Fundamentals in Gynaecologic Malignancy

Contents
Epidemiology of Gynaecological Cancers
	1	 Carcinoma Cervix
	2	 Carcinoma Ovary
	3	 Carcinoma Corpus Uteri
	4	 Carcinoma Vulva
	5	 Carcinoma Vagina
	6	 Gestational Trophoblastic Disease
	7	 Conclusion
	References
Molecular Profiling of Gynaecological Cancer and Breast Cancer
	1	 Introduction
	2	 Molecular Profiling Techniques
		2.1	 Polymerase Chain Reaction (PCR)
		2.2	 Real-Time PCR
		2.3	 Droplet Digital PCR (ddPCR)
		2.4	 Next-Generation Sequencing (NGS)
		2.5	 NGS Workflow
			2.5.1	 PCR Amplification
			2.5.2	 Massive Parallel Sequencing
			2.5.3	 Sequencing Data Analysis
	3	 Criteria for Evidence-Based Classification of Molecular Biomarkers
	4	 Microsatellite Instability-High Tumours and DNA Mismatch Repair Molecular Biomarkers
	5	 Germline Mutations Molecular Biomarkers
	6	 Molecular Profile of Gynaecologic Cancers
		6.1	 Endometrial Cancers Molecular Profile
		6.2	 Ovarian Cancers Molecular Profile
		6.3	 Cervical Cancers Molecular Profile
		6.4	 Breast Cancer Molecular Profile
	7	 Oncology Basket Trials and Precision Medicine
	8	 Multiomics and Systems Medicine Approach in Gynaecological Cancer and Breast Cancer
		8.1	 MultiOmics Studies on Breast Cancer (BRCA)
		8.2	 MultiOmics Studies on Gynaecological Cancer
	9	 Challenges of Molecular Profiling of Cancer
		9.1	 Lack of Randomized, Controlled Clinical Trials
		9.2	 Unavailability to Suitable Molecular Target Drugs
		9.3	 Challenge of Tumour Heterogeneity
		9.4	 Molecular Profiling Platform Variations
		9.5	 Challenges of Quality Control Measures for Molecular Profiling
		9.6	 Appropriate Condition for Molecular Profiling of Cancer
	10	 Future Perspective
	References
Tumour Biomarkers in Gynaecologic Oncology
	1	 Introduction
	2	 Tumour Markers in Gynaecological Cancers
	3	 Tumour Biomarkers in Ovarian Malignancies
		3.1	 Epithelial Ovarian Cancers
			3.1.1	 Carbohydrate Antigen or Carcinoma Antigen (CA125)
			3.1.2	 CA125 as Screening Marker for Ovarian Cancers
			3.1.3	 CA125 as Marker for Disease Monitoring in Ovarian Cancers
			3.1.4	 CA125 as Prognostic Marker in Ovarian Cancers
			3.1.5	 Human Epididymis Protein 4 (HE4)
			3.1.6	 Evaluation of Women with Pelvic Masses
			3.1.7	Risk of malignancy index (RMI)
			3.1.8	 Risk of Ovarian Malignancy Algorithm (ROMA)
			3.1.9	 OVA1 Test
			3.1.10	 Carcinoembryonic Antigen (CEA)
			3.1.11	 Cancer Antigen 19-9 (CA 19-9)
		3.2	 Markers of Non-epithelial Ovarian Cancers (Non-EOC)
			3.2.1	 Human Chorionic Gonadotropin (hCG)
			3.2.2	 Serum Alpha-Fetoprotein (sAFP)
			3.2.3	 Inhibin and Activin
			3.2.4	 Osteopontin (OPN)
			3.2.5	 Kallikreins (KLK)
			3.2.6	 Bikunin
			3.2.7	 Mesothelin
			3.2.8	 Vascular Endothelial Growth Factor (VEGF)
			3.2.9	 Human Prostasin (PSN)
			3.2.10	 Apolipoprotein A-I (apoA-I)
			3.2.11	 Transthyretin (TTR)
			3.2.12	 Transferrin
			3.2.13	 Creatine Kinase B (CKB)
			3.2.14	 Lysophosphatidic Acid (LPA)
	4	 Cervical Cancer
		4.1	 Squamous Cell Carcinoma Antigen (SCC-Ag)
		4.2	 CYFRA 21-1
	5	 Endometrial Cancer
	6	 Vulval Cancer
	References
Cancer: Infection and Vaccines
	1	 Introduction
	2	 Mechanism of Action
	3	 Oncogenic Viruses
		3.1	 Papillomaviruses
		3.2	 Polyomaviruses
		3.3	 Epstein–Barr Virus (Human Herpesvirus 4 or HHV4)
		3.4	 Kaposi Sarcoma Herpesvirus (KSHV or Human Herpesvirus 8 or HHV8)
		3.5	 Retroviruses
		3.6	 Hepatitis Viruses
	4	 Oncogenic Bacteria
		4.1	 Helicobacter pylori
	5	 Parasites Causing Cancer
		5.1	 Schistosoma haematobium
		5.2	 Opisthorchis viverrini and Clonorchis sinensis
	6	 The Microbiome and Carcinogenesis
	7	 Infection Control and Prevention in Cancer Patients
		7.1	 Hygiene
		7.2	 Device Associated Infection
		7.3	 Environmental Hygiene
		7.4	 Education and Awareness of Health Care Personals
	8	 Cancer Vaccines
		8.1	 Hepatitis B Vaccines
		8.2	 Human Papillomavirus Vaccines (HPV Vaccines)
	9	 Therapeutic Vaccines
		9.1	 Bacillus Calmette Guerin (BCG)
		9.2	 Sipuleucel-T
		9.3	 Talimogene Laherparepvec (T-VEC)
	10	 Conclusion
	References
Imaging in Gynaecological Malignancies
	1	 Ultrasound
	2	 Computed Tomography (CT)
	3	 Magnetic Resonance Imaging (MRI)
	4	 PET-CT
	5	 Cervical Cancer
	6	 Endometrial Cancer
	7	 Ovarian Cancer
	8	 Vaginal Cancer
	9	 Vulval Malignancies
	10	 Leiomyosarcoma
	11	 Gestational Trophoblastic Neoplasia (GTN)
	12	 Imaging Nodal Disease (N-Staging)
	13	 Imaging Metastatic Spread (M-Staging)
	14	 Image-Guided Biopsy
	15	 Conclusions
	References
Principles and Practice of Surgery in Gynaecological Cancer
	1	 Introduction
	2	 History
	3	 Roles of a Surgical Oncologist
	4	 Diagnosis and Staging
	5	 Curative Surgery
		5.1	 Surgery for Primary Cancer
		5.2	 Surgery for Metastatic Disease
		5.3	 Palliative Surgery
		5.4	 Preventive or Prophylactic Surgery
	6	 Conclusion
	References
Principles of Chemotherapy, Targeted Therapy, and Immunotherapy in Gynaecological Malignancies
