Principles and Practice of Gynecologic Oncology

 

 

Completely reorganized to be more clinically focused on diagnosis and treatment, Principles and Practice of Gynecologic Oncology, Eighth Edition, provides the up-to-date information practitioners, researchers, and students need in an easily accessible manner. Drs. Dennis S. Chi, Dineo Khabele, Don S. Dizon, and Catheryn Yashar oversee an expert team of international, multidisciplinary authors who offer practical coverage of the entire field, including new management and treatment strategies for gynecologic cancers. Each disease site now has a dedicated section with individual chapters on epidemiology, pathogenesis, prevention, diagnostic imaging, radiation, chemotherapy, targeted therapy, and more—all designed for  quick clinical reference and efficient study. 

• Features a multidisciplinary approach to treatment and care including expert views from radiation oncology, pathology, internal medicine, gastroenterology and nutrition, neurology, pharmacy, genetics, and epidemiology, in addition to medical oncology and surgery 
• Provides international perspectives in every chapter, offering unique perspectives on incidence, mortality, and treatment worldwide, as well as commentary on similarities and differences in management 
• Covers special topics such as perioperative and critical care; surgical procedures; cost-effective and value-based cancer care; pain, nutrition, and palliative care; and a new chapter on supportive care 
• Includes access to more than two dozen videos 
• Highlights authoritative content with hundreds of high-quality, full-color illustrations and nearly 250 tables for quick reference 
   
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Table of Contents:

 

 

SECTION 1: OVERVIEW OF BASIC BIOLOGY

1.1 Overview of Basic Biology

Introduction

Tumor Initiation: Biology of Oncogenes and Tumor Suppressors

Peptide Growth Factors and Receptor Tyrosine Kinases

Deoxyribonucleic Acid Repair

Metastasis

Angiogenesis

Summary

References

SECTION 2: VULVAR CANCER

2.1 Epidemiology of Vulvar Cancer

References

2.2 Vulvar Cancer: Anatomy, Natural History, and Patterns of Spread

Anatomy

Vascular Anatomy and Neurologic Innervation

Groin Anatomy and Lymphatic Drainage

Natural History (Patterns of Spread)

References

2.3 Vulvar Cancer: Etiology, Risk Factors, Genetics, and Molecular Biology

References

2.4 Vulvar Cancer: Preinvasive Disease

References

2.5 Vulvar Cancer: Clinical Presentation, Diagnostic Evaluation, and Workup

Clinical Presentation

Diagnostic Evaluation

Staging

References

2.6 Therapy for Vulvar Cancer: Radiation, Systemic Therapy, and Treatment of Persistent and Recurrent Disease

General Management

High-Grade Vulvar Intraepithelial Neoplasia

Invasive Vulvar Squamous Cell Carcinoma: Management of the Primary Tumor

Invasive Vulvar Squamous Cell Carcinoma: Management of Lymph Nodes

Management of Distant Metastatic Disease

Management of Recurrent Squamous Vulvar Cancers

Management of Nonsquamous Vulvar Cancers

Basal Cell Carcinoma

Adenocarcinoma

Paget Disease

Radiation Therapy

Adjuvant Radiotherapy to the Vulva

Adjuvant Regional Radiotherapy

Preoperative Radiotherapy

Definitive Radiotherapy

Radiation Therapy Technique

Acute Complications of Radiation Therapy

Late Complications of Radiation Therapy

Chemotherapy

Primary Treatment of Advanced Disease

Neoadjuvant Chemotherapy

Systemic Treatment of Metastatic and Recurrent Vulvar Cancer

References

2.7 Surgery for Vulvar Cancer

References

2.8 Vulvar Cancer: Pathology and Prognostic Factors

Pathology

Squamous Cell Carcinomas

Verrucous Carcinoma

Basal Cell Carcinoma

Neuroendocrine and Neuroectodermal Tumors: Merkel Cell Tumors and Peripheral Neuroectodermal Tumor/Extraosseous Ewing Sarcoma

