Cancers of the female genital system

doi:10.1093/med/9780198745440.003.0009

- Copyright Page
  - Notes
  - Notes
- Dedication
  - Notes
  - Notes
- Preface
  - Notes
  - Notes
- Acknowledgements
  - Notes
  - Notes
- List of abbreviations
  - Notes
  - Notes
- Contributors
  - Notes
  - Notes
1 Clinical approach to suspected cancer
- Notes
- Notes
2 Concepts of multidisciplinary management
- Notes
- Notes
3 Tumours of the head and neck
- Notes
- Notes
4 Tumours of the central nervous system
- Notes
- Notes
5 Thoracic tumours
- Notes
- Notes
6 Breast cancer
- Notes
- Notes
7 Cancers of the gastrointestinal system
- Notes
- Notes
8 Cancers of the genitourinary system
- Notes
- Notes
- 9.1 Cervical cancer overview 9.1 Cervical cancer overview
  - Epidemiology Epidemiology
  - Cervical cancer screening Cervical cancer screening
  - Natural history and pathology Natural history and pathology
    - Histopathological types Histopathological types
- 9.2 Clinical features, investigations, staging, and prognosis of cervical cancer 9.2 Clinical features, investigations, staging, and prognosis of cervical cancer
  - Clinical features Clinical features
  - Pretreatment evaluation and staging Pretreatment evaluation and staging
    - Pretreatment evaluation Pretreatment evaluation
    - Staging Staging
      - Salient features of FIGO staging Salient features of FIGO staging
  - Prognosis Prognosis
- 9.3 Management of cervical cancer 9.3 Management of cervical cancer
  - Non-invasive disease (carcinoma in situ) Non-invasive disease (carcinoma in situ)
    - Ectocervical lesions only: Ectocervical lesions only:
    - If the endocervical canal is involved: If the endocervical canal is involved:
  - Invasive disease Invasive disease
    - Surgery for early cervix cancer Surgery for early cervix cancer
      - Conization Conization
      - Radical trachelectomy Radical trachelectomy
      - Total hysterectomy (abdominal or vaginal) Total hysterectomy (abdominal or vaginal)
    - Adjuvant therapy after radical surgery Adjuvant therapy after radical surgery
      - Intermediate risk factors Intermediate risk factors
    - Low risk factors Low risk factors
    - Radical radiotherapy Radical radiotherapy
    - External beam radiation External beam radiation
    - Three-dimensional radiotherapy technique Three-dimensional radiotherapy technique
    - Field-based technique Field-based technique
    - AP–PA target volume AP–PA target volume
    - Lateral target volume Lateral target volume
    - Para-aortic nodes Para-aortic nodes
    - Intracavitary brachytherapy Intracavitary brachytherapy
    - Brachytherapy planning Brachytherapy planning
    - Definitions of volumes of cervical cancer brachytherapy Definitions of volumes of cervical cancer brachytherapy
    - Dose prescription Dose prescription
    - Concurrent chemoradiation with cisplatin chemotherapy Concurrent chemoradiation with cisplatin chemotherapy
  - Locally advanced disease Locally advanced disease
    - Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy, concurrent chemoRT, or radical RT alone Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy, concurrent chemoRT, or radical RT alone
    - Palliative radiotherapy/chemotherapy Palliative radiotherapy/chemotherapy
    - Surgical exenteration Surgical exenteration
    - Best supportive care Best supportive care
  - Stage IVB Stage IVB
- 9.4 Recurrent cervical cancer 9.4 Recurrent cervical cancer
  - Management of patients who relapse after primary treatment Management of patients who relapse after primary treatment
  - Therapeutic options for local relapse after primary surgery Therapeutic options for local relapse after primary surgery
