 283 | ||
| Targeted Therapy | 286 | ||
| Surgery for Recurrent Disease | 286 | ||
| Rehabilitation | 287 | ||
| Conclusions on Management | 287 | ||
| Current Areas of Research | 289 | ||
| Bibliography | 289.e1 | ||
| Incidence, Epidemiology, and Etiology | 289.e1 | ||
| Signs, Symptoms, and Attempts at Early Detection (Screening) | 289.e2 | ||
| Borderline Malignant Epithelial Neoplasms | 289.e3 | ||
| Treatment of Malignant Epithelial Neoplasms | 289.e3 | ||
| Maximal Surgical Effort | 289.e5 | ||
| Role of Radiation Therapy and Radioisotopes | 289.e7 | ||
| Chemotherapy | 289.e7 | ||
| Intraperitoneal Chemotherapy | 289.e10 | ||
| Extraovarian Peritoneal Serous Papillary Carcinoma | 289.e11 | ||
| Small Cell Carcinoma of the Ovary | 289.e11 | ||
| Use of CA-125 Levels | 289.e11 | ||
| Radiographic Imaging | 289.e12 | ||
| Maintenance Therapy | 289.e12 | ||
| Chemotherapy for Recurrent Disease and Targeted Therapies | 289.e12 | ||
| Surgery for Recurrent Disease | 289.e14 | ||
| 12 Germ Cell, Stromal, and Other Ovarian Tumors | 290 | ||
| Outline | 290 | ||
| Key Points | 290 | ||
| Germ Cell Tumors | 290 | ||
| Classification | 290 | ||
| Clinical Profile | 291 | ||
| Staging | 292 | ||
| Treatment Options | 293 | ||
| Surveillance for Stage I Tumors | 294 | ||
| Second-Look Laparotomy | 294 | ||
| Radiation Therapy | 294 | ||
| Chemotherapy | 294 | ||
| Neoadjuvant Chemotherapy | 296 | ||
| Recurrences in Germ Cell Cancer | 296 | ||
| Treatment Toxicity | 296 | ||
| Dysgerminoma | 297 | ||
| Endodermal Sinus Tumor (Yolk Sac Tumor) | 299 | ||
| Embryonal Carcinoma | 300 | ||
| Polyembryoma | 301 | ||
| Choriocarcinoma | 301 | ||
| Mixed Germ Cell Tumors | 301 | ||
| Teratoma | 301 | ||
| Mature Cystic Teratoma | 301 | ||
| Mature Solid Teratoma | 302 | ||
| Immature Teratoma | 302 | ||
| Monodermal or Highly Specialized Teratomas | 304 | ||
| Struma ovarii. | 304 | ||
| Carcinoid tumors. | 304 | ||
| Tumors of Germ Cell and Sex Cord Derivation | 304 | ||
| Gonadoblastoma | 304 | ||
| Mixed Germ Cell–sex Cord Stromal Tumors | 305 | ||
| Tumors Derived From Special Gonadal Stroma | 305 | ||
| Classification, Clinical Profile, and Staging | 305 | ||
| Treatment | 305 | ||
| Granulosa–stromal Cell Tumors | 306 | ||
| Thecomas | 309 | ||
| Fibromas and Sclerosing Stromal Cell Tumors | 309 | ||
| Sertoli-Leydig Cell Tumors | 310 | ||
| Sex Cord Tumor With Annular Tubules | 311 | ||
| Gynandroblastoma | 311 | ||
| Steroid Cell Neoplasms | 311 | ||
| Tumors Derived From Nonspecific Mesenchyme | 311 | ||
| Malignant Lymphoma | 311 | ||
| Metastatic Tumors to the Ovary | 312 | ||
| Malignant Ovarian Tumors in Children | 313 | ||
| Bibliography | 313.e1 | ||
| Germ Cell Tumors | 313.e1 | ||
| Tumor of Germ Cell and Sex Cord Derivation | 313.e4 | ||
| Tumors Derived From Special Gonadal Stroma | 313.e4 | ||
| Other Ovarian Tumors | 313.e5 | ||
| Malignant Ovarian Tumors in Children | 313.e6 | ||
| 13 Fallopian Tube Cancer | 314 | ||
| Outline | 314 | ||
| Key Points | 314 | ||
| Introduction | 314 | ||
| Traditional Characteristics | 314 | ||
| Epidemiology, Classification, and Etiology | 314 | ||
| Symptoms and Signs | 315 | ||
| Emerging Paradigms | 315 | ||
| Fallopian Tube Cancer and BRCA Mutations | 315 | ||
| Occult or Intraepithelial Fallopian Tube Cancer Found During Risk-Reducing Surgery | 315 | ||
| Serous Tubal Intraepithelial Carcinoma | 316 | ||
| Fallopian Tube Cancer and Serous Tubal Intraepithelial Carcinoma Beyond BRCA | 316 | ||
| Clinical Implications | 317 | ||
| Conclusion | 318 | ||
| Bibliography | 319.e1 | ||
| Introduction | 319.e1 | ||
| Traditional Characteristics | 319.e1 | ||
| Emerging Paradigms | 319.e1 | ||
| Clinical Implications | 319.e1 | ||
| Conclusion | 319.e2 | ||
| 14 Breast Diseases | 320 | ||
| Outline | 320 | ||
| Key Points | 320 | ||
| Introduction | 321 | ||
| Anatomy of the Breast | 321 | ||
| Embryology and Development of the Breast | 323 | ||
| Pregnancy and Breastfeeding | 323 | ||
| Benign Breast Conditions | 323 | ||
| Fibrocystic Changes | 323 | ||
| Proliferative Changes | 324 | ||
| Sclerosing Lesions | 324 | ||
| Fibroadenoma | 324 | ||
| Phyllodes Tumor | 325 | ||
| Adenoma | 325 | ||
| Superficial Thrombophlebitis | 325 | ||
| Mastitis | 325 | ||
| Duct Ectasia | 326 | ||
| Fat Necrosis | 326 | ||
| Nipple Discharge | 326 | ||
| Unilateral, Spontaneous Nipple Discharge | 326 | ||
| History and Physical Examination | 326 | ||
| Mammography | 329 | ||
| Screening Interval | 329 | ||
| Breast Imaging Reporting and Data System | 330 | ||
| Diagnostic Mammography | 331 | ||
| Mammographic Lesions | 331 | ||
