Gynecological Cancer Management E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 509

Veröffentlichungsjahr: 2011

Beschreibung

This concise and practical guide enables the gynecologist to differentiate between benign and malignant gynecologic conditions to determine the best management options for the patient. Over the past three decades, as the specialty of obstetrics and gynecology has matured into a broad and diverse group of skills and disciplines, it has become apparent that there are diagnoses and conditions in gynecologic oncology where the obstetrician-gynecologist has a level of uncertainty, or lack of confidence in his ability or knowledge base to adequately manage the patient and therefore refers the patient to a gynecologic oncologist. This text portrays the advances in the field and reviews the current management of a number of gynaecologic conditions to give the reader the confidence needed to deal with these issues. The distinguides Editors have crafted the book to include: * Case vignettes to provide clinical context * Pathology notes to aid diagnostic outcomes * Management guidance for obgyn practitioners to enable the best outcome for their patients Each topic is introduced with a concise overview followed by case-based scenarios which discuss the specific management of common problems. Providing the general gynecologist with the current clinical information necessary to manage conditions and identify the situations where consultation or referral to a gynecologic oncologist would be in the patient's best interest.

Leseprobe

Contents

List of Contributors

Preface

Acknowledgements

CHAPTER 1 Vulvar Dystrophies

Background

Lichen sclerosis, contact dermatitis, and lichen simplex chronicus

Lichen planus, plasma cell vulvitis, and desquamative inflammatory vaginitis

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

Clinical Scenario 4

References

CHAPTER 2 Vulvar Intraepithelial Neoplasia and Cancer

Background

Paget’s disease of the vulva

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

Clinical Scenario 4

Clinical Scenario 5

Clinical Scenario 6

Clinical Scenario 7

Clinical Scenario 8

Clinical Scenario 9

References

CHAPTER 3 Vaginal Intraepithelial Neoplasia

Risk factors

Prevention

Diethylstilbestrol exposure

VAIN diagnosis

Clinical presentation

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

Clinical Scenario 4

Clinical Scenario 5

References

CHAPTER 4 Cervical Neoplasia

Background

Epidemiology

Natural history of disease

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

Case Scenario 4

References

CHAPTER 5 Endometrial Hyperplasia and Endometrial Cancer

Pathogenesis

Presentation/Diagnosis

Endometrial hyperplasia and endometrial carcinoma

Clinical Scenario 1

Case Scenario 2

Clinical Scenario 3

Clinical Scenario 4

References

CHAPTER 6 Unusual Neoplasms of the Uterus

Risk factors

Incidence

Leiomyosarcomas

Carcinosarcoma

Stromal sarcomas

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

What are the clinical and histologic features of parasitic leiomyomas, leiomyomatosis peritonalis disseminata, and intravenous leiomyomatosis?

Clinical Scenario 4

Clinical Scenario 5

References

CHAPTER 7 Management of Women at High Risk for Gynecologic Cancers

Background

Genes asociated with developing cancer

Genetics underlying gynecologic malignancies

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

Clinical Scenario 4

Clinical Scenario 5

What do the pathologists at your institution do to avoid missing a “small” cancer?

References

CHAPTER 8 Evaluation and Management of the Adnexal Mass

Background

Types of adnexal mass by developmental stage

Imaging of pelvic masses

Tumor markers

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

References

CHAPTER 9 Ovarian Tumors of Low Malignant Potential

Background

Histologic subtypes

Surgical staging and management

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

Clinical Scenario 4

Clinical Scenario 5

Clinical Scenario 6

References

CHAPTER 10 Early Epithelial Ovarian Cancer

Background

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

References

CHAPTER 11 Ovarian Sex Cord–Stromal Tumors

Background

Granulosa–stromal cell tumors

Sertoli–stromal cell tumors

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

Clinical Scenario 4

Clinical Scenario 5

References

CHAPTER 12 Germ Cell Tumors of the Ovary

Background

Brief description of ovarian GCTs

Incidence

Etiology/Biology

Risks/Clinical presentation

Clinical Scenario 1

Clinical Scenario 2

References

CHAPTER 13 Adnexal Masses in Pregnancy

Background

Etiology

Diagnostic evaluation

Management: expectant versus surgical

Clinical Scenario 1

Clinical Scenario 2

References

CHAPTER 14 Gestational Trophoblastic Disease

Background

Incidence

Classification of hydatidiform moles

Clinical features of hydatidiform moles

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

Clinical Scenario 4

Clinical Scenario 5

References

Colour plates can be found facing page

Index

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Library of Congress Cataloging-in-Publication Data

Pre-malignant gynecological cancer : evaluation and management / [edited by] Daniel Clarke-Pearson, John Soper.

p. ; cm.

