REVIEW ARTICLE Sue Rimes, et al; ONCOLOGY Nurse Edition Vol. 25 No. 10 Patient education and counseling are essential in women at increased risk for ovarian and endometrial cancer. Women must be educated regarding the signs, symptoms, and risks associated with these cancers.
REVIEW ARTICLE John O. Schorge, et al; ONCOLOGY Vol. 25 No. 10 The timing and clinical benefit of a second debulking operation for recurrent disease is contentious. This article focuses on the recent debate regarding when—or whether—patients with ovarian cancer should undergo aggressive surgical resection.
NEWS & ANALYSIS Anna Azvolinsky, PhD Many doctors do not properly adhere to current guidelines for offering breast and ovarian cancer counseling and testing services to their female patients, according to a recent study from the Division of Cancer Prevention and Control at the CDC. The vignette-based national survey finds that while genetic counseling is recommended for women at high risk for breast and/or ovarian cancer, only 41% of physicians self-reported adhering to recommendations to refer for genetic counseling or testing.
REVIEW ARTICLE Maria Jose Echarri Gonzalez, et al;ONCOLOGY Vol. 25 No. 2 This article reviews the known data on the dose-effect relationship for platinum drugs in ovarian cancer, and explores why interest in platinum drugs has become the central focus of ovarian cancer treatment.
The standard management for advanced-stage ovarian cancer was established in the mid-1970s. At a 1974 National Cancer Institute Consensus Conference on Ovarian Cancer, Griffiths presented data supporting the role for aggressive cytoreductive surgery as the first step in the management of this disease, followed by cytotoxic chemotherapy.[1]
For women with a gynecologic cancer, reproductive concerns may vary not only by site of disease but also by the presentation and manifestation of the disease. Gynecologic cancer can present before childbearing has been started or completed, during pregnancy, or can even arise out of pregnancy.
WILLIAM SMALL, JR, MD
Associate Professor
Department of Radiation Oncology Division of Gynecologic Oncology
Robert H. Lurie Comprehensive Cancer Center
Northwestern University Medical School
Chicago, Illinois
, November 1, 2006
This article summarizes the current management of patients with newly diagnosed cervical cancer. The topics range from the management of early-stage disease to the phase III randomized studies that have established the current standard of care for patients with locally advanced cancer of the cervix. New approaches to combined-modality therapy with the goal of improving outcomes and decreasing complications are also described.
MICHEL ROY, MD
Full Professor
Gynecologic Oncology Service
Laval University
Quebec, Canada
, April 30, 2006
Childbearing is one of the most important life goals for many women, and fertility preservation is a very important factor in the overall quality of life of cancer survivors. Cervical cancer frequently affects young women; because some women tend to delay childbearing, fertility preservation must be considered when treatment options are discussed. Over the past decade, the radical trachelectomy procedure has become a well established fertility-preserving option for young women with early-stage cancer; this procedure is associated with low morbidity, good oncologic outcome, and a high proportion of pregnancies that reach the third trimester and babies that are delivered at term. This article will review available literature on the vaginal radical trachelectomy procedure and data from other surgical approaches, such as the abdominal radical trachelectomy. In addition, the potential future application of neoadjuvant chemotherapy followed by fertility-preserving surgery in patients with locally advanced cervical cancer will be examined. Finally, ultraconservative surgical approaches (eg, conization alone with or without laparoscopic lymphadenectomy) in very early-stage disease will be discussed.
CHARLES A. LEATH III, MD
Clinical Fellow/Instructor
LARRY C. KILGORE, MD
Professor, Department of
Obstetrics and Gynecology
Division of Gynecologic Oncology
University of Alabama
at Birmingham
Birmingham, Alabama, January 1, 2006
Early presentation of endometrial cancer permits effective management
with excellent clinical outcome. The addition of hysteroscopy to
dilatation and curettage (D&C) in the evaluation of postmenopausal
bleeding adds little to the detection of malignancy. Imaging studies such
as computed tomography, magnetic resonance imaging, and positronemission
tomography may be of use in determining the presence of
extrauterine disease in patients medically unfit for surgical staging.