| Microcalcifications | 331 | ||
| Digital Mammography | 331 | ||
| Breast Ultrasonography and Magnetic Resonance Imaging | 332 | ||
| Diagnostic Evaluation | 332 | ||
| Palpable Mass | 332 | ||
| Fine-Needle Aspiration or Biopsy | 332 | ||
| Needle Localization and Excision | 333 | ||
| Image-guided Percutaneous Breast Biopsy | 333 | ||
| Stereotactic Biopsy | 333 | ||
| Ultrasound-guided Biopsy | 334 | ||
| Tissue-acquisition Devices | 334 | ||
| Surgical Excision and Breast Biopsy | 334 | ||
| Epidemiology of Breast Cancer | 334 | ||
| Risk Factors and Assessment | 334 | ||
| Age | 334 | ||
| Family History | 334 | ||
| Personal History | 335 | ||
| Reproductive History | 335 | ||
| Exogenous Hormone Use | 335 | ||
| Prior Exposure to Radiation Therapy | 336 | ||
| Other Factors | 336 | ||
| Relative Risk | 336 | ||
| BRCA1 and BRCA2 | 336 | ||
| Natural History | 337 | ||
| Pathology | 338 | ||
| Ductal Carcinoma In Situ | 338 | ||
| Paget’s Disease | 338 | ||
| Lobular Carcinoma In Situ | 338 | ||
| Invasive Duct Carcinoma | 338 | ||
| Infiltrating Lobular Carcinoma | 338 | ||
| Inflammatory Carcinoma | 339 | ||
| Metastases From Extramammary Tumors | 339 | ||
| Biologic Markers and Prognostic Factors | 339 | ||
| Axillary Lymph Node Status | 339 | ||
| Tumor Size | 339 | ||
| Histologic Grade | 339 | ||
| Molecular Profiling | 339 | ||
| Hormone Receptors | 339 | ||
| HER2/neu | 339 | ||
| p53 | 339 | ||
| Staging of Breast Cancer Using the Tumor–Node–Metastasis System | 339 | ||
| Treatment of Breast Cancer | 339 | ||
| Surgery | 341 | ||
| Mastectomy | 341 | ||
| Breast-conservation Therapy | 342 | ||
| Patient Selection | 343 | ||
| Management of the Axilla | 344 | ||
| Sentinel Lymph Node Biopsy | 344 | ||
| Adjuvant Therapy | 345 | ||
| Estrogen Receptor–Positive Breast Cancer | 346 | ||
| HER2/neu–Positive Breast Cancer | 346 | ||
| Triple-Negative Breast Cancer | 346 | ||
| Ovarian Ablation | 346 | ||
| Tamoxifen | 347 | ||
| Aromatase Inhibitors | 348 | ||
| Gene Expression Assays | 348 | ||
| Metastatic Disease | 348 | ||
| High-dose Chemotherapy | 348 | ||
| Neoadjuvant Chemotherapy | 348 | ||
| Radiation Therapy | 349 | ||
| Breast Reconstruction | 349 | ||
| Special Issues | 349 | ||
| Breast Cancer in Older Women | 349 | ||
| Hereditary Breast Cancer | 350 | ||
| Pathologic Features | 350 | ||
| Stage | 350 | ||
| Treatment | 350 | ||
| Chemoprevention | 350 | ||
| Surveillance Versus Prophylactic Surgery in High-risk Patients | 351 | ||
| Conclusions | 352 | ||
| Bibliography | 352.e1 | ||
| Introduction | 352.e1 | ||
| Anatomy of the Breast | 352.e1 | ||
| Pregnancy and Breastfeeding | 352.e1 | ||
| Benign Breast Conditions | 352.e1 | ||
| Benign Breast Conditions. Fibroadenoma | 352.e1 | ||
| History and Physical Examination | 352.e1 | ||
| Mammography | 352.e1 | ||
| Mammography. Screening Interval | 352.e2 | ||
| Mammography. Breast Imaging Reporting and Data System | 352.e2 | ||
| Mammography. Diagnostic Mammography | 352.e2 | ||
| Breast Ultrasound and Magnetic Resonance Imaging | 352.e3 | ||
| Diagnostic Evaluation | 352.e3 | ||
| Epidemiology of Breast Cancer | 352.e3 | ||
| Risk Factors and Assessment | 352.e3 | ||
| Risk Factors and Assessment. Relative Risk | 352.e4 | ||
| Risk Factors and Assessment. BRCA1 and BRCA2 | 352.e4 | ||
| Pathology | 352.e4 | ||
| Staging of Breast Cancer Using the Tumor–Node–Metastasis System | 352.e4 | ||
| Treatment of Breast Cancer | 352.e4 | ||
| Treatment of Breast Cancer. Surgery | 352.e5 | ||
| Treatment of Breast Cancer. Surgery. Sentinel Lymph Node Biopsy | 352.e5 | ||
| Treatment of Breast Cancer. Adjuvant Therapy | 352.e5 | ||
| Treatment of Breast Cancer. Adjuvant Therapy. Node-Positive Breast Cancer | 352.e5 | ||
| Treatment of Breast Cancer. Adjuvant Therapy. Aromatase Inhibitors | 352.e5 | ||
| Treatment of Breast Cancer. Adjuvant Therapy. Metastatic Disease | 352.e5 | ||
| Special Issues | 352.e5 | ||
| Special Issues. Hereditary Breast Cancer | 352.e6 | ||
| Special Issues. Hereditary Breast Cancer. Stage | 352.e6 | ||
| Special Issues. Hereditary Breast Cancer. Chemoprevention | 352.e6 | ||
| Special Issues. Hereditary Breast Cancer. Surveillance versus Prophylactic Surgery in High-Risk Patients | 352.e6 | ||
| 15 Cancer in Pregnancy | 353 | ||
| Outline | 353 | ||
| Key Points | 353 | ||
| Background and Epidemiology of Cancer in Pregnancy | 353 | ||
| Report From the European Society of Gynecological Oncology Cancer in Pregnancy Task Force | 355 | ||
| The More Common Solid Tumors in Pregnancy | 355 | ||
| Cervical Cancer | 355 | ||
| Human Papillomavirus in Pregnancy | 356 | ||