	1	 Introduction
	2	 Basic Principles
	3	 Growth of Tumour Cell
	4	 Log Kill Hypothesis
	5	 Resistance to Chemotherapy
	6	 Dose Intensity
	7	 Single Versus Combination Therapy
	8	 Different Chemotherapy Types
	9	 Routes of Administration
	10	 Chemotherapeutic Drugs Used in the Treatment of Gynaecological Cancer
		10.1	 Alkylating Agents
		10.2	 Platinum
		10.3	 Anti-tumour Antibiotics and Anthracylines
		10.4	 Antimetabolites
		10.5	 Vinca Alkaloids
		10.6	 Topoisomerase Inhibitors
		10.7	 Taxanes
	11	 Targeted Therapies
		11.1	 Mechanisms of Action
		11.2	 Interruption of Signal Transduction Pathways
		11.3	 Induction of Apoptosis
		11.4	 Stimulation of the Immune Response
		11.5	 PI3K/mTOR/Akt Pathway
		11.6	 Poly(ADP-Ribose) Pathway
		11.7	 Principles of Immunotherapy
			11.7.1	 Tumour Immunbiology and Immunotherapy
	12	 Clinical Practice in Gynaecologic Oncology
		12.1	 Suitability for Immunotherapy
		12.2	 Antibodies Used as Immunogens
		12.3	 Cancer-Testis Antigen Vaccines
		12.4	 Dendritic Cell-Based Vaccines
		12.5	 Vaccines Designed to Generate Antibody Responses
		12.6	 Adoptive Cellular Therapy
		12.7	 Whole Tumour Antigen Vaccines
		12.8	 Immune Checkpoint Inhibitors
		12.9	 Immune Checkpoint Blockade Therapy in Endometrial Cancer
		12.10	 Immune Checkpoint Blockade Therapy in Cervical Cancer
	References
Principles and Practice of Radiation Oncology
	1	 Introduction
	2	 Timeline of Radiation Therapy (RT)
	3	 Effects of Radiation Interaction
		3.1	 Interaction of Photons with Matter
		3.2	 Interaction of Charged Particles with Matter
			3.2.1	 Bragg Curve
			3.2.2	 Bremsstrahlung
		3.3	 Interaction of Neutron with Matter
	4	 Biological Basis of Radiation Therapy
	5	 External Beam Therapy (EBRT)
		5.1	 EBRT Treatment Machines
		5.2	 Steps of Radiation Treatment Planning
			5.2.1	 Patient Selection
			5.2.2	 Patient Simulation
		5.3	 Treatment Techniques of Radiation Therapy
			5.3.1	 Conventional Technique
				Limitation of Conventional Planning
			5.3.2	 Three-Dimensional Conformal Radiation Therapy (3DCRT)
			5.3.3	 Intensity-Modulated Radiation Therapy (IMRT)
			5.3.4	 Arc Radiation Therapy
			5.3.5	 Stereotactic Techniques
	6	 Image-Guided Radiation Therapy (IGRT)
	7	 Advances 4D Radiation Therapy
		7.1	 Imaging
		7.2	 Radiation Therapy
		7.3	 Electron Beam Therapy
		7.4	 Heavy Particle Therapy
	8	 Brachytherapy
		8.1	 Role Brachytherapy in Gynaecological Cancer
		8.2	 2D Image-Based Intracavity Brachytherapy
		8.3	 3D Image-Based Intracavity Brachytherapy
	9	 Radiation Dosimetry in Radiation Therapy
	10	 The Implication of Quality Assurance (QA) in RT
	11	 Radiation Protection
		11.1	 Classified Radiation Workers
		11.2	 Pregnant Radiation Worker
		11.3	 Apprentices and Trainee
	References
Benign Breast Diseases
	1	 Introduction
	2	 Spectrum of Benign Breast Diseases
	3	 Approach to a Patient with Breast Disease
	4	 Investigations
		4.1	Ultrasound (US)
		4.2	 Mammography
		4.3	 Magnetic Resonance Imaging (MRI)
		4.4	 Fine-Needle Aspiration Cytology (FNAC)
		4.5	 Core Needle Biopsy
		4.6	 Incision Biopsy
		4.7	 Excision Biopsy
	5	 Classification of Benign Breast Lesions
		5.1	 Breast Cysts
		5.2	 Galactocele
		5.3	 Usual Ductal Hyperplasia
		5.4	 Intraductal Papillomas
		5.5	 Diffuse Papillomatosis (Multiple Papillomas)
		5.6	 Juvenile Papillomatosis
		5.7	 Sclerosing Adenosis
		5.8	 Radial Scars (Complex Sclerosing Lesions)
		5.9	 Galactorrhoea
		5.10	 Periductal Mastitis and Ductal Ectasia
