Gynecologic Cancer

by Eifel, Patricia J., M.D.; Gerchenson, David M., M.D.; Kavanagh, John J.; Silva, Elvio G., M.D.

• ISBN13: 9780387287942
• ISBN10: 0387287949
• Format: Paperback
• Copyright: 2005-12-31
• Publisher: Springer Nature

Summary

Gynecologic cancer includes cancer of the female lower genital tract: vagina, vulva, cervix, endometrium, uterus, and ovaries.Gynecologic Cancer is the fourth volume in the M.D. Anderson Cancer Care Series, featuring the current standard approach to gynecologic cancer care from the experts at M.D. Anderson Cancer Center. Designed for the practicing oncologist, this clinical guidebook allows for quick, authoritative access to the latest and best multimodality therapies. Topics covered in this volume include primary prevention and early detection, preinvasive diseases of female lower genital tract, pathology and imaging of gynecologica malignancies, treatment of vaginal, cervical, endometrial, uterine cancers. Discussions also address fertility-sparing options for treatment of women with gynecologica cancers as well as sexuality in women with gyn malignancies. Each of the 20 chapters ends with an up-to-date list of suggested readings, as well as "key practice points" highlighting the most principles and practices of each chapter for at-a-glance reference. More than 80 illustrations complement the text. This thorough, practical volume is the essential clinical guide for the oncologists, surgeons, and all physicians involved in the care of patients with gynecologic cancer.

Table of Contents

Foreword	ix
Maurie Markman
Preface	xi
Contributors	xvii
Chapter 1 Multidisciplinary Care of Patients with Gynecologic Cancers	1	(11)
David M. Gershenson, MD, John J. Kavanagh, MD, Patricia J. Eifel, MD, and Elvio G. Silva, MD
Chapter Overview	1	(1)
Introduction	1	(1)
Organization of Multidisciplinary Clinical Trial Research	2	(1)
Gynecologic Oncology Multidisciplinary Planning Conference	3	(1)
Gynecologic Oncology Multidisciplinary Planning Clinic	3	(1)
Gynecologic Cancer Practice Guidelines	4	(1)
Appendix	5	(7)
Chapter 2 Prevention and Early Detection of Endometrial and Ovarian Cancers	12	(8)
Karen H. Lu, MD
Chapter Overview	12	(1)
Introduction	13	(1)
Endometrial Cancer	13	(2)
Prevention for Women at Average Risk	13	(1)
Prevention and Screening for Women with Lynch Syndrome	13	(1)
Prevention and Screening for Women Taking Tamoxifen	14	(1)
Prevention and Screening for Obese Women	15	(1)
Ovarian Cancer	15	(3)
Screening for Women at Average Risk	16	(1)
Prevention and Screening for Women with Hereditary Breast-Ovarian Cancer Syndrome	16	(2)
Summary	18	(1)
Key Practice Points	18	(1)
Suggested Readings	19	(1)
Chapter 3 Preinvasive Disease of the Lower Genital Tract	20	(10)
Andrea Milbourne, MD, and Michele Follen, MD, PhD
Chapter Overview	20	(1)
Introduction	21	(1)
Evaluation of Patients with an Abnormal Pap Test Result	21	(3)
High-Grade Squamous Intraepithelial Lesions	22	(1)
Low-Grade Squamous Intraepithelial Lesions	23	(1)
Atypical Squamous Cells of Undetermined Significance	23	(1)
Atypical Cells of Undetermined Significance Cannot Rule Out High-Grade Dysplasia	23	(1)
Atypical Glandular Cells of Undetermined Significance	24	(1)
Evaluation of Special Cases	24	(3)
Pregnant Patients with an Abnormal Pap Test Result	24	(1)
Vaginal Dysplasia	25	(1)
Vulvar Dysplasia	25	(2)
Conclusion	27	(1)
Key Practice Points	28	(1)
Suggested Readings	28	(2)
Chapter 4 Selected Topics in Gynecologic Pathology	30	(19)
Anais Malpica, MD, Michael T. Deavers, MD, and Elvio G. Silva, MD
Chapter Overview	30	(1)