Carcinomas Arising From Bartholin Glands

Vulvar Paget Disease and Paget-Like Lesions

Vulvar Malignant Melanoma

Vulvar Sarcomas

Tumors Metastatic to the Vulva

Prognostic Factors

Presurgery

Postsurgery

References

2.9 Vulvar Cancer: Follow-Up and Survivorship Issues

Results of Therapy

Sequelae of Treatment

References

2.10 Vulvar Cancer: Future Directions

Summary

SECTION 3: VAGINAL CANCER

3.1 Vaginal Anatomy

Patterns of Spread

References

3.2 Vaginal Cancer: Etiology, Epidemiology, Risk Factors, Genetics, and Molecular Biology

Introduction

Vaginal Intraepithelial Neoplasia

Malignant Tumors of the Vagina: Squamous Cell Carcinoma

References

3.3 Symptoms and Diagnosis of Vaginal Intraepithelial Neoplasia and Vaginal Cancer

Vaginal Intraepithelial Neoplasia

Vaginal Carcinoma

Diagnostic Workup

Staging

References

3.4 Surgery for Vaginal Intraepithelial Neoplasia and Vaginal Cancer

Surgery for Invasive Cancer

References

3.5 Prognostic Factors

Prognostic Factors—Vaginal Cancer

References

3.6 Therapeutic Approach for VAIN and Invasive Vaginal Disease

Vaginal Intraepithelial Neoplasia

Vaginal Cancer

References

3.7 Treatment of Persistent and Recurrent Vaginal Cancer

References

3.8 Rare Histologies of Vaginal Cancer

Clear Cell Adenocarcinoma

Epidemiology

Risk Factors

Histopathology

Clinical Presentation

Prognostic Factors

Treatment Options

Other Adenocarcinomas

Melanoma

Treatment Options

Sarcoma

Prognostic Factors

Treatment Options

Outcomes

Lymphoma

Small Cell Carcinoma of the Vagina and Other Rare Histologies

Carcinoma of the Neovagina

History of Prior Pelvic Radiation

References

3.9 Vaginal Cancer: Follow-Up, Survivorship Issues, and Summary

Outcomes

Summary

References

SECTION 4: CERVICAL CANCER

4.1 Cervix Uteri: Epidemiology, Etiology, Risk Factors, Anatomy, Natural History, and Patterns of Spread

Epidemiology

Etiology and Risk Factors

Human Papillomavirus

Uterine Cervix Anatomy

Uterine Cervix Disease Natural History

Preinvasive Disease

Invasive Disease

Metastatic Disease

References

4.2 Genetics and Molecular Biology of Cervical Cancer

References

4.3 Cervical Cancer: Clinical Presentation and Diagnostic Evaluation

Preclinical Invasive Disease

Screening Cytology

Human Papillomavirus Testing

Colposcopy

Conization

Loop Diathermy

Clinical Invasive Disease

Symptoms and Complaints

Physical Findings

Diagnostic Biopsy

Staging

Clinical Staging Procedures

Clinical Laboratory Studies

Clinical Serum Tumor Markers

Clinical Radiographic Studies

Pretreatment Para-Aortic Node Operative Staging

Sentinel Lymph Node Mapping in Early Uterine Cervix Cancer

References

4.4 Surgery for Cervical Cancer

Class I: Extrafascial Hysterectomy

Class II: Modified Radical Hysterectomy

Class III: Radical Hysterectomy

Class IV: Extended Radical Hysterectomy

Class V: Extended Radical Hysterectomy Or Pelvic Exenteration

New Classifications of Radical Hysterectomy

Alternative Operations for Uterine Cervix Cancer

Radical Vaginal Hysterectomy

Radical Trachelectomy

Nerve-Sparing Radical Hysterectomy

Total Pelvic Exenteration

References

4.5 Cervical Cancer: Pathology

Squamous Cell Carcinoma

Preinvasive Disease

Microinvasive Disease

Invasive Disease

Squamous Cell Carcinoma Variants

Papillary Squamous and Transitional Cell Carcinoma

Verrucous Carcinoma

Warty Carcinoma

Lymphoepithelioma-Like Carcinoma

Adenosquamous Carcinoma

Adenocarcinoma

Adenocarcinoma In Situ

Adenocarcinoma

Mucinous Adenocarcinoma

Mucinous Adenocarcinoma, Endocervical Variant

Mucinous Adenocarcinoma, Intestinal Type, Signet-Ring, and Colloid Variants

Mucinous Adenocarcinoma, Minimal Deviation Variant

Mucinous Adenocarcinoma, Well-Differentiated Villoglandular Variant

Adenocarcinoma, Endometrioid Variant

Adenocarcinoma, Clear Cell Variant

Adenocarcinoma, Papillary Serous Variant

Adenocarcinoma, Mesonephric Variant

Adenocarcinoma, Microcystic Endocervical Variant

Glassy Cell Carcinoma

Adenoid Cystic Carcinoma

Adenoid Basal Epithelioma (Carcinoma)

Neuroendocrine Cancers

Small Cell Carcinoma

Mixed Epithelial and Mesenchymal Tumors

Other Malignant Tumors

Uterine Cervix Cancer Prognostic Factors

Surgicopathologic Factors

Lymph Node Factors

Clinical Stage Factors

Histopathology Factors

Hypoxia and Anemia Factors

Uterine Cervix Cancer Biomarkers and Imaging Correlates

References

4.6 Radiation Therapy, Immunotherapy, and Targeted Therapies in Cervix Cancer

Radiation Therapy

External Beam Radiation Therapy

Intensity-Modulated Radiation Therapy for Uterine Cervix Cancer

Extended-Field Radiation Therapy for Uterine Cervix Cancer

Uterine Cervix Brachytherapy

Altered Radiation Fractionation

Total Radiation Therapy Treatment Time

Urgent Palliative Radiation for Uterine Cervix Cancer

Immunotherapy and Targeted Therapy Approaches in Cervical Cancer

Therapeutic Vaccines

Adoptive Cell Therapies

Antibody-Drug Conjugates

Immune Checkpoint Blockade and Combinations

References

4.7 Treatment of Persistent or Recurrent Uterine Cervix Cancer

General Considerations

Radical Surgery for Pelvic Disease After Prior Radiation Therapy

Radical Radiation or Radiochemotherapy for Pelvic Disease After Prior Surgery

Chemotherapy and Biologic Targeted Agents for Persistent or Recurrent Uterine Cervix Cancer

