Few breast cancer risk factors are prevalent in more than 10% to 15% of the population, although some associated with very large relative risks (e.g., mutated genes, cellular atypia). Estimates of the summary population attributable risk for breast cancer range from only 21% to 55%, leaving most of the population attributable risk for the disease unexplained. Age is one of the most important risk factors for breast cancer. Although age-adjusted incidence rates continue to rise, breast cancer mortality has fallen in the past decade in the United States. It is useful for determining the extent of the disease, predicting overall survival, and providing guidance for therapy. Clinically established prognostic factors in breast cancer and concepts and mechanisms of breast cancer metastasis are also discussed. We hope our forums help the clinicians’ better understanding of the disease process and the patient management.Read More

The surgeon has become an integral part of a multidisciplinary team who manages patients with breast carcinoma. This team includes the diagnostic radiologist, radiation oncologist, medical oncologist, and pathologist. Our resolute purpose must always be to promote the best interest of each individual patient, and not those of surgery, radiotherapy or chemotherapy. The significant contributions of investigators for breast cancer management in the 20th century established the outcome results for conservative surgical techniques to be equivalent to those of radical approaches with regard to disease-free and overall survival. Preservation of the nipple-areolar complex (NAC) while performing a mastectomy is not a new concept for the treatment of breast disease. Historically, the subcutaneous mastectomy was performed in the setting of prophylaxis for high-risk patients or to reduce breast pain, but often left much breast tissue within the skin flaps and at the base of the NAC.Read More

Complications after any operation can be minimized with thorough preoperative evaluation, meticulous technique, hemostasis, and wound closure. In addition to the standard oncologic evaluation, preoperative evaluation includes assessment of the patient's overall physiologic condition, with particular emphasis on tolerability of anesthesia, uncontrolled diabetes, hypertension, anemia, coagulopathy, or steroid dependency. The purpose of this document is to review commonly used approaches for the care of the post-mastectomy wound and addresses the complications encountered in these patients. Rehabilitation of the post-mastectomy patients produces problems of varying complexity. Pathophysiology, prevention, and management of lymphedema are also discussed. Mastectomy is a safe operation with low morbidity and mortality. Although the incidence of post-operative complications is low, physicians should be aware of the morbidity unique to mastectomy and axillary node dissection.Read More

Radiation therapy (RT) plays an important role in management of breast cancer. In all situations, RT must be delivered in a manner that will appropriately treat the target tissues and minimize risks to adjacent normal tissues. For patients desirous of breast-conserving therapy (BCT), lumpectomy plus breast RT is typically the preferred approach, because it provides long-term survival rates equivalent to that achieved with mastectomy. This chapter also briefly reviews our current understanding of the role of adjuvant systemic therapy in the management of breast cancer in the modern era.Read More

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. As patients move away from the acute phase of illness, healthy sexual functioning is an important step toward re-establishing their sense of well-being. Several physiologic and psychological factors specific to oncology patients (e.g. advanced disease, radical surgery, pelvic irradiation, symptoms related to menopause, pre-morbid sexual dysfunction, and negative self-concept) can promote sexual morbidity. These issues may place cancer survivors at increased risk for the development of sexual problems.Read More

Each year approximately 36,000 women in the United States are diagnosed with endometrial cancer. There are currently no routine screening techniques for endometrial cancer in the general population. It is predominantly a disease of affluent, obese, postmenopausal women of low parity. Over the last few decades, age-standardized incidence rates have risen in most countries and in urban populations. Developing countries and Japan have incidence rates four to five times lower than western industrialized nations, with the lowest rates being in India and south Asia. There are currently no routine screening techniques for endometrial cancer in the general population. The vast majority of women have early-stage disease at diagnosis owing to postmenopausal bleeding. The American Cancer Society (ACS) has recommended that at the time of menopause, the average-risk woman should be informed about the risks for symptoms of endometrial cancer and be strongly encouraged to report any unexpected bleeding or spotting to her gynecologist. When appropriate, genetic counseling and testing should be offered.Read More

The carcinoma of the endometrium is easily diagnosed, but the well-differentiated cancers may be difficult to separate from advanced atypical hyperplasia. This document also outlines the rationale for the use of chemotherapy in selected patients with endometrial cancer. In a disease long regarded as the province of the surgeon and radiation oncologist, a new look at chemotherapy is producing promising results. After the diagnosis of endometrial carcinoma has been histologically confirmed, the patient should undergo a thorough evaluation. A complete physical examination can discover suspicious lymph nodes and areas of spread within the pelvis. These patients often have other medical problems that must be evaluated for their effect on treatment choices for the cancer.Read More

Although ovarian cancer is the second most common female reproductive cancer, preceded by cancer of the uterus, more women die from ovarian cancer than from cervical and uterine cancers combined. Ovarian cancer remains the most lethal of the gynecologic malignancies. The role of the generalist obstetricians -- gynecologists and primary care physicians in early detection of ovarian cancer is also defined in this article. Recommended cancer-screening protocols in women with high-risk is also discussed. Data suggest that currently available screening tests do not appear to be beneficial for screening low-risk, asymptomatic women. An annual gynecologic examination with an annual pelvic examination is recommended for preventive health care. Approximately one in 70 women will develop ovarian cancer in their lifetime. This increases to 4% to 6% if there is a family history in a first-degree relative.Read More

Ovarian cancer remains the most lethal of gynecologic malignancies, and its mortality exceeds the combined mortality from both cervical and endometrial cancer in the United States. Ovarian malignancy is the fourth most common cause of cancer death in American women and accounts for 5% of all cancer deaths. Insightful overview of the current understanding of the ovarian malignancy as well as the areas of continuing challenges are also discussed in this series of the articles exploring different aspects of ovarian cancer. While therapy for ovarian malignancy has undergone important progress, there is growing concern about the quality of life of these patients. The contributors to this symposium include many of the experts who have advanced the management of this disease, and their articles thoughtfully describe the progress and point to future areas of reproductive research.Read More

Germ cell tumors represent a relatively small proportion (~20%) of all ovarian tumors, but are becoming increasingly important in the clinical practice of obstetrics and gynecology. Malignant germ cell tumors of the ovary account forRead More