  - Local recurrence after primary radiotherapy Local recurrence after primary radiotherapy
- 9.5 Role of chemotherapy 9.5 Role of chemotherapy
  - Systemic CT in stage IVB or recurrent disease Systemic CT in stage IVB or recurrent disease
- 9.6 Treatment-related morbidity for cervical cancer 9.6 Treatment-related morbidity for cervical cancer
  - Introduction Introduction
  - Surgery Surgery
  - Radiation therapy Radiation therapy
- 9.7 Newer approaches to cervical cancer 9.7 Newer approaches to cervical cancer
  - Introduction Introduction
- Further reading Further reading
  - Notes
- 9.8 Endometrial cancer 9.8 Endometrial cancer
  - Introduction Introduction
  - Aetiology/risk factors Aetiology/risk factors
    - Hereditary non-polyposis coli (Lynch syndrome) Hereditary non-polyposis coli (Lynch syndrome)
  - Clinical features Clinical features
    - History/presentation History/presentation
    - Examination Examination
  - Diagnosis Diagnosis
    - Ultrasound scan Ultrasound scan
    - Endometrial sampling/hysteroscopy Endometrial sampling/hysteroscopy
  - Screening Screening
  - Pathology Pathology
    - Tumour classification Tumour classification
    - Tumour grade Tumour grade
    - Pattern of spread Pattern of spread
    - Molecular features Molecular features
    - Biomarkers and prognostic markers Biomarkers and prognostic markers
  - Investigations Investigations
    - Magnetic resonance imaging Magnetic resonance imaging
    - Computed tomography Computed tomography
    - Examination under anaesthesia Examination under anaesthesia
  - Staging Staging
  - Prognosis Prognosis
- 9.9 Management of endometrial cancer 9.9 Management of endometrial cancer
  - Introduction Introduction
  - Surgery for stage I disease Surgery for stage I disease
    - Total laparoscopic hysterectomy and bilateral salpingo-oophorectomy Total laparoscopic hysterectomy and bilateral salpingo-oophorectomy
    - Laparoscopic surgery for endometrial cancer Laparoscopic surgery for endometrial cancer
    - Vaginal hysterectomy Vaginal hysterectomy
  - Surgery for stage II disease Surgery for stage II disease
    - Radical hysterectomy, bilateral salpingo-oophorectomy +/– lymphadenectomy Radical hysterectomy, bilateral salpingo-oophorectomy +/– lymphadenectomy
  - Surgery for advanced endometrial cancer (stages III/IV) Surgery for advanced endometrial cancer (stages III/IV)
    - Lymphadenectomy Lymphadenectomy
    - Omentectomy/omental biopsy Omentectomy/omental biopsy
  - Complications of surgery Complications of surgery
    - General General
    - Specific to abdominopelvic surgery Specific to abdominopelvic surgery
- 9.10 Role of radiotherapy 9.10 Role of radiotherapy
  - Introduction Introduction
  - Adjuvant radiotherapy Adjuvant radiotherapy
  - Radical radiotherapy Radical radiotherapy
  - Treatment of pelvic recurrence Treatment of pelvic recurrence
  - Palliative radiotherapy Palliative radiotherapy
  - Radiotherapy toxicity Radiotherapy toxicity
    - Early effects Early effects
    - Late effects Late effects
- 9.11 Role of chemotherapy and hormonal agents 9.11 Role of chemotherapy and hormonal agents
  - Chemotherapy Chemotherapy
    - Adjuvant chemotherapy Adjuvant chemotherapy
    - Palliative chemotherapy Palliative chemotherapy
  - Hormonal agents Hormonal agents
    - Progestogens Progestogens
    - Aromatase inhibitors Aromatase inhibitors
- 9.12 Recurrence and metastasis 9.12 Recurrence and metastasis
  - Introduction Introduction
  - Symptoms that may indicate recurrence Symptoms that may indicate recurrence
  - Treatment options for recurrent and metastatic endometrial cancer Treatment options for recurrent and metastatic endometrial cancer
    - Surgery Surgery