| Evaluation of the Papanicolaou Smear in Pregnancy | 356 | ||
| The Performance of Colposcopy in Pregnancy | 356 | ||
| The Natural History of Cervical Intraepithelial Neoplasia in Pregnancy | 357 | ||
| Conization and Related Procedures in Pregnancy | 358 | ||
| Management of Cervical Intraepithelial Neoplasia in Pregnancy | 359 | ||
| Management of Squamous Cell Abnormalities | 360 | ||
| Management of Glandular Cell Abnormalities | 360 | ||
| Intrapartum Hysterectomy | 361 | ||
| Invasive Cervical Cancer | 361 | ||
| Microinvasive Disease | 361 | ||
| Cesarean–Radical Hysterectomy With Pelvic Lymphadenectomies | 362 | ||
| Radical Trachelectomy With Lymphadenectomy | 363 | ||
| Whole-Pelvis Radiotherapy With Intracavitary Brachytherapy | 363 | ||
| Episiotomy Site Recurrence | 364 | ||
| Planned Delay of Therapy | 365 | ||
| Neoadjuvant Chemotherapy in Pregnancy | 366 | ||
| Prognosis for Patients With Cervical Cancer in Pregnancy | 366 | ||
| Obstetric Outcomes | 367 | ||
| Ovarian Cancer | 367 | ||
| Asymptomatic Adnexal Masses | 369 | ||
| Laparoscopic Management of the Ovarian Mass | 369 | ||
| Robotic-Assisted Laparoscopic Management of Adnexal Masses During Pregnancy | 369 | ||
| Ovarian Masses Specific to Pregnancy | 370 | ||
| Histologic Types of Ovarian Tumors | 370 | ||
| Borderline Ovarian Tumors | 370 | ||
| Frankly Malignant Ovarian Tumors | 371 | ||
| Malignant Germ Cell Tumors in Pregnancy | 371 | ||
| Dysgerminoma in Pregnancy | 372 | ||
| Sex Cord–Stromal Tumors in Pregnancy | 372 | ||
| Chemotherapy for Nonepithelial Ovarian Cancer During Pregnancy | 373 | ||
| Epithelial Ovarian Cancer in Pregnancy | 373 | ||
| Chemotherapy for Epithelial Ovarian Cancer During Pregnancy | 374 | ||
| Targeted (biologic) therapy for ovarian cancer in pregnancy. | 374 | ||
| Other Types of Malignant Ovarian Tumors | 375 | ||
| Summary of the Adnexal Mass and Ovarian Cancer in Pregnancy | 375 | ||
| Breast Cancer | 375 | ||
| Presentation | 376 | ||
| Evaluation | 376 | ||
| Surgical Management | 378 | ||
| Sentinel Lymph Node Identification | 378 | ||
| Breast Reconstruction | 379 | ||
| Adjuvant Therapy | 379 | ||
| Neoadjuvant and Adjuvant Chemotherapy for Pregnancy-Associated Breast Cancer | 379 | ||
| Chemotherapy for Metastatic Breast Cancer | 380 | ||
| HER2/Neu–Targeted Agents in Pregnancy | 380 | ||
| Hormonal Treatments for Pregnancy-Associated Breast Cancer | 381 | ||
| Prognosis of Pregnancy-Associated Breast Cancer | 381 | ||
| Lactation | 381 | ||
| Hormonal Considerations: Pregnancy Preceding Breast Cancer | 382 | ||
| Protective effect of human chorionic gonadotropin. | 382 | ||
| Recent antecedent pregnancy. | 382 | ||
| Breastfeeding. | 382 | ||
| Hormonal Considerations: Pregnancy Coincident With Breast Cancer | 382 | ||
| Estrogen-Receptor and Progesterone-Receptor Status | 383 | ||
| Pregnancy Termination | 383 | ||
| Tamoxifen | 383 | ||
| Hormonal Considerations: Pregnancy After Breast Cancer | 384 | ||
| Prophylactic Oophorectomy | 384 | ||
| Survival Among Patients With Pregnancy-Associated Breast Cancer | 385 | ||
| Evaluation and Therapeutic Modalities | 385 | ||
| Anesthesia and Surgery in Pregnant Patients | 385 | ||
| Anesthesia | 385 | ||
| Surgery | 386 | ||
| Laparotomy | 386 | ||
| Laparoscopy | 386 | ||
| Diagnostic and Therapeutic Radiation in Pregnancy | 387 | ||
| Radiobiology | 387 | ||
| Radiation-induced Anomalies | 387 | ||
| Diagnostic Radiology | 388 | ||
| Ionizing Radiation | 389 | ||
| Nonionizing Radiation | 389 | ||
| Radionuclides | 389 | ||
| Radiation Therapy | 390 | ||
| Radiation-induced Carcinogenesis | 390 | ||
| Genetic Damage and Infertility | 390 | ||
| Chemotherapy | 391 | ||
| Teratology and Embryology | 391 | ||
| Transplacental Studies | 391 | ||
| Classes of Antineoplastic Agents | 392 | ||
| Antimetabolites. | 392 | ||
| Alkylators. | 393 | ||
| Anthracycline and Antitumor Antibiotics | 393 | ||
| Plant Alkaloids | 393 | ||
| Taxanes | 393 | ||
| Platinum Analogs | 393 | ||
| Pharmacokinetics, Sublethal Fetal Effects, and Maternal Risks | 394 | ||
| Estimating the Stillbirth Rate | 394 | ||
| Occupational Exposure | 394 | ||
| Recommendations on the Use of Chemotherapy During Pregnancy | 395 | ||
| Timing of Delivery | 395 | ||
| Breastfeeding | 395 | ||
| Long-term Neonatal Follow-up | 395 | ||
| Supportive Therapy | 395 | ||
| Serum Tumor Markers in Pregnancy | 397 | ||
| Hematologic Malignancies in Pregnancy | 398 | ||
| Leukemia | 398 | ||
| Leukemia in Pregnancy | 399 | ||
| Chemotherapy for Acute Leukemia in Pregnancy | 399 | ||
| Acute Myelogenous Leukemia | 399 | ||
