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Recent Advances in Gyne-oncology
Dilip Kumar Dutta
CHAPTER ONE:
Cancer of Vulva
INTRODUCTION
MOLECULAR BIOLOGY AND GENETICS
STAGING
DIAGNOSIS
TREATMENT (FIG. 1.3 TO 1.5)
Chemoradiation
HPV Vaccine
5-year Survival
Special Situation
CHAPTER TWO:
Cancer of Vagina
INTRODUCTION
ANATOMY OF VAGINA
INCIDENCE
ETIOLOGY
TYPES
SPREAD
CLINICAL FEATURES
DIAGNOSIS
STAGING
MANAGEMENT
PROGNOSIS
Vaginal Cancer Screening and Prevention
Adenocarcinoma of the Vagina
Melanoma of Vagina
Sarcoma of Vagina
Secondary Vaginal Tumors
Recurrent Vaginal Cancer
CONCLUSION
CHAPTER THREE:
Cancer of Cervix
ABSTRACT
SCREENING FOR CERVICAL CANCER
Types
Analysis of Screening Results
Levels of Prevention
Background
Negative for Intraepithelial Lesion or Malignancy
Infection
Other Findings
Epithelial Cell Abnormalities
Squamous Cells (Table 3.2)
Glandular Cells
Why Screening is so Important in Relation to Cervical Cancer?
Standard Practice of Screening
When to Start and When to Stop Screening?
Frequency of Screening
HPV-DNA Test
HPV Vaccine and its Effect on Screening
Analysis of Screening Report
New Research
Where We Stand Today?
MICROINVASION
Stage IA1
Stage IA2
Follow-up
Invasive Carcinoma
Initial Evaluation
Stage IB1, IIA < 4 cm
Surgery
Radiotherapy
Adjuvant Therapy Postsurgery
Concurrent Chemoradiation
Neoadjuvant Chemotherapy Followed by Radical Hysterectomy and Pelvic Lymphadenectomy
Advanced Cervical Cancer
Definition
Primary Treatment
Irradiation Dose and Technique
Stage IVB or Recurrent Disease (Tables 3.4 to 3.6)
Background
Management of Patients who Relapse after Primary Treatment
Therapeutic Options for Local Relapse after Primary Surgery
Distant Metastasis
Special Circumstances1 Incident Cervical Cancer
Level of Evidence C
Cervical Cancer During Pregnancy
CHAPTER FOUR:
Cancer of the Corpus Uteri
INTRODUCTION
INCIDENCE
Causative Factors
Increased Risk is Associated with
Clinical Features
Symptoms
Signs
Anatomy
Notes on Pathologic Grading
Rules Related to Staging
Prognostic Tumor Characteristics for High Risk
Surgical Staging Procedure for Endometrial Cancer (Fig. 4.3)
Is Lymphadenectomy Necessary or not?
Is Lymphadenectomy Therapeutic?
Who Should Perform the Surgery?
Adjuvant Radiotherapy
Progestogen Therapy
Plan for Surgery
Stage I
Stage II
Stage III
Stage IV
Treatment by Stage
Special Considerations
Diagnosis Posthysterectomy
Medically Inoperable Patient
Diagnosis in the Young Woman
Positive Peritoneal Cytology
Follow-up
Can you Prescribe HRT?
Recurrence
Future Direction
CONCLUSION
CHAPTER FIVE:
Fallopian Tube Cancer
INTRODUCTION
HISTOPATHOLOGY
RISK FACTORS
SYMPTOMS
DIAGNOSIS
STAGING (TABLE 5.2)
Treatment
Surgery
Radiation Therapy
Chemotherapy
Second Look Laparotomy
Hormonal Therapy
Combined Modality
PROGNOSIS
CONCLUSION
CHAPTER SIX:
Cancer of Ovary
INTRODUCTION
CLASSIFICATION OF OVARIAN CANCER
Etiology or Risk Factors for Ovarian Cancer
Genetic Factors
Environmental Factors
Endocrine and Reproductive Factors
SCREENING AND DIAGNOSIS OF OVARIAN CANCER
History and Ovarian Cancer Diagnosis
Pelvic Examination and Ovarian Cancer Diagnosis
Imaging Studies to Diagnose Ovarian Cancer
STAGING OF PRIMARY OVARIAN CANCER
Technique for Surgical Staging
Omentectomy
OVARIAN CANCER TREATMENT
Ovarian Cancer Surgery
Role of Prophylactic Surgery
Chemotherapy to Treat Ovarian Cancer
GERM CELL TUMOR
Concept of Borderline Ovarian Cancer (Fig. 6.4 A And B)
Histological features
FOLLOW-UP OVARIAN CANCER TREATMENT
OVARIAN CANCER AND SEXUAL CONCERNS
CONCLUSION
CHAPTER SEVEN:
Gestational Trophoblastic Disease
INTRODUCTION
EPIDEMIOLOGY
CAUSES AND GENETICS
PATHOLOGY
CLASSIFICATION OF GESTATIONAL TROPHOBLASTIC DISEASE
Benign Forms
Malignant Forms
