Gynaecological cancers

doi:10.1093/med/9780199235636.003.0010

Oxford Desk Reference: Oncology (1 edn)

Thankamma V Ajithkumar (ed.) et al.

https://doi.org/10.1093/med/9780199235636.001.0001

Published online:

01 October 2011

Published in print:

01 June 2011

Online ISBN:

9780191725760

Print ISBN:

9780199235636

- Copyright Page
  - Notes
  - Notes
- Preface
  - Notes
  - Notes
- Acknowledgements
  - Notes
  - Notes
- Detailed contents
  - Notes
  - Notes
- List of abbreviations
  - Notes
  - Notes
- List of contributors
  - Notes
  - Notes
1 Introduction
- Notes
- Notes
2 Clinical approach to suspected cancer
- Notes
- Notes
3 Concepts of multidisciplinary management
- Notes
- Notes
- 4.1 Head & neck cancer
  - Notes
  - Notes
- 4.2 CNS tumours
  - Notes
  - Notes
- 4.3 Thoracic tumours
  - Notes
  - Notes
- 4.4 Breast cancer
  - Notes
  - Notes
- 4.5 Gastro-intestinal cancers
  - Notes
  - Notes
- 4.6 Genito-urinary cancer
  - Notes
  - Notes
- - Cervical cancer: epidemiology, screening, and pathology Cervical cancer: epidemiology, screening, and pathology
    - Epidemiology Epidemiology
    - Cervical cancer screening Cervical cancer screening
    - Natural history and pathology Natural history and pathology
    - Further reading Further reading
  - Cervical cancer: clinical features, investigations, staging, and prognosis Cervical cancer: clinical features, investigations, staging, and prognosis
    - Clinical features Clinical features
    - Pretreatment evaluation and staging Pretreatment evaluation and staging
      - Pretreatment evaluation Pretreatment evaluation
      - Staging Staging
        
        Stage grouping Stage grouping
        
        Salient features of FIGO staging Salient features of FIGO staging
    - Prognosis Prognosis
  - Cervical cancer: primary management Cervical cancer: primary management
    - Stage 0 cervical cancer (carcinoma in situ) Stage 0 cervical cancer (carcinoma in situ)
    - Stage IA: also labelled as superficially invasive cervical cancers (see Fig. ) Stage IA: also labelled as superficially invasive cervical cancers (see Fig. )
      - Conization Conization
      - Total hysterectomy (abdominal or vaginal) Total hysterectomy (abdominal or vaginal)
      - Intracavitary brachytherapy alone Intracavitary brachytherapy alone
    - Stage IB and IIA (see Fig. ) Stage IB and IIA (see Fig. )
      - Stage IB1 Stage IB1
      - Stage IB2 and IIA (see Fig. ) Stage IB2 and IIA (see Fig. )
        
        Adjuvant therapy after radical surgery Adjuvant therapy after radical surgery
      - Radical radiotherapy Radical radiotherapy
        
        Conventional radiotherapy technique Conventional radiotherapy technique
        
        Three-dimensional radiotherapy technique Three-dimensional radiotherapy technique
        