| Acute Lymphoblastic Leukemia | 400 | ||
| Acute Promyelocytic Leukemia | 400 | ||
| Management of Chronic Leukemia | 400 | ||
| Chronic Myelocytic Leukemia | 400 | ||
| Hairy Cell Leukemia, Multiple Myeloma, and Chronic Lymphocytic Leukemia | 401 | ||
| Hodgkin Disease | 401 | ||
| Hodgkin Disease in Pregnancy | 402 | ||
| Management of Hodgkin Disease in Pregnancy | 402 | ||
| Non-Hodgkin Lymphoma | 405 | ||
| Non-Hodgkin Lymphoma in Pregnancy | 405 | ||
| Other Tumors in Pregnancy | 406 | ||
| Melanoma | 406 | ||
| Staging of Melanoma | 407 | ||
| Melanoma in Pregnancy | 407 | ||
| Historical Series of Melanoma in Pregnancy | 407 | ||
| Contemporary Studies of Melanoma in Pregnancy | 408 | ||
| Management of Melanoma in Pregnancy | 408 | ||
| Melanoma Metastatic to the Products of Conception | 409 | ||
| Thyroid Cancer | 409 | ||
| Thyroid Cancer in Pregnancy | 410 | ||
| Undifferentiated Lesions | 410 | ||
| Prognosis Among Pregnant Women With Thyroid Cancer | 410 | ||
| Rare Gynecologic Malignancies in Pregnancy | 411 | ||
| Vulvar Cancer | 411 | ||
| Historical series of vulvar cancer in pregnancy. | 412 | ||
| Management of vulvar cancer in pregnancy. | 412 | ||
| Primary Invasive Vaginal Tumors | 412 | ||
| Endometrial Cancer | 413 | ||
| Fallopian Tube Cancer | 414 | ||
| Trophoblastic Tumors of the Fallopian Tube: “Ectopic” Pregnancy | 414 | ||
| Placental and Fetal Tumors | 415 | ||
| Complete Hydatidiform Mole With Coexistent Fetus | 415 | ||
| Placental and Fetal Metastases | 416 | ||
| Primary Fetal Tumors | 417 | ||
| Bibliography | 418.e1 | ||
| Background and Epidemiology | 418.e1 | ||
| Cervical Cancer in Pregnancy | 418.e1 | ||
| Ovarian Cancer in Pregnancy | 418.e3 | ||
| Breast Cancer in Pregnancy | 418.e4 | ||
| Anesthesia and Surgery | 418.e6 | ||
| Diagnostic and Therapeutic Radiation | 418.e6 | ||
| Chemotherapy | 418.e7 | ||
| Tumor Markers | 418.e8 | ||
| Hematologic Malignancies in Pregnancy | 418.e8 | ||
| Melanoma in Pregnancy | 418.e9 | ||
| Thyroid Cancer in Pregnancy | 418.e9 | ||
| Vulvar Cancer in Pregnancy | 418.e9 | ||
| Primary Invasive Vaginal Cancer in Pregnancy | 418.e9 | ||
| Endometrial Cancer in Pregnancy | 418.e10 | ||
| Fallopian Tube Cancer in Pregnancy | 418.e10 | ||
| Twin Pregnancy With Coexisting Complete Mole and Fetus | 418.e10 | ||
| Maternal Malignancy Metastatic to the Products of Conception | 418.e10 | ||
| 16 Complications of Disease and Therapy | 419 | ||
| Outline | 419 | ||
| Key Points | 419 | ||
| Disease–Oriented Complications | 419 | ||
| Hemorrhage | 419 | ||
| Urinary Tract Complications | 420 | ||
| Ureteral Obstruction | 420 | ||
| Urinary Tract Fistulas | 422 | ||
| Gastrointestinal Complications | 422 | ||
| Gastrointestinal Obstruction | 422 | ||
| Gastrointestinal Fistulas | 423 | ||
| Venous Thromboembolic Complications | 423 | ||
| Risk Factors | 423 | ||
| Prophylactic Methods | 423 | ||
| Low-dose heparin. | 424 | ||
| Low-molecular-weight heparins. | 424 | ||
| Oral agents. | 424 | ||
| Mechanical Methods | 424 | ||
| Graduated compression stockings. | 425 | ||
| External pneumatic compression. | 425 | ||
| Postoperative Prophylaxis | 425 | ||
| Management of Deep Vein Thrombosis and Pulmonary Embolism | 425 | ||
| Diagnosis of deep vein thrombosis. | 425 | ||
| Doppler ultrasonography. | 425 | ||
| Venography. | 426 | ||
| Magnetic resonance venography. | 426 | ||
| Impedance plethysmography. | 426 | ||
| Treatment of deep vein thrombosis. | 426 | ||
| Low-molecular-weight heparin. | 426 | ||
| Unfractionated heparin. | 426 | ||
| Long-term anticoagulation. | 426 | ||
| Oral anticoagulants. | 426 | ||
| Inferior vena cava filter. | 427 | ||
| Diagnosis of pulmonary embolism. | 427 | ||
| Superior vena cava syndrome. | 427 | ||
| Biliary Obstruction | 427 | ||
| Treatment-Related Complications | 428 | ||
| Surgical | 428 | ||
| Intraoperative and Postoperative Hemorrhage | 428 | ||
| Intraoperative management of vascular complications. | 428 | ||
| Hypogastric (internal iliac) artery ligation. | 429 | ||
| Management of shock. | 429 | ||
| Central monitoring. | 429 | ||
| Intraoperative Genitourinary Injuries | 430 | ||
| Postoperative Urinary Tract Injury | 431 | ||
| Bladder Dysfunction After Radical Surgery | 432 | ||
| Intraoperative Gastrointestinal Injuries | 433 | ||
| Postoperative Gastrointestinal Complications | 433 | ||
| Ileus. | 433 | ||
| Small bowel obstruction. | 435 | ||
| Colonic obstruction. | 435 | ||
| Diarrhea. | 436 | ||
| Fistula. | 436 | ||
| Lymphedema | 436 | ||
| Lymphocysts | 436 | ||
| Postoperative Infections | 437 | ||
