Index

Cervical Cancer: Contemporary Management K Chitrathara, Shalini Rajaram, Amita Maheshwari

SECTION 1: CONVENTIONAL SCREENING, NEWER SCREENING METHODS, HPV CARCINOGENESIS, BIOMARKERS AND HPV VACCINATION
CHAPTER 1:Cervical Cancer Screening in the Developing World
- BURDEN OF CERVICAL CANCER
- NATURAL HISTORY AND CONTROL OPTIONS
- SCREENING TESTS AND PROGRAMS FOR CERVICAL NEOPLASIA
- NEW PARADIGMS IN CERVICAL SCREENING
- ACCURACY OF CERVICAL SCREENING TESTS
- ROUTINE SCREENING PROGRAMS IN DEVELOPING COUNTRIES
- EVIDENCE FOR INCIDENCE AND MORTALITY REDUCTION FOLLOWING NONCYTOLOGY SCREENING TESTS IN DEVELOPING COUNTRIES
- EFFICACY, SAFETY AND ACCEPTABILITY OF FIELD BASED TREATMENTS FOR CIN IN DEVELOPING COUNTRIES
- COST-EFFECTIVE SCREENING APPROACHES IN LOW-RESOURCE SETTINGS
- CLINICAL EARLY DIAGNOSIS
- CONCLUSION
CHAPTER 2:Cytology for Screening: Scope and Limitationsd
- INTRODUCTION
- CERVICAL CYTOLOGY AS AN EFFECTIVE SCREENING TEST
- NEW CYTOLOGICAL TERMINOLOGY
- THE 2001 BETHESDA SYSTEM FOR REPORTING PAP SMEAR RESULTS (ABRIDGED)
- CURRENT PROTOCOLS FOR MANAGEMENT OF SCREEN POSITIVE
- LIMITATIONS OF CERVICAL CANCER SCREENING IN DEVELOPING COUNTRIES
- CERVICAL CYTOLOGY: NEW TECHNOLOGIES
- COST-EFFECTIVENESS OF CERVICAL CYTOLOGY CANCER SCREENING
- CONCLUSION
CHAPTER 3:Management of Abnormal Pap Smears
- INTRODUCTION
- BASIS FOR CERVICAL SCREENING
- LIQUID BASED CYTOLOGY
- PATHOPHYSIOLOGY OF CERVICAL INTRAEPITHELIAL NEOPLASIA
- PREVENTION OF CERVICAL ABNORMALITIES
- CLASSIFICATION OF PAP SMEAR
- SCREENING PROGRAMS
- EARLY DETECTION OF ABNORMAL PAP SMEAR AND CERVICAL INTRAEPITHELIAL NEOPLASIA
- MANAGEMENT OF WOMEN WITH ASCUS ABNORMALITY
- FEATURES OF DYSKARYOSIS ON CYTOLOGY
- COLPOSCOPIC FEATURES OF CERVICAL INTRAEPITHELIAL NEOPLASIA
- HISTOLOGICAL FEATURES OF CERVICAL INTRAEPITHELIAL NEOPLASIA
- GLANDULAR NEOPLASIA
- ABNORMAL CERVICAL CYTOLOGY DURING PREGNANCY AND MANAGEMENT
- CONCLUSION
CHAPTER 4:Liquid Based Cytology
- INTRODUCTION
- SCREENING TESTS FOR CERVICAL CANCER
- CONVENTIONAL EXFOLIATIVE CERVICAL CYTOLOGY (PAPANICOLAOU TEST)
- LIQUID BASED CYTOLOGY
- CONCLUSION
CHAPTER 5:HPV Carcinogenesis, Clinical Applications and Biomarkers in Cancer Cervix
- INTRODUCTION
- GENOME OF HPV
- MECHANISM OF CARCINOGENESIS BY HPV
- HPV INFECTION
- DEVELOPMENT OF PRECANCER AND CANCER
- CLINICAL IMPLICATIONS OF HPV ONCOGENESIS
- CONCLUSION
CHAPTER 6:Current Status of HPV DNA Testing
- NATURAL HISTORY OF HPV INFECTION
- HPV DNA TESTING
- POLYMERASE CHAIN REACTION METHOD
- HYBRID CAPTURE ASSAY (HC2)
- PERFORMANCE OF HPV DNA TEST
- HIGH NPV OF HPV TESTING
- CLINICAL IMPLICATIONS
- AGE OF SCREENING
- KEY ISSUES IN HPV TESTING
- CLINICAL UTILITY OF HPV TESTING
  - HPV DNA Testing as a Primary Screening Test
- ADJUNCTIVE TESTING FOR HPV DNA TEST
- HPV DNA TESTING IN THE TRIAGE OF EQUIVOCAL [ASCUS OR LOW-GRADE (LSIL)] CYTOLOGIC FINDINGS