Conclusion

References

4.8 Survivorship Issues Following Treatment for Cervical Cancer

Longer Term Complications Following Surgery-Only Treatment

Complications Following Preoperative Radiation

Long-Term Complications Following Radiation-Only Treatment

Long-Term Complications Following Adjuvant Radiation Therapy

Complications Following Chemoradiation

Thromboembolic Adverse Events

Sexual Dysfunction

Insufficiency Fractures

References

4.9 Cervical Cancer: Future Directions

References

SECTION 5: CORPUS: EPITHELIAL TUMORS

5.1 Endometrial Cancer: Introduction, Anatomy, Natural History, and Patterns of Spread

Introduction

Anatomy

Classification

Molecular Subtypes

Clinical Implications

References

5.2 Endometrial Cancer: Etiology, Epidemiology, Risk Factors, Genetics, and Molecular Biology

Epidemiology and Risk Factors

Protective Factors

Natural History of Disease

References

5.3 Endometrial Cancer: Clinical Presentation, Diagnostic Evaluation, and Workup

Diagnostic Evaluation

Screening

Prevention

Clinical Presentation

Diagnostic Workup

Preoperative Assessment

Evaluation of Metastatic Spread

References

5.4 Surgery for Endometrial Cancer

Introduction

Staging of Disease

Management of Lymph Nodes

Minimally Invasive Surgery

Surgical Management of Intraperitoneal Disease

Surgical Recommendations

References

5.5 Endometrial Cancer: Pathology and Prognostic Factors

Pathologic Factors of Prognostic Significance

Predicting Nodal Disease

Prognostic Factors

Patterns of Failure

Pathology

Hyperplasia

Endometrial Intraepithelial Neoplasia

Simple Hyperplasia

Complex Hyperplasia

Atypical Hyperplasia

Progression From Hyperplasia to Cancer

Pathologic Diagnosis

References

5.6 Therapy for Endometrial Cancer: Radiation, Chemotherapy, Targeted, Immunotherapy, and Other New and Novel Agents

General Management

Results of Standard Therapy and Their Sequelae

Adjuvant Radiation Therapy

Early-Stage Disease

Advanced-Stage Disease

Special Situations

Positive Cytology Without Adnexal or Serosal Involvement

Definitive Radiation for Inoperable Disease

Radiation Therapy Techniques

Intravaginal Brachytherapy

External Beam Radiation

Complications of Radiation

Systemic Therapies

Endometrial Cancer and Cytotoxic Chemotherapy

Endocrine Therapy

Cytotoxic Chemotherapy

Targeted Therapy

The PI3K/AKT/Mammalian Target of Rapamycin Pathway

Angiogenesis

Vascular Endothelial Growth Factor Receptor Ligand

Vascular Endothelial Growth Factor Receptor Inhibitors

Mismatch Repair

Role of Immunotherapy in the Management of Patients With Endometrial Cancer

HER2/neu

WEE1 Inhibitors

The Poly (Adenosine Diphosphate Ribose) Polymerase

References

5.7 Treatment of Persistent and Recurrent Endometrial Cancer

Management of Patients With Serous, Clear Cell Histology

References

5.8 Endometrial Cancer: Special Conditions

Fertility-Sparing Treatment

Medical Management

Pregnancy Outcomes

Ovarian Preservation

References

5.9 Endometrial Cancer: Follow-Up and Survivorship Issues

Surveillance

Survivorship Issues

Sexual Health

Survivorship Considerations for Young Women

References

5.10 Endometrial Cancer: Future Directions

Summary

References

SECTION 6: CORPUS: MESENCHYMAL TUMORS

6.1 Mesenchymal Tumors: Introduction, Anatomy, Natural History, and Patterns of Spread

Introduction

Anatomy

Natural History

Patterns of Spread

References

6.2 Mesenchymal Tumors: Etiology, Epidemiology, and Risk Factors

Histologic Distribution

Age Distribution

Racial Distribution

Risk Factors

Prior Radiation Exposure

Hormone Exposure and Obesity

Tamoxifen Use

Hereditary Predisposition

References

6.3 Mesenchymal Tumors: Clinical Presentation and Diagnostic Evaluation and Workup

Clinical Presentation

Presenting Symptoms and Signs

Diagnostic Evaluation/Workup

Physical Examination and Preoperative Imaging

Tumor Markers

Endometrial Sampling

References

6.4 Surgery for Newly Diagnosed Uterine Corpus Mesenchymal Tumors

Surgery for Newly Diagnosed Patients

Preoperative or Intraoperative Diagnosis

Preoperative Workup

Resectable Disease

Uterine Preservation

Role of Nodal Evaluation or Lymphadenectomy

Role of Oophorectomy

Cytoreductive Surgery for Patients With Extrauterine Disease at Initial Diagnosis

