Principles and Practice of Gynecologic Oncology

Cover......Page 1
Half Title Page......Page 3
Title Page......Page 5
Copyright......Page 6
Dedication......Page 7
FOREWORD......Page 8
CONTENTS......Page 9
CONTRIBUTING AUTHORS......Page 11
PREFACE......Page 15
ACKNOWLEDGMENTS......Page 17
SECTION I: EPIDEMIOLOGY OF GYNECOLOGIC CANCER......Page 19
UTERINE CORPUS CANCER......Page 21
OVARIAN CANCER......Page 26
CERVICAL CANCER......Page 30
VULVAR CANCER......Page 35
VAGINAL CANCER......Page 36
GESTATIONAL TROPHOBLASTIC DISEASES......Page 37
SUMMARY......Page 38
References......Page 39
OVARIAN CANCER......Page 49
ENDOMETRIAL CANCER......Page 51
References......Page 53
INTRODUCTION TO THE BIOLOGY OF GYNECOLOGIC NEOPLASIA......Page 55
BIOCHEMISTRY OF NEOPLASTIC CELLS......Page 71
References......Page 81
CLINICAL IMPLICATIONS OF INVASION, ANGIOGENESIS, AND METASTASIS......Page 89
BIOLOGY OF INVASION......Page 90
BIOLOGY OF ANGIOGENESIS......Page 93
NOVEL TECHNOLOGIES TO STUDY MOLECULAR MECHANISMS OF METASTASIS......Page 96
CLINICAL APPLICATION: THERAPY DIRECTED AGAINST INVASION, ANGIOGENESIS, AND METASTASIS......Page 97
References......Page 98
GENETIC PARADIGM OF TUMORIGENESIS......Page 103
TUMOR-SUPPRESSOR GENES......Page 105
ONCOGENES......Page 111
ENDOMETRIAL CANCER......Page 114
OVARIAN CANCER......Page 118
CERVICAL CANCER......Page 122
References......Page 123
CANCER IMMUNOLOGY: OVERVIEW......Page 131
IMMUNOMODULATION AND CYTOKINE THERAPY......Page 134
BASIS FOR ANTIBODY-MEDIATED THERAPY OF CANCER......Page 136
CLINICAL TRIALS WITH MONOCLONAL ANTIBODIES......Page 141
CANCER VACCINES DESIGNED TO AUGMENT ANTIBODY RESPONSES......Page 150
CLINICAL TRIALS WITH SELECTED VACCINES DESIGNED PRIMARILY TO INDUCE T-CELL RESPONSES......Page 152
ANTI-IDIOTYPE VACCINES......Page 154
References......Page 155
OVARIAN AND FALLOPIAN TUBE CANCERS......Page 163
ENDOMETRIAL CANCERS......Page 171
CERVICAL CANCERS......Page 174
VULVAR AND VAGINAL CANCERS......Page 176
References......Page 177
CERVIX CANCER......Page 183
OVARIAN CANCER......Page 187
ENDOMETRIAL CANCER......Page 190
References......Page 191
HISTORICAL PERSPECTIVE......Page 195
COMPONENTS OF A CLINICAL TRIAL......Page 197
PHASES OF DRUG DEVELOPMENT TRIALS......Page 200
DIAGNOSTIC STUDIES......Page 205
STUDIES INVOLVING ADVANCED EXPERIMENTAL BIOTECHNOLOGIES......Page 207
HYPOTHESIS TEST......Page 208
DATA MONITORING......Page 209
ETHICS IN CLINICAL TRIALS......Page 210
References......Page 212
IMAGING MODALITIES......Page 215
EXAMINATION TECHNIQUES AND NORMAL ANATOMY......Page 216
CERVICAL CANCER......Page 220
ENDOMETRIAL CANCER......Page 227
GESTATIONAL TROPHOBLASTIC DISEASE......Page 232
OVARIAN CANCER......Page 234
VAGINAL CANCER......Page 242
VULVAR CANCER......Page 243
References......Page 245
SECTION II: THERAPEUTIC MODALITIES AND RELATED SUBJECTS......Page 249
PREOPERATIVE RISK ASSESSMENT......Page 251
PREPARATION FOR SURGERY......Page 260