  - HPV DNA Testing for Follow-up Post-treatment
  - HPV DNA Based Screening in the Developing World
- CARE HPV TEST
- MANAGEMENT OPTIONS OF POSITIVE HPV TEST
- SELF SAMPLING FOR HPV DNA TESTING
- COST EFFECTIVENESS
- NEW PARADIGMS FOR SCREENING IN THE AGE OF HPV VACCINATION
- CONCLUSION
CHAPTER 7:Role of Colposcopy in Diagnosis
- INTRODUCTION
- COLPOSCOPY FOR PRIMARY SCREENING
- COLPOSCOPY FOR DIAGNOSIS OF CIN
- COLPOSCOPIC ASSESSMENT OF MICROINVASION / INVASION
- RECORDING OF OBSERVATIONS
  - Diagrammatic Presentation
- ACCURACY OF COLPOSCOPY AS DIAGNOSTIC MODALITY
- DISADVANTAGES OF COLPOSCOPY IN DIAGNOSIS OF CIN
  - ‘See and Treat’ Protocol
- COLPOSCOPIC DIRECTED BIOPSY
- CONCLUSION
CHAPTER 8:Treatment of Cervical Intraepithelial Neoplasia
- Introduction
- CRYOTHERAPY
- LARGE LOOP EXCISION OF THE TRANSFORMATION ZONE (LLETZ OR LEEP)
- COLD KNIFE CONE BIOPSY
- HYSTERECTOMY
- FOLLOW-UP AFTER TREATMENT OF CIN
- MANAGEMENT OF CERVICAL INTRA-EPITHELIAL NEOPLASIA IN PREGNANCY
- SINGLE VISIT APPROACH FOR THE TREATMENT OF CERVICAL INTRA- EPITHELIAL NEOPLASIA
- CONCLUSION
CHAPTER 9:HPV Vaccination in Primary Prevention of Cervical Cancer
- INTRODUCTION
- NATURAL HISTORY OF HPV INFECTION
- IMMUNOLOGY OF HPV INFECTION
- IMMUNOLOGY OF HPV VACCINATION
- HPV VACCINES
- EFFICACY OF HPV VACCINATION IN INDUCING IMMUNITY AND PREVENTING HPV INFECTION AND CERVICAL NEOPLASIA
- CLINICAL PRACTICE GUIDELINES FOR HPV VACCINATION
- SAFETY
- CHALLENGES FOR HPV VACCINATION IN NATIONAL IMMUNIZATION PROGRAMS
- CONCLUSION
SECTION 2: PATHOLOGY OF CERVICAL CANCER
CHAPTER 10:Histopathology of Preinvasive Squamous Lesions and Microinvasive Squamous Cell Carcinoma
- INTRODUCTION
  - Histology of Ectocervix
- HISTOLOGY OF ENDOCERVIX
- CONCLUSION
CHAPTER 11:Pathology of Carcinoma Cervix
- INTRODUCTION
- PRECURSOR LESIONS
  - Cervical Intraepithelial Neoplasia (CIN)
- CIN 1
- MICROINVASIVE SQUAMOUS CARCINOMA
- SQUAMOUS CELL CARCINOMA
- ENDOCERVICAL ADENOCARCINOMA
  - Minimal Deviation Adenocarcinoma (MDA)
  - Villoglandular Adenocarcinoma
- UNCOMMON CARCINOMAS AND NEUROENDOCRINE TUMORS
- CONCLUSION
CHAPTER 12:Adenocarcinoma and Other Rare Histologic Entities: Clinical Aspects
- ADENOCARCINOMA
- OTHER RARE CANCERS OF CERVIX
- CONCLUSION
SECTION 3: SURGICAL MANAGEMENT OF EARLY STAGE DISEASE
CHAPTER 13:Surgical Anatomy of the Cervix
- Introduction
CHAPTER 14:Staging and Pretreatment Investigative Work-up
- INTRODUCTION
- ROUTES OF SPREAD OF CERVICAL CANCER
- STAGING
- LIMITATIONS OF CLINICAL STAGING
- CONCLUSION
CHAPTER 15:Sentinel Lymph Node Evaluation
- INTRODUCTION
- ROLE OF SENTINEL NODE BIOPSY IN CERVICAL CANCER—POTENTIAL USES AND ADVANTAGES (Table 15.1)
  - Early Cervical Cancer
  - Advanced Cervical Cancer
- PITFALLS AND CHALLENGES
- TECHNIQUE OF SENTINEL LYMPH NODE BIOPSY
- STUDIES ON SENTINEL LYMPH NODE BIOPSY