| Urinary tract infections. | 437 | ||
| Pulmonary infections. | 438 | ||
| Wound infections. | 438 | ||
| Intraabdominal and pelvic abscess. | 439 | ||
| Necrotizing fasciitis. | 439 | ||
| Special Populations | 440 | ||
| Obesity | 440 | ||
| Incidence and definition. | 440 | ||
| Postoperative complications and management. | 440 | ||
| Elderly patients. | 441 | ||
| Radiation Therapy | 442 | ||
| Gastrointestinal Complications | 442 | ||
| Acute complications. | 442 | ||
| Chronic conditions. | 443 | ||
| Urologic Complications | 446 | ||
| Sexual Function and Vaginal Stenosis | 446 | ||
| Bibliography | 448.e1 | ||
| Hemorrhage | 448.e1 | ||
| Genitourinary System | 448.e1 | ||
| Gastrointestinal Tract | 448.e2 | ||
| Venous Thromboembolism | 448.e3 | ||
| Postoperative Infections, Fever, and Wounds | 448.e4 | ||
| Surgical Complications | 448.e5 | ||
| Lymphocysts and Lymphedema | 448.e5 | ||
| Sepsis and Invasive Monitoring | 448.e5 | ||
| Special Populations | 448.e6 | ||
| Complications of Radiation Therapy | 448.e7 | ||
| 17 Basic Principles of Chemotherapy | 449 | ||
| Outline | 449 | ||
| Key Points | 449 | ||
| Historical Overview | 450 | ||
| General Principles | 450 | ||
| Cell Cycle Control and Growth Kinetics | 450 | ||
| Dynamics of Chemotherapy | 453 | ||
| Pharmacologic Principles | 454 | ||
| Drug Interactions | 455 | ||
| Drug Resistance | 456 | ||
| Calculation of Dosage | 456 | ||
| Jelliffe Method | 457 | ||
| Cockroft–Gault Method | 457 | ||
| Calvert Formula | 457 | ||
| Categories of Drugs in Current Use (Table 17.7) | 458 | ||
| Alkylating Agents | 458 | ||
| Antimetabolites | 463 | ||
| Antitumor Antibiotics | 463 | ||
| Agents Derived From Plants | 463 | ||
| Hormonal Agents | 463 | ||
| Targeted Therapies and Immunotherapy | 463 | ||
| Drug Toxicity | 464 | ||
| Hematologic Toxicity | 464 | ||
| Growth Factor Therapy | 464 | ||
| Granulocyte-stimulating therapy. | 464 | ||
| Erythrocyte-stimulating therapy. | 465 | ||
| Platelet-stimulating Therapy | 465 | ||
| Gastrointestinal Toxicity | 465 | ||
| Skin Reactions | 466 | ||
| Hypersensitivity | 467 | ||
| Hepatic Toxicity | 467 | ||
| Pulmonary Toxicity | 467 | ||
| Cardiac Toxicity | 467 | ||
| Renal Toxicity | 468 | ||
| Genitourinary Toxicity | 468 | ||
| Neurologic Toxicity | 468 | ||
| Gonadal Dysfunction | 468 | ||
| Supportive Care | 468 | ||
| Evaluation of New Agents | 468 | ||
| Phase I | 468 | ||
| Phase II | 468 | ||
| Phase III | 469 | ||
| Bibliography | 469.e1 | ||
| Historical Overview | 469.e1 | ||
| Drug Resistance | 469.e1 | ||
| Calculation of Dosage | 469.e1 | ||
| Drug Toxicity | 469.e1 | ||
| 18 Targeted Therapy and Molecular Genetics | 470 | ||
| Outline | 470 | ||
| Key Points | 470 | ||
| Targeted Therapy | 471 | ||
| Foundation of Targeted Therapy | 471 | ||
| Targeted Agents | 472 | ||
| Angiogenesis | 473 | ||
| Vascular Endothelial Growth Factors and Vascular Endothelial Growth Factor Receptors | 473 | ||
| Agents Targeting the Vascular Endothelial Growth Factor Pathway | 474 | ||
| Bevacizumab | 474 | ||
| Ovarian cancer. | 474 | ||
| Uterine cancer. | 476 | ||
| Cervical cancer. | 476 | ||
| VEGF-Trap (Aflibercept) | 476 | ||
| Agents Targeting Vascular Endothelial Growth Factor Receptors | 477 | ||
| AZD2171 (Cediranib) | 477 | ||
| IMC-1121B (Ramucirumab) | 477 | ||
| Agents Targeting Multiple Vascular Endothelial Growth Factor–Related Molecules | 477 | ||
| Sunitinib | 477 | ||
| Pazopanib | 477 | ||
| Brivanib | 478 | ||
| Nintedanib | 478 | ||
| Vascular Disrupting Agents | 478 | ||
| Vadimezan (ASA404/DMXAA) | 479 | ||
| Fosbretabulin (Combretastatin A4); Ombrabulin (AVE8062) | 479 | ||
| Other Antiangiogenic Agents | 479 | ||
| Thalidomide | 479 | ||
| Phosphatidylinositol-3-Kinase/AKT Pathway | 479 | ||
| Agents Targeting mTOR | 480 | ||
| Temsirolimus (CC1-779) | 480 | ||
| Everolimus (RAD001) | 481 | ||
| Ridaforolimus (AP23573; MK-8669) | 481 | ||
| Agents Targeting AKT | 481 | ||
| Agents Targeting PI3K | 481 | ||
| Combination Agents | 481 | ||
| Ras/Raf Pathway | 482 | ||
| Agents Targeting MEK | 482 | ||
| Poly-ADP-Ribose Polymerase Pathway | 482 | ||
| Olaparib | 483 | ||
| Veliparib | 483 | ||
| Rucaparib | 484 | ||
| Niraparib | 484 | ||
| Epidermal Growth Factor Receptor Pathway | 484 | ||
| Small Molecule Inhibitors Targeting Epidermal Growth Factor Receptor | 485 | ||
| Gefitinib | 485 | ||
| Erlotinib | 485 | ||
| Monoclonal Antibodies Targeting Epidermal Growth Factor Receptor | 485 | ||
| Cetuximab | 485 | ||
| Trastuzumab | 485 | ||
| Pertuzumab | 486 | ||
| Seribantumab | 486 | ||
| Combination Agents | 486 | ||
| Lapatinib | 486 | ||