		5.11	 Infective Conditions of the Breast
		5.12	 Mastalgia
		5.13	 Mondor’s Disease [49]
		5.14	 Traumatic Fat Necrosis [50]
		5.15	 Gynecomastia
	6	 Benign Proliferative Stromal Lesions
		6.1	 Diabetic Fibrous Mastopathy
		6.2	 Pseudoangiomatous Stromal Hyperplasia of the Breast
	7	 Benign Neoplasms
		7.1	 Fibroadenoma
		7.2	 Lipoma
		7.3	 Tubular Adenoma
		7.4	 Hamartoma
		7.5	 Granular Cell Tumour
		7.6	 Phyllodes Tumour
	8	 Conclusion
	References
Breast Cancer
	1	 Incidence and Etiology
	2	 Risk Factors for Breast Cancer
		2.1	 Breast Pathology
		2.2	 Other Hormonal Factors
		2.3	 Reproductive Factors
		2.4	 History of Breast Cancer
		2.5	 Lifestyle Factors
	3	 Protective Factors That May Reduce Breast Cancer Risk
	4	 Epidemiology
	5	 Role of Breast Imaging to Diagnose Breast Cancer
	6	 Staging and Restaging
		6.1	 TNM and Staging of Breast Cancer
		6.2	 Changes in T Classification Between 7th and 8th Edition
		6.3	 Changes in N Classification from 7th to 8th Edition
		6.4	 Changes in Metastases (M) Classification
	7	 Approach to a Patient with a Suspected Breast Cancer
		7.1	 Biopsy Techniques in Nonpalpable or Palpable Breast Lesions
	8	 Breast Cancer Immunohistochemistry
		8.1	 Receptor Expression Scoring
		8.2	 H-Score
		8.3	 Allred/Quick Score
		8.4	 J-Score
	9	 American Society of Clinical Oncology/College of American Pathologists Recommendations
	10	 Surgical Anatomy of the Breast
		10.1	 Surgical Anatomy Pertinent to the Oncoplastic Breast Surgeon
	11	 Surgery for Breast Cancer
		11.1	 What Constitutes a Clear Margin?
		11.2	 Oncoplastic Breast Surgery
		11.3	 Sentinel Lymph Node Biopsy
			11.3.1	 Technique of Sentinel Lymph Node Biopsy
			11.3.2	 Management of Positive Sentinel Lymph Nodes
			11.3.3	 Sentinel Lymph Node Biopsy in the Setting of Neoadjuvant Chemotherapy
	12	 Postmastectomy Radiation Therapy
		12.1	 Indications for PMRT
		12.2	 For 1–3 Nodes
		12.3	 T3N0
		12.4	 Complete Nodal Response After Neoadjuvant Chemotherapy
		12.5	 Internal Mammary Node Coverage
		12.6	 Postmastectomy Radiation Therapy After Implant/Tissue Expander
		12.7	 Whole Breast Radiation After Breast Conservation Therapy
	13	 Chemotherapy in Breast Cancer
		13.1	 Role of Taxanes
		13.2	 Trials Evaluating Sequential Administration of Taxanes to Anthracyclines
		13.3	 Trials Evaluating Concurrent Administration of Taxanes with Anthracyclines
		13.4	 Trial Replacing Anthracyclines with Taxanes
		13.5	 Optimal Taxane Dose and Schedule
		13.6	 Dose-Dense Chemotherapy
		13.7	 Timing of Chemotherapy
	14	 Targeted Therapy in HER 2 Neu Positive Breast Cancer
		14.1	 Duration of HER 2 Targeted Therapy
	15	 Role of Neo-Adjuvant Chemotherapy (NACT) in Breast Cancer
	16	 Evolving Role of Chemoimmunotherapy for Triple-Negative Breast Cancer
	17	 Endocrine Therapy in Breast Cancer
		17.1	 Neoadjuvant Hormone Therapy
	18	 Metastatic Breast Cancer
		18.1	 Her 2 Positive Metastatic Breast Cancer
			18.1.1	 First-Line Therapy
			18.1.2	 Second-Line Therapy
			18.1.3	 Third Line Therapy and Beyond
			18.1.4	 Premenopausal Patients
			18.1.5	 Postmenopausal Patients
		18.2	 Triple-Negative Metastatic Breast Cancer
	19	 Management of Breast Cancer in the Elderly
	20	 Current Status of Screening for Breast Cancer
	References
Cervical Cancer Screening
	1	 Introduction
	2	 Methods of Cervical Cancer Screening
		2.1	 HPV Testing
		2.2	 Cytology
		2.3	 Visual Inspection with Acetic Acid (VIA)
		2.4	 Colposcopy