Pathologic characteristics of a CHM (Table 7.1):
PRESENTATION AND CLINICAL FEATURES
General Features
Nonmetastatic Disease
Metastatic Disease
DIAGNOSIS OF MOLAR PREGNANCY
Human Chorionic Gonadotropin
Ultrasonography (Figs 7.3 to 7.5)
MANAGEMENT OF MOLAR PREGNANCY
Initial Management
Staging and Stratification
Chemotherapy
Therapeutic
Prophylactic
Chemotherapy Regimen for Low-Risk Disease
Salvage Therapy of Low Risk GTN
Chemotherapy Regimen for High-Risk Disease
Management of Stage IV GTN
Drug-Resistant Disease
Role of Surgery
Role of Radiation Therapy
hCG Follow-Up
CHORIOCARCINOMA (CC)
Histopathological Features
Diagnosis
Management
PLACENTAL-SITE TROPHOBLASTIC TUMOR
Postchemotherapy Sequelae and Follow-Up
Subsequent Pregnancies
Recurrent GTN
Screening and Treatment of Gestational Trophoblastic Disease in Developing Countries
Psychosocial Consequences of GTN
CONCLUSIONS
CHAPTER EIGHT:
Cancer of the Breast
INTRODUCTION
SCREENING
RISK FACTORS
HEREDITARY BREAST CANCER
ANATOMY
Primary Site
Regional Lymph Nodes
Axillary
Internal Mammary
Metastatic Sites
Diagnosis
Investigations Needed
Clinical Staging
Pathological Staging
RULES FOR CLASSIFICATION
TMN Classification
Definition of TMN
Regional Lymph Nodes (N)
Distant Metastasis (M)
CLINICAL PRACTICE GUIDELINES
Palpable Mass
Cystic Lesion
Solid Lesion
Preoperative Investigations
Handling the Surgical Specimens
Hormone Receptor Levels
TUMOR MANAGEMENT BASED ON TMN CLASSIFICATION
Paget's Disease of the Breast
Ductal carcinoma in situ
Lobular Carcinoma In Situ
Stage I or H Invasive Cancer
Partial mastectomy, axillary dissection and radiation therapy
Modified Radical Mastectomy (Fig. 8.9)
Radical Mastectomy
Locally Advanced Tumors
Breast Conservative Surgery (Fig. 8.10)
Breast Reconstruction Operations (Fig. 8.11)
SPECIAL SITUATIONS
Inflammatory Breast Cancer
Local Regional Recurrence
Carcinoma of the Breast in Pregnancy
Tamoxifen and Endometrial Cancer
CHAPTER NINE:
Radiotherapy in Gynecological Cancer
INTRODUCTION
EARLY-STAGE CERVICAL CANCER
General Principles of Management
Radiation Therapy
Adjuvant Radiation
Adjuvant Combined Chemoradiation Therapy
Definitive Radiation
Surgery vs. Radiation
Definitive Chemoradiation
SUMMARY OF BRACHYTHERAPY
ABS Strongly Recommends that:
Treatments Classified with Respect to Source loading
Treatments Classified with Respect to Dose
Rate
Evolution of Brachytherapy In Carcinoma Cervix
Manchester System Applicators
Modern Fletcher-Suit Applicator Systems
Simulation
ICRU Bladder and Rectal Ref Points
Rectal Ref Point
Interstitial Brachytherapy
HDR Brachytherapy
Advantages of HDR versus LDR
SEQUELAE OF RADIATION THERAPY
Acute
Late
Carcinoma Endometrium
Vulvar Cancers
CHAPTER TEN:
On the Origin of Ovarian and Endometrial Cancers: Molecular Profiling of Gynecologic Cancers
INTRODUCTION
CERVIX, VAGINA AND VULVAR CANCERS
ENDOMETRIAL CANCER
OVARIAN CANCER
Time Honored Concepts
Implication of the Molecular Analysis of Ovarian Cancers
Differences in Genetic Profiles Segregate Between Low Grade and High Grade Serous Cancers
On the Cell of Origin of Cvarian Cancers
CHAPTER ELEVEN:
Recent Advances in Chemotherapy in Gynecological Oncology
INTRODUCTION
CELL KILL HYPOTHESIS
THE CELL CYCLE
CHEMOTHERAPY RESISTANCE OF CANCER CELLS
HOST DEFENCES
ROUTE OF ADMINISTRATION
Chemotherapy Toxicity
Therapeutic Agents Used in the Treatment of Gynecological Cancer
CHEMOTHERAPY—OVARIAN CANCER
Advanced Ovarian Cancer
Neoadjuvant Chemotherapy
Newer Group of CT Drugs Used in Ovarian Cancer
Nonepithelial Ovarian Cancers
Endometrial Cancer
In Uterine Sarcoma
Leiomyosarcoma
Cervical Cancer
Vaginal Cancer
Vulval Cancer
Gestational Trophoblastic Desease
Combination Chemotherapy
Breast Cancer
INDEX
TOC
Index
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