| Multipathway Targeted Agents | 486 | ||
| Sorafenib | 486 | ||
| Vandetanib | 486 | ||
| Imatinib | 487 | ||
| Dasatinib | 487 | ||
| Cabozantinib (XL-184) | 487 | ||
| Other Targets of Interest | 487 | ||
| Angiopoietin (Ang)/Tie-2 | 487 | ||
| Aurora Kinase | 488 | ||
| Delta-Like 4 (DII4)/Notch | 488 | ||
| Folate Receptor α | 488 | ||
| Vintafolide (EC-145) | 488 | ||
| Antimesothelin Antibodies | 489 | ||
| Histone Acetyltransferases and Histone Deacetylases | 489 | ||
| Platelet-derived Growth Factor | 489 | ||
| P53 | 489 | ||
| Immune Therapy | 489 | ||
| Unique Toxicities of Targeted Therapy | 490 | ||
| Hypertension | 490 | ||
| Reverse Protein Leukoencephalopathy | 490 | ||
| Cardiotoxicity | 490 | ||
| Renal Toxicity | 490 | ||
| Thromboembolic Events | 491 | ||
| Gastrointestinal Perforation and Fistula | 491 | ||
| Cutaneous Complications | 491 | ||
| Metabolic Abnormalities | 491 | ||
| Special Considerations for Targeted Therapies | 492 | ||
| Conclusions | 492 | ||
| Acknowledgments | 492 | ||
| Bibliography | 492.e1 | ||
| Targeted Therapy and Targeted Agents | 492.e1 | ||
| Angiogenesis | 492.e1 | ||
| Phosphatidylionositol-3-Kinase (PI3K) and AKT Pathway | 492.e4 | ||
| Ras/Raf Pathway | 492.e5 | ||
| Poly-ADP-Ribose Polymerase Pathway | 492.e5 | ||
| Epidermal Growth Factor Receptor Pathway | 492.e6 | ||
| Multipathway Targeted Agents | 492.e7 | ||
| Other Targets of Interest | 492.e8 | ||
| Unique Toxicities of Targeted Therapy | 492.e9 | ||
| Special Considerations for Targeted Therapies | 492.e10 | ||
| 19 Genes and Cancer | 493 | ||
| Outline | 493 | ||
| Key Points | 493 | ||
| Genetic Alterations in Cancer | 495 | ||
| Mechanisms of Human Gene Mutation | 497 | ||
| Single Base Pair Substitutions and Point Mutations | 499 | ||
| Larger Deletions | 499 | ||
| Insertions | 500 | ||
| Duplications | 501 | ||
| Inversions | 501 | ||
| Translocations | 501 | ||
| Cancer Epigenetics | 501 | ||
| Genomic Imprinting and Cancer | 502 | ||
| Genetic Alterations That Cause Cancer | 502 | ||
| Oncogenes | 502 | ||
| Tumor Suppressor Genes | 504 | ||
| Apoptosis | 505 | ||
| Mismatch Repair Defects | 506 | ||
| Telomerase | 508 | ||
| Hereditary Cancer Risk Assessment: Genetic Counseling and Genetic Testing | 509 | ||
| Clinically Relevant Hereditary Syndromes | 509 | ||
| Hereditary Breast and Ovarian Cancer (BRCA1 and BRCA2; Other DNA Repair Pathway Genes) | 510 | ||
| Management Guidelines for Hereditary Breast and Ovarian Cancer (BRCA1 and BRCA2) | 512 | ||
| Lynch Syndrome (Hereditary Nonpolyposis Colon Cancer) | 513 | ||
| Genetic Testing for Lynch Syndrome | 515 | ||
| Management Guidelines for Lynch Syndrome (Fig. 19.36) | 516 | ||
| Less Common Inherited Cancer Syndromes Relevant to Gynecologic Oncology | 518 | ||
| Peutz-Jeghers Syndrome | 518 | ||
| Management guidelines for Peutz-Jeghers syndrome. | 518 | ||
| Cowden Syndrome | 519 | ||
| Li-Fraumeni Syndrome | 519 | ||
| Genetic Counseling and Genetic Testing for Hereditary Cancers | 520 | ||
| Referral of Gynecologic Cancer Patients for Hereditary Cancer Risk Assessment | 521 | ||
| Ovarian Cancer | 521 | ||
| Timing of Referral for Patients With Ovarian Cancer | 521 | ||
| Endometrial Cancer | 521 | ||
| Referral of the Patient for Genetic Counseling Based on Personal History of Breast Cancer or Family History of Cancer | 522 | ||
| Genetic Testing | 522 | ||
| General Guidelines for Genetic Testing for Hereditary Cancer Risk | 522 | ||
| Informed Consent | 522 | ||
| Ordering Genetic Testing | 523 | ||
| Interpreting the Test Results | 523 | ||
| Legal Aspects of Genetic Testing | 523 | ||
| Long-Term Contact for Patients and Families With Hereditary Risk for Cancer | 525 | ||
| DNA Banking | 525 | ||
| Conclusion | 525 | ||
| Glossary | 526 | ||
| Bibliography | 527.e1 | ||
| Introduction | 527.e1 | ||
| Genetic Alterations in Cancer | 527.e1 | ||
| Oncogenes and Tumor Suppressor Genes | 527.e1 | ||
| Mismatch Repair Defects | 527.e2 | ||
| Telomerase | 527.e2 | ||
| Clinically Relevant Inherited Cancers | 527.e2 | ||
| Clinically Relevant Genetic Cancers for Gynecologists | 527.e3 | ||
| Lynch Syndrome or Hereditary Nonpolyposis Colon Cancer | 527.e3 | ||
| Other Hereditary Syndromes | 527.e4 | ||
| Peutz-Jehgers Syndrome | 527.e4 | ||
| Cowden Syndrome | 527.e5 | ||
| Li-Fraumeni Syndrome | 527.e5 | ||
| Risk Assessment for Hereditary Cancers and Counseling | 527.e5 | ||
| Lynch Syndrome (Hereditary Nonpolyposis Colon Cancer) and Mismatch Repair Defects | 527.e6 | ||
| Medicolegal Issues Associated With Genetic Testing | 527.e6 | ||
| 20 Palliative Care and Quality of Life | 528 | ||