Postoperative Diagnosis

Uterine Morcellation

References

6.5 Pathology of Uterine Mesenchymal Tumors

Introduction

Overview of Molecular Landscape of Uterine Mesenchymal Tumors

Leiomyosarcomas and Other Smooth Muscle Tumors

Benign Metastasizing Leiomyoma

Endometrial Stromal Neoplasms

Stromal Nodule

Low-Grade Endometrial Stromal Sarcoma

High-Grade Endometrial Stromal Sarcoma

Undifferentiated Uterine Sarcomas

Müllerian Adenosarcoma

Uterine Tumor Resembling Ovarian Sex Cord Tumor

Perivascular Epithelioid Cell Tumors

Inflammatory Myofibroblastic Tumor

Other Rare Uterine Sarcomas

References

6.6 Radiation Therapy for Uterine Corpus Mesenchymal Tumors

Uterine Sarcomas

References

6.7 Chemotherapy for Uterine-Limited and Advanced Uterine Sarcomas

Introduction

Limited or Completely Resected Disease

Uterine Leiomyosarcoma

Low-Grade Endometrial Stromal Sarcoma

Adenosarcoma

Rhabdomyosarcomas

Neoadjuvant Chemotherapy

Chemotherapy for Metastatic Disease

Single-Agent Therapies

Combination Therapy

Endometrial Stromal Sarcoma

High-Grade Undifferentiated Endometrial Sarcoma

Toxicity of Systemic Therapies

Systemic Therapy: Summary

Hormonal, Targeted, Immunotherapy, and Other, New, and Novel

Hormonal Therapy

Endometrial Stromal Sarcoma

Metastatic/Recurrent Endometrial Stromal Sarcoma

Other Uterine Sarcomas

Biologic and Targeted Therapy

Angiogenesis Inhibitors

Tyrosine Kinase Inhibitors

PI3K/AKT/mTOR Pathway

Targeted Therapy for Tumor Genomic Alterations

Immunotherapy

Soft-Tissue Sarcoma

Leiomyosarcoma

Novel Agents

Hormonal, Targeted, Immunotherapy, and Other, New, and Novel Therapy: Summary

References

6.8 Surgery for Persistent and Recurrent Uterine Sarcomas

Surgery for Recurrent Disease

References

6.9 Uterine Sarcomas: Follow-Up, Survivorship Issues, and Future Directions

Surveillance Recommendations

Menopause Symptom Management

Future Directions

References

SECTION 7: GESTATIONAL TROPHOBLASTIC DISEASE: MOLAR PREGNANCY AND GESTATIONAL TROPHOBLASTIC NEOPLASIA

7.1 Epidemiology, Genetics, and Pathology in Gestational Trophoblastic Disease

Introduction

Epidemiology

Genetics

Pathology

References

7.2 Management of Molar Pregnancy

Introduction

Patient Assessment

Initial Management

Postmolar Surveillance

Contraception During Human Chorionic Gonadotropin Surveillance

References

7.3 Management of Low-Risk Gestational Trophoblastic Neoplasia

Gestational Trophoblastic Neoplasia

Diagnosis of Gestational Trophoblastic Neoplasia

Human Chorionic Gonadotropin

Staging of Gestational Trophoblastic Neoplasia

Treatment for Low-Risk Gestational Trophoblastic Neoplasia

Consolidation

References

7.4 Management of High-Risk Gestational Trophoblastic Neoplasia

High-Risk Gestational Trophoblastic Neoplasia

Ultrahigh-Risk Gestational Trophoblastic Neoplasia

Patients With Brain Metastases

Chemoresistance or Relapsed Disease

Placental Site Trophoblastic Tumor and Epithelioid Trophoblastic Tumor

Localized Disease

Metastatic Disease

References

7.5 Gestational Trophoblastic Disease: Postdiagnosis and Treatment, Long-Term Sequelae, and Quality-of-Life Issues

Introduction

Future Fertility

Secondary Malignancies

Relationship Issues/Sexual Function

References

SECTION 8: EPITHELIAL OVARIAN CANCER

8.1 Epidemiology and Risk Factors

Epidemiology

Weight/Body Mass Index

Reproductive Factors: Menstrual Cycles, Pregnancy, Breastfeeding, and Infertility

Contraceptives and Ovarian Cancer Risk Reduction

Conclusions

References

8.2 Hereditary Ovarian Cancer: BRCA and HNPCC—Panel Testing

Biology of BRCA-Associated Ovarian Cancer

Clinical Features of BRCA-Associated Ovarian Cancer

Gene Panel Testing of Germline DNA and Counseling

Follow-up of BRCA1/2-Positive Patients Who Do Not Want to Undergo Risk-Reducing Salpingo-Oophorectomy

Prophylactic Risk-Reducing Salpingo-Oophorectomy for Prevention of BRCA-Associated Ovarian Cancer

Indications for Surgery for BRCA1/2 Mutations

Surgery: Risk-Reducing Salpingo-Oophorectomy

Postoperative Results

Pathology and Prognosis after Risk-Reducing Salpingo-Oophorectomy Specimens

Biology and Clinical Features of Lynch Syndrome–Associated Ovarian Cancers

Prophylactic Surgery for Prevention of Lynch Syndrome–Associated Cancers

References

8.3 Natural History of the Disease: Patterns of Spread

Mucinous, Clear Cell, and Endometrioid Ovarian Cancer

Serous Papillary Ovarian Cancer

Lymph Node Metastasis

Recurrent Ovarian Cancer

References

8.4 Ovarian Cancer: Etiology, Genetics, and Molecular Biology

Ovarian Cancer Etiology

Ovarian Cancer Genetics and Genomics

High-Grade Serous Ovarian Cancer

Gene Expression

The Role of the Tumor Microenvironment as an Integral Part of the Tumor Organ

Endometrioid and Clear Cell Ovarian Cancers

Synchronous Endometrioid Ovarian and Endometrial Cancers

Borderline and Invasive Low-Grade Serous Ovarian Cancers

Mucinous Ovarian Cancer

Future Directions

References

8.5 Ovarian Cancer: Clinical Presentation and Diagnostic Workup

Clinical Presentation of Patients With A Benign Adnexal Mass or Early-Stage Ovarian Cancer

Clinical Presentation of Patients With Advanced Ovarian Cancer

Diagnosis of Ovarian Cancer

Clinical Examination

Laboratory Tests

The CA-125 Tumor Marker

The HE4 Tumor Marker

OVA1

Other Markers That May Assist With the Differential of an Adnexal Mass

DNA Methylation Profile

Carcinoembryonic Antigen

Imaging of Adnexal Masses and Early Ovarian Cancer: Ultrasound and Magnetic Resonance Imaging

Imaging of Advanced Ovarian Cancer: Computed Tomography, Positron Emission Tomography Scan, and Magnetic Resonance Imaging

Differential Diagnosis of Ovarian Cancer

References

8.6 Surgery for Ovarian Cancer

Introduction and definitions

Early-Stage Ovarian Cancer

The Role of Lymph Node Dissection in Early and Advanced Ovarian Cancer

Advanced Epithelial Ovarian Cancer: Rationale for Surgical Debulking

Surgical Debulking—Pelvic and Upper Abdominal Procedures

Role of Lymph Node Dissection in Surgery for Advanced Ovarian Cancer

Neoadjuvant Chemotherapy

Hyperthermic Intraperitoneal Chemotherapy

Summary of Primary Debulking Surgery for Ovarian Cancer

Interval Debulking for Suboptimally Debulked Patients

Secondary Cytoreductive Surgery for Recurrent Disease

Palliative Surgery Including Surgery for Malignant Bowel Obstruction

Fluorescence-Guided Surgery

References

8.7 Ovarian Cancer: Pathology

Classification

Intraoperative Consultation (Frozen Section)

College of American Pathologists, 2020 World Health Organization, and International Collaboration on Cancer Reporting Guidelines

