Women's Health and Education Center (WHEC)

Gynecologic Oncology

List of Articles

  • Uterine Cancer: A Modern Approach to Surgical Management
    This review discusses the current understanding of endometrial cancer and to provide guidelines for management that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented. A thorough understanding of the epidemiology, pathophysiology, and diagnostic and management strategies for this type of cancer allows the gynecologists to identify women at increased risk, contribute toward risk reduction, and facilitate early diagnosis. Sentinel lymph node (SLN) mapping is based on the concept that lymph node metastasis is the result of an orderly process; that is, lymph drains in a specific pattern away from the tumor, and therefore, if the SLN, or first node, is negative for metastasis, then the nodes after the SLN, should be negative. This approach can help patients avoid the side effects associated with a complete lymphadenectomy, although disease must be thoroughly staged for accurate prognosis and determination of appropriate treatment approach. Surgeon experience, adherence to an SLN algorithm, and the use of pathologic "ultra-staging" are key factors for successful SLN mapping.

  • Current Ovarian Cancer Management
    Epithelial ovarian cancer is the second most common gynecologic malignancy, but is the leading cause of death from gynecologic cancer in the United States. In this discussion four updates are selected based on recent important updates in the guidelines and on debate among the experts about recent clinical trials. The topics include:

    1) intraperitoneal (IP) chemotherapy,
    2) CA-125 monitoring for ovarian cancer recurrence,
    3) surveillance recommendations for less common ovarian histopathologies, and
    4) recent changes in therapy for recurrent epithelial ovarian cancer.

    During primary surgery for advanced stage epithelial ovarian cancer all attempts should be made to achieve complete cytoreduction. When this is not achievable the surgical goal should be optimal (<1cm) residual disease. All women undergoing surgery for ovarian cancer should be counseled about the clinical benefit associated with combined intravenous (IV) and intraperitoneal (IP) chemotherapy administration prior to surgery. Surgical cytoreduction (debulking) is recommended as initial treatment for many women with ovarian cancer, even those with metastatic disease. After surgical debulking, adjuvant systemic therapy (e.g. taxane/platinum) is recommended for many patients. Several different systemic regimens are recommended. Primary adjuvant therapy regimens include intravenous (IV) with (or without) intraperitoneal (IP) options. All of the regimens may be used for epithelial ovarian, primary peritoneal, and fallopian tube cancers.

  • Hereditary Cancer Risk Assessment in Gynecology
    The purpose of this document to review current recommendations for genetic testing for susceptibility to cancers, including ovarian, fallopian tube, breast, endometrial, and colon cancers due to inherited mutations in the BRCA genes or in the mismatch repair genes associated with hereditary nonpolyposis colon cancer (HNPCC) syndrome. Family history remains the cornerstone of patient identification. Genetic testing of appropriate individuals further enables us to identify patients with hereditary cancer syndromes, for their own benefit as well that of their entire family. Clinical genetic testing for gene mutations allows physicians to more precisely identify women who are at substantial risk of breast cancer and ovarian cancer.

  • Cervical Cancer Prevention: Managing Low-Grade Cervical Neoplasia
    Cervical cancer is the most common cancer in women, and caused by the human papillomavirus (HPV). Most sexually active women will acquire HPV in their lifetime. Although infection clears in most cases, it does persist in some women. Long-term persistence of HPV -- particularly with high-risk types -- has been established as a necessary cause of precancerous lesions. Cervical screening programs have been very successful in the United States, Europe, and other regions, are able to achieve broad and sustained coverage. Cervical cancer prevention can now be made even better. Substantial modifications of practice are forthcoming, motivated by improved understanding of HPV natural history and cervical carcinogenesis. The focus of this discussion is on management of atypical squamous cells of undermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL). This series on Cervical Cancer Prevention, will also serve as a baseline for understanding the future effects of HPV vaccination on the cervical cancer screening results.

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