Vulvar Intraepithelial Neoplasia, Simplex Type	31	(1)
p16 in Cervical Intraepithelial Neoplasia	32	(1)
Large Cell Neuroendocrine Carcinoma of the Cervix	33	(2)
Endocervical Adenocarcinoma Versus Endometrial Adenocarcinoma	35	(2)
Endometrial Hyperplasia and Carcinoma	37	(1)
Dedifferentiated Endometrioid Adenocarcinoma	38	(2)
Grading of Ovarian Serous Carcinoma	40	(1)
Invasive Implants of Ovarian Serous Borderline Tumors	41	(1)
Mucinous Tumors of the Ovary	42	(2)
Cellular Fibroma of the Ovary	44	(1)
Key Practice Points	45	(1)
Suggested Readings	46	(3)
Chapter 5 Imaging of Gynecologic Malignancies	49	(15)
Revathy Iyer, MD
Chapter Overview	49	(1)
Introduction	50	(1)
Imaging Modalities	51	(2)
US	51	(1)
CT	52	(1)
MRI	52	(1)
PET	52	(1)
Cervical Cancer	53	(2)
Endometrial Cancer	55	(2)
Ovarian Cancer	57	(3)
Lymphadenopathy	60	(1)
Key Practice Points	61	(1)
Suggested Readings	61	(3)
Chapter 6 Contemporary Treatment of Vaginal and Vulvar Cancers	64	(23)
Patricia J. Eifel, MD, and Thomas W. Burke, MD
Chapter Overview	64	(1)
Introduction	65	(1)
Epidemiology	66	(1)
Anatomy and Patterns of Spread	66	(2)
Clinical Evaluation and Staging	68	(1)
Prognostic Factors	69	(2)
Treatment of Vaginal Carcinomas	71	(6)
VAIN	71	(1)
Stage I Tumors	71	(3)
Stage II Tumors	74	(1)
Stage III-IVA Tumors	75	(2)
Regional Management	77	(1)
Treatment of Vulvar Carcinomas	77	(7)
VIN	77	(1)
T1a Tumors	78	(1)
T1b-T2 Tumors	78	(1)
T3-T4a Tumors	79	(2)
Regional Management	81	(3)
Key Practice Points	84	(1)
Suggested Readings	84	(3)
Chapter 7 Treatment of Early Cervical Cancer	87	(15)
Charles F. Levenback, MD
Chapter Overview	87	(1)
Introduction	88	(1)
Clinical Presentation	88	(1)
History and Physical Examination	89	(1)
Staging	89	(3)
Impact of Histologic Subtype on Treatment Planning	92	(1)
Squamous Carcinoma	92	(1)
Adenocarcinoma	92	(1)
Neuroendocrine Tumors	93	(1)
Treatment Recommendations for Microinvasive Cervical Cancer	93	(1)
Treatment Recommendations for Stage IB, Disease: Surgery versus Radiotherapy	94	(3)
Treatment Recommendations for Stage IB, Disease	97	(1)
Radical Hysterectomy for Early Cervical Cancer	97	(3)
Choice of Incision	97	(1)
Management of the Ovaries	98	(1)
What to Do First?	98	(1)
Laparoscopically Assisted Radical Vaginal Surgery	98	(1)
Sentinel Node Biopsy	99	(1)
Key Practice Points	100	(1)
Suggested Readings	100	(2)
Chapter 8 Treatment of Locally Advanced Cervical Cancer	102	(23)
Anuja Jhingran, MD, Patricia J. Eifel, MD, and Pedro T. Ramirez, MD
Chapter Overview	102	(1)
Introduction	103	(1)
Clinical Evaluation	103	(1)
General Treatment Approach	104	(4)
Radiation Therapy Technique	108	(7)
External-Beam Radiation Therapy	108	(3)
Brachytherapy	111	(4)
Para-aortic Radiation Therapy	115	(3)
Treatment of Stage IVA Disease	118	(1)
Treatment of Locally Recurrent Disease	118	(2)
Treatment of Stage IVB Disease at Presentation or Recurrence	120	(1)
Complications of Radiation Therapy	121	(1)
Key Practice Points	122	(1)
Suggested Readings	123	(2)
Chapter 9 Uterine Sarcomas	125	(23)
Lois M. Ramondetta, MD, Diane C. Bodurka, MD, Michael T. Deavers, MD, and Anuja Jhingran, MD
Chapter Overview	126	(1)
Introduction	126	(1)
Staging	127	(1)
Uterine Malignant Mixed Miillerian Tumors	127	(5)
Epidemiology and Tumor Features	127	(1)
Surgical Treatment	128	(1)
Pathologic Evaluation	129	(1)
Radiation Therapy	130	(1)
Chemotherapy	131	(1)
Hormonal Therapy	132	(1)
Treatment Summary	132	(1)
Leiomyosarcoma	132	(5)
Epidemiology and Tumor Features	132	(2)
Surgical Treatment	134	(1)
Pathologic Evaluation	135	(1)
Radiation Therapy	136	(1)
Chemotherapy	136	(1)
Treatment of Recurrent Disease	137	(1)
