Gynecologic Malignancies in the Elderly

  • Dan-Arin Silasi
  • Peter E. Schwartz
  • Thomas J. Rutherford


Pelvic reproductive organ cancers include those that arise in the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. In the United States, the number of persons over 65 years of age has been increasing at a disproportionately higher rate than that of the general population. According to the U.S. Census Bureau, the percentage of women 65 years of age and older has increased from 13.1% in 1980 to 14.6% in 1990.


Ovarian Cancer Cervical Cancer Sentinel Lymph Node Human Papilloma Virus Radical Hysterectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Jemal A, Siegel R, Ward E et al (2007) Cancer statistics, 2007. CA Cancer J Clin 57(1):43–66PubMedCrossRefGoogle Scholar
  2. 2.
    Saraiya M, Watson M, Wu X et al (2008) Incidence of in situ and invasive vulvar cancer in the US, 1998-2003. Cancer 113(10):2865–2872PubMedCrossRefGoogle Scholar
  3. 3.
    Van Beurden M, Kate FJ, Smits HL et al (1995) Multifocal vulvar intraepithelial neoplasia grade III and multicentric lower genital tract neoplasia is associated with transcriptionally active human papilloma virus. Cancer 75:2879–2884PubMedCrossRefGoogle Scholar
  4. 4.
    Insinga RP, Liaw KL, Johnson LG et al (2008) A systematic review of the prevalence and attribution of human papillomavirus types among cervical, vaginal, and vulvar precancers and cancers in the United States. Cancer Epidemiol Biomarkers Prev 17(7):1611–1622PubMedCrossRefGoogle Scholar
  5. 5.
    de Koning MN, Quint WG, Pirog EC (2008) Prevalence of mucosal and cutaneous human papillomaviruses in different histologic subtypes of vulvar carcinoma. Mod Pathol 21(3):334–344PubMedCrossRefGoogle Scholar
  6. 6.
    Fishman DA, Chambers SK, Kohorn EI et al (1995) Extra-mammary Paget’s disease of the vulva. Gynecol Oncol 56:266–270PubMedCrossRefGoogle Scholar
  7. 7.
    Lloyd J, Flanagan AM (2000) Mammary and extramammary Paget’s disease. J Clin Pathol 53:742–749PubMedCrossRefGoogle Scholar
  8. 8.
    De Simone P, Silipo V, Buccini P et al (2008) Vulvar melanoma: a report of 10 cases and review of the literature. Melanoma Res 18(2):127–133PubMedCrossRefGoogle Scholar
  9. 9.
    Lopez-Varela E, Oliva E, McIntyre JF et al (2007) Primary treatment of Bartholin’s gland carcinoma with radiation and chemoradiation: a report on ten consecutive cases. Int J Gynecol Cancer 17(3):661–667PubMedCrossRefGoogle Scholar
  10. 10.
    Jones RW, Baranyai J, Stables S (1997) Trends in squamous cell carcinoma of the vulva: the influence of vulvar intraepithelial neoplasia. Obstet Gynecol 90:448–452PubMedCrossRefGoogle Scholar
  11. 11.
    Roma AA, Hart WR (2007) Progression of simplex (differentiated) vulvar intraepithelial neoplasia to invasive squamous cell carcinoma: a prospective case study confirming its precursor role in the pathogenesis of vulvar cancer. Int J Gynecol Pathol 26(3):248–253PubMedCrossRefGoogle Scholar
  12. 12.
    Hussain SK, Madeleine MM, Johnson LG et al (2008) Cervical and vulvar cancer risk in relation to the joint effects of cigarette smoking and genetic variation in interleukin 2. Cancer Epidemiol Biomarkers Prev 17(7):1790–1799PubMedCrossRefGoogle Scholar
  13. 13.
    van der Avoort IA, Shirango H, Hoevenaars BM et al (2006) Vulvar squamous cell carcinoma is a multifactorial disease following two separate and independent pathways. Int J Gynecol Pathol 25(1):22–29PubMedCrossRefGoogle Scholar
  14. 14.
    Hillemanns P, Wang X, Staehle S et al (2006) Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO(2) laser vaporization, photodynamic therapy, excision and vulvectomy. Gynecol Oncol 100(2):271–275PubMedCrossRefGoogle Scholar
  15. 15.
    Hatta N, Yamada M, Hirano T et al (2008) Extramammary Paget’s disease: treatment, prognostic factors and outcome in 76 patients. Brit J Dermatol 158(2):313–318Google Scholar
  16. 16.
    DeSimone CP, Crisp MP, Ueland FR et al (2006) Concordance of gross surgical and final fixed margins in vulvar intraepithelial neoplasia 3 and vulvar cancer. J Reprod Med 51(8):617–620PubMedGoogle Scholar
  17. 17.
    Lee PK, Choi MS, Ahn ST et al (2006) Gluteal fold V-Y advancement flap for vulvar and vaginal reconstruction: a new flap. Plast Reconstr Surg 118(2):401–406PubMedCrossRefGoogle Scholar
  18. 18.