Recommendations for Reporting

Recommendations Regarding Gross Examination

Recent Changes in Classification and Terminology

Cytopathology

Borderline Tumors

Primary Versus Metastatic Ovarian Carcinomas

Mucinous Metastases

Mucinous Tumors Associated With Pseudomyxoma Peritonei

Nonmucinous Metastases

Serous Tumors

Benign Serous Cystadenoma and Adenofibroma

Serous Borderline Tumor

Low-Grade Serous Carcinoma

High-Grade Serous Carcinoma of Ovarian, Tubal, and Peritoneal Origin

Mucinous Tumors

Mucinous Cystadenoma and Adenofibroma

Mucinous Borderline Tumor

Mucinous Carcinoma

Mural Nodules in Mucinous Tumors

Endometrioid Tumors

Benign Endometrioid Adenofibromas

Endometrioid Borderline Tumors

Endometrioid Carcinoma

Endometrioid Carcinoma Associated With Uterine Endometrial Carcinoma

Seromucinous Tumors

Seromucinous Cystadenoma and Adenofibroma

Seromucinous Borderline Tumor

Clear Cell Ovarian Tumors

Clear Cell Cystadenomas/Adenofibromas and Clear Cell Borderline Tumors

Clear Cell Carcinomas

Brenner Tumors

Benign Brenner Tumor

Borderline Brenner Tumors

Malignant Brenner Tumors

Mixed Epithelial Ovarian Tumors

Carcinosarcoma

Mesonephric-Like Adenocarcinoma

Other Ovarian Tumors

Undifferentiated and Dedifferentiated Carcinoma

Small Cell Carcinoma of the Ovary, Hypercalcemic Type

Tumors of the Fallopian Tubes

Benign Fallopian Tube Tumors

Malignant Fallopian Tube Tumors

References

8.8 Epithelial Ovarian Cancer: Prognostic Factors

Tumor Stage

Age

Prognostic Variables in Early-Stage Disease

Histologic Subtype

Grade

CA-125 Levels in Early-Stage Disease

Prognostic Variables in Stage III/IV Disease

Volume of Residual Disease After Surgery

Histologic Subtype and Grade in Advanced Disease

CA-125 Levels in Advanced Disease

Other Prognostic Factors

Long-Term Survivors

References

8.9 Management of Early-Stage Ovarian Cancer

Management of Early-Stage (I and II) Ovarian Cancer

Surgical Therapy for Early-Stage Ovarian Carcinoma

Postoperative Therapy for Stage I Ovarian Carcinoma

Chemotherapy for Early-Stage High-Grade Serous Cancers

Early-Stage Fallopian Tube Carcinomas and Serous Tubal Intraepithelial Carcinomas

References

8.10 Management of Borderline Tumors and Low-Grade Serous Tumors

Early-Stage Borderline Tumors

Surgery

Prognosis and Therapy of Early-Stage Serous and Mucinous Borderline Tumors

Advanced-Stage Serous Borderline Tumors

Surgery

Prognosis and Adjuvant Systemic Therapy

Therapy for Advanced-Stage Low-Grade Serous Cancers and Invasive Recurrences of Serous Borderline Tumors

References

8.11 Management of Advanced-Stage Ovarian Cancer

Surgery

Chemotherapy

Platinum Use

Addition of Paclitaxel to Platinum Chemotherapy

Alternate Paclitaxel Dosing

Alternate Taxanes

Addition of a Third Cytotoxic Agent to Frontline Chemotherapy

Substitution of an Alternate Cytotoxic Agent for Paclitaxel

Addition of Bevacizumab to Primary Chemotherapy

Intraperitoneal Chemotherapy

Clinical Use of Intraperitoneal Therapy for Ovarian Cancer

Consolidation/Maintenance

Consolidative/Maintenance Chemotherapy

Maintenance With Poly(ADP-Ribose) Polymerase Inhibitors

Maintenance with Immune Checkpoint Inhibitors

References

8.12 Approach to Advanced and Recurrent Clear Cell, Mucinous, or Endometrioid Cancer

Treatment Considerations for Advanced or Recurrent Clear Cell, Mucinous, and Endometrioid Ovarian Cancer

Endometrioid Ovarian Cancer

Clear Cell Ovarian Carcinoma

Mucinous Ovarian Tumors

References

8.13 Treatment of Ovarian Carcinosarcoma

Ovarian Carcinosarcoma

References

8.14 Ovarian Cancer: Survivorship Issues

Survivorship After a Diagnosis of Ovarian Cancer

Follow-up of Patients in Remission

Uses of CA-125 During Ovarian Cancer Treatment

References

8.15 Treatment of Persistent and Recurrent Ovarian Cancer and Palliative Care

Treatment of Persistent/Recurrent Disease

Timing of Treatment Initiation

Secondary Cytoreductive Surgery

Second-Line Chemotherapy

References

8.16 New Therapeutics

Antibody-Drug Conjugates

Cell Cycle Checkpoint Kinase Inhibitors

GAS6/AXL Pathway

Immunologic Therapies

References

SECTION 9: OVARIAN GERM CELL TUMORS

9.1 Ovarian Germ Cell Tumors: Introduction, Anatomy, Natural History, and Patterns of Spread

Introduction

Anatomy

Natural History

Patterns of Spread

References

9.2 Malignant Ovarian Germ Cell Tumors: Etiology, Epidemiology, Risk Factors, Genetics, and Molecular Biology

Etiology

Epidemiology and Risk Factors

Genetics

Molecular Biology

References

9.3 Ovarian Germ Cell Tumors: Clinical Presentation and Diagnostic Evaluation and Workup

Clinical Presentation

Diagnostic Evaluation/Workup

Biologic Markers

Imaging

References

9.4 Surgery for Ovarian Germ Cell Tumors

Goal of Primary Surgery

Operative Findings

Route of Primary Surgery

Extent of Primary Surgery and Surgical Staging

Primary Surgery

Extent of Surgical Staging

Bilateral Ovarian Involvement

Cytoreductive Surgery

Fertility Preservation

Managing the Unstaged Patient

Second-Look Surgery

Secondary Cytoreduction

Differences in Pediatric and Adult Paradigms

References

9.5 Ovarian Germ Cell Tumors: Pathology and Prognostic Factors

Pathology

Teratomas

Dysgerminoma

Yolk Sac Tumor

Embryonal Carcinoma

Choriocarcinoma

Mixed Germ Cell Tumors

References

9.6 Therapy for Ovarian Germ Cell Tumors: Radiation, Chemotherapy, Targeted Therapy, Immunotherapy, and Other New and Novel Agents