However, these studies are not sufficiently sensitive to replace surgical
staging and have little role in routine preoperative evaluation. Clinical
staging alone is clearly inadequate, as 23% of preoperative clinical
stage I/II patients are upstaged with comprehensive surgical staging.
Preoperative tumor grade from D&C or office biopsy may be inaccurate
and lead to an underestimate of tumor progression if used to determine
which patients should be surgically staged. Clinical estimation
of depth of invasion, with or without frozen section, is inaccurate and
may lead to underestimation of disease status when surgical staging is
not performed. The practice of resecting only clinically suspicious nodes
should be discouraged as it is no substitute for comprehensive surgical
staging. Comprehensive surgical staging provides proper guidance for
postoperative adjuvant therapy, avoiding needless radiation in 85% of
clinical stage I/II patients. Finally, resection of occult metastasis with
surgical staging may improve survival.
Key points for primary care physicians from a new study: HIV-positive women are vulnerable to invasive cervical cancer. This finding underscores the need for screening per guidelines and to follow-up... More »
Women diagnosed with endometrial cancer at age 50 or younger had a fourfold increased risk for a subsequent colorectal cancer diagnosis, according to a historical cohort study published recently in... More »
Of the predominant gynecologic cancers, cancer of the uterine cervix is the least common, with only 12,200 new cases anticipated in the United States in 2010. Nevertheless, approximately 4,210 women... More »
Whole-pelvis intensity modulated radiotherapy has become a standard of care in cervical cancer, but efforts to find better and more specific ways to deliver interstitial brachytherapy are ongoing. More »
Some may argue that the new ACOG, ACS and other cervical cancer screening guidelines will detect the majority of at-risk women. We should not be content with settling for identifying a majority of... More »
A 43-year-old woman presented with symptoms of abdominal pain and uterine bleeding. At physical examination, a palpable mass was present in the right lower abdominal quadrant.
A 46-year-old woman presented for medical evaluation due to a 2-month history of increasing difficulty in ambulation, especially getting up out of a chair or climbing stairs. She had also noticed swelling and discoloration of both upper eyelids (as depicted).
A 48-year-old African American female presents with severe uterine bleeding. She states that she has been bleeding very heavily for the past two days and the flow is increasing. She is also diabetic and hypertensive. Pelvic examination revealed an enlarged irregularly shaped uterus. A large mass was noted by ultrasonography and the uterus was removed. A section of the mass is evaluated.
In this interview we discuss HPV-associated cancers, which are on the rise, and the low vaccination coverage for HPV with Edgar Simard, PhD, MPH, senior epidemiologist of surveillance research, who studies the impact of prevention and screening on cancer incidence at the American Cancer Society.
Five Steps to Improving Patient Access Judy Capko, May 21, 2013 Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.
Growing HIPAA Threat – Ignore Windows XP at Your Own Peril Marion K. Jenkins, May 21, 2013 Chances are good that you have some major ticking software time bombs lurking in your medical practice's computer environment, namely Windows XP and Server 2003.
Three Areas to Reduce Costs at Your Medical Practice Greg Mertz, May 19, 2013 By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.
Dos and Don’ts for Starting a Physician Blog Michael Woo-Ming, MD, May 18, 2013 Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.
A 43-year-old woman presented with symptoms of abdominal pain and uterine bleeding. At physical examination, a palpable mass was present in the right lower abdominal quadrant.
A 46-year-old woman presented for medical evaluation due to a 2-month history of increasing difficulty in ambulation, especially getting up out of a chair or climbing stairs. She had also noticed swelling and discoloration of both upper eyelids (as depicted).
A 48-year-old African American female presents with severe uterine bleeding. She states that she has been bleeding very heavily for the past two days and the flow is increasing. She is also diabetic and hypertensive. Pelvic examination revealed an enlarged irregularly shaped uterus. A large mass was noted by ultrasonography and the uterus was removed. A section of the mass is evaluated.
In this interview we discuss HPV-associated cancers, which are on the rise, and the low vaccination coverage for HPV with Edgar Simard, PhD, MPH, senior epidemiologist of surveillance research, who studies the impact of prevention and screening on cancer incidence at the American Cancer Society.