    Black D, Tornos C, Soslow RA et al (2007) The outcomes of patients with positive margins after excision for intraepithelial Paget’s disease of the vulva. Gynecol Oncol 104(3):547–550PubMedCrossRefGoogle Scholar
  19. 19.
    Homesley HD (1995) Management of vulvar cancer. Cancer 76:2159–2170PubMedCrossRefGoogle Scholar
  20. 20.
    Stehman FB, Bundy BW, Dvoretsky PM et al (1992) Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group. Obstet Gynecol 79:490–497PubMedGoogle Scholar
  21. 21.
    Morris JM (1977) A formula for selective lymphadenectomy: its application to cancer of the vulva. Obstet Gynecol 50:152–158PubMedGoogle Scholar
  22. 22.
    Rouzier R, Haddad B, Atallah D et al (2005) Surgery for vulvar cancer. Clin Obstet Gynecol 48(4):869–878PubMedCrossRefGoogle Scholar
  23. 23.
    Fanfani F, Garganese G, Fagotti A et al (2006) Advanced vulvar carcinoma: is it worth operating? A perioperative management protocol for radical and reconstructive surgery. Gynecol Oncol 103(2):467–472PubMedCrossRefGoogle Scholar
  24. 24.
    de Hullu JA, van der Avoort IA, Oonk MH et al (2006) Management of vulvar cancers. Eur J of Surg Oncol 32(8):825–831CrossRefGoogle Scholar
  25. 25.
    Moore RG, DePasquale S, Steinhoff MM et al (2003) Sentinel node identification and the ability to detect metastatic tumor to inguinal lymph nodes in vulvar malignancies. Gynecol Oncol 89(3):475–479PubMedCrossRefGoogle Scholar
  26. 26.
    Levenback C, Coleman RL, Burke TW et al (2001) Intraoperative lymphatic mapping and sentinel node identification with blue dye in patients with vulvar cancer. Gynecol Oncol 83(2):276–281PubMedCrossRefGoogle Scholar
  27. 27.
    de Hullu JA, Hollema H, Piers DA et al (2000) Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva. J Clin Oncol 18(15):2811–2816PubMedGoogle Scholar
  28. 28.
    Decesare SL, Fiorica JV, Roberts WS et al (1997) A pilot study utilizing intraoperative lymphoscintigraphy for identification of the sentinel lymph nodes in vulvar cancer. Gynecol Oncol 66(3):425–428PubMedCrossRefGoogle Scholar
  29. 29.
    Robison K, Steinhoff MM, Granai CO et al (2006) Inguinal sentinel node dissection versus standard inguinal node dissection in patients with vulvar cancer: a comparison of the size of metastasis detected in inguinal lymph nodes. Gynecol Oncol 101(1):24–27PubMedCrossRefGoogle Scholar
  30. 30.
    Hampl M, Hantschmann P, Michels W, German Multicenter Study Group et al (2008) Validation of the accuracy of the sentinel lymph node procedure in patients with vulvar cancer: results of a multicenter study in Germany. Gynecol Oncol 111(2):282–288PubMedCrossRefGoogle Scholar
  31. 31.
    Johann S, Klaeser B, Krause T et al (2008) Comparison of outcome and recurrence-free survival after sentinel lymph node biopsy and lymphadenectomy in vulvar cancer. Gynecol Oncol 110(3):324–328PubMedCrossRefGoogle Scholar
  32. 32.
    Hefler LA, Grimm C, Six L et al (2008) Inguinal sentinel lymph node dissection vs. complete inguinal lymph node dissection in patients with vulvar cancer. Anticancer Res 28((1B):515–517Google Scholar
  33. 33.
    Landrum LM, Skaggs V, Gould N et al (2008) Comparison of outcome measures in patients with advanced squamous cell carcinoma of the vulva treated with surgery or primary chemoradiation. Gynecol Oncol 108(3):584–590PubMedCrossRefGoogle Scholar
  34. 34.
    Parthasarathy A, Cheung MK, Osann K et al (2006) The benefit of adjuvant radiation therapy in single-node-positive squamous cell vulvar carcinoma. Gynecol Oncol 103(3):1095–1099PubMedCrossRefGoogle Scholar
  35. 35.
    Micha JP, Goldstein BH, Rettenmaier MA et al (2006) Pelvic radiation necrosis and osteomyelitis following chemoradiation for advanced stage vulvar and cervical carcinoma. Gynecol Oncol 101(2):349–352PubMedCrossRefGoogle Scholar
  36. 36.
    Landoni F, Maneo A, Zanetta G et al (1996) Concurrent preoperative chemotherapy with 5-fluorouracil and mitomycin C and radiotherapy (FUMIR) followed by limited surgery in locally advanced and recurrent vulva carcinoma. Gynecol Oncol 61:321–327PubMedCrossRefGoogle Scholar
  37. 37.
    Cunningham MJ, Goyer RP, Gibbons SK et al (1997) Primary radiation, cisplatin and 5-fluorouracil for advanced squamous carcinoma of the vulva. Gynecol Oncol 66:258–261PubMedCrossRefGoogle Scholar
  38. 38.