Evolution of Chemotherapy

Immediate Toxicity of Chemotherapy

Sequelae of Chemotherapy

Previous Use of Radiation Therapy in Dysgerminoma

Sequelae of Radiation Therapy

Adjuvant Treatment by Risk and Histology

Dysgerminoma

Nondysgerminoma

Immature Teratoma

Targeted Therapy, Immunotherapy, and Other New and Novel Agents

References

9.7 Treatment of Persistent and Recurrent Ovarian Germ Cell Tumors

Management of Residual or Recurrent Disease

Targeted Therapy, Immunotherapy, and Other New and Novel Agents

References

9.8 Ovarian Germ Cell Tumors: Special Conditions

Gliomatosis Peritonei

Growing Teratoma Syndrome

References

9.9 Ovarian Germ Cell Tumors: Follow-Up and Survivorship Issues

Survivorship

Neurotoxicity

Ototoxicity

Raynaud Phenomenon

Cardiovascular Disease and Metabolic Syndrome

Second Cancers

Gonadal Function and Fertility

Subsequent Ovarian Cysts

Quality of Life

References

9.10 Ovarian Germ Cell Tumors: Future Directions

Surgery and Staging

Molecular Testing

Adjuvant Therapy

Surveillance

Strategies for Research

References

SECTION 10: OVARIAN SEX CORD-STROMAL TUMORS

10.1 Ovarian Sex Cord-Stromal Tumors: Introduction, Anatomy, Natural History, and Patterns of Spread

Introduction

References

10.2 Ovarian Sex Cord-Stromal Tumors: Etiology, Epidemiology, Risk Factors, Genetics, and Molecular Biology

Incidence and Mortality

Etiology and Risk Factors

Genetics

Molecular Biology

References

10.3 Ovarian Sex Cord-Stromal Tumors: Clinical Presentation, Diagnostic Evaluation, and Workup

Clinical Presentation

Evaluation/Workup

Tumor Markers

References

10.4 Surgery for Ovarian Sex Cord-Stromal Tumors

References

10.5 Ovarian Sex Cord-Stromal Tumors: Pathology and Prognostic Factors

Introduction

Adult Granulosa Cell Tumor

Juvenile Granulosa Cell Tumor

Fibroma

Sertoli Cell Tumor

Sertoli-Leydig Cell Tumor

Sex Cord Tumor With Annular Tubules

Leydig Cell Tumors

Steroid Cell Tumor, Not Otherwise Specified

References

10.6 Therapy for Ovarian Sex Cord-Stromal Tumors: Radiation, Chemotherapy, Targeted Therapy, Immunotherapy, and Other New and Novel Agents

Chemotherapy—Adjuvant Treatment

Chemotherapy—Advanced-Stage Disease

Radiation

References

10.7 Treatment of Persistent or Recurrent Sex Cord-Stromal Tumors

Secondary Cytoreductive Surgery

Chemotherapy

Endocrine Therapy

Angiogenesis Inhibitors

Other Agents

References

10.8 Ovarian Sex Cord-Stromal Tumors: Special Conditions

References

10.9 Ovarian Sex Cord-Stromal Tumors: Follow-Up and Survivorship Issues

References

10.10 Ovarian Sex Cord-Stromal Tumors: Future Directions

Introduction

Gaps in Knowledge

Molecular Insights

Genetic Model Systems

Clinical Trials

References

SECTION 11: BREAST CANCER

11.1 Breast Cancer: Introduction

11.2 Breast Cancer: Epidemiology, Risk Factors, Anatomy, and Natural History

Epidemiology

Risk Factors

Anatomy

Natural History of Breast Cancer

References

11.3 Breast Cancer: Clinical Presentation

Introduction

Physical Examination

Staging

References

11.4 Breast Imaging

Screening Guidelines

Mammography and Digital Breast Tomosynthesis

Mammography Regulations and Reporting

Breast Ultrasound

Breast Magnetic Resonance Imaging

Screening Breast Magnetic Resonance Imaging

Magnetic Resonance Imaging for the Preoperative Evaluation of Breast Cancer

Breast Magnetic Resonance Imaging: Other Roles

Emerging Modalities in Breast Imaging

References

11.5 Breast Pathology

Benign Epithelial Changes

Carcinoma in Situ

Ductal Carcinoma in Situ

Paget Disease of the Nipple

Lobular Carcinoma In Situ

Invasive Breast Carcinoma

Special Types

Invasive Lobular Carcinoma

Tubular Carcinoma

Cribriform Carcinoma

Mucinous Carcinoma

Papillary Carcinoma

Invasive Micropapillary Carcinoma

Carcinoma With Apocrine Differentiation

Secretory Carcinoma

Other Tumors

Fibroepithelial Lesions

Metaplastic Carcinoma

Inflammatory Carcinoma

Angiosarcoma

Breast Cancer Biomarkers

Hormonal Receptors

HER2

Ki-67

Other Markers

PD-L1 Expression

Genomic Studies and Breast Cancer Subtypes

Conclusion

References

11.6 Surgical Management of the Breast

In Situ Disease

Early Invasive Disease

Locally Advanced Breast Cancer

Surgery for Inflammatory Breast Cancer

Oncoplastic Breast Surgery

Aesthetic Flat Closure and Contralateral Prophylactic Mastectomy

Palliative Mastectomy

References

11.7 Surgical Management of the Axilla

Management of the Clinically and Pathologically Negative Axilla

Management of Clinically Node-Negative, SLN+ Patient

Role of Sentinel Node Biopsy Following Neoadjuvant Systemic Therapy for Node-Positive Patients