CRITICAL CARE AND POSTOPERATIVE MANAGEMENT......Page 262
References......Page 281
TECHNICAL ASPECTS OF SURGERY......Page 287
SURGICAL MANAGEMENT OF GYNECOLOGIC CANCER......Page 298
THE FUTURE OF GYNECOLOGIC ONCOLOGY......Page 303
References......Page 304
THE MATURATION PERIOD: 1992–2003......Page 307
BASIC ELEMENTS OF LAPAROSCOPIC SURGERY......Page 308
LAPAROSCOPIC RETROPERITONEAL STAGING: PELVIC AND AORTIC LYMPH NODE DISSECTIONS......Page 314
LAPAROSCOPIC ASSISTANCE TO RADICAL SURGERY AND LAPAROSCOPIC RADICAL SURGERY......Page 325
LAPAROSCOPY AND CANCER OF THE CERVIX......Page 331
LAPAROSCOPY IN OVARIAN CANCER......Page 334
References......Page 337
INTRODUCTION TO RADIOBIOLOGY......Page 343
INTRODUCTION TO RADIATION PHYSICS......Page 351
RADIATION PRODUCTION......Page 352
CLINICAL APPLICATIONS......Page 362
INTRACAVITARY APPLICATORS: CERVICAL CANCER......Page 368
EXTERNAL BEAM IRRADIATION FOR GYNECOLOGIC CANCERS......Page 378
EXTERNAL BEAM IRRADIATION FOR GYNECOLOGIC CANCERS......Page 383
References......Page 391
HISTORICAL OVERVIEW OF CANCER CHEMOTHERAPY......Page 399
TUMOR BIOLOGY IN RELATION TO CHEMOTHERAPY......Page 400
PHARMACOLOGIC PRINCIPLES OF CHEMOTHERAPY......Page 402
DRUG RESISTANCE AND TUMOR CELL HETEROGENEITY......Page 409
GENERAL PRINCIPLES OF CHEMOTHERAPY......Page 411
MANAGEMENT OF CHEMOTOXICITIES......Page 414
DEVELOPMENTAL CHEMOTHERAPY......Page 419
References......Page 423
DETERMINANTS OF EFFECTIVE DRUG THERAPIES......Page 427
CLINICAL PHARMACOLOGY OF ACTIVE DRUGS AGAINST GYNECOLOGIC CANCERS......Page 429
MODULATING AGENTS/SUPPORTIVE CARE DRUGS USED IN THE TREATMENT OF GYNECOLOGIC CANCERS......Page 467
References......Page 470
HORMONE RECEPTOR PATHWAYS AND MECHANISMS......Page 481
HORMONES AS RISK FACTORS FOR HUMAN MALIGNANCIES......Page 484
HORMONES AND THE PREVENTION OF HUMAN CANCERS......Page 488
HORMONES AND THE TREATMENT OF HUMAN CANCERS......Page 493
References......Page 498
SYSTEMIC THERAPIES: ADVANCES IN THE 21st CENTURY......Page 503
RADIATION THERAPY: ADVANCES IN THE 21st CENTURY......Page 519
ADVANCES IN FERTILITY-SPARING SURGERY......Page 525
ROBOTICALLY ASSISTED LAPAROSCOPIC SURGERY......Page 532
References......Page 534
DEFINITIONS AND TERMINOLOGY OF PREINVASIVE LESIONS OF THE LOWER GENITAL TRACT......Page 541
NATURAL HISTORY OF PREINVASIVE LESIONS OF THE LOWER GENITAL TRACT......Page 544
RISK FACTORS FOR THE DEVELOPMENT OF LOWER GENITAL TRACT CANCERS AND PREINVASIVE LESIONS OF THE LOWER GENITAL TRACT......Page 546
HUMAN PAPILLOMAVIRUS......Page 548
PREVALENCE OF HPV INFECTIONS......Page 551
OUTCOME AFTER EXPOSURE TO HPV......Page 552
PATHOLOGY OF PREINVASIVE LESIONS OF THE LOWER GENITAL TRACT......Page 553
CYTOLOGIC SCREENING FOR CERVICAL CANCER AND ITS PRECURSORS......Page 559
MANAGEMENT OF CYTOLOGIC ABNORMALITIES AND CIN......Page 562
References......Page 567
SECTION III: DISEASE SITES......Page 571
ANATOMY......Page 573
EPIDEMIOLOGY......Page 575
