Ebook Gynecologic oncology clinical practice and surgical atlas: Part 1

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Dedication
Thistextbookandallofourprofessionalaccomplishmentswouldnotbepossible
without the enduring support of our families. We dedicate this effort to our
understanding spouses, Scott, Michelle, and Cathy; our high-spirited children,
MatthewandJocelynKarlan,Jackson,Chloe,andHaleyBristow,Jason,Lucas,
and Evan Li; and to our loving parents, Beverly and Stanley Young, Lynn and
Lonnie Bristow, and Chien and Marian Li, who raised us with passions for
caringandeternallearning.Ourmanyteachersandmentorsprovideduswiththe
knowledgeandskillstocareforwomenwithgynecologiccancersandmotivated
ustocontinuepushingthetherapeuticenvelopeuntilcuresarewithinourgrasp.
Our colleagues—physicians, scientists, nurses, and other professionals—work
shoulder to shoulder with us, and support, challenge, motivate, and make us
laugh when it is most needed. And most importantly, this book is dedicated to
thelegionsofwomenwithgynecologiccancer,bothlivingandinourmemories,
who have taught us tenacity, selflessness, and courage. We hope that this text
will educate future generations of clinicians and scientists whom we can enlist
onourjourneytoendcancerasathreattowomen.

Contents
Contributors
Preface

FUNDAMENTALTOPICS
1. Epidemiology of Gynecologic Cancers, Clinical Trials, and Statistical
Considerations
WendyR.BrewsterandKrishnansuS.Tewari
2.GeneticsandBiologyofGynecologicCancers
DouglasA.Levine
3.DiagnosticModalities
DavidStarks,BinYang,andPeterG.Rose

DISEASESITES
4.PreinvasiveDiseaseoftheLowerGenitalTract
LeviS.DownsJr.andJoriS.Carter
5.CervicalCancer
AngelaJ.Ziebarth,KennethH.Kim,andWarnerK.Huh
6.EndometrialHyperplasiaandCancer


DavidA.Iglesias,MarilynHuang,PamelaT.Soliman,BojanaDjordjevic,
andKarenH.Lu
7.UterineSarcomas
GaryS.Leiserowitz
8.GestationalTrophoblasticDisease
DiljeetK.Singh
9.VulvarCancer

MarkMilamandCharlesF.Levenback
10.VaginalCancer
WilliamJ.Lowery,JunzoChino,andLauraJ.Havrilesky
11.ManagementoftheAdnexalMass
RituSalaniandChristaNagel
12. High-Grade Serous Carcinomas of the Ovary, Fallopian Tube, and
Peritoneum
DavidE.CohnandRonaldD.Alvarez
13. Epithelial Ovarian Cancers: Low Malignant Potential and Non-Serous
OvarianHistologies
GregoryP.Sfakianos,AngelesAlvarezSecord,andIe-MingShih
14.GermCellandSexCord-StromalOvarianCancers
SusanC.ModesittandJubileeBrown
15.BreastCancerandRelatedDiseases
CatherineM.DangandM.WilliamAudeh


16.CancerinPregnancy
MalaikaAmneusandChristineH.Holschneider
17.MetastasestotheGynecologicTract
S.DianeYamadaandNitaK.Lee

IIICLINICALMANAGEMENTTOPICS
18.PerioperativeandCriticalCare
RenataUrbanandLee-mayChen
19.PrinciplesofRadiationTherapy
Wui-JinKohandLindsayR.Sales
20.PrinciplesofChemotherapy
UrsulaA.Matulonis
21.TargetedTherapyandImmunotherapy

RobertL.ColemanandPaulJ.Sabbatini
22.IntegrativeOncology,QualityofLife,andSupportiveCare
DiljeetK.SinghandVivianE.vonGruenigen
23.SurgicalInstrumentationandSutures
JohnC.ElkasandAddieAlkhas