    Wagenaar HC, Colombo N, Vergote I et al (2001) Bleomycin, methotrexate, and CCNU in locally advanced or recurrent, inoperable, squamous-cell carcinoma of the vulva: an EORTC gynaecological cancer cooperative group study. European organization for research and treatment of cancer. Gynecol Oncol 81:348–354PubMedCrossRefGoogle Scholar
  39. 39.
    Han SC, Kim DH, Higgins SA et al (2000) Chemoradiation as primary or adjuvant treatment for locally advanced carcinoma of the vulva. Int J Radiat Oncol Biol Phys 47:1235–1244PubMedCrossRefGoogle Scholar
  40. 40.
    Mulayim N, Mulayim N, Foster Silver D, Schwartz PE et al (2004) Chemoradiation with 5-fluorouracil and mitomycin C in the treatment of vulvar squamous cell carcinoma. Gynecol Oncol 93(3):659–666PubMedCrossRefGoogle Scholar
  41. 41.
    Burger MPM, Hollema H, Emanuels AG et al (1995) The importance of the groin node status for the survival of T1 and T2 vulvar carcinoma patients. Gynecol Oncol 57:334–337CrossRefGoogle Scholar
  42. 42.
    Beller V, Sideri M, Maisonneuve P et al (2001) Carcinoma of the vagina: 24th annual report on the results of treatment in gynecological cancer. J Epidemiol Biostat 6:141–152PubMedGoogle Scholar
  43. 43.
    Wu X, Matanoski G, Chen VW (2008) Descriptive epidemiology of vaginal cancer and survival by race, ethnicity, and age in the United States. Cancer 113(10):2873–2882PubMedCrossRefGoogle Scholar
  44. 44.
    Beller U, Benedet JL, Creasman WT et al (2006) Carcinoma of the vagina. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet 95:S29–S42PubMedCrossRefGoogle Scholar
  45. 45.
    Takai N, Kai N, Hirata Y et al (2008) Primary malignant melanoma of the vagina. Eur J Gynaecol Oncol 29(5):558–559PubMedGoogle Scholar
  46. 46.
    Fu YS (2002) Pathology of the uterine cervix, vagina and vulva, 2nd edn. Saunders, PhiladelphiaGoogle Scholar
  47. 47.
    Daling J, Madeleine M, Schwartz S et al (2002) A population based study of squamous cell vaginal cancer: HPV and cofactors. Gynecol Oncol 84:263–270PubMedCrossRefGoogle Scholar
  48. 48.
    Hellman K, Silfversward C, Nilsson B et al (2004) Primary carcinoma of the vagina: factors influencing the age at diagnosis. The Radiumhemmet series 1956-96. Int J Gynecol Cancer 14:491–501PubMedCrossRefGoogle Scholar
  49. 49.
    Carter JJ, Madeleine MM, Shera K et al (2001) Human papillomavirus 16 and 18 L1 serology compared across anogenital cancer sites. Cancer Res 61:1934–1940PubMedGoogle Scholar
  50. 50.
    Indraccolo U, Chiocci L, Baldoni A (2008) Does vaginal intraepithelial neoplasia have the same evolution as cervical intraepithelial neoplasia? Eur J Gynaecol Oncol 29(4):371–373PubMedGoogle Scholar
  51. 51.
    Schockaert S, Poppe W, Arbyn M et al (2008) Incidence of vaginal intraepithelial neoplasia after hysterectomy for cervical intraepithelial neoplasia: a retrospective study. Am J Obstet Gynecol 199(2):113.e1–113.e5CrossRefGoogle Scholar
  52. 52.
    Gonzalez BE, Torres A, Busquets M (2008) Prognostic factors for the development of vaginal intraepithelial neoplasia. Eur J Gynaecol Oncol 29(1):43–45Google Scholar
  53. 53.
    Srodon M, Stoler MH, Baber GB, Kurman RJ (2007) The distribution of low and high-risk HPV types in vulvar and vaginal intraepithelial neoplasia (VIN and VaIN). Am J Surg Pathol 31(9):1452–1454Google Scholar
  54. 54.
    Stock RG, Chen AS, Seski J (1995) A 30 year experience in the management of primary carcinoma of the vagina: analysis of prognostic factors and treatment modalities. Gynecol Oncol 56:45–52PubMedCrossRefGoogle Scholar
  55. 55.
    Benedetti PP, Bellati F, Plotti F (2008) Neoadjuvant chemotherapy followed by radical surgery in patients affected by vaginal carcinoma. Gynecol Oncol 111(2):307–311CrossRefGoogle Scholar
  56. 56.
    Nashiro T, Yagi C, Hirakawa M et al (2008) Concurrent chemoradiation for locally advanced squamous cell carcinoma of the vagina: case series and literature review. Int J Clin Oncol 13(4):335–339PubMedCrossRefGoogle Scholar
  57. 57.
    Beller V, Sideri M, Maisonneuve P (2001) Carcinoma of the vagina: 24th annual report on the results of treatment in gynecological cancer. J Epidemiol Biostat 6:141–152PubMedGoogle Scholar
  58. 58.
    Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58(2):71–96PubMedCrossRefGoogle Scholar
  59. 59.
    Smith HO, Tiffany MF, Qualls CR et al (2000) The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States: a 24 year population-based study. Gynecol Oncol 78:97–105PubMedCrossRefGoogle Scholar
  60. 60.
    Duggan MA, McGregor SE, Benoit JL (1995) The human papilloma virus status of invasive cervical adenocarcinoma: a clinico-pathological and outcome analysis. Hum Pathol 26:319–325PubMedCrossRefGoogle Scholar
  61. 61.
    dos Reis R, Frumovitz M, Milam MR et al (2007) Adenosquamous carcinoma versus adenocarcinoma in early-stage cervical cancer patients undergoing radical hysterectomy: an outcomes analysis. Gynecol Oncol 107(3):458–463PubMedCrossRefGoogle Scholar
  62. 62.
    De Vuyst H, Clifford GM, Nascimento MC et al (2009) Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer 124(7):1626–1636PubMedCrossRefGoogle Scholar
  63. 63.
    Li W, Wang W, Si M et al (2008) The physical state of HPV16 infection and its clinical significance in cancer precursor lesion and cervical carcinoma. J Cancer Res Clin 134(12):1355–1361CrossRefGoogle Scholar
  64. 64.
    Lee SW, Kim YM, Son WS et al (2009) The efficacy of conservative management after conization in patients with stage IA1 microinvasive cervical carcinoma. Acta Obstet Gynecol Scand 88(2):209–215PubMedCrossRefGoogle Scholar
  65. 65.
    Yen TC, Lai CH, Ma SY et al (2006) Comparative benefits and limitations of 18F-FDG PET and CT-MRI in documented or suspected recurrent cervical cancer. Eur J Nucl Med Mol Imaging 33(12):1399–1407PubMedCrossRefGoogle Scholar
  66. 66.
    Mitchell DG, Snyder B, Coakley F et al (2009) Early invasive cervical cancer: MRI and CT predictors of lymphatic metastases in the ACRIN 6651/GOG 183 intergroup study. Gynecol Oncol 112(1):95–103PubMedCrossRefGoogle Scholar
  67. 67.
    Piver MS, Rutledge F, Smith JP (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 44:265–272PubMedGoogle Scholar
  68. 68.
    Nezhat FR, Datta MS, Liu C et al (2008) Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer. J Soc Laparoendosc Surg 12(3):227–237Google Scholar
  69. 69.
    Obermair A, Gebski V, Frumovitz M et al (2008) A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. J Minim Invasive Gynecol 15(5):584–588PubMedCrossRefGoogle Scholar
  70. 70.
    Hosaka M, Watari H, Takeda M et al (2008) Treatment of cervical cancer with adjuvant chemotherapy versus adjuvant radiotherapy after radical hysterectomy and systematic lymphadenectomy. J Obstet Gynaecol Res 34(4):552–556PubMedCrossRefGoogle Scholar
  71. 71.
    Goksedef BP, Kunos C, Belinson JL et al (2009) Concurrent cisplatin-based chemoradiation International Federation of Gyne­cology and Obstetrics stage IB2 cervical carcinoma. Am J Obstet Gynecol 200(2):175.e1–175.e5CrossRefGoogle Scholar
  72. 72.
    Ohara K, Tanaka YO, Oki A et al (2008) Comparison of tumor regression rate of uterine cervical squamous cell carcinoma during external beam and intracavitary radiotherapy. Radiat Med 26(9):526–532PubMedCrossRefGoogle Scholar
  73. 73.
    Huguet F, Cojocariu OM, Levy P et al (2008) Preoperative concurrent radiation therapy and chemotherapy for bulky stage IB2, IIA, and IIB carcinoma of the uterine cervix with proximal parametrial invasion. Int J Radiat Oncol 72(5):1508–1515CrossRefGoogle Scholar
  74. 74.
    Zivanovic O, Alektiar KM, Sonoda Y et al (2008) Treatment patterns of FIGO Stage IB2 cervical cancer: a single-institution experience of radical hysterectomy with individualized postoperative therapy and definitive radiation therapy. Gynecol Oncol 111(2):265–270PubMedCrossRefGoogle Scholar
  75. 75.
    Walker JL, Morrison A, DiSilvestro P, Gynecologic Oncology Group et al (2009) A phase I/II study of extended field radiation therapy with concomitant paclitaxel and cisplatin chemotherapy in patients with cervical carcinoma metastatic to the para-aortic lymph nodes: a Gynecologic Oncology Group study. Gynecol Oncol 112(1):78–84PubMedCrossRefGoogle Scholar
  76. 76.
    Kapp DS, Fischer D, Gutierrez E et al (1983) Pretreatment prognostic factors in carcinoma of the uterine cervix: a multivariate analysis of the effect of age, stage, histology and blood counts on survival. Int J Radiat Oncol Biol Phys 9:445–455PubMedCrossRefGoogle Scholar
  77. 77.