    - Radiotherapy Radiotherapy
    - Chemotherapy Chemotherapy
    - Hormonal treatment Hormonal treatment
    - Symptomatic measures Symptomatic measures
- Further reading Further reading
  - Notes
- 9.13 Uterine sarcomas 9.13 Uterine sarcomas
  - Introduction Introduction
  - Incidence/epidemiology Incidence/epidemiology
  - Aetiology Aetiology
  - Clinical features Clinical features
  - Diagnosis Diagnosis
  - Pathology Pathology
  - Hormone receptors Hormone receptors
  - Molecular features Molecular features
  - Staging Staging
  - Prognosis Prognosis
  - Prognostic factors Prognostic factors
  - Patterns of relapse Patterns of relapse
  - Principles of management Principles of management
  - Surgical Surgical
  - Radiotherapy Radiotherapy
  - Chemotherapy (adjuvant) Chemotherapy (adjuvant)
  - Hormonal treatment (adjuvant) Hormonal treatment (adjuvant)
  - Chemotherapy (advanced/metastatic) Chemotherapy (advanced/metastatic)
  - Hormonal treatment (advanced/metastatic) Hormonal treatment (advanced/metastatic)
  - Support group Support group
- Further reading Further reading
  - Notes
- Internet resources Internet resources
  - Notes
- 9.14 Epithelial ovarian cancer 9.14 Epithelial ovarian cancer
  - Introduction, pathology, and clinical features Introduction, pathology, and clinical features
  - Risk factors Risk factors
    - Hormonal and environmental factors Hormonal and environmental factors
    - Hereditary predisposition Hereditary predisposition
      - BRCA 1 and BRCA 2 BRCA 1 and BRCA 2
    - Hereditary non-polyposis colon cancer Hereditary non-polyposis colon cancer
    - Risk reduction/prevention Risk reduction/prevention
  - Screening Screening
  - Pathology Pathology
  - Clinical features Clinical features
- Further reading Further reading
  - Notes
- Internet resources Internet resources
  - Notes
- 9.15 Investigations, staging, and prognosis for epithelial ovarian cancer 9.15 Investigations, staging, and prognosis for epithelial ovarian cancer
  - Special investigations Special investigations
  - Differential diagnosis Differential diagnosis
  - Staging Staging
- 9.16 Early stage disease of epithelial ovarian cancer 9.16 Early stage disease of epithelial ovarian cancer
  - Principles of treatment Principles of treatment
  - Surgery Surgery
  - Chemotherapy Chemotherapy
- 9.17 Advanced stage disease of epithelial ovarian cancer 9.17 Advanced stage disease of epithelial ovarian cancer
  - Principles of treatment Principles of treatment
  - Surgery Surgery
  - Chemotherapy Chemotherapy
  - Anti-angiogenic agents Anti-angiogenic agents
  - Intraperitoneal chemotherapy Intraperitoneal chemotherapy
  - PARP inhibitors PARP inhibitors
  - Combination treatment Combination treatment
- Further reading Further reading
  - Notes
- 9.18 Epithelial ovarian cancer: Recurrent disease 9.18 Epithelial ovarian cancer: Recurrent disease
  - Principles of management Principles of management
  - Chemotherapy Chemotherapy
    - Treatment of women with a platinum-free interval >6 months Treatment of women with a platinum-free interval >6 months
    - Treatment of women with a platinum-free interval of <6 months Treatment of women with a platinum-free interval of <6 months
  - Hormones Hormones
  - Surgery Surgery
  - Novel therapeutic approaches Novel therapeutic approaches
    - Anti-angiogenics Anti-angiogenics
    - PARP inhibitors PARP inhibitors
      - Olaparib Olaparib
      - Niraparib Niraparib
      - Rucaparib Rucaparib
    - Combination treatment Combination treatment
  - Immunotherapy Immunotherapy
  - Future directions Future directions
- 9.19 Epithelial ovarian cancer: Palliative care issues and conclusion 9.19 Epithelial ovarian cancer: Palliative care issues and conclusion