Includes bibliographical references and index. ISBN 978-1-4051-9079-4 (hardcover : alk. paper)

1. Generative organs, Female-Cancer. 2. Gynecologic pathology. 3. Precancerous conditions.

I. Clarke-Pearson, Daniel L. II. Soper, John (John T.)

[DNLM: 1. Genital Neoplasms, Female-diagnosis. 2. Genital Neoplasms, Female-therapy. 3. Genitalia, Female-pathology. 4. Precancerous Conditions. WP 145 P925 2009]

RC280.G5P738 2009

616.99’465-dc22 2009031375

This book is dedicated to:

Our wives, Kathleen Clarke-Pearson and Maureen Soper and our children Don, Emily, Mary and Mike Clarke-Pearson; and Emily, Will and Alex Soper for their constant support and love as we have pursued our careers.

Our mentors, Roy T. Parker, MD, William T. Creasman, MD, Charles B. Hammond, MD, Allen Addison, MD, William N. Spellacy, MD, James R. Scott, MD, and Gary H. Johnson, MD, for the standards of excellence they set for us, for the wealth of knowledge that they shared, and for their continued friendship and guidance.

List of Contributors

Daniel L. Clarke-Pearson, MD, FACOG, FACS

Robert A. Ross Distinguished Professor and Chair Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

John T. Soper, MD, FACOG

Charles Hendricks Distinguished Professor Division of Gynecologic Oncology Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Lisa N. Abaid, MD, MPH

Gynecologic Oncology Associates Newport Beach, CA, USA

Victoria Lin Bae-Jump, MD, PhD

Assistant Professor Division of Gynecologic Oncology Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Ursula Balthazar, MD

Fellow

Clinical Instructor

Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

John F. Boggess, MD

Associate Professor Division of Gynecologic Oncology Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Leigh A. Cantrell, MD, MSPH

Fellow

Clinical Instructor

Division of Gynecologic Oncology

Department of Obstetrics and Gynecology

University of North Carolina School of Medicine Chapel Hill, NC, USA

Wesley C. Fowler, Jr. MD, FACOG, FACS

Palumbo Distinguished Professor of Gynecologic Oncology Director, Division of Gynecologic Oncology Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Paola A. Gehrig, MD, FACOG

Associate Professor Division of Gynecologic Oncology Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Rabbie K. Hanna, MD

Fellow

Clinical Instructor

Division of Gynecologic Oncology

Department of Obstetrics and Gynecology

University of North Carolina at Chapel Hill, NC, USA

Chad Livasy, MD

Associate Professor

Department of Pathology and Laboratory Medicine University of North Carolina School of Medicine Chapel Hill, NC, USA

Alberto A. Mendivil, MD

Fellow

Clinical Instructor Division of Gynecologic Oncology Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Jennifer L. Ragazzo, MD

Assistant Professor

Division of Women’s Primary Healthcare Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Emma Rossi, MD

Fellow

Clinical Instructor Division of Gynecologic Oncology Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Aaron Shafer, MD

Fellow

Clinical Instructor Division of Gynecologic Oncology Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Linda Van Le, MD, FACOG, FACS

Professor

Division of Gynecologic Oncology Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Denniz Zolnoun, MD, FACOG

Associate Professor

Division of Advanced Laparoscopy and Pelvic Pain Department of Obstetrics and Gynecology University of North Carolina School of Medicine Chapel Hill, NC, USA

Preface

Over the past three decades, the specialty of obstetrics and gynecology has matured into a broad and diverse group of skills and disciplines. Advances in the basic science of reproduction, human physiology, genetics, oncology, surgical technology, and pharmacology have broadened our understanding of the field and at the same time provided the opportunity to provide improved health to women under our care.

The breadth of the specialty has resulted in specific areas of subspecialization recognized by the American Board of Obstetrics and Gynecology (ABOG): maternal-fetal medicine, reproductive endocrinology and infertility, female reconstructive surgery and pelvic floor medicine, and gynecologic oncology. All of these subspeciliaties require a minimum of 3 additional years of training beyond the traditional 4 years of training in obstetrics and gynecology. And there are specific written and oral examinations in these subspecialties that are required before ABOG will issue a “Certificate of Special Competence.”

Given the subspecialists’ additional skill and knowledge in their area of subspecialty training, the general obstetrician and gynecologist must decide when it is appropriate for a patient to remain under his or her care, and when it is most appropriate to refer to a subspecialist for consultation or continuing care.

In the area of gynecologic oncology, it has become apparent that there are diagnoses and conditions where the obstetrician and gynecologist has a level of uncertainty (or lack of confidence in his or her ability or knowledge base to adequately manage the patient) and therefore refers the patient to a gynecologic oncologist. For example, should every adenxal mass discovered by physical examination or ultrasound be referred to a gynecologic oncologist because it “might” be an ovarian cancer? Clearly this triage strategy is inappropriate. We feel that the general gynecologist should manage the “benign” ovarian tumors, while referral of “probable” ovarian cancer to a gynecologist is appropriate for best patient care. So, what are the criteria that a gynecologist can use to differentiate masses that are “possibly” ovarian cancer from those that are “probably” ovarian cancer?