    Haasbeek CJ, Uitterhoeve AL, van der Velden J et al (2008) Long-term results of salvage radiotherapy for the treatment of recurrent cervical carcinoma after prior surgery. Radiother Oncol 89(2):197–204PubMedCrossRefGoogle Scholar
  78. 78.
    Magrina HF, Stanhope CR, Weaver AL (1997) Pelvic exenterations: supralevator, infralevator and with vulvectomy. Gynecol Oncol 64:130–135PubMedCrossRefGoogle Scholar
  79. 79.
    Penalven MA, Barreau G, Sevin BU et al (1996) Surgery for the treatment of locally recurrent disease. J Natl Cancer Inst 21:117–122Google Scholar
  80. 80.
    Vergote IB (1997) Exenterative surgery. Curr Opin Obstet Gynecol 9:25–28PubMedCrossRefGoogle Scholar
  81. 81.
    Rose PG, Blessing JA, Gershensen DM et al (1999) Paclitaxel and cisplatin as first-line therapy in recurrent or advanced squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol 17:2676–2680PubMedGoogle Scholar
  82. 82.
    Ahmed A, Zamba G, DeGeest K et al (2008) The impact of surgery on survival of elderly women with endometrial cancer in the SEER program from 1992-2002. Gynecol Oncol 111(1):35–40PubMedCrossRefGoogle Scholar
  83. 83.
    Levy T, Golan A, Menczer J (2006) Endometrial endometrioid carcinoma: a glimpse at the natural course. Am J Obstet Gynecol 195(2):454–457PubMedCrossRefGoogle Scholar
  84. 84.
    Cirisano FD Jr, Robboy SJ, Dodge RK et al (1999) Epidemiologic and surgicopathologic findings of papillary serous and clear cell endometrial cancers when compared to endometrioid carcinoma. Gynecol Oncol 74(3):385–394PubMedCrossRefGoogle Scholar
  85. 85.
    Spaziani E, Picchio M, Petrozza V et al (2008) Carcinosarcoma of the uterus: a case report and review of the literature. Eur J Gynaecol Oncol 29(5):531–534PubMedGoogle Scholar
  86. 86.
    Lin JF, Slomovitz BM (2008) Uterine sarcoma 2008. Curr Oncol Rep 10(6):512–518PubMedCrossRefGoogle Scholar
  87. 87.
    Albert RH, Clark MM (2008) Cancer screening in the older patient. Am Fam Phys 78(12):1369–1374Google Scholar
  88. 88.
    Patel C, Ullal A, Roberts M et al (2009) Endometrial carcinoma detected with SurePath liquid-based cervical cytology: comparison with conventional cytology. Cytopathology 20(6):380–387PubMedCrossRefGoogle Scholar
  89. 89.
    Leitao MM Jr, Kehoe S, Barakat RR et al (2009) Comparison of D&C and office endometrial biopsy accuracy in patients with FIGO grade 1 endometrial adenocarcinoma. Gynecol Oncol 113(1):105–108PubMedCrossRefGoogle Scholar
  90. 90.
    Sierecki AR, Gudipudi DK, Montemarano N et al (2008) Comparison of endometrial aspiration biopsy techniques: specimen adequacy. J Reprod Med 53(10):760–764PubMedGoogle Scholar
  91. 91.
    Kurman RK, Kaminski PF, Norris HJ (1985) The behavior of endometrial hyperplasia: a long-term study of “untreated” hyperplasia in 170 patients. Cancer 56:403–412PubMedCrossRefGoogle Scholar
  92. 92.
    Mittal K, Sebenik M, Irwin C et al (2009) Presence of endometrial adenocarcinoma in situ in complex atypical endometrial hyperplasia is associated with increased incidence of endometrial carcinoma in subsequent hysterectomy. Mod Pathol 22(1):37–42PubMedCrossRefGoogle Scholar
  93. 93.
    McKenney JK, Longacre TA (2009) Low-grade endometrial adenocarcinoma: a diagnostic algorithm for distinguishing atypical endometrial hyperplasia and other benign (and malignant) mimics. Adv Anat Pathol 16(1):1–22PubMedCrossRefGoogle Scholar
  94. 94.
    Geisler JP, Geisler HE, Melton ME et al (1999) What staging surgery should be performed on patients with uterine papillary serous carcinoma? Gynecol Oncol 74(3):465–467PubMedCrossRefGoogle Scholar
  95. 95.
    Bristow RE, Asrari F, Trimble EL et al (2001) Extended surgical staging for uterine papillary serous carcinoma: survival outcome of locoregional (stage I-III) disease. Gynecol Oncol 81(2):279–286PubMedCrossRefGoogle Scholar
  96. 96.
    Chan JK, Loizzi V, Youssef M et al (2003) Significance of comprehensive surgical staging in noninvasive papillary serous carcinoma of the endometrium. Gynecol Oncol 90(1):181–185PubMedCrossRefGoogle Scholar
  97. 97.
    Mendivil A, Schuler KM, Gehrig PA (2009) Non-endometrioid adenocarcinoma of the uterine corpus: a review of selected histological subtypes. Cancer Control 16(1):46–52PubMedGoogle Scholar
  98. 98.