IVSURGICALATLAS
24.OvarianandFallopianTubeProcedures


EricL.EisenhauerandJeffreyM.Fowler
25.UterineProcedures
JohnO.SchorgeandDavidM.BorutaII
26.CervicalProcedures
DanielleVicusandAllanCovens
27.VulvarandVaginalExcisionalProcedures
MarkA.Morgan,SarahH.Kim,andSameerA.Patel
28.Lymphadenectomy
LisaA.dosSantosandNadeemR.Abu-Rustum
29.StagingProcedures
SummerB.DewdneyandMatthewA.Powell
30.CytoreductiveProcedures
EdwardJ.TannerIII,FadyKhoury-Collado,andDennisS.Chi
31.MinimallyInvasiveSurgery
PedroT.Ramirez,MichaelFrumovitz,andPedroF.Escobar
32.PelvicExenteration
A.TotalPelvicExenteration
BarbaraA.GoffandHowardG.Muntz
B.UrinaryDiversions
ThomasC.KrivakandPanitiSukumvanich

C.VaginalandVulvarReconstruction
LeighG.SeamonandJayW.Carlson
33.AncillaryProcedures
JoanL.Walker
Index


Contributors
NadeemR.Abu-Rustum,MD
AttendingGynecologyService
DepartmentofSurgery
MemorialSloan-KetteringCancer
CenterNewYork,NewYork
Chapter28

AddieAlkhas,MD
Fellow
DepartmentofGynecologicOncology
NationalCapitalConsortiuminGynecologicOncologyWashington,DC
Chapter23

RonaldD.Alvarez,MD
ProfessorandDirector
DivisionofGynecologicOncology
DepartmentofObstetricsandGynecology
UniversityofAlabamaatBirmingham
Birmingham,Alabama
Chapter12

MalaikaAmneus,MD
AssistantProfessor
DepartmentofObstetricsandGynecology
DavidGeffenSchoolofMedicineatUCLA
LosAngeles,California
Chapter16

M.WilliamAudeh,MD,MS
AssociateClinicalProfessorofMedicine
DavidGeffenSchoolofMedicineatUCLA


LosAngeles,California
Chapter15

DavidM.BorutaII,MD
AssistantProfessor
DepartmentofObstetricsandGynecology
HarvardMedicalSchool
Boston,Massachusetts
Chapter25

WendyR.Brewster,MD,PhD
AssociateProfessorandDirector
CenterforWomen’sHealthResearch
DepartmentofObstetricsandGynecology
UniversityofNorthCarolina
LinebergerComprehensiveCancerCenter
ChapelHill,NorthCarolina

Chapter1

JubileeBrown,MD
AssociateProfessor
DepartmentofGynecologicOncologyandReproductiveMedicineUniversityof
TexasM.D.AndersonCancerCenterHouston,Texas
Chapter14

JayW.Carlson,DO
ClinicalAssociateProfessor
DepartmentofObstetricsandGynecology
DesMoinesUniversity
DesMoines,Iowa
Chapter32C

JoriS.Carter,MD
InstructorandClinicalFellow
DivisionofGynecologicOncology
UniversityofMinnesotaMedicalSchool
Minneapolis,Minnesota


Chapter4

Lee-mayChen,MD
Professor
EdwardC.Hill,MD,EndowedChair
DivisionofGynecologicOncology
DepartmentofObstetrics,Gynecology,andReproductiveSciencesUCSFHelen
DillerFamilyComprehensiveCancerCenterSanFrancisco,California

Chapter18

DennisS.Chi,MD
Professor
GynecologyService
DepartmentofSurgery
MemorialSloan-KetteringCancerCenter
NewYork,NewYork
Chapter30

JunzoChino,MD
AssistantProfessor
DepartmentofRadiationOncology
DukeUniversity
Durham,NorthCarolina
Chapter10
DavidE.Cohn,MD
Professor
DepartmentofObstetricsandGynecology
OhioStateUniversityMedicalCenter
Columbus,Ohio
Chapter12

RobertL.Coleman,MD
Professor and Vice Chair, Clinical Research Department of Gynecologic
Oncology
UniversityofTexasM.D.AndersonCancerCenterHouston,Texas
Chapter21