Endometrial Stromal Sarcoma	137	(4)
Epidemiology and Tumor Features	137	(2)
Surgical Treatment	139	(1)
Radiation Therapy	140	(1)
Chemotherapy	140	(1)
Hormonal Therapy	140	(1)
Undifferentiated Sarcomas	141	(1)
Epidemiology and Tumor Features	141	(1)
Surgical Treatment	141	(1)
Adjuvant Therapy	141	(1)
Adenosarcoma	141	(2)
Epidemiology and Tumor Features	141	(2)
Surgical Treatment	143	(1)
Radiation Therapy	143	(1)
Chemotherapy	143	(1)
Hormonal Therapy	143	(1)
Summary	143	(1)
Surgical Approach for Uterine Sarcomas	143	(1)
Radiation Therapy Approach for Uterine Sarcomas	143	(1)
Key Practice Points	144	(1)
Suggested Readings	144	(4)
Chapter 10 Treatment of Endometrial Cancer	148	(27)
Lois M. Ramondetta, MD, Thomas W. Burke, MD, Russell Broaddus, MD, PhD, and Anuja Jhingran, MD
Chapter Overview	148	(1)
Introduction	149	(1)
Epidemiology	149	(1)
Pretreatment Evaluation	150	(2)
Surgical Treatment	152	(1)
Surgical Staging	153	(1)
Tumor Features	154	(2)
Pathologic Evaluation of the Hysterectomy Specimen	156	(1)
Adjuvant Treatment	157	(4)
Adjuvant Radiation Therapy	157	(2)
Adjuvant Hormonal Therapy	159	(1)
Adjuvant Chemotherapy	160	(1)
Treatment of Residual Disease	161	(5)
Stage III Disease	161	(1)
Stage IV Disease	162	(4)
Treatment of Recurrent Disease	166	(3)
Radiation Therapy	166	(1)
Hormonal Therapy	167	(1)
Chemotherapy	168	(1)
Hormone Replacement Therapy	169	(1)
Key Practice Points	169	(1)
Suggested Readings	170	(5)
Chapter 11 Surgery for Ovarian Cancer	175	(13)
Judith K. Wolf, MD, and J. Taylor Wharton, MD
Chapter Overview	175	(1)
Introduction	176	(1)
Exploratory Laparotomy and Primary Tumor Debulking	176	(5)
Preoperative Assessment	176	(2)
Surgical Technique	178	(3)
Interval Debulking Surgery	181	(1)
Second-Look Surgery	182	(1)
Secondary Tumor Debulking	183	(1)
Surgery for Palliation	184	(2)
Summary	186	(1)
Key Practice Points	186	(1)
Suggested Readings	186	(2)
Chapter 12 Chemotherapy for Epithelial Ovarian Cancer	188	(19)
Michele L. Donato, MD, Xipeng Wang, MD, John J. Kavanagh, MD, and David M. Gershenson, MD
Chapter Overview	188	(1)
Introduction	189	(1)
Primary Chemotherapy	190	(2)
Early-Stage Disease	190	(1)
Advanced-Stage Disease	191	(1)
Neoadjuvant Chemotherapy	192	(2)
Intraperitoneal Chemotherapy	194	(1)
Consolidation Therapy	195	(1)
Therapeutic Strategies for Recurrent Ovarian Cancer	196	(7)
Definitions	196	(1)
Salvage Chemotherapy for Platinum-Sensitive Disease	197	(2)
Salvage Chemotherapy for Platinum-Refractory or Platinum-Resistant Disease	199	(2)
Hormonal Therapy	201	(1)
High-Dose Chemotherapy	202	(1)
Key Practice Points	203	(1)
Suggested Readings	203	(4)
Chapter 13 Treatment of Rare Ovarian Malignancies	207	(19)
Jubilee Brown, MD, and David M. Gershenson, MD
Chapter Overview	207	(1)
Introduction	208	(1)
Sex Cord–Stromal Tumors	209	(6)
General Treatment Guidelines	209	(3)
Surgical Therapy	209	(2)
Postsurgical Therapy	211	(1)
Disease-Specific Considerations	212	(3)
Granulosa Cell Tumors	212	(2)
Sertoli-Leydig Cell Tumors	214	(1)
Lipid Cell Tumors (Steroid Cell Tumors) and Gynandroblastomas	215	(1)
Sex Cord Tumor with Annular Tubules	215	(1)
Germ Cell Tumors	215	(6)
General Treatment Guidelines	216	(4)
Preoperative Evaluation	216	(1)
Surgical Therapy	216	(2)
Postsurgical Therapy	218	(2)
Disease-Specific Considerations	220	(1)
Teratomas	220	(1)
Dysgerminoma	220	(1)
Choriocarcinoma	221	(1)
Ovarian Tumors of Low Malignant Potential	221	(2)
Clinical and Pathologic Characteristics	221	(1)
Guidelines for Therapy	222	(1)
Prognosis	223	(1)
Other Uncommon Ovarian Tumors	223	(1)
Key Practice Points	224	(1)
Suggested Readings	224	(2)