    Seamon LG, Cohn DE, Henretta MS et al (2009) Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? Gynecol Oncol 113(1):36–41PubMedCrossRefGoogle Scholar
  99. 99.
    Zullo F, Palomba S, Falbo A et al (2009) Laparoscopic surgery vs laparotomy for early stage endometrial cancer: long-term data of a randomized controlled trial. Am J Obstet Gynecol 200(3):296.e1–296.e9CrossRefGoogle Scholar
  100. 100.
    Neubauer NL, Havrilesky LJ, Calingaert B et al (2009) The role of lymphadenectomy in the management of preoperative grade 1 endometrial carcinoma. Gynecol Oncol 112(3):511–516PubMedCrossRefGoogle Scholar
  101. 101.
    Frederick PJ, Straughn JM Jr (2009) The role of comprehensive surgical staging in patients with endometrial cancer. Cancer Control 16(1):23–29PubMedGoogle Scholar
  102. 102.
    Creutzberg CL, van Putten WL, Koper PC et al (2000) Surgery and postoperative radiation versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomized trial. Lancet 355:1401–1411CrossRefGoogle Scholar
  103. 103.
    Kuoppala T, Mäenpää J, Tomas E et al (2008) Surgically staged high-risk endometrial cancer: randomized study of adjuvant radiotherapy alone vs. sequential chemo-radiotherapy. Gynecol Oncol 110:190–195PubMedCrossRefGoogle Scholar
  104. 104.
    Fleming GF, Brunetto VL, Cella D et al (2004) Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 22:2159–2166PubMedCrossRefGoogle Scholar
  105. 105.
    Randall ME, Filiaci VL, Muss H et al (2006) Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol 24:36–44PubMedCrossRefGoogle Scholar
  106. 106.
    Linkov F, Taioli E (2008) Factors influencing endometrial cancer mortality: the Western Pennsylvania Registry. Future Oncol 4(6):857–865PubMedCrossRefGoogle Scholar
  107. 107.
    Shenfield CB, Pearcey RG, Ghosh S et al (2009) The management of inoperable Stage I endometrial cancer using intracavitary brachytherapy alone: a 20-year institutional review. Brachytherapy 8(3):278–283PubMedCrossRefGoogle Scholar
  108. 108.
    Fishman DA, Roberts KB, Chambers JT et al (1996) Radiation therapy as exclusive treatment for medically inoperable patients with stage I and II endometrioid carcinoma of the endometrium. Gynecol Oncol 61:189–196PubMedCrossRefGoogle Scholar
  109. 109.
    Temkin SM, Fleming G (2009) Current treatment of metastatic endometrial cancer. Cancer Control 16(1):38–45PubMedGoogle Scholar
  110. 110.
    Homesley HD, Filiaci V, Gibbons SK et al (2009) A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: A Gynecologic Oncology Group study. Gynecol Oncol 112(3):543–552PubMedCrossRefGoogle Scholar
  111. 111.
    Blake P, Swart AM, Orton J, ASTEC/EN.5 Study Group et al (2009) Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet 373(9658):137–146PubMedCrossRefGoogle Scholar
  112. 112.
    Fowler JM, Brady WE, Grigsby PW et al (2009) Sequential chemotherapy and irradiation in advanced stage endometrial cancer: A Gynecologic Oncology Group phase I trial of doxorubicin-cisplatin followed by whole abdomen irradiation. Gynecol Oncol 112(3):553–557PubMedCrossRefGoogle Scholar
  113. 113.
    Fujimoto T, Nanjyo H, Fukuda J et al (2009) Endometrioid uterine cancer: histopathological risk factors of local and distant recurrence. Gynecol Oncol 112(2):342–347PubMedCrossRefGoogle Scholar
  114. 114.
    Indraccolo U, Luchetti G, Indraccolo SR (2008) Malignant transformation of uterine leiomyomata. Eur J Gynaecol Oncol 29(5):543–544PubMedGoogle Scholar
  115. 115.
    Wu TI, Hsu KH, Huang HJ et al (2008) Prognostic factors and adjuvant therapy in uterine carcinosarcoma. Eur J Gynaecol Oncol 29(5):483–488PubMedGoogle Scholar
  116. 116.
    Landreat V, Paillocher N, Catala L et al (2008) Low-grade endometrial stromal sarcoma of the uterus: review of 10 cases. Anticancer Res 28(5B):2869–2874PubMedGoogle Scholar
  117. 117.
    Hannigan EV, Gomez LG (1979) Uterine leiomyosarcoma. Am J Obstet Gynecol 134:557–564PubMedGoogle Scholar
  118. 118.
    Hensley ML, Blessing JA, Mannel R et al (2008) Fixed-dose rate gemcitabine plus docetaxel as first-line therapy for metastatic uterine leiomyosarcoma: a Gynecologic Oncology Group phase II trial. Gynecol Oncol 109(3):329–334PubMedCrossRefGoogle Scholar
  119. 119.
    Reed NS, Mangioni C, Malmstrom H et al (2008) Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). Eur J Cancer 44(11):1612CrossRefGoogle Scholar
  120. 120.