As educators of residents in obstetrics and gynecology, we have come to believe that many of the women we see in referral should be cared for by obstetricians and gynecologists. While we agree that referral of women with known or suspected gynecologic cancers is appropriate, we also feel that there are a number of conditions that do not require referral or consultation.

It is not our intent to explore the reasons for these referrals. The goal of this book is to review the current management of a number of gynecologic conditions that we gynecologic oncologists often see in consultation yet believe should be managed by the general gynecologist.

This text is not intended to be an extensive resource or reference encyclopedia of selected gynecologic conditions. There are several comprehensive texts of gynecology that serve as excellent reference sources. Rather, we have chosen to present each topic with a concise overview or background followed by case-based scenarios that discuss the specific management of these common problems. We hope this will be a practical guide to the management of many gynecologic conditions that the general gynecologist can and should manage.

In many instances, the pathologist serves as an important consultant. While at UNC we enjoy the consultation of pathologists who specialize in gynecologic pathology, we recognize that general gynecologists in the community must rely on their pathologists who practice the breadth of surgical pathology. The communication between the pathologist and the gynecologist is critical in decision-making. We have therefore added sections entitled “Pathology Notes,” which are intended to share with the reader issues that we feel are important to establish the correct diagnosis (and therefore result in the proper treatment). Again, we do not intend this to serve as a comprehensive pathology text, but rather to highlight the important issues in the pathologic evaluation of these specific conditions. Hopefully, they will result in better understanding between the gynecologist and the pathologist.

In the end, we hope this text will provide the general gynecologist with the current clinical information necessary to manage most conditions that are not true gynecologic malignancies and at the same time identify the situations where consultation or referral to a gynecologic oncologist would be in the patient’s best interest.

Daniel Clarke-Pearson

John Soper

October 2009

Acknowledgements

We wish to acknowledge our Wiley-Blackwell publisher, Martin Sugden, PhD, who helped us develop the vision of the unique content and focus for this book and for his support in launching this endeavour. We appreciate the diligent work of the Wiley-Blackwell editorial staff, especially Cathryn Gates, Rebecca Huxley and Baljinder Kaur who provided the editorial expertise to bring this book to fruition.

To our co-authors who worked diligently to complete their manuscripts on the prescribed time-line, we extend our thanks! And a special thanks to Chad Livasy, MD, Alice Chuang, MD, and Glen Yamagada, MD for providing the excellent images which further enhance the clinical scenarios.

CHAPTER 1

Vulvar Dystrophies

Denniz Zolnoun, MD

Department of Obstetrics and Gynecology,

University of North Carolina School of Medicine, Chapel Hill, NC, USA

Pathology Notes: Chad Livasy, MD

Associate Professor, Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA

Background

Vulvo-vaginal symptoms are among the most common reasons that women seek health care; upward of 6 million physician office visits are made by women of all age ranges for vulvo-vaginal symptoms.1 Despite such staggering statistics, most clinicians are not adequately prepared to diagnose and treat chronic vulvo-vaginal symptoms. Overlapping clinical appearance, symptoms, and pathophysiology, compounded by nonspecific histology on biopsy, are the main causes for confusion.

This chapter will focus on the following six nonmalignant vulvo-vaginal conditions that clinically may raise concern about premalignant processes:

Lichen sclerosisContact dermatitisLichen simplex chronicusLichen planusPlasma cell vulvitisDesquamative inflammatory vaginitis

These conditions share overlapping symptoms of itching and burning to variable degrees. Collectively, these conditions are challenging to care for due to lack of consensus on diagnosis and treatment, intractable and fluctuating clinical course, overlapping morphology and histology, and significant individual variation in treatment response. Additionally, many of these conditions often coexist, posing yet another layer of complexity in deciphering the cause of a patient’s chief complaint. Given the intertwined pathophysiology, it is no wonder that the care of these patients seems more a proverbial shot in the dark than a stepwise methodical process.

The diagnostic definition of these six conditions is based on a constellation of symptoms, morphology, and histopathology. As noted in Table 1.1, the primary complaint of the first three conditions is itching, while the primary complaints of the last three are burning, rawness, and pain with intercourse. Thus, using a symptom-based approach, the discussion of these disorders is divided into two parts: conditions with primary complaints of itching (lichen sclerosis, contact dermatitis, and lichen simplex chronicus), and those with primary complaints of burning/rawness sensation (lichen planus, plasma cell vulvitis, and desquamative inflammatory vaginitis). Vulvar intraepithelial dysplasia (VIN), which is often associated with unilateral and focal itching, will be discussed in Chapter 2.