	3	 Federation of Obstetrics and Gynaecological Societies of India Good Clinical Practice Recommendations (FOGSI GCPR) 2018
	4	 WHO Guidelines for Cervical Cancer Screening [20]
		4.1	 IA. Recommendations for All Women (General Population and Women with HIV)
		4.2	 IB. Recommendations Specific for General Population of Women
		4.3	 IC. Recommendations Specific for Women with HIV
		4.4	 IIA. Good Practice Guideline for All Women
		4.5	 IIB. Good Practice Guidelines for General Population of Women
		4.6	 IIIC. Good Practice Guidelines for Women with HIV
	Annexure 1 [20]
		Strength of Recommendations
	References
Management of Precancerous Lesions of Cervix
	1	 Introduction
	2	 Anatomy
	3	 Etiopathogenesis
	4	 Terminology
	5	 Colposcopy
	6	 Management
		6.1	 CIN1, Women ≥25 Years
		6.2	 CIN2 and CIN3, Women ≥25 Years
		6.3	 CIN in Special Populations
			6.3.1	 CIN in <25 Years Women
			6.3.2	 Pregnant Patients
			6.3.3	 Adolescents
			6.3.4	 Immunocompromised
			6.3.5	 Sexual Partners and Sexual Minority Women (SMW)
			6.3.6	 HPV Vaccination
	7	 Treatment
		7.1	 Ablative Therapy
			7.1.1	 Cryosurgery
			7.1.2	 Laser Ablation
			7.1.3	 Thermocoagulation or Cold Coagulation
			7.1.4	 Diathermy
		7.2	 Excisional Therapy
			7.2.1	 Loop Electrosurgical Excision Procedure/LEEP
			7.2.2	 Cold Knife Conization
			7.2.3	 Laser Conization
			7.2.4	 Hysterectomy
		7.3	 Medical Therapy
	References
Cancer of the Uterine Cervix
	1	 Introduction
	2	 Brief Anatomy
		2.1	 Pelvic Spaces
	3	 Natural History of Cervical Cancer
	4	 Patho-Physiology
	5	 Staging
		5.1	FIGO Staging
		5.2	 TNM System
	6	 Risk Factors
	7	 Clinical Evaluation and Staging Procedure
	8	 Histopathology
	9	 Management of Early Stage Cervical Cancer
		9.1	 Management of Stage IA1
		9.2	 Management of Stage IA2
		9.3	 Management of Stage IB1
		9.4	 Management of Stage IB2 and IIA1
		9.5	 Management of Stage IB3 and IIA2
	10	 Radical Hysterectomy
		10.1	 History
		10.2	 Route of Surgery
		10.3	 Pre-operative Preparation in OT
		10.4	 Surgical Steps
	11	 Radiotherapy in CA Cervix
		11.1	 External Beam Radiation Therapy
		11.2	 Patient Positioning
		11.3	 Simulation
		11.4	 Intensity-Modulated Radiotherapy
		11.5	 Image-Guided Radiation Therapy
		11.6	 Sterotactic Body Radiotherapy
		11.7	 Midline Shielding in AP-PA Portals and Use of Parametrial Boost
		11.8	 Para-Aortic Node Irradiation
		11.9	 Hyperfractinated or Accelerated Hyperfractionated Radiation Therapy
	12	 General Management
		12.1	 Invasive Disease
		12.2	 Stage IA
		12.3	 Stage IB to IIA
		12.4	 Stage I B2 to IV A
	13	 Side Effects of Radiation
	14	 Brachytherapy in Cervical Cancer
		14.1	 Basic Principles of Intracavitary Brachytherapy (ICBT)
		14.2	 Image Based Brachytherapy and Prescription to Volumes
		14.3	 Brachytherapy Planning and Dose Prescription in IGBT
		14.4	 Interstitial Combined with Intracavitary Brachytherapy (IS + ICBT) for Cervical Carcinoma
		14.5	 Vaginal Cuff Brachytherapy After Hysterectomy in Carcinoma Cervix
	15	 Post-treatment Follow-Up
	16	 Recurrent Disease
	17	 Special Circumstances
		17.1	 Cervical Cancer with Pregnancy
		17.2	 Inadvertent Simple Hysterectomy in Carcinoma Cervix
	18	 Recent Important Trial Updates
		18.1	 Randomized Study Between Radical Surgery and Radiotherapy for the Treatment of Stage IB–IIA Cervical Cancer: 20-Year Update
		18.2	 Minimally Invasive Versus Abdominal Radical Hysterectomy for Cervical Cancer
		18.3	SUCCOR study
		18.4	OUTBACK Trial
