Preventing Malignancies of the Reproductive Tract, An Issue of Obstetrics and Gynecology Clinics (The Clinics: Internal Medicine)

Cover......Page 1
Foreword......Page 2
Preface......Page 4
Selection bias......Page 6
Observational studies and gynecologic cancer prevention......Page 7
Information bias......Page 8
Healthy-user bias......Page 9
Chance......Page 10
Randomized clinical trials and gynecologic cancer prevention......Page 11
Modification by risk factors and biological characteristics......Page 13
Additional challenges for strengthening cancer-prevention trials......Page 14
References......Page 15
Hereditary breast and ovarian cancer syndrome......Page 18
BRCA genetic testing......Page 19
Intensified screening......Page 23
Chemoprevention......Page 24
Prophylactic surgery......Page 25
Hereditary non-polyposis colorectal cancer syndrome-associated ovarian cancer......Page 28
Summary......Page 29
References......Page 30
The high-risk patient......Page 33
Other chemopreventive agents for ovarian cancer......Page 35
Rectovaginal pelvic examination......Page 36
Cancer antigen 125 tumor marker......Page 37
Combined tumor markers......Page 38
Transvaginal ultrasonography......Page 39
Combined screening modalities......Page 40
Proteomics......Page 42
Bilateral salpingo-oophorectomy......Page 43
Other gynecologic procedures......Page 44
Summary and recommendations......Page 45
References......Page 46
Ovarian Cancer Hormonal and Environmental Risk Effect......Page 53
General risk factors......Page 54
General protective factors......Page 56
Environmental risk factors......Page 57
Oral contraception......Page 59
Chemoprevention of ovarian cancer......Page 61
Summary......Page 62
References......Page 63
Identification of defective DNA mismatch repair......Page 67
Inherited defective DNA mismatch repair and risk of endometrial cancer......Page 71
Identifying individuals who have Lynch syndrome......Page 73
Endometrial cancer phenotype in Lynch syndrome......Page 75
Screening and prevention......Page 77
Prophylactic surgery......Page 78
References......Page 79
Management of Abnormal Uterine Bleeding and the Pathology of Endometrial Hyperplasia......Page 82
The clinical problem, risk factors, and diagnostic approach......Page 83
Clinical management of abnormal uterine bleeding......Page 87
Pathologic evaluation of endometrial biopsies and the pathology of endometrial hyperplasia......Page 89
Molecular pathology of endometrial hyperplasia and carcinoma......Page 93
The concept of endometrial intraepithelial neoplasia......Page 96
Type II endometrial carcinoma and endometrial intraepithelial carcinoma......Page 97
Future developments......Page 98
References......Page 99
Cervical cancer burden......Page 103
Cervical cancer burden......Page 105
Cervical transformation zone......Page 107
Screening test characteristics......Page 108
Specimen collection......Page 109
Liquid-based cytology......Page 110
Computerized screening technologies......Page 111
Evaluation of cytology results......Page 112
Follow-up and management of abnormalities......Page 113
New screening techniques for cervical cancer......Page 114
Carcinogenic human papillomavirus testing......Page 115
Type-specific human papillomavirus testing......Page 116
Cellular markers......Page 117
See-and-treat options......Page 118
Summary......Page 119
References......Page 120
Quadrivalent vaccine FUTURE II......Page 125
Current paradigm for prevention of cervical cancer......Page 127
Human papillomavirus awareness and vaccine acceptability......Page 129
Efficacy......Page 130
Quadrivalent vaccine FUTURE I......Page 131
Bivalent vaccine......Page 132
Safety and reproductive toxicity......Page 133
Age to vaccinate......Page 134
Cost-effectiveness analyses......Page 136
Guidelines for prophylactic vaccination......Page 137
Policy considerations......Page 138
Summary......Page 139
References......Page 140
Vulvar intraepithelial neoplasia......Page 146
Precursors to vulvar cancer......Page 147
Lichen sclerosus, lichen simplex chronicus, and squamous cell hyperplasia......Page 148
Molecular biology of precursor lesions......Page 149
Vulvar cytology......Page 150
Colposcopy and biopsy......Page 151
Topical agents......Page 152
Wide local excision, skinning vulvectomy, and simple vulvectomy......Page 153
The role of human papillomavirus vaccination......Page 154
Vaginal intraepithelial neoplasia......Page 155
Risk factors for progression to cancer......Page 156
Colposcopy and biopsy......Page 157
Topical agents......Page 158
Laser ablation......Page 159
The role of human papillomavirus vaccination......Page 160
References......Page 161