AllanCovens,MD,FRCSC
Professor
DepartmentofObstetricsandGynecology
DivisionofGynecologicOncology
UniversityofToronto
Toronto,Ontario
Chapter26

CatherineM.Dang,MD
AssociateDirector
WassermanBreastCancerRiskReductionProgramDepartmentofSurgery
Cedars-SinaiMedicalCenter
LosAngeles,California
Chapter15

SummerB.Dewdney,MD
AssistantProfessor
DivisionofGynecologicOncology
RushUniversityMedicalCenter
Chicago,Illinois
Chapter29

BojanaDjordjevic,MD
AssistantProfessor
Department of Pathology and Laboratory Medicine University of Ottawa,
OttawaHospital
Ottawa,Ontario
Chapter6

LisaA.dosSantos,MD

GynecologicOncologyFellow
DepartmentofSurgery
MemorialSloan-KetteringCancerCenter
NewYork,NewYork
Chapter28

LeviS.DownsJr,MD,MS


AssociateProfessorandDirector
DivisionofGynecologicOncology
Obstetrics,GynecologyandWomen’sHealthUniversityofMinnesota
Minneapolis,Minnesota
Chapter4

EricL.Eisenhauer,MD
AssistantProfessor
DepartmentofObstetricsandGynecology
DivisionofGynecologicOncology
OhioStateUniversity
Columbus,Ohio
Chapter24

JohnC.Elkas,MD,JD
AssociateClinicalProfessor
Department of Obstetrics and Gynecology, Inova Campus Virginia
CommonwealthUniversity
FallsChurch,Virginia
Chapter23

PedroF.Escobar,MD
Director of Minimally Invasive Surgery and Robotics Section of Gynecologic
Oncology
DepartmentofObstetricsandGynecology
ClevelandClinic
Cleveland,Ohio
Chapter31

JeffreyM.Fowler,MD
JohnG.BoutselisProfessorinGynecologicOncologyDepartmentofObstetrics
andGynecology
OhioStateUniversity
Columbus,Ohio
Chapter24

MichaelFrumovitz,MD,MPH


AssociateProfessor
DepartmentofGynecologicOncology
UniversityofTexasM.D.AndersonCancerCenterHouston,Texas
Chapter31

BarbaraA.Goff,MD
ProfessorandDirector
DivisionofGynecologicOncology
DepartmentofObstetricsandGynecology
UniversityofWashington
Seattle,Washington
Chapter32A

LauraJ.Havrilesky,MD,MHSc
AssociateProfessor
DepartmentofObstetricsandGynecology
DukeUniversityMedicalCenter
Durham,NorthCarolina
Chapter10

ChristineH.Holschneider,MD
AssociateProfessor
DepartmentofObstetricsandGynecology
DavidGeffenSchoolofMedicineatUCLA
LosAngeles,California
Chapter16
MarilynHuang,MD,MS
Fellow
DepartmentofGynecologicOncologyandReproductiveMedicineUniversityof
TexasM.D.AndersonCancerCenterHouston,Texas
Chapter6

WarnerK.Huh,MD
AssociateProfessor
DepartmentofObstetricsandGynecology
UniversityofAlabamaatBirmingham
Birmingham,Alabama


Chapter5

DavidA.Iglesias,MD

Fellow
DepartmentofGynecologicOncologyandReproductiveMedicineUniversityof
TexasM.D.AndersonCancerCenterHouston,Texas
Chapter6

FadyKhoury-Collado,MD
Fellow
Gynecology Service, Department of Surgery Memorial Sloan-Kettering Cancer
Center
NewYork,NewYork
Chapter30

KennethH.Kim,MD
FellowandClinicalInstructor
DepartmentofObstetricsandGynecology
UniversityofAlabama
Birmingham,Alabama
Chapter5

SarahH.Kim,MD,MSCE
AssistantProfessor
SurgicalOncology
FoxChaseCancerCenter
Philadelphia,Pennsylvania
Chapter27