		18.5	EMBRACE I Trial
		18.6	 Current Ongoing Trials
			18.6.1	 Surgical Treatment Related Trials
			18.6.2	 Trials Associated with Chemotherapy/Immunotherapy in Cervical Cancer
	References
Endometrial Cancer
	1	 Epidemiology and Risk Factors
		1.1	 Hereditary Risk
	2	 Etiopathogenesis
	3	 Histopathological Features of Endometrial Cancers
		3.1	 Endometrioid Carcinomas (Type I) (Figs. 1 and 2)
			3.1.1	 Endometrioid Adenocarcinomas with Clear Cells
			3.1.2	 Ciliated Cell Carcinoma
			3.1.3	 Endometrioid Adenocarcinoma with Squamous Differentiation
		3.2	 Non-endometrioid Carcinomas (Type II)
			3.2.1	Clear Cell Carcinomas (Fig. 4)
			3.2.2	 Squamous Cell Carcinomas of Endometrium
			3.2.3	Undifferentiated Carcinoma
	4	 Diagnosis and Screening, Imaging, Tumour Markers
	5	 Staging
		5.1	 Histopathologic grades (G)
		5.2	 Pathologic Grading Notes
	6	 Route of Spread
	7	 Prognostic Factors
		7.1	 Age
		7.2	 Histologic Type, Grade, and Myometrial Invasion
		7.3	 Lymphovascular Space Invasion
		7.4	 Positive Peritoneal Cytology
		7.5	 Hormonal Receptor Status
		7.6	 Tumour size
		7.7	 Molecular Subgroups
	8	 Surgical Management
		8.1	 Pelvic Lymphadenectomy
		8.2	 Paraaortic Nodal Dissection (Fig. 9)
		8.3	 Sentinel Node Biopsy
		8.4	 Omentectomy
		8.5	 Minimal Invasive Surgery
		8.6	 Role of Cytoreductive Surgery
	9	 Adjuvant Treatment
	10	 Radiotherapy in Endometrial Cancer
		10.1	 External Beam Radiotherapy (EBRT) in Endometrial Cancer
		10.2	 Brachytherapy in Endometrial Cancer
			10.2.1	 Adjuvant Brachytherapy Post-hysterectomy
			10.2.2	 Brachytherapy for Vaginal Vault Recurrence
			10.2.3	 Brachytherapy for Primary Inoperable Endometrial Cancer
	11	 Neoadjuvant Therapy in Endometrial Cancer
	12	 Treatment of Metastatic Endometrial Cancer
	13	 Role of Hormonal Therapy
	14	 Recurrent Endometrial Cancer
	15	 Management of Endometrial Carcinoma in Young Women
	16	 Synchronous Primary Cancers of the Endometrium and Ovary
	17	 Summary and Conclusion
	References
Uterine Sarcoma
	1	 Introduction
	2	 Clinical Presentation
	3	 Risk Factors
	4	 Classification
	5	 Biological and Molecular Behaviour
	6	 Leiomyosarcoma
		6.1	 Staging
		6.2	 Prognostic Factors
		6.3	 Treatment
		6.4	 Role of Lymphadenectomy
		6.5	 Role of Radiotherapy
		6.6	 Role of Chemotherapy
		6.7	 Role of Targeted Therapy and Immunotherapy
		6.8	 Recurrent Disease
		6.9	 Uterine Fibroids and Their Morcellation
	7	 Endometrial Stromal Sarcomas
	8	 Undifferentiated Uterine Sarcoma
	9	 Other Tumour Types
	10	 Follow-up [6]
	11	 Clinical Outcomes
	12	 Conclusion
	References
Epithelial Ovarian Cancer
	1	 Epidemiology and Risk Factors
	2	 Hereditary Ovarian Cancer
		2.1	 Management of Women with Hereditary Ovarian Cancer
	3	 Pathogenesis
	4	 Immunohistochemistry (IHC)
	5	 Patterns of Spread
		5.1	 Trans-coelomic (Fig. 3)
		5.2	 Lymphatic
		5.3	 Hematogenous
	6	 Prognostic Factors of Epithelial Ovarian Carcinoma
	7	 Diagnosis and Staging
		7.1	 Clinical Presentation
		7.2	 Tumour Markers
		7.3	 Transvaginal Sonography (TVS)
		7.4	 Role of MRI, CT, PET-CT
	8	 Surgery for Early-Stage Ovarian Cancer
	9	 Advanced Epithelial Ovarian Cancer
		9.1	 Upfront Neoadjuvant Chemotherapy (NACT)
		9.2	 Number of NACT Cycles Before and After IDS
	10	 Chemotherapy
		10.1	 Recommendation for Adjuvant Treatment of Early-Stage Ovarian Cancer
		10.2	 Advanced-Stage Ovarian Cancer
		10.3	 Intraperitoneal Chemotherapy
		10.4	 Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