        Concurrent chemoradiation with cisplatin chemotherapy Concurrent chemoradiation with cisplatin chemotherapy
    - Stages IIB, IIIA, and IIIB Stages IIB, IIIA, and IIIB
      - Radiation therapy doses Radiation therapy doses
    - Stage IVA Stage IVA
    - Stage IVB Stage IVB
    - Further reading Further reading
  - Cervical cancer: management of recurrence Cervical cancer: management of recurrence
    - Management of patients who relapse after primary treatment: Management of patients who relapse after primary treatment:
    - Therapeutic options for local relapse after primary surgery (see Fig. ) Therapeutic options for local relapse after primary surgery (see Fig. )
    - Local recurrence after primary radiotherapy Local recurrence after primary radiotherapy
  - Cervical cancer: role of chemotherapy Cervical cancer: role of chemotherapy
    - Systemic CT in stage IVB or recurrent disease Systemic CT in stage IVB or recurrent disease
    - Further reading Further reading
  - Cervical cancer: treatment-related morbidity Cervical cancer: treatment-related morbidity
    - Surgery Surgery
    - Radiation therapy Radiation therapy
  - Cervical cancer: newer approaches Cervical cancer: newer approaches
    - Cervical cancer research Cervical cancer research
      - HPV DNA as the primary biomarker for early detection of pre-cancer lesions and triaging HPV DNA as the primary biomarker for early detection of pre-cancer lesions and triaging
      - HPV E6 and E7 protein detection in the severe dysplastic and invasive carcinoma HPV E6 and E7 protein detection in the severe dysplastic and invasive carcinoma
      - Viral load and integration Viral load and integration
      - Secondary biomarkers in the detection of cervical cancer Secondary biomarkers in the detection of cervical cancer
    - Further reading Further reading
  - Endometrial cancer Endometrial cancer
    - Incidence/epidemiology Incidence/epidemiology
    - Aetiology/risk factors Aetiology/risk factors
      - Tamoxifen Tamoxifen
      - Hereditary non-polyposis coli Hereditary non-polyposis coli
    - Clinical features Clinical features
  - Endometrial cancer: diagnosis, screening, and pathology Endometrial cancer: diagnosis, screening, and pathology
    - Diagnosis Diagnosis
      - Ultrasound scan Ultrasound scan
      - Endometrial sampling/hysteroscopy Endometrial sampling/hysteroscopy
    - Screening Screening
    - Pathology Pathology
      - Tumour classification Tumour classification
  - Endometrial cancer: investigations, staging, and prognosis Endometrial cancer: investigations, staging, and prognosis
    - Investigations Investigations
      - Examination under anaesthesia Examination under anaesthesia
      - Magnetic resonance imaging Magnetic resonance imaging
      - Computed tomography Computed tomography
    - Staging Staging
    - Prognosis Prognosis
    - Further reading Further reading
  - Endometrial cancer: role of surgery Endometrial cancer: role of surgery
    - Surgery for stage I disease Surgery for stage I disease
      - Total abdominal hysterectomy and bilateral salpingo-oophorectomy Total abdominal hysterectomy and bilateral salpingo-oophorectomy
      - Lymphadenectomy Lymphadenectomy
        