Wui-JinKoh,MD
ProfessorofRadiationOncology
SeattleCancerCareAlliance
University of Washington Medical Center and School of Medicine Seattle,

Washington
Chapter19

ThomasC.Krivak,MD


AssistantProfessor
Director,GynecologicOncologyFellowshipDivisionofGynecologicOncology
Magee-Women’s Hospital of the University of Pittsburgh Medical Center
Pittsburgh,Pennsylvania
Chapter32B

NitaK.Lee,MD
Assistant Professor of Obstetrics and Gynecology University of Chicago
MedicalCenter
Chicago,Illinois
Chapter17

GaryS.Leiserowitz,MD,MS
Professor,AssociateViceChair,andChiefDivisionofGynecologicOncology
DepartmentofObstetricsandGynecology
UCDavisMedicalCenter
Sacramento,California
Chapter7

CharlesF.Levenback,MD
Professor
DepartmentofGynecologicOncology
MedicalDirector
GynecologicOncologyCenter

UniversityofTexasM.D.AndersonCancerCenterHouston,Texas
Chapter9

DouglasA.Levine,MD
AssociateAttendingSurgeon
GynecologyService
DepartmentofSurgery
MemorialSloan-KetteringCancerCenter
NewYork,NewYork
Chapter2

WilliamJ.Lowery,MD
GynecologicOncologyFellow


DivisionofGynecologicOncology
DukeUniversityMedicalCenter
Durham,NorthCarolina
Chapter10

KarenH.Lu,MD
Professor
DepartmentofGynecologicOncologyandReproductiveMedicineUniversityof
TexasM.D.AndersonCancerCenterHouston,Texas
Chapter6

UrsulaA.Matulonis,MD
MedicalDirector,AssociateProfessorofMedicineHarvardMedicalSchool
MedicalDirectorofGynecologicOncology
Dana-FarberCancerInstitute

Boston,Massachusetts
Chapter20

MarkMilam,MD,MPH
AssistantProfessor
Obstetrics,Gynecology,andWomen’sHealthUniversityofLouisville
Louisville,Kentucky
Chapter9
SusanC.Modesitt,MD
AssociateProfessorandDirector
GynecologicOncologyDivision
ObstetricsandGynecologyDepartment
UniversityofVirginiaHealthSystem
Charlottesville,Virginia
Chapter14

MarkA.Morgan,MD
Chief,SectionofGynecologicOncology
DepartmentofSurgery
FoxChaseCancerCenter
Philadelphia,Pennsylvania
Chapter27


HowardG.Muntz,MD
ClinicalAssociateProfessor
DepartmentofObstetricsandGynecology
UniversityofWashingtonSchoolofMedicineSeattle,Washington
Chapter32A

ChristaI.Nagel,MD
GynecologicOncologyFellow
DepartmentofObstetricsandGynecology
DivisionofGynecologicOncology
UniversityofTexasSouthwesternMedicalCenterDallas,Texas
Chapter11

SameerA.Patel,MD
AssistantClinicalProfessor
DepartmentofSurgicalOncology
DivisionofPlasticandReconstructiveSurgeryFoxChaseCancerCenter
Philadelphia,Pennsylvania
Chapter27

MatthewA.Powell,MD
AssistantProfessor
DepartmentofObstetricsandGynecology
WashingtonUniversitySchoolofMedicine
St.Louis,Missouri
Chapter29

PedroT.Ramirez,MD
AssociateProfessor
DepartmentofGynecologicOncology
UniversityofTexasM.D.AndersonCancerCenterHouston,Texas
Chapter31

PeterG.Rose,MD
ProfessorandDirector
SectionofGynecologicOncology

Women’sHealthInstitute


ClevelandClinic
Cleveland,Ohio
Chapter3

PaulJ.Sabbatini,MD
AssociateAttendingPhysician
GynecologicMedicalOncologyService
DepartmentofMedicine
MemorialSloan-KetteringCancerCenter
NewYork,NewYork
Chapter21