    Resnik E, Chambers SK, Carcangiu ML et al (1996) Malignant uterine smooth muscle tumors: role of etoposide, cisplatin and doxorubicin (EPA) chemotherapy. J Surg Oncol 63:145–147PubMedCrossRefGoogle Scholar
  121. 121.
    Kasper B, Dietrich S, Mechtersheimer G et al (2007) Large institutional experience with dose-intensive chemotherapy and stem cell support in the management of sarcoma patients. Oncology 73(1–2):58–64PubMedCrossRefGoogle Scholar
  122. 122.
    Long HJ 3rd, Blessing JA, Sorosky J (2005) Phase II trial of dacarbazine, mitomycin, doxorubicin, and cisplatin with sargramostim in uterine leiomyosarcoma: a Gynecologic Oncology Group study. Gynecol Oncol 99(2):339–342PubMedCrossRefGoogle Scholar
  123. 123.
    Wolfson AH, Brady MF, Rocereto T et al (2007) A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatin-ifosfamide and mesna (CIM) as post-surgical therapy in stage I-IV carcinosarcoma (CS) of the uterus. Gynecol Oncol 107(2):177–185PubMedCrossRefGoogle Scholar
  124. 124.
    Homesley HD, Filiaci V, Markman M et al (2007) Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study. J Clin Oncol 25(5):526–531PubMedCrossRefGoogle Scholar
  125. 125.
    Nemani D, Mitra N, Guo M et al (2008) Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol 111(1):82–88PubMedCrossRefGoogle Scholar
  126. 126.
    Pautier P, Rey A, Haie-Meder C et al (2004) Adjuvant chemotherapy with cisplatin, ifosfamide, and doxorubicin followed by radiotherapy in localized uterine sarcomas: results of a case-control study with radiotherapy alone. Int J Gynecol Cancer 14(6):1112–1117PubMedCrossRefGoogle Scholar
  127. 127.
    Goodman MT, Shvetsov YB (2009) Incidence of ovarian, peritoneal, and fallopian tube carcinomas in the United States, 1995-2004. Cancer Epidemiol Biomarkers Prev 18(1):132–139PubMedCrossRefGoogle Scholar
  128. 128.
    Baekelandt M, Kockx M, Wesling F et al (1993) Primary adenocarcinoma of the fallopian tube: review of the literature. Int J Gynecol Cancer 3:65–71PubMedCrossRefGoogle Scholar
  129. 129.
    Leath CA 3rd, Numnum TM, Straughn JM Jr et al (2007) Outcomes for patients with fallopian tube carcinoma managed with adjuvant chemotherapy following primary surgery: a retrospective university experience. Int J Gynecol Cancer 17(5):998–1002PubMedCrossRefGoogle Scholar
  130. 130.
    Arora N, Tewari D, Cowan C et al (2008) Bevacizumab demonstrates activity in advanced refractory fallopian tube carcinoma. Int J Gynecol Cancer 18(2):369–372PubMedCrossRefGoogle Scholar
  131. 131.
    Rosen AC, Klein M, Rosen HR et al (1994) Preoperative and postoperative CA-125 serum levels in primary fallopian tube carcinoma. Arch Gynecol Obstet 255:665–668CrossRefGoogle Scholar
  132. 132.
    Pectasides D, Pectasides E, Economopoulos T (2006) Fallopian tube carcinoma: a review. Oncologist 11(8):902–912PubMedCrossRefGoogle Scholar
  133. 133.
    Benedet JL, Miller DM (1992) Tumors of fallopian tube: clinical features, staging and management. In: Coppleson M, Monoghan JM, Morrow CP et al (eds) Gynecologic oncology: fundamental principles and clinical practice. Churchill Livingstone, Edinburgh, pp 853–860Google Scholar
  134. 134.
    US Cancer Statistics Working Group. United States Cancer Statistics: 1999–2005 Incidence and Mortality Web-Based Report.
  135. 135.
    Permuth-Wey J, Sellers TA (2009) Epidemiology of ovarian cancer. Methods Mol Biol 472:413–437PubMedCrossRefGoogle Scholar
  136. 136.
    Minino AM, Heron MP, Smith BL (2006) Deaths: preliminary data for 2004. Natl Vital Stat Rep 54(19):1–50Google Scholar
  137. 137.
    Aletti GD, Podratz KC, Moriarty JP et al (2009) Aggressive and complex surgery of advanced ovarian cancer: an economic analysis. Gynecol Oncol 112(1):16–21PubMedCrossRefGoogle Scholar
  138. 138.
    Barnholtz-Sloan JS, Schwartz AG, Qureshi F et al (2003) Ovarian cancer: changes in patterns at diagnosis and relative survival over the last three decades. Am J Obstet Gynecol 189:1120–1127PubMedCrossRefGoogle Scholar
  139. 139.
    Nguyen HN, Averette HE, Janicek M (2004) Ovarian carcinoma. A review of the significance of familial risk factors and the role of prophylactic oophorectomy in cancer prevention. Cancer 74:545–555CrossRefGoogle Scholar
  140. 140.