Chapter 14 Gestational Trophoblastic Disease	226	(18)
Hui T. See, MD, Ralph S. Freedman, MD, PhD, Andrzej P. Kudelka, MD, and John J. Kavanagh, MD
Chapter Overview	226	(1)
Introduction	227	(1)
Epidemiology	228	(1)
Pathology	229	(1)
Clinical Presentation	230	(1)
Complete Mole	230	(1)
Partial Mole	230	(1)
Malignant GTTs	231	(1)
Diagnosis	231	(1)
Staging and Prognosticating Systems	232	(1)
Treatment	233	(6)
Molar Pregnancy	233	(2)
Nonmetastatic Malignant GTTs	235	(1)
Metastatic GTTs	236	(3)
Low-Risk Disease	236	(1)
High-Risk Disease	237	(1)
Management of First Remission	238	(1)
Salvage Therapy	238	(1)
Placental Site Tumors	239	(1)
GTTs Coexisting with Normal Pregnancies	239	(1)
Follow-up	239	(2)
Future Childbearing	240	(1)
Phantom hCG Syndrome	240	(1)
Key Practice Points	241	(1)
Suggested Readings	242	(2)
Chapter 15 Fertility-Sparing Options for Treatment of Women with Gynecologic Cancers	244	(17)
Pedro T. Ramirez, MD
Chapter Overview	244	(1)
Cervix	245	(4)
Preinvasive Lesions	245	(1)
Adenocarcinoma In Situ	246	(1)
Microinvasive Disease (Stage IA1)	247	(2)
Stage IA2 and IB1 Disease	249	(1)
Uterus	249	(2)
Ovary	251	(5)
Ovarian Low-Malignant-Potential Tumors	251	(1)
Invasive Ovarian Carcinoma	252	(4)
Ovarian Cryopreservation and Transplantation	256	(1)
Conclusion	257	(1)
Key Practice Points	258	(1)
Suggested Readings	259	(2)
Chapter 16 Quality of Life and Sexual Functioning	261	(18)
Diane C. Bodurka, MD, and Charlotte C. Sun, DrPH
Chapter Overview	261	(1)
Introduction	262	(1)
Measuring Quality of Life	262	(1)
Treatment-Related Side Effects	263	(3)
Neutropenia and Anemia	264	(1)
Neurotoxicity	264	(1)
Urinary Issues	264	(1)
Chemotherapy-Induced Nausea and Vomiting	265	(1)
Alopecia	265	(1)
Psychosocial Concerns	266	(1)
Spirituality	266	(1)
Sexual Functioning	267	(2)
Complementary and Alternative Medicine	269	(1)
Palliative Chemotherapy	270	(1)
Palliative Surgery	271	(1)
Support Services	272	(2)
Case Managers	272	(1)
Patient Advocates	273	(1)
Anderson Network Volunteers	273	(1)
Ostomy Nurses	273	(1)
Nutritionists	273	(1)
Physical and Occupational Therapists	274	(1)
End-of-Life Issues	274	(2)
Key Practice Points	276	(1)
Acknowledgment	276	(1)
Suggested Readings	276	(3)
Chapter 17 Palliative Care for Gynecologic Malignancies	279	(25)
Florian Strasser, MD, ABHPM, Michael W. Bevers, MD, and Eduardo Bruera, MD
Chapter Overview	280	(1)
Introduction	280	(1)
Palliative Care Assessment	281	(5)
Patient's Self-Report of Symptoms	282	(1)
Assessment of Important Syndromes and Conditions Using Clinically Administered Screening Instruments	282	(3)
Cognitive Impairment	283	(1)
Psychosocial and Existential Distress	283	(1)
Risks for Altered Symptom Expression	284	(1)
Gastrointestinal Dysfunction	284	(1)
Social, Family, and Lifestyle Disruptions	284	(1)
Patient Knowledge of the Disease and Prognosis	285	(1)
Management of Selected Symptoms and Syndromes in Patients with Advanced Cancer	286	(10)
Pain	286	(5)
Assessment	286	(1)
Pharmacologic Treatment	287	(1)
Side Effects of Opioids	288	(1)
Adjuvant Medications for Pain Control	289	(1)
Treatment of Bone and Neuropathic Pain	289	(1)
Difficult-to-Manage Pain	290	(1)
Anorexia/Cachexia	291	(1)
Characteristics	291	(1)
Treatment	292	(1)
Constipation	292	(1)
Chronic Nausea	293	(1)
Delirium	293	(2)
Depression and Anxiety	295	(1)
Dyspnea	295	(1)
Assessment	295	(1)
Treatment	295	(1)
Management of Syndromes Specific to Gynecologic Cancer	296	(3)
Lymphedema	296	(1)
Bleeding Complications	297	(1)
Infections	297	(1)
Fistula	297	(1)
Bowel Obstruction	298	(1)
Talking About Cancer	299	(3)
Key Practice Points	302	(1)
Suggested Readings	302	(2)
Index	304