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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5186_Библиотеки_им_академика_М_И_Перельмана.pdf
SeniorStaffSpecialist
PalliativeMedicineSpecialist
GynaecologicalCancerCentre
RoyalHospitalforWomen
NewSouthWales,Australia
AntonioM.Pessegueiro,MD
AssociateProfessor
DepartmentofMedicine
DavidGeffenSchoolofMedicineatUCLA
UniversityofCaliforniaLosAngeles
LosAngeles,California
JenniferA.M.Philip,MBBS,MMed,GDip
ChairofPalliativeMedicine
DepartmentofMedicineatSt.Vincent’sHospital
UniversityofMelbourne
Parkville,Victoria
OncologyDepartment
St.Vincent’sHospital,Melbourne
Fitzroy,Victoria
MalteRenz,MD,PhD
GynecologicOncologyResearch
DivisionofGynecologicOncology
DepartmentofObstetricsandGynecology
StanfordUniversitySchoolofMedicine
StanfordWomen’sCancerCenter
StanfordCancerInstitute
Stanford,California
NormanW.Rizk,MD
BertholdandBelleN.GuggenhimeProfessorinMedicine
DepartmentofMedicine
StanfordUniversitySchoolofMedicine
Stanford,California
ShannonSalvador,MD
AssistantProfessor
DepartmentofObstetricsandGynaecology
SirMortimerB.DavisJewishGeneralHospital
Montreal,Quebec
PrimoSchär,PhD
ProfessorofMolecularGenetics
DeanFacultyofMedicine
DepartmentofBiomedicine
UniversityofBasel
Basel,Switzerland
CarlE.Schulze,MD
AssistantClinicalProfessor
DepartmentofMedicine—Nephrology
DavidGeffenSchoolofMedicineatUCLA
UniversityofCaliforniaLosAngeles
LosAngeles,California
DigishD.Shah,MD
AssociateClinicalProfessor
DepartmentofMedicine
DavidGeffenSchoolofMedicineatUCLA
UniversityofCaliforniaLosAngeles
LosAngeles,California
RebeccaA.Shelby,PhD
AssociateProfessor
PsychiatryandBehavioralSciences
DukeUniversity
Durham,NorthCarolina
MalcolmI.Smith,MD
ClinicalProfessor
DepartmentofMedicine
DavidGeffenSchoolofMedicineatUCLA
UniversityofCaliforniaLosAngeles
LosAngeles,California
OdetteSpruijt,MD
AssociateProfessor
DepartmentofMedicine
UniversityofMelbourne
Melbourne,Australia
MarissaK.Srour,MD
DepartmentofSurgery
Cedars-SinaiMedicalCenter
LosAngeles,California
KathrynL.Terry,ScD
AssociateProfessor
DepartmentofObstetrics,Gynecology,andReproductiveBiology
HarvardMedicalSchool
Epidemiologist
ObstetricsandGynecology
BrighamandWomen’sHospital
Boston,Massachusetts
WinifredG.Teuteberg,MD
ClinicalAssociateProfessor
DepartmentofMedicine
StanfordUniversitySchoolofMedicine
Stanford,California
JanB.Vermorken,MD,PhD
EmeritusProfessorofOncology
DepartmentofMedicalOncology
AntwerpUniversityHospital
Edegem,Belgium
ForewordtotheFirstEdition
Closetothebeginningofthiscentury,WilliamOslerobserved,“Thepracticeofmedicineis
anart,basedonscience.”Thatbriefcharacterizationofourprofessionringstrue,evenaswe
approachthenextcenturyinthemidstofbrilliant,acceleratingscientificdiscovery.
Some aspects of the art—including compassion and the basic skills of history taking and
physical examination—are, or should be, common to all physicians and remain largely
unchangedbyacenturyofresearch.Inotherways,the“art,”whichcanalsobetranslatedas
“craft”fromtheoriginalGreekwork“techne,”hasbeengreatlyenlargedanddiversifiedby
scienceandtechnology.Thus,thespecialskillsrequiredbyagynecologiconcologistderive
notonlyfromexperienceandpractice,butalsofromtheproliferationofknowledgeinmany
branches of science. Indeed, it is mainly the developments of science in obstetrics and
gynecology—andin some otherdisciplines—thathave evolved theclinicalsubspecialty of
gynecologiconcology.
The art and the science are connected not only by ancestry, however. Their relationship
continuestobeaninterdependentone.Oneoftheever-expandinggloriesofmedicineisthat
what is learned in the laboratory can enhance learning at the bedside and what is learned
fromexperiencewithpatientshelpstoshapeanddirectscientificinquiry.
Doctorswhoremainlifelongstudentsareexhilaratedbytheseinterconnectionsandmakethe
bestteachersofclinicalmedicine.ItisinthescholarlytraditionthatJonathanS.Berekand
NevilleF. Hacker,withcontributions from distinguishedcolleagues intheirown discipline
and in fields that bear upon it, have brought together the salient information required to
develop the acumen and skills that enable clinicians to understand and to care for women
sufferingfromtumors.