        Omentectomy/omental biopsy Omentectomy/omental biopsy
    - Laparoscopic surgery for endometrial cancer Laparoscopic surgery for endometrial cancer
    - Vaginal hysterectomy Vaginal hysterectomy
    - Surgery for stage II disease Surgery for stage II disease
    - Surgery for advanced endometrial cancer (stages III/IV) Surgery for advanced endometrial cancer (stages III/IV)
    - Complications of surgery Complications of surgery
      - General General
      - Specific to abdominopelvic surgery Specific to abdominopelvic surgery
    - Further reading Further reading
  - Endometrial cancer: role of radiotherapy Endometrial cancer: role of radiotherapy
    - Adjuvant radiotherapy Adjuvant radiotherapy
    - Selective application of adjuvant radiotherapy Selective application of adjuvant radiotherapy
    - Indications for adjuvant radiotherapy Indications for 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
    - Further reading Further reading
  - Endometrial cancer: role of chemotherapy and hormonal agents Endometrial cancer: role of chemotherapy and hormonal agents
    - Chemotherapy Chemotherapy
      - Indications for chemotherapy Indications for chemotherapy
      - Cytotoxic chemotherapy with single agent activity Cytotoxic chemotherapy with single agent activity
      - Combination chemotherapy Combination chemotherapy
      - Chemotherapy in the adjuvant treatment of early stage, high-risk endometrial cancer Chemotherapy in the adjuvant treatment of early stage, high-risk endometrial cancer
    - Hormonal agents Hormonal agents
      - Progestogens Progestogens
      - Gonadotrophin-releasing hormone (GnRH) analogues Gonadotrophin-releasing hormone (GnRH) analogues
      - Aromatase inhibitors Aromatase inhibitors
    - Further reading Further reading
  - Endometrial cancer: recurrence and metastasis Endometrial cancer: recurrence and metastasis
    - 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
  - Uterine sarcomas Uterine sarcomas
    - Incidence/epidemiology Incidence/epidemiology
    - Aetiology Aetiology
    - Clinical features Clinical features
    - Diagnosis Diagnosis
    - Pathology Pathology
    - Hormone receptors Hormone receptors
  - Uterine sarcomas: management Uterine sarcomas: management
    - 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
    - Role of radiotherapy Role of radiotherapy
    - Role of chemotherapy: adjuvant Role of chemotherapy: adjuvant
    - Role of chemotherapy: metastatic Role of chemotherapy: metastatic
    - Hormonal treatments Hormonal treatments
    - Further reading Further reading
    - Internet resource Internet resource
  - Epithelial ovarian cancer: introduction, pathology, and clinical features Epithelial ovarian cancer: introduction, pathology, and clinical features
    - Introduction Introduction
    - 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
    - Screening Screening
    - Pathology Pathology
    - Clinical features Clinical features
    - Further reading Further reading
    - Internet resources Internet resources
  - Epithelial ovarian cancer: investigations, staging, and prognosis Epithelial ovarian cancer: investigations, staging, and prognosis
    - Special investigations Special investigations
    - Differential diagnosis Differential diagnosis
    - Staging Staging
    - Further reading Further reading
  - Epithelial ovarian cancer: early stage disease Epithelial ovarian cancer: early stage disease
    - Principles of treatment Principles of treatment
    - Surgery Surgery
    - Chemotherapy Chemotherapy
    - Further reading Further reading
  - Epithelial ovarian cancer: advanced stage disease Epithelial ovarian cancer: advanced stage disease
    - Principles of treatment Principles of treatment
    - Surgery Surgery
    - Chemotherapy Chemotherapy
      - Intraperitoneal chemotherapy Intraperitoneal chemotherapy
    - Further reading Further reading
  - Epithelial ovarian cancer: recurrent disease Epithelial ovarian cancer: recurrent disease
    - Principles of management Principles of management
    - Chemotherapy Chemotherapy
    - Hormones Hormones
    - Surgery Surgery
    - Novel therapeutic approaches Novel therapeutic approaches
    - Further reading Further reading
  - Epithelial ovarian cancer: palliative care issues Epithelial ovarian cancer: palliative care issues
    - Conclusion Conclusion
    - Further reading Further reading
  - Malignant ovarian germ cell tumours: introduction Malignant ovarian germ cell tumours: introduction
    - Overview Overview
    - Epidemiology Epidemiology
    - Aetiology Aetiology
    - Pathology Pathology
      - Primitive germ cell tumours Primitive germ cell tumours
      - Biphasic or triphasic teratoma Biphasic or triphasic teratoma
      - Monodermal highly specialized teratoma Monodermal highly specialized teratoma
      - Somatic type tumours associated with biphasic or triphasic teratoma Somatic type tumours associated with biphasic or triphasic teratoma
      - Immunohistochemical and molecular features Immunohistochemical and molecular features
    - Clinical features Clinical features
      - Examination Examination
    - Investigations Investigations
    - Diagnosis Diagnosis
      - Tumour markers Tumour markers
      - Imaging Imaging
    - Staging Staging
    - Further reading Further reading
  - Malignant ovarian germ cell tumours: management Malignant ovarian germ cell tumours: management
    - 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
    - Neo-adjuvant chemotherapy Neo-adjuvant chemotherapy
    - Postoperative management strategies Postoperative management strategies
      - Extending surveillance strategies Extending surveillance strategies
    - Adjuvant chemotherapy Adjuvant chemotherapy
      - Chemotherapy overview Chemotherapy overview
        
        3-day BEP 3-day BEP
        
        Alternative adjuvant regimens Alternative adjuvant regimens
      - Number of courses Number of courses
  - Malignant ovarian germ cell tumours: prognosis, surveillance, and management of recurrence Malignant ovarian germ cell tumours: prognosis, surveillance, and management of recurrence
    - 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
    - Conclusion Conclusion
    - Further reading Further reading
  - Sex cord-stromal tumours 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
      - 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
    - Thecoma-fibroma tumours Thecoma-fibroma tumours
      - Thecoma Thecoma
      - Fibroma/fibrosarcoma Fibroma/fibrosarcoma
    - Sertoli stromal-cell tumours (androblastoma) Sertoli stromal-cell tumours (androblastoma)
      - Pure Sertoli cell tumours Pure Sertoli cell tumours
      - Sertoli–Leydig cell tumours Sertoli–Leydig cell tumours
    - Sex cord tumour with annular tubules (SCTAT) Sex cord tumour with annular tubules (SCTAT)
      - SCTAT without Peutz–Jeghers syndrome 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
    - Borderline ovarian tumours Borderline ovarian tumours
      - Introduction Introduction
      - Aetiology Aetiology
      - Clinicopathological features Clinicopathological features
      - Diagnosis Diagnosis
      - Staging Staging
      - Treatment Treatment
        