Inflammatory Breast Cancer

Sentinel Node Biopsy in Patients With Ductal Carcinoma In Situ

Patients With Ductal Carcinoma In Situ Undergoing Contralateral Prophylactic Mastectomy

Sentinel Node Biopsy in Older Patients: The Choosing Wisely Campaign

Technique of Axillary Lymph Node Dissection

Sentinel Lymph Node Biopsy

Future Directions on Lymphatic Surgery

References

11.8 Endocrine Therapy for Breast Cancer

Endocrine Therapy for Newly Diagnosed Hormone Receptor–Positive Disease

Omitting Chemotherapy for People With HR+ Disease: Role of Genomic Expression Profiling

Agents and the Duration of Treatment in the Adjuvant Setting

Ovarian Ablation or Suppression

Cyclin-Dependent Kinase Inhibitors

Neoadjuvant Endocrine Therapy

Endocrine Therapy for Risk Reduction

References

11.9 Approaches to Systemic Therapy for Breast Cancer: Neoadjuvant and Adjuvant Management

Neoadjuvant Chemotherapy

Evaluating Response to Neoadjuvant Chemotherapy

Neoadjuvant Chemotherapy Considerations

Chemotherapy Regimens

HER2-Negative Disease (HR+ or Triple-Negative Breast Cancer)

