This review discusses the current understanding of endometrial cancer and to provide guidelines for management that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented. A thorough understanding of the epidemiology, pathophysiology, and diagnostic and management strategies for this type of cancer allows the gynecologists to identify women at increased risk, contribute toward risk reduction, and facilitate early diagnosis. Sentinel lymph node (SLN) mapping is based on the concept that lymph node metastasis is the result of an orderly process; that is, lymph drains in a specific pattern away from the tumor, and therefore, if the SLN, or first node, is negative for metastasis, then the nodes after the SLN, should be negative. This approach can help patients avoid the side effects associated with a complete lymphadenectomy, although disease must be thoroughly staged for accurate prognosis and determination of appropriate treatment approach. Surgeon experience, adherence to an SLN algorithm, and the use of pathologic "ultra-staging" are key factors for successful SLN mapping.Read More

Epithelial ovarian cancer is the second most common gynecologic malignancy, but is the leading cause of death from gynecologic cancer in the United States. In this discussion four updates are selected based on recent important updates in the guidelines and on debate among the experts about recent clinical trials. The topics include: 1) intraperitoneal (IP) chemotherapy, 2) CA-125 monitoring for ovarian cancer recurrence, 3) surveillance recommendations for less common ovarian histopathologies, and 4) recent changes in therapy for recurrent epithelial ovarian cancer. During primary surgery for advanced stage epithelial ovarian cancer all attempts should be made to achieve complete cytoreduction. When this is not achievable the surgical goal should be optimal (Read More

The purpose of this document to review current recommendations for genetic testing for susceptibility to cancers, including ovarian, fallopian tube, breast, endometrial, and colon cancers due to inherited mutations in the BRCA genes or in the mismatch repair genes associated with hereditary nonpolyposis colon cancer (HNPCC) syndrome. Family history remains the cornerstone of patient identification. Genetic testing of appropriate individuals further enables us to identify patients with hereditary cancer syndromes, for their own benefit as well that of their entire family. Clinical genetic testing for gene mutations allows physicians to more precisely identify women who are at substantial risk of breast cancer and ovarian cancer.Read More

Cervical cancer is the most common cancer in women, and caused by the human papillomavirus (HPV). Most sexually active women will acquire HPV in their lifetime. Although infection clears in most cases, it does persist in some women. Long-term persistence of HPV -- particularly with high-risk types -- has been established as a necessary cause of precancerous lesions. Cervical screening programs have been very successful in the United States, Europe, and other regions, are able to achieve broad and sustained coverage. Cervical cancer prevention can now be made even better. Substantial modifications of practice are forthcoming, motivated by improved understanding of HPV natural history and cervical carcinogenesis.  The focus of this discussion is on management of atypical squamous cells of undermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL). This series on Cervical Cancer Prevention, will also serve as a baseline for understanding the future effects of HPV vaccination on the cervical cancer screening results.Read More

Given that infections with the human papillomavirus (HPV) can lead to cervical cancer, screening and diagnostic programs involving Papanicolaou smears (Pap test) and colposcopy are the standard of care in North America. As more than 80% of cervical cancers are preventable by routine screening, the United States has clearly been successful in reducing HPV-related cancers with the implementation of the cervical cancer screening programs. The purpose of this review is to discuss the current management and summarize recommendations for managing high-grade cervical neoplasia (CIN2, 3+). Areas in which improvement can be made in the recognition of high-risk features during colposcopy are also discussed. Once colposcopic technique is improved, accuracy for detection of high-risk premalignant disease increases. Carcinogenic or "high-risk" human papillomavirus (high-risk HPV) testing has become the standard triage worldwide for women with atypical squamous cells of undermined significance (ASC-US) cytology and is designated as a stand-alone follow-up option in a number of post-colposcopy and post-treatment clinical management scenarios.Read More

When different histologic types of cervical cancer are considered and trends are reexamined, it becomes apparent that observed declines are reflective of squamous cell carcinomas predominately; the rates for adenocarcinomas continue to rise. This rise in incidence may be due to the greater difficulty in screening for glandular precursor lesions that often arise high within the endocervical canal.  These strategies reflect new information concerning the natural history of cervical carcinogenesis and the performance of screening and diagnostic tests, and they take into account the cost and efficacy of various treatment and follow-up options. This document will describe staging criteria and treatment for cervical glandular carcinomas. For practical purposes, it will focus on the glandular cells and adenocarcinoma histologies onlyRead More

Worldwide, cervical cancer is the second most common malignancy in women and a major cause of morbidity and mortality. Cervical cancer is gender-specific disease that disproportionately affects women in the lowest socioeconomic classes throughout the world. In 2004, the 57th World Health Assembly adopted World Health Organization's global reproductive health strategy, which identified five priority areas including "combating sexually transmitted infections"; the strategy also specifically addressed cervical cancer prevention. Screening programs have successfully reduced disease rates in developed countries that support cytology-based services; these services are too complex for most developing countries to implement. Many important advances have also taken place in the diagnosis and treatment of cervical cancer. This review also defines the strategies for diagnosis and management of abnormal cervical cytology and histology. These strategies reflect new information concerning the natural history of cervical carcinogenesis and the performance of screening and diagnostic tests. The most important component in the management of cervical cancer will always be primary prevention.Read More

Globally, cervical cancer is a major health problem, with a yearly incidence of 371,000 cases and an annual death rate of 190,000. 78% of cases occur in developing countries where cervical cancer is the second most frequent cause of cancer-related death in women. Invasive cervical carcinoma, once the most common reproductive-tract cancer in the United States, has recently fallen to the rank of third most common. The purpose of this document is to describe staging criteria and treatment for cervical carcinoma. For practical purposes, it will focus on the squamous and adenocarcinoma histologies only. In addition, new evidence has documented conclusively that survival rates for women with cervical cancer improve when radiotherapy is combined with cisplatin-based chemotherapy in advanced cases.Read More

Breast cancer biology is a topic of intensive research, and there have been huge breakthroughs in recent years. Scientific insight into estrogen-receptor biology has led to major advances in estrogen-targeted prevention and chemotherapy. Increased breast density has emerged as a dominant, detectable, and modifiable risk factor for subsequent development of breast cancer in women. The purpose of this document is to discuss clinical application of the various tools available to assess a woman's risk for breast cancer and apply in clinical practice. This review also provides a comprehensive examination of the importance of breast density as a dominant risk factor for the development of breast cancer, highlighting the role that genetics and hormones play in maintaining breast density in postmenopausal women. Future research can be directed toward the detection of preexisting conditions (such as gene mutations) that put women at risk for highly aggressive cancers. Recommendations for genetic testing are reviewed here, with a particular focus on the components of genetic counseling, identifying individuals for testing, and interpreting test results.Read More

It is estimated that 217,640 new cases of breast cancer will be diagnosed in United States this year; more than 99% of these breast cancers occur in women. Breast cancer is the most common malignancy among U.S. women and it is the second leading cause of death from cancer among American women (lung cancer is first). A woman's lifetime risk (80-year life-span) of developing breast cancer is 12.5%, or 1 in 8. Early detection of breast cancer has been shown to decrease the mortality rate. Technology continues to evolve to improve the accuracy of detection. The review also focuses on mammography and other detection techniques as screening tools to identify non-palpable lesions. This information is designed to aid practitioners in making decisions about appropriate care. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institutions or type of practices.Read More