- CONCLUSION
CHAPTER 16:Radical Trachelectomy
- INTRODUCTION
- HISTORY
- STAGING OF EARLY CERVICAL CANCERS
- TUMOR SPREAD
- RADICAL VAGINAL TRACHELECTOMY WITH LAPAROSCOPIC LYMPHADENECTOMY
  - Indications for Radical Vaginal Trachelectomy
  - Preoperative Preparation
- OPERATIVE TECHNIQUE- RADICAL VAGINAL TRACHELECTOMY
- RADICAL ABDOMINAL TRACHELECTOMY
  - Specific Indications for Radical Abdominal Trachelectomy
- OPERATIVE STEPS
- CONCLUSION
CHAPTER 17:Radical Hysterectomy with Pelvic Lymphadenectomy
- Introduction
- PATIENT SELECTION
- RADICAL HYSTERECTOMY AND PELVIC LYMPHADENECTOMY
- PREOPERATIVE ASSESSMENT
  - Surgical Anatomy
  - The Paravesical Space
- THE PARARECTAL SPACE
- LYMPHATIC DRAINAGE OF THE CERVIX
- THE OPERATION
- PRESERVATION OF OVARIAN FUNCTION
- POSTOPERATIVE CARE
- COMPLICATIONS
- CONCLUSION
CHAPTER 18:Surgical Technique of Radical Hysterectomy
- RADICAL HYSTERECTOMY—Author's Modification
- CONCLUSION
CHAPTER 19:Laparoscopic Radical Nerve-sparing Hysterectomy
- INTRODUCTION
- ANATOMY
- PATIENT POSITION AND PREPARATION
- PELVIC LYMPHADENECTOMY
- LAPAROSCOPIC NERVE-SPARING RADICAL HYSTERECTOMY
  - Vaginal Preparation
- POSTERIOR AND LATERAL EXPOSURE
- ANTERIOR EXPOSURE
- CARDINAL LIGAMENT RESECTION (Figs 19.6A to F)
- VAGINAL DISSECTION, EXTRACTION AND CLOSURE
  - Clinical Results
- CONCLUSION
CHAPTER 20:Radical Vaginal Hysterectomy
- INTRODUCTION
- INDICATIONS FOR SURGERY
- SURGICAL TECHNIQUE
  - Extraperitoneal Lymphadenectomy
  - Radical Vaginal Hysterectomy
- CONCLUSION
CHAPTER 21:Complications of Radical Surgery
- INTRODUCTION
- FACTORS AFFECTING OUTCOME
- INTRAOPERATIVE HEMORRHAGE
- INTRAOPERATIVE INJURIES
- INFECTIONS
- POSTOPERATIVE HEMORRHAGE
- FISTULA FORMATION
- LYMPHOCYST
- VENOUS THROMBOSIS AND PULMONARY EMBOLUS
- NEUROPATHIES
- RECTAL DYSFUNCTION
- BLADDER DYSFUNCTION
- SEXUAL DYSFUNCTION
- LYMPHEDEMA
- MEASURES TO DECREASE COMPLICATION RATES
- CONCLUSION
SECTION 4: RADIOTHERAPY AND CHEMOTHERAPY: MANAGEMENT OF EARLY AND ADVANCED DISEASE
CHAPTER 22:Radiation Therapy in Cancer Cervix: Principles and Techniques
- EXTERNAL BEAM RADIATION THERAPY
- BRACHYTHERAPY
  - Low Dose Rate Brachytherapy System (LDR)
  - High Dose Rate (HDR) Intracavitary Brachytherapy
- PROGNOSTIC FACTORS IN CARCINOMA CERVIX
- TREATMENT IN EARLY STAGE CERVICAL CANCER STAGE I B1, NON-BULKY STAGE IIA1
- ADJUVANT RADIATION THERAPY
- LOCALLY ADVANCED STAGE (FIGO STAGE IIB -IVA)
- TREATMENT FOR RELAPSE
- EXTERNAL RADIATION THERAPY PLANNING
  - Simulation
  - Field Arrangements for External Beam Radiation
- COMPLICATIONS IN RADIATION THERAPY
- LATE TOXICITIES OF RADIATION
- ROLE OF MRI /PET FUSION IN RADIO-THERAPY PLANNING—DR JOSEPH EDISON
CHAPTER 23:Concurrent Chemotherapy and Radiation for Carcinoma Cervix
- INTRODUCTION
- CHEMORADIATION THERAPY
- CONCLUSION
CHAPTER 24:Interstitial Brachytherapy in Cancer Cervix