        Surgery Surgery
        
        Adjuvant treatment Adjuvant treatment
      - Unexpected postoperative diagnosis of borderline tumours Unexpected postoperative diagnosis of borderline tumours
      - Residual or recurrent disease Residual or recurrent disease
      - Fertility Fertility
      - Follow-up Follow-up
      - Prognosis Prognosis
    - Other uncommon ovarian tumours Other 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
    - Internet resources Internet resources
  - Gestational trophoblastic disease Gestational trophoblastic disease
    - Introduction Introduction
    - Epidemiology and aetiology Epidemiology and aetiology
      - Epidemiology Epidemiology
      - Aetiology Aetiology
    - Pathology Pathology
      - Hydatidiform mole Hydatidiform mole
      - Choriocarcinoma Choriocarcinoma
      - Placental site trophoblastic tumour (PSTT) Placental site trophoblastic tumour (PSTT)
    - Clinical features Clinical features
      - Complete hydatidiform mole (CHM) Complete hydatidiform mole (CHM)
      - Partial hydatidiform mole (PHM) Partial hydatidiform mole (PHM)
      - Gestational trophoblastic neoplasia (GTN) Gestational trophoblastic neoplasia (GTN)
    - Further reading Further reading
  - Gestational trophoblastic disease: diagnosis, staging and prognosis Gestational trophoblastic disease: diagnosis, staging and prognosis
    - Initial management Initial management
    - Registration and assessment Registration and assessment
    - Persistent gestational trophoblastic disease Persistent gestational trophoblastic disease
      - Central nervous system assessment Central nervous system assessment
    - Counselling and communication Counselling and communication
    - Further reading Further reading
  - Gestational trophoblastic disease: low risk Gestational trophoblastic disease: low risk
    - Principles of management Principles of management
      - Low-risk metastatic GTN Low-risk metastatic GTN
    - Specific management Specific management
      - 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
      - Pregnancy Pregnancy
      - Communication with referring gynaecologist and GP Communication with referring gynaecologist and GP
    - Further reading Further reading
    - Internet resource Internet resource
  - Gestational trophoblastic disease: high risk Gestational trophoblastic disease: high risk
    - Principles of management Principles of management
      - Treatment toxicity Treatment toxicity
    - Specific management Specific management
      - Relapsed or resistant high-risk disease Relapsed or resistant high-risk disease
    - Role of surgery Role of surgery
      - Long-term complications of treatment Long-term complications of treatment
    - Follow-up Follow-up
    - Further reading Further reading
    - Internet resource Internet resource
  - Gestational trophoblastic disease: special situations Gestational trophoblastic disease: special situations
    - Pulmonary metastases (Fig. ) Pulmonary metastases (Fig. )
    - Brain/central nervous system disease (Fig. ) Brain/central nervous system disease (Fig. )
    - Other sites of metastasis Other sites of metastasis
    - Placental site trophoblastic tumour (PSTT) Placental site trophoblastic tumour (PSTT)
    - Twin molar pregnancy Twin molar pregnancy
    - Ectopic molar pregnancy Ectopic molar pregnancy
    - Fertility issues Fertility issues
      - Contraception Contraception
    - Further reading Further reading
    - Internet resource Internet resource
  - Cancers of vulva and vagina Cancers of vulva and vagina
    - Vulval cancer Vulval cancer
      - 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 (VIN) Vulvar intraepithelial neoplasia (VIN)
        
        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
        
        Education Education
        
        Vulval cytology Vulval cytology
      - Clinical features Clinical features
      - Diagnosis and staging Diagnosis and staging
    - Vaginal cancer Vaginal cancer
      - 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
        