RituSalani,MD,MBA
AssistantProfessor
DepartmentofObstetricsandGynecology
OhioStateUniversity
Columbus,Ohio
Chapter11

LindsayR.Sales,MD
ResidentinRadiationOncology
UniversityofWashingtonMedicalCenter
Seattle,Washington
Chapter19

JohnO.Schorge,MD
AssociateProfessor

Department of Obstetrics, Gynecology and Reproductive Biology Harvard
MedicalSchool
Chief,GynecologicOncology
VincentObstetricsandGynecologyServiceMassachusettsGeneralHospital
Boston,Massachusetts
Chapter25

LeighG.Seamon,DO,MPH
AssistantProfessor
ObstetricsandGynecology


DivisionofGynecologicOncology
UniversityofKentucky,MarkeyCancerCenterLexington,Kentucky
Chapter32C

AngelesAlvarezSecord,MD
AssociateProfessor
DepartmentofObstetricsandGynecology
DivisionofGynecologicOncology
DukeUniversityMedicalCenter
Durham,NorthCarolina
Chapter13

GregoryP.Sfakianos,MD
Fellow
DepartmentofObstetricsandGynecology
DivisionofGynecologicOncology
DukeUniversityMedicalCenter
Durham,NorthCarolina

Chapter13
Ie-MingShih,MD,PhD
Professor
DepartmentsofPathologyandOncology
JohnsHopkinsMedicalInstitutions
Baltimore,Maryland
Chapter13

DiljeetK.Singh,MD,DrPH
AssistantProfessor
DepartmentofObstetricsandGynecology
Northwestern University Feinberg School of Medicine Chicago, Illinois
Chapters8and22

PamelaT.Soliman,MD,MPH
AssistantProfessor
DepartmentofGynecologicOncology
UniversityofTexasM.D.AndersonCancerCenterHouston,Texas
Chapter6


DavidStarks,MD
GynecologicOncologyFellowship
DivisionofGynecologicOncology
ClevelandClinicFoundation
Cleveland,Ohio
Chapter3

PanitiSukumvanich,MD
AssistantProfessor

DivisionofGynecologicOncology
Magee-Women’s Hospital of the University of Pittsburgh Medical Center
Pittsburgh,Pennsylvania
Chapter32B

EdwardJ.TannerIII,MD
GynecologicOncologyFellow
DepartmentofSurgery
MemorialSloan-KetteringCancerCenter
NewYork,NewYork
Chapter30

KrishnansuS.Tewari,MD
AssociateProfessor
DepartmentofGynecologicOncology
UniversityofCalifornia,Irvine
Orange,California
Chapter1

RenataUrban,MD
AssistantProfessor
DepartmentofObstetricsandGynecology
DivisionofGynecologicOncology
UniversityofWashingtonMedicalCenter
UniversityofWashingtonSchoolofMedicineSeattle,Washington
Chapter18

DanielleVicus,MD,FRCSC

AssistantProfessor
DivisionofGynecologicOncology
DivisionofSurgicalOncology
TorontoSunnybrookHealthSciencesCentreUniversityofToronto
Toronto,Ontario
Chapter26

VivianE.VonGruenigen,MD
Chair
DepartmentofObstetricsandGynecology
SummaAkronCityHospital
MedicalDirector
Women’sHealthServices
SummaHealthSystem
Akron,Ohio
Chapter22

JoanL.Walker,MD
George Lynn Cross Research Professor and Chief Section of Gynecologic
Oncology
DepartmentofObstetricsandGynecology
UniversityofOklahoma,HSC
OklahomaCity,Oklahoma
Chapter33

S.DianeYamada,MD
AssociateProfessorandChief
SectionofGynecologicOncology
DepartmentofObstetricsandGynecology
UniversityofChicagoMedicalCenter

Chicago,Illinois
Chapter17

BinYang,MD,PhD
AssociateProfessor
PathologyandLaboratoryMedicineInstituteClevelandClinicLernerCollegeof
MedicineCleveland,Ohio