CLINICAL PRESENTATION......Page 576
PATTERNS OF SPREAD......Page 577
PATHOLOGY......Page 578
PROGNOSTIC FACTORS......Page 586
TREATMENT......Page 589
SURGICAL TECHNIQUES......Page 591
RADIATION THERAPY......Page 595
CHEMOTHERAPY......Page 599
RESULTS OF THERAPY......Page 601
MANAGEMENT OF OTHER VULVAR MALIGNANCIES......Page 602
FUTURE DIRECTIONS......Page 603
References......Page 604
EPIDEMIOLOGY AND ETIOLOGIC RISK FACTORS......Page 609
DIAGNOSTIC WORKUP......Page 611
STAGING......Page 612
PATHOLOGIC CLASSIFICATION......Page 613
PROGNOSTIC FACTORS INFLUENCING CHOICE OF TREATMENT......Page 615
GENERAL MANAGEMENT: TREATMENT OPTIONS AND OUTCOME BY FIGO STAGES......Page 616
PATTERNS OF FAILURE IN SQUAMOUS CELL CARCINOMA......Page 627
TREATMENT COMPLICATIONS AND THEIR MANAGEMENT......Page 628
CLEAR CELL CARCINOMA OF THE VAGINA......Page 630
NONEPITHELIAL TUMORS OF THE VAGINA......Page 631
SALVAGE THERAPY......Page 633
SUMMARY AND CONCLUSIONS......Page 635
References......Page 636
RISK FACTORS AND ETIOLOGY......Page 641
NATURAL HISTORY......Page 642
CLINICAL PRESENTATION AND DIAGNOSTIC EVALUATION......Page 643
PATHOLOGY......Page 647
PROGNOSTIC FACTORS......Page 654
GENERAL MANAGEMENT AND RESULTS OF TREATMENT......Page 657
UNUSUAL CLINICAL SITUATIONS......Page 662
MANAGEMENT OF CERVICAL CANCER DURING PREGNANCY......Page 665
HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNODEFICIENCY SYNDROME AND CERVICAL NEOPLASIA......Page 667
SURGERY......Page 669
RADIATION THERAPY......Page 670
COMBINED MODALITY TREATMENT......Page 679
TREATMENT OF RECURRENT CARCINOMA OF THE CERVIX......Page 682
COMPLICATIONS AND SEQUELAE OF TREATMENT......Page 686
References......Page 690
ANATOMY......Page 701
EPIDEMIOLOGY AND RISK FACTORS......Page 702
NATURAL HISTORY OF DISEASE......Page 704
CLINICAL PRESENTATION......Page 705
DIAGNOSTIC WORKUP......Page 706
PATHOLOGY......Page 716
MOLECULAR ALTERATIONS IN THE PATHOGENESIS AND PROGRESSION OF ENDOMETRIAL ADENOCARCINOMA......Page 722
PATHOLOGIC FACTORS OF PROGNOSTIC SIGNIFICANCE......Page 723
ADJUVANT RADIATION THERAPY......Page 726
RADIATION THERAPY TECHNIQUES......Page 730
SYSTEMIC THERAPIES......Page 732
FUTURE DIRECTIONS......Page 739
References......Page 740
EPIDEMIOLOGY AND RISK FACTORS......Page 751
DIAGNOSIS AND EVALUATION......Page 752
STAGING AND NODAL INVOLVEMENT......Page 753
PATHOLOGY......Page 754
RADIATION THERAPY......Page 759
CHEMOTHERAPY......Page 763
LONG-TERM RESULTS OF THERAPY......Page 773
MOLECULAR BIOLOGY, GENETICS, FUTURE DIRECTIONS, AND CONCLUSIONS......Page 774
References......Page 775
RISK FACTORS AND PATHOGENESIS......Page 781
PATHOLOGY......Page 786
DIAGNOSIS AND CLINICAL EVALUATION......Page 805
SCREENING......Page 806
SURGICAL STAGING......Page 808
TREATMENT CONSIDERATIONS......Page 812
TREATMENT OF PERSISTENT/RECURRENT DISEASE......Page 832
SELECTED ISSUES IN PALLIATIVE CARE......Page 838
NEW DIRECTIONS......Page 839
References......Page 842