| Outline | 528 | ||
| Key Points | 528 | ||
| Evolution of Palliative Care | 528 | ||
| Quality of Life in Gynecologic Cancers | 530 | ||
| Quality of Life in Ovarian Cancer | 530 | ||
| Quality of Life in Cervical Cancer | 533 | ||
| Quality of Life in Endometrial Cancer | 534 | ||
| Management of Common Physical Symptoms | 535 | ||
| Fatigue | 535 | ||
| Pain | 540 | ||
| Nausea and Vomiting | 547 | ||
| Diarrhea and Constipation | 550 | ||
| Cachexia and Malnutrition | 550 | ||
| Psychosocial and Spiritual Needs of Patients and Families | 551 | ||
| Strategies for Breaking Bad News and Preserving Hope | 552 | ||
| Management of Psychosocial and Spiritual Distress | 553 | ||
| Quality of Life Issues in Advanced and Recurrent Ovarian Cancer | 554 | ||
| Pleural Effusions | 554 | ||
| Small Bowel Obstruction | 554 | ||
| Ascites | 555 | ||
| Role of Palliative Surgical Procedures | 555 | ||
| Quality of Life Issues in Advanced and Recurrent Uterine and Cervical Cancer | 555 | ||
| Ureteral Obstruction | 555 | ||
| Fistula | 556 | ||
| Sexual Dysfunction | 556 | ||
| Anxiety and Depression | 557 | ||
| End-of-Life Decision Making | 557 | ||
| Patient Benefit | 557 | ||
| Patient Self-determination | 557 | ||
| Legal Developments That Have a Bearing on End-of-Life Decision Making | 557 | ||
| Surrogate Decision Making | 558 | ||
| Futility | 558 | ||
| Hospice | 559 | ||
| Bibliography | 559.e1 | ||
| Evolution of Palliative Care | 559.e1 | ||
| Quality of Life | 559.e1 | ||
| Management of Common Physical Symptoms | 559.e2 | ||
| Fatigue | 559.e2 | ||
| NCCN Fatigue | 559.e2 | ||
| Pain | 559.e3 | ||
| Nausea and Vomiting | 559.e3 | ||
| Diarrhea and Constipation | 559.e4 | ||
| Cachexia and Malnutrition | 559.e4 | ||
| Strategies for Breaking Bad News and Preserving Hope | 559.e4 | ||
| Management of Psychosocial and Spiritual Distress | 559.e4 | ||
| Pleural Effusion | 559.e5 | ||
| Small Bowel Obstruction | 559.e5 | ||
| Ascites | 559.e5 | ||
| Role of Palliative Surgical Procedures | 559.e5 | ||
| Ureteral Obstruction | 559.e5 | ||
| Fistula | 559.e6 | ||
| Sexual Dysfunction | 559.e6 | ||
| Anxiety and Depression | 559.e6 | ||
| End-of-Life Decision Making | 559.e6 | ||
| Futility | 559.e6 | ||
| Hospice | 559.e7 | ||
| 21 Role of Minimally Invasive Surgery in Gynecologic Malignancies | 560 | ||
| Outline | 560 | ||
| Key Points | 560 | ||
| Laparoscopic Surgery in Gynecologic Oncology | 560 | ||
| Laparoscopic Surgical Staging of Gynecologic Malignancies | 561 | ||
| Robotic Surgery in Gynecologic Malignancies | 561 | ||
| Minimally Invasive Surgery Learning Curve | 561 | ||
| Minimally Invasive Surgical Technique | 562 | ||
| Positioning of the Patient | 562 | ||
| Port Sites and Setup | 563 | ||
| Surgical Procedure and Technique | 564 | ||
| Applications of Minimally Invasive Surgery in Gynecologic Oncology | 566 | ||
| Cervical Cancer | 566 | ||
| Early-stage Cervical Cancer: Radical Hysterectomy | 566 | ||
| Early-Stage Cervical Cancer: Fertility-Sparing Surgery | 568 | ||
| Advanced-Stage Cervical Cancer: Surgical Staging | 568 | ||
| Endometrial Cancer | 569 | ||
| Laparoscopy | 569 | ||
| Robotics | 571 | ||
| Single-Site Surgery | 572 | ||
| Minimally Invasive Sentinel Lymph Node Assessment | 572 | ||
| Removal of a Large Uterus | 573 | ||
| Uterine Manipulation for Minimally Invasive Surgery | 573 | ||
| Adnexal Mass | 573 | ||
| Minimally Invasive Surgery Management | 574 | ||
| Ovarian Cancer | 575 | ||
| Diagnosis of Ovarian Cancer | 575 | ||
| Ovarian Cyst Rupture | 575 | ||
| Early-stage Ovarian Cancer | 575 | ||
| Advanced Ovarian Cancer | 576 | ||
| Complications of Laparoscopic Surgery | 577 | ||
| Port-site Recurrences | 578 | ||
| Conclusions | 578 | ||
| Bibliography | 578.e1 | ||
| Minimally Invasive Surgery in Gynecologic Oncology | 578.e1 | ||
| Minimally Invasive Surgery Surgical Technique | 578.e1 | ||
| Laparoscopy in Cervical Cancer | 578.e2 | ||
| Laparoscopy in Endometrial Cancer | 578.e5 | ||
| Laparoscopic Management of Adnexal Mass | 578.e7 | ||
| Laparoscopy in Ovarian Cancer | 578.e8 | ||
| Complications | 578.e10 | ||
| 22 Epidemiology of Commonly Used Statistical Terms and Analysis of Clinical Studies | 579 | ||
| Outline | 579 | ||
| Key Points | 579 | ||
| Epidemiology | 579 | ||
| Evidence-Based Medicine | 579 | ||
| Measures in Epidemiology | 580 | ||
| Analysis of Clinical Trials | 581 | ||
| Types of Clinical Trials | 583 | ||
| Evaluation of Clinical Trials | 583 | ||
| Placebo Treatment Groups | 584 | ||
| Controls Used in Clinical Trials | 584 | ||
| Studies of Therapy | 584 | ||