		10.5	 Dose-Dense Therapy
	11	 Molecular Targeted Therapies
	12	 Recurrent Ovarian Cancer
	13	 Treatment Assessment
	14	 Secondary Cytoreductive Surgery for Recurrent Disease
	15	 Chemotherapy for Recurrent Ovarian Cancer
		15.1	 Platinum-Sensitive Disease
		15.2	 Platinum-Resistant and Refractory Disease
		15.3	 Targeted Therapy in Recurrent Setting
	16	 Hormonal Therapy
	17	 Summary
	References
Malignant Germ Cell Tumours of the Ovary
	1	 Pathologenesis and Classification
		1.1	 Dysgerminoma
		1.2	 Immature Teratoma
		1.3	 Yolk Sac Tumour
		1.4	 Embryonal Carcinoma
		1.5	 Non-gestational Choriocarcinoma
		1.6	 Polyembryoma
		1.7	 Mixed Germ Cell Tumour
	2	 Presentation and Investigation
	3	 Surgical Management
		3.1	 Second Look Laparotomy
		3.2	 The Role of Salvage Surgery
	4	 Chemotherapy
		4.1	 Chemotherapy for Relapsed Disease
	5	 Prognosis and Post-treatment Issues
	6	 Follow-up
	7	 Conclusion
	References
Stromal Tumour of Ovary
	1	 Introduction
		1.1	 Pure Sex Cord Tumours
			1.1.1	 Granulosa Cell Tumours of the Ovary (GCT)
			1.1.2	Sertoli Cell Tumours
			1.1.3	 Sex Cord-Stromal Tumours with Annular Tubules
		1.2	 Pure Stromal Tumours
		1.3	 Mixed Sex Cord-Stromal Tumours
	2	 Diagnosis and Management
	3	 Surgical Management
	4	 Adjuvant Treatment
		4.1	 Role of Endocrine Therapy
	5	 Posttreatment Surveillance
	6	 Recurrent Disease
	7	 Summary and Conclusion
	References
Secondary Ovarian Tumour
	1	 Introduction
	2	 Epidemiology
	3	 Pathogenesis
	4	 Symptoms and Signs
		4.1	 Diagnosis
	5	 Tumour Markers
	6	 Imaging
	7	 Endoscopy
	8	 Histopathology
		8.1	 Histology
		8.2	 Genomics
	9	 Treatment
		9.1	 Role of Cytoreductive Surgery
		9.2	 Role of Adjuvant Chemotherapy
		9.3	 Prognostic Factors
	10	 Conclusion
	References
Fallopian Tube Carcinoma
	1	 Introduction
	2	 Pathogenesis
	3	 Clinical Features and Diagnosis
	4	 Staging
	5	 Patterns of Spread
	6	 Prevention and Treatment
	7	 Conclusion
	References
Carcinoma Vulva
	1	 Introduction
	2	 Surgical Anatomy
		2.1	 Vascular Supply
		2.2	 Lymphatic Drainage
			2.2.1	 Local Channels
			2.2.2	 Draining Nodes
	3	 Premalignant Diseases of Vulva
		3.1	 Diagnosing Premalignant Disease of the Vulva
	4	 Aetiology of Vulval Carcinoma
	5	 Modes of Spread
	6	 Clinical Presentation
	7	 Evaluation
		7.1	 Biopsy
		7.2	 Pre-Operative Investigation
	8	 Staging
		8.1	 New FIGO Staging of Vulval Carcinoma
	9	 Pathology
	10	 Management
		10.1	 Surgical Management
			10.1.1	 Primary Lesion
			10.1.2	 Nodal Management
	11	 Radiotherapy (RT)
		11.1	 Adjuvant Chemotherapy or Chemoradiation
		11.2	 Radiotherapy as a Primary Modality in Treating Vulval Carcinoma vs. Neoadjuvant Radiotherapy
		11.3	 Palliative Radiotherapy
	12	 Recurrent Vulval Carcinoma
	13	 Follow-Up
	14	 Prognosis
	15	 Paget’s Disease of Vulva
	16	Melanoma
	17	Bartholin’s Gland Carcinoma
	18	Basal Cell Carcinoma
	19	Verrucous Carcinoma
	References
Carcinoma Vagina
	1	 Anatomy
	2	 Premalignant Neoplasm of Vagina (VAIN)
	3	 Malignant Neoplasm of Vagina
		3.1	 Epidemiology
		3.2	 Histological Types
		3.3	 Pattern of Spread
		3.4	 Clinical Presentation
		3.5	 Evaluation
	4	 Staging
	5	 Prognostic Factors
	6	 Treatment
		6.1	 Surgery
		6.2	 Radiotherapy
		6.3	 Chemoradiotherapy
	7	 Follow-Up
	8	 Prognosis
	9	 Recurrence
	10	 Vaginal Adeno Carcinoma
	11	 Vaginal Melanoma
	References
Gestational Trophoblastic Disease
	1	 Introduction and Classification
	2	 Epidemiology
	3	 Pathology