  - Palliative care issues Palliative care issues
  - Conclusion Conclusion
- Further reading Further reading
  - Notes
- 9.20 Malignant ovarian germ cell tumours 9.20 Malignant ovarian germ cell tumours
  - Epidemiology Epidemiology
  - Aetiology Aetiology
  - Pathology Pathology
    - Immunohistochemical and molecular features Immunohistochemical and molecular features
  - Clinical features Clinical features
  - Examination Examination
  - Investigations Investigations
    - Other investigations Other investigations
  - Diagnosis Diagnosis
    - Tumour markers Tumour markers
    - Imaging Imaging
  - Staging Staging
- Further reading Further reading
  - Notes
- 9.21 Management of malignant ovarian germ cell tumours 9.21 Management of malignant ovarian germ cell tumours
  - General principles of surgery General principles of surgery
  - Primary surgery Primary surgery
    - Role of optimal cytoreduction Role of optimal cytoreduction
  - Second-look laparotomy Second-look laparotomy
  - Neoadjuvant chemotherapy Neoadjuvant chemotherapy
  - Postoperative management strategies Postoperative management strategies
    - Surveillance Surveillance
  - Adjuvant chemotherapy Adjuvant chemotherapy
    - Tests at baseline pre-chemotherapy and during treatment Tests at baseline pre-chemotherapy and during treatment
      - Pretreatment Pretreatment
      - During treatment During treatment
    - Three-day BEP Three-day BEP
    - Alternative adjuvant regimens Alternative adjuvant regimens
    - POMB-ACE/POMB-ACE-PAV POMB-ACE/POMB-ACE-PAV
    - Practical considerations for BEP chemotherapy Practical considerations for BEP chemotherapy
    - Number of courses Number of courses
- 9.22 Prognosis, surveillance, and management of recurrence in malignant ovarian germ cell tumours 9.22 Prognosis, surveillance, and management of recurrence in malignant ovarian germ cell tumours
  - Prognostic factors Prognostic factors
  - Post-treatment surveillance Post-treatment surveillance
  - Management of relapsed and refractory tumours Management of relapsed and refractory tumours
    - Salvage surgery Salvage surgery
  - Issues of survivorship Issues of survivorship
    - Secondary malignancies Secondary malignancies
    - Fertility and teratogenesis Fertility and teratogenesis
- 9.23 Sex cord-stromal tumours 9.23 Sex cord-stromal tumours
  - Introduction and classification Introduction and classification
  - Granulosa cell tumours Granulosa cell tumours
    - Adult granulosa cell tumours Adult granulosa cell tumours
    - Clinical presentation Clinical presentation
    - Investigations and diagnosis Investigations and diagnosis
      - Ultrasound Ultrasound
      - Tumour markers Tumour markers
      - Endometrial biopsy Endometrial biopsy
    - Treatment Treatment
    - Adjuvant therapy Adjuvant therapy
    - Recurrent disease or metastatic disease Recurrent disease or metastatic disease
    - Follow-up Follow-up
    - Prognosis Prognosis
    - Juvenile granulosa cell tumours Juvenile granulosa cell tumours
  - Fibrosarcoma Fibrosarcoma
  - Sertoli–Leydig cell tumours Sertoli–Leydig cell tumours
  - Sex cord tumour with annular tubules (SCTAT) without Peutz–Jeghers syndrome Sex cord tumour with annular tubules (SCTAT) without Peutz–Jeghers syndrome
    - SCTAT associated with Peutz–Jeghers syndrome SCTAT associated with Peutz–Jeghers syndrome
  - Gynandroblastoma Gynandroblastoma
  - Steroid or lipid cell tumours Steroid or lipid cell tumours
- 9.24 Borderline ovarian tumours 9.24 Borderline ovarian tumours
  - Introduction Introduction
  - Clinicopathological features Clinicopathological features
  - Diagnosis Diagnosis
  - Staging Staging
  - Treatment Treatment