        Small cell carcinoma Small cell carcinoma
        
        Sarcoma botyroides Sarcoma botyroides
      - Screening Screening
      - Clinical features Clinical features
      - Diagnosis and staging Diagnosis and staging
    - Further reading Further reading
    - Internet resource Internet resource
  - Management of vulval cancer Management of vulval cancer
    - Principles of management Principles of management
      - Surgery Surgery
        
        Early-stage disease Early-stage disease
        
        Advanced disease Advanced disease
        
        Lateral lesions Lateral lesions
        
        Other lesions Other lesions
      - Radiotherapy Radiotherapy
      - Chemotherapy Chemotherapy
      - Chemoradiotherapy Chemoradiotherapy
    - Prognosis Prognosis
    - Post-treatment issues Post-treatment issues
    - Recurrence and management Recurrence and management
    - Recent advances Recent advances
      - Sentinel lymph node biopsy Sentinel lymph node biopsy
    - Further reading Further reading
  - Management of vaginal cancer Management of vaginal cancer
    - Principles of management Principles of management
      - Surgery Surgery
      - Radiotherapy Radiotherapy
      - Chemoradiotherapy Chemoradiotherapy
    - Prognosis Prognosis
    - Post-treatment issues Post-treatment issues
    - Recurrence and management Recurrence and management
    - Recent advances Recent advances
      - HPV vaccine HPV vaccine
      - Sentinel node detection Sentinel node detection
    - Further reading Further reading
  - Notes
  - Notes
- 4.8 Skin cancer
  - Notes
  - Notes
- 4.9 Bone tumours and soft tissue sarcomas
  - Notes
  - Notes
- 4.10 Haematological malignancies
  - Notes
  - Notes
- 4.11 Endocrine tumours
  - Notes
  - Notes
- 4.12 Paediatric malignancies
  - Notes
  - Notes
- 4.13 HIV related tumours
  - Notes
  - Notes
- 4.14 Cancers of unknown primary
  - Notes
  - Notes
- Notes
5 Oncological emergencies
- Notes
- Notes
6 Special situations in oncology
- Notes
- Notes
7 Palliative care
- Notes
- Notes
8 Clinical management of cancer: flowcharts
- Notes
- Notes
9 Appendix
- Notes
- Notes
- Index
  - Notes
  - Notes

Chapter

4.7 Gynaecological cancers

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https://doi.org/10.1093/med/9780199235636.003.0010

Pages

314–385

Published:

June 2011

Extract

Cervical cancer: epidemiology, screening, and pathology

Epidemiology

Cervical cancer is a serious health problem, with nearly 520,000 women developing the disease each year worldwide of whom 443,000 are women in developing countries (Parkin et al. 2005).

There are many risk factors from epidemiological to analytical implicated in the development of cervical cancer.

Human papilloma virus (HPV) has emerged as the principal sexually transmitted causal agent in the development of cancer of the uterine cervix. Almost all women who develop cervical cancer are infected with an oncogenic HPV type, more frequently with type 16 or 18 and to a lesser extent with other oncogenic types. In addition to HPV, cofactors such as parity, use of oral contraceptives, tobacco smoking, immunosuppression, infection with other sexually transmitted diseases, and poor nutrition have been associated with the development of cervical cancer. Age of first sexual intercourse, lifetime number of sexual partners, history of sexually transmitted infections, and other characteristics of sexual activity are linked to the likelihood of becoming infected with HPV and are considered important for the progression of HPV-infected lesions to cervical cancer (Das et al. 2000; National Cancer Registry Programme 2006). An analysis of the pooled data from 11 case–control studies from nine countries (all but two of which were developing countries) involving 1918 women with cervical cancer found that eight HPV types—16, 18, 31, 35, 45, 52, and 58—account for almost 95% of cervical cancers (Muñoz et al. 2003).

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Contents

4.7 Gynaecological cancers

Extract

Cervical cancer: epidemiology, screening, and pathology

Epidemiology

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Contents

4.7 Gynaecological cancers

Extract

Cervical cancer: epidemiology, screening, and pathology

Epidemiology

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