HER2-Positive Disease

References

11.10 Radiation Therapy for Breast Cancer

Breast-Conserving Therapy

Postmastectomy Radiation Therapy

Radiation Therapy to the Regional Lymph Nodes

Radiation Therapy After Neoadjuvant Chemotherapy and Surgery

Radiation Therapy for in Situ Breast Disease

De-Escalation of Radiation Therapy

Hypofractionation

Partial Breast Irradiation

Omission of Radiation Therapy

Radiation Therapy: Other Indications

Radiation Therapy Techniques

Intact Breast

Chest Wall

Regional Lymphatics

Accelerated Partial Breast Irradiation

References

11.11 Multidisciplinary Approach to Breast Cancer Care

11.12 Systemic Treatment for Metastatic Breast Cancer

The Role of Chemotherapy and Systemic Agents

HER2-Directed Therapy

Endocrine Therapy in Metastatic Breast Cancer

Duration of Treatment in Metastatic Disease

References

11.13 Breast Cancer in the Older Patient

Adjuvant Chemotherapy

Adjuvant Endocrine Therapy

Surgical Management and Radiation Oncology in the Older Patient

References

11.14 Pregnancy-Associated Breast Cancer

Background and Epidemiology of Pregnancy-Associated Breast Cancer

Risk Factors for Pregnancy-Associated Breast Cancer

Diagnosis/Imaging

Treatment Approach to Pregnancy-Associated Breast Cancer

Anesthesia and Surgery

Radiation Therapy

Systemic Therapy

Outcomes for Patients With Pregnancy-Associated Breast Cancer

Pregnancy After Breast Cancer Treatment

References

11.15 Breast Cancer: Survivorship Issues

Surveillance

Psychosocial Issues

Lifestyle Changes

Side Effects from Endocrine Therapy

Bone Health

Cardiovascular Health

Fatigue

Pain and Neuropathy

Lymphedema

Cancer-Related Cognitive Decline

Molecular-Targeted Therapies

Fertility

Models of Care

References

SECTION 12: SPECIAL TOPICS

12.1 Clinical Trials Methodology and Analysis

Classification of Study Designs

Components of a Clinical Trial

Objectives

End Points

Eligibility Criteria

Phases of Therapeutic Intervention Trials

Phase 1 Trials

Phase 2 Trials

Phase 3 Trials

Efficacy Trials

Equivalency Trials

Noninferiority Trials

Randomized Trials

Randomization Techniques

Trials With Historical Controls

Factorial Designs

Hypothesis Test

P-Value

Multiple Comparison Control for Clinical Trials

Translational Research

Biospecimen Collection

Biomarker Development Process

Publicly Available Data

Developing Translational Research Studies and Reporting Results

Clinical Trials Involving Targeted Therapies

Conclusion

Acknowledgments

References

12.2 Cost-Effective and Value-Based Gynecologic Cancer Care

Overview of Cost, Quality, and Value in Health Care

Cost and Comparative Effectiveness

Summary

Defining and Measuring Value in Oncology

Status Quo Measurement of Value in Health Care

Proposed Methods of Value Measurement in Oncology Care

Financial Toxicity—Costs From the Patient Perspective

Conclusions—Value in Health Care

Principals of Health Economic Analyses

Cost-effectiveness Analyses

Cost-minimization Analyses

Cost-utility Analyses

Methods for Development of a Health Economic Decision Model

Input Development for Health Economic Models

Estimation of Costs

Modeling Effectiveness

Modeling Quality of Life

Modeling Approaches to Reducing Mortality From Gynecologic Cancers

Modeling the Natural History of Cancer

Simulation of Interventions

Cervical Cancer

Questions Addressed by Cervical Cancer Models

Ovarian Cancer

Cost-Effectiveness of Therapeutics in Gynecologic Cancers

Ovarian Cancer

Cervical Cancer

Endometrial Cancer

Chapter Summary

Key Points

References

12.3 Perioperative and Critical Care

Introduction

Preoperative Risk Assessment

Initial Preoperative Evaluation

Cardiac Risk Assessment

Perioperative 𝛃-Blockade

Pulmonary Risk Assessment

Endocrinologic Risk Assessment

Diabetes

Thyroid Disorders

Adrenal Suppression

Renal Risk Assessment

Chronic Kidney Disease

Dialysis Patients

Hepatic Risk Assessment

Preoperative Nutritional Assessment

Preparation for Surgery

Enhanced Recovery After Surgery

Medication Management

Blood Banking

Bowel Preparation and Preoperative Fasting

Antibiotic Prophylaxis

Skin Preparation

Perioperative Venous Thromboembolism Prophylaxis

Frailty

Critical Care and Postoperative Management

Cardiovascular Issues

Pulmonary Issues

Mode

Fluid and Electrolyte Issues

Postoperative Nutritional Issues

Renal Issues

Shock

Infectious Disease Issues

End-of-Life Considerations

Gastrointestinal

References

12.4 Nutrition Support of Patients With Gynecologic Cancer

Introduction

Nutritional Assessment

Anthropometric and Biochemical Markers

Prevalence of Malnutrition

Significance of Malnutrition

Etiology of Malnutrition

Impaired Food Intake and Malabsorption

Metabolic Derangements

Nutritional Therapies

Total Parenteral Nutrition

Enteral Nutrition

Oral Dietary Therapy

Pharmacologic Agents

Ethical Considerations

References

12.5 Management of Pain

Introduction

Assessment of Cancer Pain

Evaluation of the Pain Complaint

Etiology

Pathophysiology

Pain Syndromes

Management of Acute Pain

Preemptive Analgesia

Systemic Opioid Therapy

Co-analgesic Therapy

Wound Infiltration

Regional Anesthetic Techniques

Neuraxial Analgesia

Other Approaches

Management of Chronic Cancer Pain

Pain, Illness Burden, and Palliative Care

Role of Primary Therapies in Pain Management

Analgesics Approaches: Pharmacologic Management

Nonopioid Analgesics

Opioid Analgesics

Routes of Administration

Guidelines for the Administration of Opioid Drugs

Management of Common Opioid Side Effects

Opioid Abuse and Addiction

Adjuvant Analgesics

Other Approaches for Chronic Pain Management

Interventional Approaches

Neuromodulation Approaches

Rehabilitative Approaches

Surgical Neuroablative Approaches

Psychological Approaches

Integrative Medicine Approaches

Conclusion

References

12.6 Palliative and Supportive Care

Introduction

Systems of Palliative Care Delivery: Specialized Palliative Care, Primary Palliative Care, and Hospice Care

Specialty Palliative Care

Primary Palliative Care

Hospice Care

Primary Palliative Care for the Gynecologic Oncologist

Symptom Management

Communication

Caregiver Needs

Quality of Life

Scales and Measures

Quality of Care at the End of Life

Quality of Life as a Clinical Trial End Point

Barriers to the Use of Palliative Care in Gynecologic Oncology

Lack of Specialty Palliative Care Services

Poor Reimbursement

Misconceptions About Palliative Care

Improving Palliative Care for Women With Gynecologic Cancers

Education

Partnering With Specialty Palliative Care

Conclusion

References

12.7 Hereditary Cancer Genetics

Introduction

Background and Associated Cancer Risks

Ovarian Cancer

Endometrial Cancer and Hereditary Cancer Syndromes

Management of Cancer Probands

Epithelial Ovarian Cancer

Implications of a Germline Ovarian Cancer Predisposition Gene Mutation in a Patient With Ovarian Cancer

Endometrial Cancer and Lynch Syndrome

Other Hereditary Syndromes Associated With a Gynecologic Malignancy

Li-Fraumeni

Cowden

Peutz-Jeghers

Identification and Management of High-Risk Mutation Carriers

Population Screening, Cascade Testing, and Traceback Testing

Cascade Testing Barriers and Facilitators

Solutions

Future Directions/Prevention as Cancer Care

References

12.8 Biologic and Physical Principles of Radiation Oncology

Radiation Oncology as a Specialty

Introduction to Radiobiology

Interaction of Ionizing Radiation With Tissue and DNA Damage

Ionizing Radiation–Induced Cell Death

Cell Survival Curves and Tumor Control Probability

Factors Influencing Tissue Sensitivity to Radiation Therapy

Combining Radiotherapy With Systemic Therapies

Introduction to Radiation Physics

Units Used in Radiation and Radiation Therapy

Radiation Production

Radionuclides

Linear Accelerators

Simulation

Computerized Dosimetry

Brachytherapy Principles

Radiation Protection

Clinical Applications

Historical Background

External Beam Irradiation for Gynecologic Cancers

Cervical and Vaginal Cancers

Midline Blocks

Parametrial/Nodal Boosting in Cervical Cancer

Endometrial Cancer

Extended-Field Irradiation

Pelvic and Inguinal Irradiation

Oligometastatic Gynecologic Cancer

Brachytherapy Systems for the Treatment of Cervical Cancer

The Manchester System

The Fletcher (M.D. Anderson) System

Point A Redefined

Limitations of Brachytherapy Systems: Point A

Limitations of Brachytherapy Systems: mg-hr Systems

Contemporary Dose Specification for Cervical Cancer

Importance of Brachytherapy in Cervical Cancer

Brachytherapy Applicators

Intracavitary Applicators: Cervical Cancer

Low-Dose Rate

Importance of Optimal Applicator Placement

Interstitial Applicators: Cervical and Vaginal Cancers—Low-Dose Rate and High-Dose Rate

High-Dose Rate Brachytherapy for Cervical Cancer

Conversion From Low-Dose Rate to High-Dose Rate

High-Dose Rate Applicators

High-Dose Rate Treatment Planning

High-Dose Rate Dosimetry Generation

Dose-Fractionation Schemes

Sequencing of External Beam Radiation With Brachytherapy

Brachytherapy for Endometrial Cancer

Radiation-Induced Tissue Effects

Skin

Bone Marrow/Pelvic Bones

Liver

Kidney

Ovaries

Vagina

Stomach, Small and Large Intestines

Bladder/Ureters/Urethra

Bladder and Rectosigmoid—Low-Dose Rate

Bladder and Rectosigmoid—High-Dose Rate

Future Focus

References

Index

 

 

An aparitie	9 mar 2024
Autor	DENNIS CHI, Andrew Berchuck, Don S. Dizon MD, Catheryn M. Yashar MD
Editura	LWW
Format	Hardcover
ISBN	9781975183271
Limba	Engleza
Nr pag	1000