- INTRODUCTION
  - Indications for Interstitial Brachytherapy in Cancer Cervix
  - Remote Afterloading
- DOSE RATE: LDR, MDR, HDR AND PDR
- CONCLUSION
CHAPTER 25:Chemotherapy for Cervical Cancer: An Update
- INTRODUCTION
  - Palliative Chemotherapy
- NEOADJUVANT CHEMOTHERAPY FOLLOWED BY RADIATION
- NACT FOLLOWED BY SURGERY
- NEOADJUVANT CHEMOTHERAPY FOR FERTILITY PRESERVING SURGERY
- NACT: NEWER DRUGS
- CONCURRENT CHEMORADIATION THERAPY (CCRT)
- ADJUVANT CHEMOTHERAPY
- RECENT DEVELOPMENTS: TARGETED THERAPIES
- CONCLUSION
CHAPTER 26:Complications of Pelvic Radiotherapy in Gynecological Malignancies
- INTRODUCTION
- CONCLUSION
CHAPTER 27:Postradiation Conservative Surgery
- INTRODUCTION
- ASSESSMENT OF PELVIC OPERABILITY
- URETER AND BLADDER
- JUSTIFICATION OF SALVAGE CONSERVATIVE HYSTERECTOMY
- THE MODIFICATIONS USED IN MODIFIED RADICAL HYSTERECTOMY (MRH)
  - General Principles
- STEPS OF THE PROCEDURE
- COMPLICATIONS
  - Preoperative Complications
  - Postoperative Complications
- SIMPLE MEASURES OF SKIN CARE IN LYMPHEDEMA LEGS
- CONCLUSION
SECTION 5: MANAGEMENT OF RECURRENT AND METASTATIC DISEASE
CHAPTER 28:Pelvic Exenteration
- INTRODUCTION
  - Historical Aspects
    - Classification
- INDICATIONS AND PATIENT SELECTION
- OPERATIVE PROCEDURE
- TECHNIQUE OF PELVIC EXENTERATION
- POSTOPERATIVE CARE
- COMPLICATIONS
- PELVIC EXENTERATION IN ENDOMETRIAL CANCER
- PELVIC EXENTERATION IN OVARIAN CANCER
- CONCLUSION
CHAPTER 29:Role of Chemotherapy in Recurrent/Metastatic Cervical Cancer
- INTRODUCTION
- EVALUATION OF THE PATIENT
- PROGNOSTIC FACTORS FOR PREDICTING RESPONSE TO TREATMENT
- SINGLE AGENT CHEMOTHERAPY
  - IA. Platinum Based Singlet Therapy
  - I B. Nonplatinum Based Singlet Therapy
- DOUBLE AGENT CHEMOTHERAPY
- CONCLUSION
SECTION 6: IMAGING MODALITIES FOR CANCER CERVIX
CHAPTER 30:Role of Imaging
- INTRODUCTION
- ULTRASOUND
- COMPUTED TOMOGRAPHY
- MAGNETIC RESONANCE IMAGING
- POSITRON EMISSION TOMOGRAPHY
- CONCLUSION
SECTION 7: SPECIAL CASE SCENARIOS
CHAPTER 31:Pregnancy and Cervical Neoplasia
- INTRODUCTION
- DIAGNOSIS
- COLPOSCOPY
- CERVICAL BIOPSY
  - Effect of Cancer Cervix on Pregnancy and Vice Versa
- MANAGEMENT
- PROGNOSIS
- CONCLUSION
CHAPTER 32:Management of Invasive Carcinoma Cervix after Inadvertent Hysterectomy
- INTRODUCTION
- CONCLUSION
SECTION 8: PALLIATIVE CARE
CHAPTER 33:Palliative and End of Life Care for Patients with Cervical Cancer
- INTRODUCTION
- PHYSICAL SYMPTOMS AND THEIR MANAGEMENT
  - Pain
  - Assessment of Pain
- MANAGEMENT OF PAIN
  - General Guidelines
- ROUTE OF ADMINiSTRATION
- MALIGNANT INTESTINAL OBSTRUCTION
- CONSTIPATION
  - Treatment
- ANOREXIA AND FATIGUE
- DYSPNEA AND TERMINAL SEDATION
  - Management
- PSYCHOLOGICAL SYMPTOMS AND THEIR MANAGEMENT
- CONCLUSION

INDEX

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Chapter Notes