GYNECOLOGIC ONCOLOGY HANDBOOK...Gynecologic Oncology Handbook An Evidence-Based Clinical Guide...

#. Chapter Title xiii

GYNECOLOGIC ONCOLOGY HANDBOOK

An Evidence-Based Clinical Guide

Michelle F. Benoit

M. Yvette Williams-Brown

Creighton L. Edwards

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© Springer Publishing Company, LLC.© Springer Publishing Company, LLC.

© Springer Publishing Company, LLC.

Gynecologic Oncology Handbook

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Gynecologic Oncology Handbook An Evidence-Based Clinical Guide

Michelle F. Benoit, MDSeattle, Washington

M. Yvette Williams-Brown, MD, MMS

Baylor College of MedicineHouston, Texas

Creighton L. Edwards, MDBaylor College of Medicine

Houston, Texas

New York

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Visit our website at www.demosmedpub.com

ISBN: 9781620700051 e-book ISBN: 9781617051678

Acquisitions Editor: Richard Winters Compositor: S4Carlisle

© 2013 Demos Medical Publishing, LLC. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmit-ted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors, and publisher have made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time of production of the book. Nevertheless, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market.

Library of Congress Cataloging-in-Publication Data

Benoit, Michelle F., author. Gynecologic oncology handbook : an evidence-based clinical guide / Michelle F. Benoit, Marian Yvette Williams-Brown, Creighton L. Edwards. p. ; cm.Includes bibliographical references and index.ISBN-13: 978-1-62070-005-1ISBN-10: 1-62070-005-0ISBN-13: 978-1-61705-167-8 (e-book)I. Williams-Brown, Marian Yvette, author. II. Edwards, Creighton L., author. III. Title.[DNLM: 1. Genital Neoplasms, Female—therapy—Handbooks. 2. Genital Neoplasms, Female—diagnosis—Handbooks. 3. Intraoperative Complications—Handbooks. 4. Postopera-tive Complications—Handbooks. 5. Pregnancy Complications, Neoplastic—Handbooks. WP 39]RC280.G5616.99’465--dc23 2013004085

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In Memoriam Dr. Edward V. Hannigan

An amazing mentor, a consummate clinician, and a gentle soul. non omnis moriar

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Contents

Preface ix

1 . Gynecologic Oncology Referral Parameters 1

2 . Disease Sites 3

A. Preinvasive Disease 3

B. Cervical Cancer 11

C. Ovarian Cancer 37

D. Uterine Cancer 81

E. Vulvar Cancer 111

F. Vaginal Cancer 127

G. Gestational Trophoblastic Disease 133

3. Hereditary Cancer Syndromes 147

4 . Screening 151

A. Ovarian Cancer Screening 151

B. Cervical Cancer Screening 157

5. Surgical Care 163

A. Anatomy 163

B. Surgical Devices 169

C. Surgical Procedures 175

D. Intraoperative Complications 187

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viii Contents

E. Postoperative Care Protocols 191

F. Postoperative Complications 197

6. Medical Comorbidity Management 207

A. Preoperative Risk Assessment 207

B. Perioperative Management in Gynecologic Oncology 209

C. Critical Care 223

7. Treatment Modalities 249

A. Chemotherapy 249

B. Radiation Therapy 267

8. Reproductive Function and Cancer 285

A. Sexual Function and Cancer 285

B. Fertility and Cancer Treatment 287

C. Cancer in Pregnancy 289

9. Survival Care 297

A. Surveillance Recommendations 297

B. Surveillance Visit Checklist 303

10. Palliative Care 305

11. Statistics 309

12. Reference Material 321

Performance Status Scales 321

Adverse Event Grading 322

RECIST (Response Evaluation Criteria in Solid Tumors) 322

Useful Formulas 323

Abbreviations 324

Index 335

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Preface

This handbook is structured to provide comprehensive care for the gynecologic cancer patient. It is directed toward clinicians at all levels of training and the chapters are tiered in this fashion. Basic diagnosis, workup, staging, and treatment are outlined fi rst. Specifi c surgical and adjuvant therapies are then recommended refl ecting current standards of care. Finally, the evidence-based medicine is summarized in support of recommended treatments. Thus, the medical student can have a dedi-cated overview, the resident can refer to directed patient care protocols, and the fellow and practicing physician can support their clinical deci-sions with easily accessible literature.

It has been our honor to put together this handbook for our friends and colleagues. We acknowledge the dedication it has taken from the physicians, support staff, and especially our patients, to design and par-ticipate in the trials that have advanced our knowledge of these diffi -cult gynecologic cancers. We hope the information provided herein can continue to guide high-quality care and refl ect our commitment to the subspecialty.

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Gynecologic Oncology Referral Parameters

I. Endometrial Cancer

A. Biopsy confirmed endometrial cancer of any grade

II. Pelvic Mass

A. Presence of, or concern for, advanced disease:

1. Omental caking

2. Pleural effusion

3. Ascites

B. A clinically suspicious pelvic mass:

1. Larger than 8 cm

2. Complex

3. Fixed

4. Nodular

5. Bilateral

6. Excrescences

7. Solid components

C. Premenarchal girls with a pelvic mass

D. Postmenopausal women with a suspicious mass or elevated tumor markers. Suspicious findings include: a solid mass, a sim-ple mass greater than 8–10 cm, or a complex mass. ACOG recom-mends referral for a CA-125 above 35.

E. Perimenopausal women with an ovarian mass, particularly when associated with an elevated CA-125. ACOG recommends referral for a CA-125 above 200 in pre- or peri-menopausal women.

F. Young patients who have a pelvic mass and elevated tumor markers (CA-125, AFP, hCG, LDH)

1 1. Gynecologic Oncology Referral Parameters

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2 Gynecologic Oncology Handbook

G. A suspicious pelvic mass found in a woman with a significant family or personal history of ovarian, breast, or other cancers (one or more first-degree relatives) .

III. Cervical Cancer

A. A biopsy (conization or directed) confirming invasive carcinoma

B. Women with suspicious cervical lesions should be referred but can be biopsied before referral.

IV. Vaginal Cancer

A. All women with invasive vaginal cancer

B. Depending on practitioner’s comfort level:

1. Women with unexplained abnormal cytology after colpos-copy and biopsy

2. Women with VAIN 3 lesions (suspicious of invasion) who require treatment

V. Vulvar Cancer

A. Biopsy confirmed invasive vulvar cancer

B. Women with a suspicious vulvar lesion should be biopsied before referral. These suspicious lesions include:

1. Nonhealing ulcers

2. Areas of chronic pain or pruritus

3. Areas of pigment change

4. Grossly enlarged lesion

C. Depending on practitioner’s comfort level:

1. Women with multifocal, complex, and/or recurrent VIN 3

2. Women with Paget’s disease of the vulva

VI. Gestational Trophoblastic Disease

A. Referral should occur after evacuation of the molar pregnancy if there is evidence of persistent trophoblastic disease/gestational trophoblastic disease (GTD):

1. GTD (low or high risk)

2. Choriocarcinoma

3. Placental site trophoblastic tumor

If there is evidence of metastatic disease at initial diagnosis, referral should occur immediately.

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