PracticalGynecologicOncologyreflectstheindivisibilityofartandscienceinmedicine.The
two editors—one in Los Angeles and one in Sydney—worked and studied together for 7
yearsinthesamehospitalandlaboratoriesandremainmutuallyhelpfulintellectualallieson
oppositeshoresofthePacificOcean.
ShermanM.Mellinkoff,MD
DeanEmeritusProfessorofMedicine
UCLADavidGeffenSchoolofMedicine
LosAngeles,California
Preface
The discipline of gynecologic oncology has changed significantly since its inception as a
subspecialty of Obstetrics and Gynecology in the United States in 1973. We were fellows
together at UCLA in 1979, and now,four decades later, it is interesting to reflect on the
changes that have occurred. Although there have been impressive advances in all related
fields, we believe that the most outstanding advances have been in medical imaging,
molecularbiology,andminimallyinvasivesurgery.
Whenwecommencedourfellowships,medicalimagingwasrestrictedtoplainx-rays,firstgenerationCT scans, andgray-scaleultrasonography.The advent oftheMRI in the 1990s
andthePETscaninthe2000shaveprovidedfargreaterdefinitionoftheprimarycancerand
anyfoci of metastaticdisease.The completion oftheHuman Genome Projectin 2003 has
generated a surge in molecular biology research, with new targeted therapies becoming
available on almost a monthly basis. These therapies have created a paradigm shift in
survivalforselectedpatientsandhaveofferedhopetoallpatientsandtheirlovedonesthata
curemaybeonthehorizon.Finally,theintroductionoflaparoscopicsurgeryforendometrial
cancerinthe1990sandroboticsurgeryinthe2000shavenotchangedthetypesofoperations
required, but have substantially improved patient comfort and recovery, and markedly
shortenedthelengthofpostoperativehospitalstay.
Intheearlyyearsofthespecialty,thegynecologiconcologistwasregardedasthephysician
whowasable to deal with virtually all thesurgicalneeds of a woman withagynecologic
malignancy, along with all her chemotherapeutic and palliative requirements. Significant
advances in all fields of surgeryandthe establishment of medical oncology and palliative
medicineas legitimatesubspecialties ofmedicine haveenabled theroleof thegynecologic
oncologisttoevolveintothatoftheleaderofalargemultidisciplinaryteam.Theteamshould
includeavarietyofmedicalandsurgicalspecialists,oncologynursepractitioners,specialty
nurses,andparamedicalpersonnel,includingpsychologists,socialworkers,physiotherapists,
anddietitians.
The surgical management of advanced ovarian cancer has become more radical, with
increasing emphasis on the need to resect all macroscopic metastatic disease. This has
necessitatedcollaborationwithhepatobiliaryandeventhoracicsurgeonsinselectedcases.A
more conservative approach to the lymph nodes has been advocated by some for vulvar,
cervical,andendometrialcancer,andtheseconceptsareaddressedinthisnewedition.
All chapters in this new edition have been extensively revised and updated, but special
mentionshouldbemadeofthecontributionsofnewauthors.NewchaptersonGeneticsand
Cancer Cell Biology have been added by our outstanding colleagues, Malte Renz from
Stanford and ViolaHeinzelmann-Schwarz from Switzerland, respectively. Shireen Heidari
andcolleaguesfromStanfordhaverewrittenthechapteronCommunicationSkills,Gottfried
Konecny from UCLAhas substantially updated the chapter on Chemotherapy, and Odette
Spruijt from Australia has substantially updated the chapter on Symptom Relief and
Palliative Care. The multidisciplinary approach to gynecologic cancer has been
acknowledgedbytheinclusionasco-authorsofPatriciaEifel,aradiationoncologistfromthe
MD Anderson Hospital in Houston, on the vulvar and vaginal cancer chapters; Jan
Vermorken,amedicaloncologistfromAntwerp,andMichaelJackson,aradiationoncologist
fromSydney,onthecervicalcancerchapter;andMichaelFriedlander,amedicaloncologist
fromSydney,onthechaptersonuterine,ovarian,andgermcelltumors.
The first four editions of our book were titled Practical Gynecologic Oncology. In
recognitionof its sustained utility,LippincottWilliams & Wilkinsrenamed the 5thedition
Berek&Hacker’sGynecologicOncology,andwehaveretainedthattitleforthis7thedition.
Sincethe 4th edition,our book hasbeen officiallytranslated into Chineseand Spanish, an
acknowledgmentofitsinternationalappeal.In2016,itwasmadetheofficialtextbookforthe
Global Curriculum and Mentorship Program introduced by the International Gynecologic
CancerSociety.
Theformatforthiseditionhasbeenslightlymodified.Thetextispresentedtwocolumnsper
page, permitting a more condensed size. It preserves the basic format and style of the
previous editions, being divided into four sections: General Principles, Disease Sites,
MedicalandSurgicalTopics,and Qualityof Life.As withprevious editions,where levelI
evidenceisnotavailable,wehaveinterjectedourpersonalrecommendations,justifyingour
positionwithadequatereferencetotheavailableliterature.