PATHOLOGY......Page 855
CLINICAL FEATURES......Page 858
SURGERY......Page 859
CHEMOTHERAPY FOR OVARIAN GERM CELL TUMORS......Page 862
DYSGERMINOMA......Page 866
LATE EFFECTS OF TREATMENT......Page 868
References......Page 869
GRANULOSA CELL TUMORS......Page 873
TUMORS IN THE THECOMA-FIBROMA GROUP......Page 877
SERTOLI STROMAL CELL TUMORS......Page 878
OVARIAN SEX CORD TUMOR WITH ANNULAR TUBULES......Page 881
SEX CORD–STROMAL TUMORS, UNCLASSIFIED......Page 882
TREATMENT......Page 885
MOLECULAR PATHOGENESIS......Page 887
References......Page 888
EPIDEMIOLOGY......Page 893
MOLAR PREGNANCY......Page 894
GESTATIONAL TROPHOBLASTIC NEOPLASMS......Page 899
References......Page 909
RISK FACTORS......Page 915
ANATOMY......Page 916
NATURAL HISTORY OF BREAST CANCER......Page 917
IMAGING STUDIES OF THE BREAST......Page 918
THE WORKUP FOR SUSPECTED BREAST CANCER......Page 923
BREAST PATHOLOGY......Page 925
GENOMIC CLASSIFICATION OF BREAST CANCER......Page 931
PROGNOSTIC AND PREDICTIVE FACTORS......Page 932
SURGICAL CONSIDERATIONS......Page 933
CHEMOTHERAPY......Page 938
ENDOCRINE THERAPY......Page 941
RADIATION THERAPY......Page 944
SEQUELAE OF TREATMENT......Page 947
SPECIAL CONSIDERATIONS......Page 949
FUTURE DIRECTIONS......Page 951
SUMMARY OF CONTEMPORARY CLINICAL TRIALS......Page 954
References......Page 955
SECTION IV: SPECIAL MANAGEMENT TOPICS......Page 965
TUMOR RELATED......Page 967
SURGERY RELATED......Page 968
CHEMOTHERAPY AND RADIATION RELATED......Page 969
SURGICAL ANTIMICROBIAL PROPHYLAXIS......Page 971
BOWEL PREPARATION......Page 972
CLINICAL SYNDROMES......Page 973
References......Page 980
CHEMOTHERAPY......Page 983
RADIATION THERAPY......Page 985
SURGERY......Page 990
References......Page 996
ASSESSMENT OF CANCER PAIN......Page 1001
MANAGEMENT OF ACUTE PAIN......Page 1005
MANAGEMENT OF CHRONIC CANCER PAIN......Page 1006
THERAPEUTIC APPROACHES: PHARMACOLOGIC MANAGEMENT......Page 1007
THERAPEUTIC APPROACHES: OTHER APPROACHES IN CHRONIC PAIN MANAGEMENT......Page 1017
References......Page 1018
NUTRITIONAL ASSESSMENT......Page 1023
PREVALENCE OF MALNUTRITION......Page 1024
ETIOLOGY OF MALNUTRITION......Page 1025
NUTRITIONAL THERAPIES......Page 1027
References......Page 1033
QUALITY OF LIFE......Page 1037
QOL OUTCOMES AND CLINICAL TRIAL UPDATES FOR ENDOMETRIAL, CERVICAL, AND OVARIAN CANCER......Page 1038
CHALLENGES IN GYNECOLOGIC CANCER SURVIVORSHIP......Page 1040
CONCLUSION......Page 1042
References......Page 1043
ADVANCE PLANNING FOR END OF LIFE CARE: REDUCING THE EMOTIONAL BURDEN ON SURROGATE DECISION MAKERS......Page 1047
MEETING THE NEED FOR MEDICAL ORDERS: THE POLST PARADIGM PROGRAM......Page 1048
UNIQUE CIRCUMSTANCES FOR DECISION MAKING: PREGNANT PATIENTS......Page 1049
MAXIMIZING PALLIATION: MANAGING SYMPTOMS AT THE END OF LIFE......Page 1050
REQUESTS FOR HELP IN DYING......Page 1054
CONCLUSIONS......Page 1055
References......Page 1056
INDEX......Page 1059
Color Plates......Page 1091