    - Surgery Surgery
    - Adjuvant treatment Adjuvant treatment
    - Unexpected postoperative diagnosis of border-line tumours Unexpected postoperative diagnosis of border-line tumours
  - Residual or recurrent disease Residual or recurrent disease
  - Follow-up Follow-up
  - Prognosis Prognosis
- 9.25 Uncommon ovarian tumours 9.25 Uncommon ovarian tumours
  - Carcinosarcoma or malignant mixed Müllerian tumours Carcinosarcoma or malignant mixed Müllerian tumours
  - Small cell carcinoma of the ovary Small cell carcinoma of the ovary
- Further reading Further reading
  - Notes
- Internet resources Internet resources
  - Notes
- 9.26 Gestational trophoblastic disease overview 9.26 Gestational trophoblastic disease overview
  - Introduction Introduction
  - Epidemiology Epidemiology
  - Aetiology Aetiology
  - Pathology Pathology
    - Hydatidiform mole Hydatidiform mole
    - Choriocarcinoma Choriocarcinoma
    - Placental site and epithelioid trophoblastic tumour (PSTT/ETT) Placental site and epithelioid trophoblastic tumour (PSTT/ETT)
  - Clinical features Clinical features
    - Complete hydatidiform mole (CHM) Complete hydatidiform mole (CHM)
    - Partial hydatidiform mole (PHM) Partial hydatidiform mole (PHM)
    - Gestational trophoblastic neoplasia Gestational trophoblastic neoplasia
  - Initial management Initial management
  - Gestational trophoblastic neoplasia Gestational trophoblastic neoplasia
    - Central nervous system assessment Central nervous system assessment
  - Management of low-risk GTN Management of low-risk GTN
    - Low-risk metastatic GTN Low-risk metastatic GTN
    - Relapsed or resistant low-risk disease Relapsed or resistant low-risk disease
    - Role of hysterectomy Role of hysterectomy
    - Follow-up Follow-up
      - During treatment During treatment
      - Following completion of treatment Following completion of treatment
    - Contraception Contraception
  - Management of high-risk GTN Management of high-risk GTN
  - Treatment toxicity Treatment toxicity
    - Relapsed or resistant high-risk disease Relapsed or resistant high-risk disease
    - UK high-risk GTD regimen UK high-risk GTD regimen
      - Arm A: Arm A:
      - Arm B: Arm B:
    - Salvage protocols for high-risk patients Salvage protocols for high-risk patients
      - EP/EMA EP/EMA
      - TE/TP TE/TP
    - Role of surgery Role of surgery
    - Long-term complications of treatment Long-term complications of treatment
    - Follow-up Follow-up
- 9.27 Special situations 9.27 Special situations
  - Pulmonary metastases Pulmonary metastases
  - Brain/central nervous system disease Brain/central nervous system disease
  - Other sites of metastasis Other sites of metastasis
  - Placental site and epithelioid trophoblastic tumours (PSTT/ETT) Placental site and epithelioid trophoblastic tumours (PSTT/ETT)
  - Twin molar pregnancy Twin molar pregnancy
  - Fertility issues Fertility issues
    - Contraception Contraception
- Internet resources Internet resources
  - Notes
- 9.28 Cancers of the vulva and vagina 9.28 Cancers of the vulva and vagina
  - Cancers of the vulva Cancers of the vulva
    - Epidemiology Epidemiology
    - Aetiology Aetiology
      - Age Age
      - Human papilloma virus Human papilloma virus
      - Immunosuppression Immunosuppression
      - Smoking Smoking
      - Chronic skin conditions and inflammation Chronic skin conditions and inflammation
      - Vulvar intraepithelial neoplasia Vulvar intraepithelial neoplasia
      - Lifestyle and social background Lifestyle and social background
    - Pathology Pathology
      - Squamous cell carcinoma Squamous cell carcinoma
      - Vulval melanoma Vulval melanoma
      - Adenocarcinoma Adenocarcinoma