WearemostgratefultoDeborahBerekforhervaluableassistancewithdesignandcontent
editing. We appreciate the important contribution of the Lippincott Williams & Wilkins,
WoltersKluwerstaff,especiallyChrisTeja,ThomasCelona,andAnthonyGonzalez.Thanks
toChrisMilleratAptaraforherexcellentfinesseofthepageproofs,andDustyneSchulze,
Administrative Assistant at Stanford, for her assistance with the manuscript. We thank
Jennifer Clements and Tim Hengst for their outstanding figure illustrations and drawings.
Finally,weextendspecialthankstoCharleyMitchellwhohasbeensupportiveofourbook
sinceitsinception.
Onbehalf of the Stanford Women’s Cancer Center,we acknowledgethegenerosity of our
benefactors,especiallyLaurieKrausLacob,NicoleKidman,KeithUrban,TrishaYearwood,
GarthBrooks,RitaWilson,TomHanks,andLisaSchatzandtheentireUnderOneUmbrella
Committee.Wearegratefulforthesupportofourcolleagues—DeanEmeritusPhilipPizzo,
Stanford University School of Medicine; Beverly Mitchell, Emeritus Director, Stanford
Cancer Institute; Dean Lloyd Minor, Stanford University School of Medicine; David
Entwistle,CEO, Stanford HealthCare; Sri Seshadri,Vice President,Stanford Health Care;
StevenArtandi,Director,StanfordCancerInstitute;andEbenRosenthal,DirectorofCancer
Services, Stanford Comprehensive Cancer Center; and Charles Prober, Director, Stanford
CenterforHealthEducation.InSydney,weacknowledgethesupportofourmultidisciplinary
teamattheGynaecologicalCancerCentre,especiallyMichaelFriedlander,whohasworked
astheconsultantmedicaloncologistattheRoyalHospitalforWomeninSydneyforthepast
30years.Wewouldalsoliketoacknowledgethesupportofourlaboratoryresearchteamat
theLowyInstitute ofthe UniversityofNewSouthWales,headedbyCarolynFord,andof
VanessaMadunic,GeneralManageroftheRoyalHospitalforWomen.Allarecommittedto
excellenceinpatient-centeredcare,andallare constantlystriving toimprove outcomesfor
gynecologiccancerpatients.Atbothinstitutions,theenduringsupportofourbenefactorshas
beencriticaltoourgynecologiconcologyresearchandclinicalprograms.
Our book is written primarily for gynecologic oncologists, fellows undertaking training in
gynecologic oncology,and consultant gynecologists. It should also be helpful for medical
oncologists and radiation oncologists whose practices involve a significant component of
gynecologiccancercare.
We offer this book to those who strive to improve the care of women with gynecologic
malignancies.
JonathanS.Berek
NevilleF.Hacker
Contents
Contributors
ForewordtotheFirstEdition
Preface
SectionI
GeneralPrinciples
Chapter1:
CancerGenetics
MalteRenz
AllisonW.Kurian
Chapter2:
CancerCellBiology
ViolaHeinzelmann-Schwarz
RosGlasspool
PrimoSchär
Chapter3:
Biologic,Targeted,andImmuneTherapy
MalteRenz
JonathanS.Berek
OliverDorigo
Chapter4:
Chemotherapy
GottfriedE.Konecny
MichaelL.Friedlander
Chapter5:
RadiationTherapy
PatriciaJ.Eifel
LaurenE.Colbert
Chapter6:
Pathology
ChristinaS.Kong
TeriA.Longacre
Chapter7:
EpidemiologyandBiostatistics
DanielW.Cramer
KathrynL.Terry
SectionII
DiseaseSites
Chapter8:
PreinvasiveDisease
MichaelJ.Campion
KarenCanfell
Chapter9:
CervicalCancer
NevilleF.Hacker
MichaelJackson
JanB.Vermorken
Chapter10:
UterineCancer
NevilleF.Hacker
MichaelL.Friedlander
Chapter11:
EpithelialOvarian,FallopianTube,andPeritonealCancer
JonathanS.Berek
MichaelL.Friedlander
NevilleF.Hacker
Chapter12:
GermCellandNonepithelialOvarianCancers
JonathanS.Berek
MichaelL.Friedlander
NevilleF.Hacker
Chapter13:
VulvarCancer
NevilleF.Hacker
PatriciaJ.Eifel
Chapter14:
VaginalCancer
NevilleF.Hacker
PatriciaJ.Eifel
Chapter15:
GestationalTrophoblasticDisease
RossS.Berkowitz
NeilS.Horowitz
DonaldP.Goldstein
Chapter16:
BreastDisease
ArmandoE.Giuliano
MarissaK.Srour
Chapter17:
CancerinPregnancy
FrédéricAmant
CharlotteMaggen