| Blinding | 584 | ||
| When to Stop a Clinical Trial | 585 | ||
| Bibliography | 585.e1 | ||
| 23 Basic Principles in Gynecologic Radiotherapy | 586 | ||
| Outline | 586 | ||
| Key Points | 586 | ||
| Introduction to Electromagnetic Radiation | 587 | ||
| Radiation Units | 588 | ||
| Radiation Physics | 588 | ||
| Energy Deposition | 588 | ||
| Sources of Radiation | 589 | ||
| Photon Interactions | 589 | ||
| Radioactive Decay | 589 | ||
| Inverse Square Law | 590 | ||
| Depth Dose Characteristics of Radiation | 591 | ||
| Radiobiology | 591 | ||
| Structural Changes | 592 | ||
| Radiosensitivity | 592 | ||
| Radiosensitizers, Hypoxic Cell Sensitizers, and Radioprotectors | 595 | ||
| Genetic Effects | 595 | ||
| Fetal Effects | 596 | ||
| Principles of Clinical Radiation Therapy | 597 | ||
| External-beam Radiation (Teletherapy) | 597 | ||
| Local Radiation (Brachytherapy) | 597 | ||
| Normal Tissue Tolerance | 598 | ||
| Pelvic Organ Tolerance | 598 | ||
| Long-term Effects | 600 | ||
| New Radiation Modalities | 600 | ||
| Protons | 600 | ||
| Electrons | 602 | ||
| Fast Neutrons | 602 | ||
| Negative Pi Mesons and Other Heavy Ions | 602 | ||
| New Radiation Delivery Technology | 602 | ||
| Intraoperative Radiation | 602 | ||
| Hyperthermia | 602 | ||
| Three-dimensional Conformal Radiation Therapy | 603 | ||
| Intensity-modulated Radiation Therapy | 603 | ||
| Stereotactic Radiotherapy | 603 | ||
| Immune-tagged Radiation Therapy | 603 | ||
| Glossary | 603 | ||
| Bibliography | 605.e1 | ||
| Radiation Physics | 605.e1 | ||
| Radiobiology | 605.e1 | ||
| Principles of Clinical Radiation Therapy | 605.e2 | ||
| New Radiation Modalities | 605.e2 | ||
| New Radiation Delivery Technology | 605.e2 | ||
| Appendix A Staging: Staging of Cancer at Gynecologic Sites | 606 | ||
| Abstract | 606 | ||
| Cervix Uteri, Corpus Uteri, Ovary, Vagina, Vulva, Gestational Trophoblastic Tumors, and Fallopian Tube | 606 | ||
| 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 | ||
| Anatomy | e1 | ||
| Rules for Classification | e1 | ||
| Staging Classification | e2 | ||
| Notes About the Staging | e2 | ||
| Histopathology | e2 | ||
| Histopathologic Types | e2 | ||
| Histopathologic Grade | e3 | ||
| Stage Grouping for the Cervix | e3 | ||
| Corpus | e3 | ||
| Anatomy | e3 | ||
| Rules for Classification | e3 | ||
| Surgical Staging Classification | e3 | ||
| Notes About the Staging | e4 | ||
| Histopathology—degree of differentiation. | e4 | ||
| Notes on Pathologic Grading | e4 | ||
| Rules Related to Staging | e4 | ||
| Histopathology | e4 | ||
| Ovary, Fallopian Tube, and Peritoneal | e5 | ||
| Anatomy | e5 | ||
| Rules for Classification | e5 | ||
| Staging Classification | e5 | ||
| Histopathology | e6 | ||
| Histopathologic Grade (G) | e6 | ||
| Fallopian Tube | e6 | ||
| FIGO Staging for Fallopian Tube Carcinoma | e7 | ||
| Uterine Sarcoma | e8 | ||
| Staging of Uterine Sarcomas (Leiomyosarcomas, Endometrial Stromal Sarcomas, and Adenosarcomas) | e8 | ||
| Endometrial Stromal Sarcomas | e8 | ||
| Adenosarcomas | e8 | ||
| Carcinosarcomas | e8 | ||
| Vagina | e8 | ||
| Classification by Site | e8 | ||
| Appendix B Modified From Common Terminology Criteria for Adverse Events (Common Terminology Criteria for Adverse Events)* | 607 | ||
| Quick Reference | 607 | ||
| Components and Organization | 607 | ||
| System Organ Class | 607 | ||
| CTCAE Terms | 607 | ||
| Definitions | 607 | ||
| Grades | 607 | ||
| Appendix B Modified From Common Terminology Criteria for Adverse Events (Common Terminology Criteria for Adverse Events)* | e12 | ||
| Quick Reference | e12 | ||
| Components and Organization | e12 | ||
| System Organ Class | e12 | ||
| CTCAE Terms | e12 | ||
| Definitions | e12 | ||
| Grades | e12 | ||
| Grade 5 | e12 | ||
| Appendix C Blood Component Therapy | 608 | ||
| Bibliography | 610.e1 | ||
| Appendix D Suggested Recommendations for Routine Cancer Screening | 611 | ||
| Cervical Cancer | 611 | ||
| Breast Cancer | 611 | ||
| Endometrial Cancer | 611 | ||
| Ovarian Cancer | 611 | ||
| Colorectal Cancer | 612 | ||
| Lung Cancer | 612 | ||
| Appendix E Nutritional Therapy | 613 | ||
| Enternal Nutrition | 614 | ||
| Bibliography | 616.e1 | ||
| Index | 617 | ||
| A | 617 | ||
| B | 618 | ||
| C | 618 | ||
| D | 620 | ||
| E | 621 | ||
| F | 622 | ||
| G | 622 | ||
| H | 623 | ||
| I | 624 | ||
| J | 624 | ||
| K | 624 | ||
| L | 624 | ||
| M | 625 | ||
| N | 626 | ||
| O | 626 | ||
| P | 626 | ||
| Q | 628 | ||
| R | 628 | ||
| S | 628 | ||
| T | 629 | ||
| U | 630 | ||
| V | 630 | ||
| W | 631 | ||
| Y | 631 | ||
| Inside Back Cover | ibc1 |