		3.1	 Hydatidiform Mole (HM)
		3.2	 Invasive Moles (Chorioadenoma Destruens)
		3.3	 Placental Site Trophoblastic Tumour (PSTT)/Epithelioid Trophoblastic Tumour (ETT)
		3.4	 Choriocarcinoma
	4	 Molecular Biology
	5	 Diagnosis
		5.1	 Measurement of Serum hCG
		5.2	 FIGO criteria for diagnosing GTN after molar pregnancy are [18]:
	6	 Role of Imaging
	7	 Metastasis in GTN
		7.1	 Hepatic Metastasis
		7.2	 Brain Metastasis
	8	 Staging and Risk Categorization
		8.1	 Prognostic Scoring
	9	 Pretreatment Evaluation of GTN
	10	 Treatment of Benign GTD
	11	 Treatment of Malignant GTN
		11.1	 Low Risk
		11.2	 High-Risk Regimens
			11.2.1	 EMACO
			11.2.2	 EMA-EP
		11.3	 Ultra-High Risk
	12	 Role of Surgery
	13	 Role of Radiotherapy
	14	 PSTT
	15	 ETT
	16	 Follow-Up
	17	 Recurrent GTN
	18	 Contraception and Fertility Preservation
	19	 Subsequent Pregnancy
	20	 Secondary Malignancies
	21	 Conclusion
	References
Gynaecological Cancer in Pregnancy
	1	 Introduction
	2	 Epidemiology
	3	 Imaging Cancer in Pregnancy
		3.1	 Non-Ionising Imaging Procedure
			3.1.1	 Grey-Scale, Doppler, Spectral and Contrast-Enhanced Ultrasound
			3.1.2	 Magnetic Resonance Imaging (MRI)
		3.2	 Ionising Imaging Procedure
			3.2.1	 Multi-Detector Computed Tomography [MDCT]
			3.2.2	 Positron Emission Tomography [Pet] and Nuclear Scintigraphy
	4	 Impact of Cancer with Pregnancy in Laboratory Parameters
	5	 Treatment
		5.1	 Management of Cervical Cancer in Pregnancy
			5.1.1	 Role of Surgery for Cervical Cancer in Pregnancy with Desire for Fertility Preservation
			5.1.2	 Role of Neo-Adjuvant Chemotherapy for Cervical Cancer in Pregnancy with Desire for Fertility Preservation
			5.1.3	 Role of Surgery/Concomitant Chemoradiotherapy for Cervical Cancer in Pregnancy When Fertility Not Desired
			5.1.4	 Obstetrical Management
		5.2	 Management of Ovarian Cancer in Pregnancy
			5.2.1	 Role of Surgery for Ovarian Cancer in Pregnancy
			5.2.2	 Role of Chemotherapy for Epithelial Ovarian Cancer in Pregnancy
			5.2.3	 Role of Chemotherapy in Non-Epithelial Ovarian Cancer in Pregnancy
		5.3	 Management of Vulval Cancer in Pregnancy
		5.4	 Management of Vaginal Cancer in Pregnancy
	6	 Care of the Neonates and Paediatric Age Group
	References
Role of MIS in Gynaecological Cancers
	1	 Introduction
	2	 Principles of Laparoscopic Surgery
		2.1	 Preoperative Considerations
		2.2	 Abdominal Entry
		2.3	 Electrosurgery
			2.3.1	 Monopolar Electrosurgery
			2.3.2	 Bipolar Electrosurgery
			2.3.3	 Advanced MIS Devices
				Ligasure
				EnSeal
			2.3.4	 Special circumstances: Obesity
	3	 Principles of Robotic Surgery
		3.1	 Parts of a Robot
			3.1.1	 Surgeon Console
			3.1.2	 Patient Cart
			3.1.3	 The Vision Cart
		3.2	 Docking of the Robot
	4	 Role of Robotic Surgery in Gynaecologic Oncology
		4.1	 Benefits of Robotics Over Open Surgery
		4.2	 Benefits Over Traditional Laparoscopy
		4.3	 Disadvantages of Robotic Surgery
	5	 Role of MIS in Endometrial Cancer
	6	 Role of MIS in Vulval Cancer
		6.1	 VEIL Procedure (Limb Subcutaneous Approach)
		6.2	 Robotic VEIL (R-VEIL)
	7	 Role of MIS in Ovarian Cancer
	8	 Role of MIS in Cervical Cancer
	9	 Role of Sentinel Lymph Node Mapping in Minimally Invasive Gynaecologic Oncology
	10	 Oncological Hazards
		10.1	 Port Site Recurrences
		10.2	 Tumour Rupture
		10.3	 Morcellation
	11	 Conclusions
	References
Hormone Replacement Therapy after Gynaecological Cancer
	1	 Introduction
	2	 HRT in Ovarian Cancer
	3	 HRT in Endometrial Cancer