      - Sarcomas Sarcomas
    - Screening Screening
    - Clinical features Clinical features
    - Diagnosis and staging Diagnosis and staging
  - Management of vulval cancer Management of vulval cancer
    - Surgery Surgery
      - Early stage disease Early stage disease
      - Advanced disease Advanced disease
      - Lateral lesions Lateral lesions
      - Other lesions Other lesions
    - Sentinel lymph node biopsy Sentinel lymph node biopsy
    - Radiotherapy Radiotherapy
    - Chemotherapy Chemotherapy
    - Chemoradiotherapy Chemoradiotherapy
    - Prognosis Prognosis
    - Post-treatment issues Post-treatment issues
    - Recurrence and management Recurrence and management
    - Recent advances Recent advances
  - Cancers of the vagina Cancers of the vagina
    - Epidemiology Epidemiology
    - Aetiology Aetiology
      - Age Age
      - Human papilloma virus Human papilloma virus
      - Cervical intraepithelial neoplasia or cervical cancer Cervical intraepithelial neoplasia or cervical cancer
      - Vaginal intraepithelial neoplasia (VAIN) Vaginal intraepithelial neoplasia (VAIN)
      - Chronic conditions Chronic conditions
      - Social background Social background
    - Pathology Pathology
      - Squamous cell carcinoma Squamous cell carcinoma
      - Adenocarcinoma Adenocarcinoma
      - Malignant melanoma Malignant melanoma
      - Sarcoma botyroides Sarcoma botyroides
    - Screening Screening
    - Clinical features Clinical features
    - Diagnosis and staging Diagnosis and staging
  - Management of vaginal cancer Management of vaginal cancer
    - Surgery Surgery
    - Sentinel node detection Sentinel node detection
    - Radiotherapy Radiotherapy
    - Chemoradiotherapy Chemoradiotherapy
    - HPV vaccine HPV vaccine
    - Prognosis Prognosis
    - Post-treatment issues Post-treatment issues
    - Recurrence and management Recurrence and management
    - Recent advances Recent advances
- Internet resources Internet resources
  - Notes
- Notes
- Notes
10 Cancers of the skin
- Notes
- Notes
11 Cancers of the musculoskeletal system
- Notes
- Notes
12 Tumours of the haemopoietic system
- Notes
- Notes
13 Endocrine tumours
- Notes
- Notes
14 Paediatric tumours
- Notes
- Notes
15 Oncological emergencies and acute oncology
- Notes
- Notes
16 Special situations in oncology
- Notes
- Notes
17 Palliative care
- Notes
- Notes
18 Clinical management of cancers—flowcharts
- Notes
- Notes

Chapter

9 Cancers of the female genital system

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https://doi.org/10.1093/med/9780198745440.003.0009

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234–286

Published:

April 2021

Abstract

This chapter covers cancers of the female genital system. Topics include cervical cancer (clinical features, investigations, staging, and prognosis, management, recurrent cancer, chemotherapy, treatment-related morbidity, and newer approaches); endometrial cancer (management, radiotherapy, chemotherapy and hormonal agents, and recurrence and metastasis); uterine sarcomas; epithelial ovarian cancer (investigations, staging, and prognosis, early and advanced stage disease, recurrent disease, and palliative issues); malignant ovarian germ cell tumours (management, prognosis, surveillance, and management of recurrence); sex cord-stromal tumours; borderline ovarian tumours; uncommon ovarian tumours; gestational trophoblastic disease (management of gestational trophoblastic neoplasia, high-risk disease, and special situations); and cancers of the vulva and vagina.

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9 Cancers of the female genital system

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