	4	 HRT in Cervical Cancers
	5	 HRT in Vulval Cancer
	6	 HRT in Vaginal Cancer
	7	 HRT in Breast Cancer
	8	 Hormonal Versus Non-Hormonal Therapy
	9	 Conclusion
	References
The Perioperative and Critical Care Aspects in Gynaecology-Oncology
	1	 Common Concerns and Challenges
	2	 Perioperative Variables and Long-Term Cancer Outcome
	3	 Perioperative Fluid Management
		3.1	 Recommendations for Perioperative Fluid Therapy in Major Surgery
		3.2	 Blood Product Replacement
	4	 Concerns for Gynaecological Cancer Surgery
		4.1	 Anaesthetic Considerations for Carcinoma Vulva and Cervix
		4.2	 Anaesthetic Considerations for Endometrial Cancers
		4.3	 Anaesthetic Considerations for Ovarian Cancers
	5	 Recent Advances
		5.1	 Anaesthetic Considerations for Robotic Surgery
	6	 Conclusion
	References
Palliative Care in Advanced Gynaecological Malignancy
	1	 Communication with Patients
	2	 Breaking Bad News
	3	 Management of Symptoms
		3.1	 Dyspnea
		3.2	 Hemorrhage
		3.3	 Nausea and Vomiting
		3.4	 Anorexia
		3.5	 Malignant Ascites
		3.6	 Malignant Bowel Obstruction
		3.7	 Constipation
	4	 Management of Pain
		4.1	 Evaluation of Pain
		4.2	 Description of Pain
		4.3	 Causes of Pain
		4.4	 Mechanisms of Pain
		4.5	 Nonphysical Factors
		4.6	 Analgesics
		4.7	 Nonopioids
		4.8	 Opioids
	5	 Bone Metastasis
	6	 Hypercalcemia
	7	 Brain Metastasis
	8	 As Death Approaches
	References
Gynaecological Cancers and Nursing
	1	 Pre- and Postoperative Care of a Patient Undergoing Surgery for Gynaecologic Cancers
	2	 Management of Patients with Stoma
	3	 Tumour-Specific Considerations (Nursing) [4]
		3.1	 Cervical Cancer
		3.2	 Vulva
		3.3	 Endometrium and Ovary
	4	 Special Roles of the Oncology Clinical Nurse Specialist
	5	 Conclusion
	References
Prevention and Screening in Gynaecological Cancer
	1	 Introduction
	2	 Primary Prevention in Gynaecological Cancers
		2.1	 Health Promotion
		2.2	 Cancer Education
	3	 Prevention and Screening in Gynaecological Cancers
		3.1	 Breast Cancer
		3.2	 Cervical Cancer
			3.2.1	 HPV Vaccination
		3.3	 Ovarian Cancer
		3.4	 Endometrial Cancer
		3.5	 Other Gynaecological Cancer
	4	 Screening Modification for Individuals with High-Risk Gynaecological Cancer
	5	 Conclusion
	References
Recent Advances in Gynaecological Oncology
	1	 Introduction
	2	 Cervical Cancer
		2.1	 Prevention and Screening
		2.2	 Human Papillomavirus-Negative Cervical Cancer and Classification of Adenocarcinoma
		2.3	 FIGO 2018 Staging
		2.4	 Minimal Access Surgery
		2.5	 Nodal Assessment
		2.6	 Role of Conservative Surgery
		2.7	 Role of Chemotherapy in Advanced Cervical Cancer
		2.8	 Immune Checkpoint Inhibitor and PARP Inhibitor in Cervical Cancer
		2.9	 Advances in Radiotherapy
	3	 Ovarian Carcinoma
		3.1	 Screening
		3.2	 Neoadjuvant Chemotherapy + IDS vs. PDS
		3.3	 Lymph Node Assessment
		3.4	 Frontline Chemotherapy
		3.5	 Intraperitoneal Chemotherapy
		3.6	 Surgery vs. Chemotherapy for Recurrence
		3.7	 Angiogenesis Inhibitor
		3.8	 Maintenance Therapy/Monotherapy with PARP Inhibitors
	4	 Endometrial Cancer
		4.1	 Fertility Preserving Option
		4.2	 Sentinel Node (SLN) Evaluation
		4.3	 Molecular Markers Guiding Therapy
		4.4	 Immunotherapy
		4.5	 Adjuvant Treatment in High-Risk Endometrial Cancers
	5	 Vulvar Carcinoma
		5.1	 Updated Staging
		5.2	 Sentinel Node
		5.3	 Tumour-Free Surgical Margin
		5.4	 Systemic Therapy
	6	 Gestational Trophoblastic Neoplasia
	7	 Uterine Mesenchymal Tumours
	8	 Conclusion
	References