    Stratton JF, Pharoah P, Smith SK et al (1998) A systematic review and meta-analysis of family history and risk of ovarian cancer. Brit J Obstet Gynaecol 105:493–499CrossRefGoogle Scholar
  141. 141.
    Sutcliffe S, Pharoah PD, Easton DF et al (2000) Ovarian and breast cancer risks to women in families with two or more cases of ovarian cancer. Int J Cancer 87:110–117PubMedCrossRefGoogle Scholar
  142. 142.
    Risch HA, McLaughlin JR, Cole DE et al (2001) Prevalence and penetrance of germline BRCA1 and BRCA2 mutations in a population series of 649 women with ovarian cancer. Am J Hum Genet 68:700–710PubMedCrossRefGoogle Scholar
  143. 143.
    Ford D, Easton DF, Bishop DT et al (1994) Risks of cancer in BRCA1-mutation carriers. Breast Cancer Linkage Consortium. Lancet 343:692–695PubMedCrossRefGoogle Scholar
  144. 144.
    Rebbeck TR, Kauff ND, Domchek SM (2009) Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst 101(2):80–87PubMedCrossRefGoogle Scholar
  145. 145.
    Kauff ND, Domcheck SM, Friebel TM et al (2008) Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2- associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol 26(8):1331–1337PubMedCrossRefGoogle Scholar
  146. 146.
    Cannistra SA (1993) Cancer of the ovary. N Engl J Med 329:1550–1559PubMedCrossRefGoogle Scholar
  147. 147.
    Fishman DA, Schwartz PE (1994) Current approaches to the diagnosis and treatment of ovarian germ cell malignancies. Curr Opin Obstet Gynecol 6:98–104PubMedCrossRefGoogle Scholar
  148. 148.
    Price FV, Schwartz PE (1993) Management of ovarian stromal tumors. Ovarian cancer. McGraw Hill, New York, pp 405–423Google Scholar
  149. 149.
    Nicoletto MO, Caltarossa E, Donach M et al (2006) Sertoli cell tumor: a rare case in an elderly patient. Eur J Gynaecol Oncol 27(1):86–87PubMedGoogle Scholar
  150. 150.
    Oliva E, Alvarez T, Young RH (2005) Sertoli cell tumors of the ovary: a clinicopathologic and immunohistochemical study of 54 cases. Am J Surg Pathol 29(2):143–156PubMedCrossRefGoogle Scholar
  151. 151.
    Arai M, Jobo T, Iwaya H et al (1999) Androgen-producing ovarian tumors: a clinicopathological study of 3 cases. J Obstet Gynaecol Res 25(6):411–418PubMedCrossRefGoogle Scholar
  152. 152.
    Silasi DA, Illuzzi JL, Kelly MG et al (2008) Carcinosarcoma of the ovary. Int J Gynecol Cancer 18(1):22–29PubMedCrossRefGoogle Scholar
  153. 153.
    Jiang R, Tang J, Cheng X et al (2009) Surgical treatment for patients with different origins of Krukenberg tumors: outcomes and prognostic factors. Eur J Surg Oncol 35(1):92–97PubMedCrossRefGoogle Scholar
  154. 154.
    Young RH (2007) From Krukenberg to today: the ever present problems posed by metastatic tumors in the ovary. Part II. Adv Anat Pathol 14(3):149–177PubMedCrossRefGoogle Scholar
  155. 155.
    Kiyokawa T, Young RH, Scully RE (2006) Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol 30(3):277–299PubMedGoogle Scholar
  156. 156.
    Cheong JH, Hyung WJ, Chen J et al (2004) Survival benefit of metastasectomy for Krukenberg tumors from gastric cancer. Gynecol Oncol 94(2):477–482PubMedCrossRefGoogle Scholar
  157. 157.
    Wakabayashi MT, Lin PS, Hakim AA (2008) The role of cytoreductive/debulking surgery in ovarian cancer. J Natl Compr Canc Netw 6(8):803–810PubMedGoogle Scholar
  158. 158.
    Goff BA, Matthews BJ, Wynn M et al (2006) Ovarian cancer: patterns of surgical care across the United States. Gynecol Oncol 103(2):383–390PubMedCrossRefGoogle Scholar
  159. 159.
    Fader AN, Rose PG (2007) Role of surgery in ovarian carcinoma. J Clin Oncol 25(20):2873–2883PubMedCrossRefGoogle Scholar
  160. 160.
    Bristow RE, Puri I, Chi DS (2009) Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol 112(1):265–274PubMedCrossRefGoogle Scholar
  161. 161.
    Aletti GD, Dowdy SC, Podratz KC et al (2007) Relationship among surgical complexity, short-term morbidity, and overall survival in primary surgery for advanced ovarian cancer. Am J Obstet Gynecol 197(6):676.e1–676.e7CrossRefGoogle Scholar
  162. 162.
    Winter WE 3rd, Maxwell GL, Tian C et al (2007) Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol 25(24):3621–3627PubMedCrossRefGoogle Scholar
  163. 163.
    Matulonis UA, Krag KJ, Krasner CN et al (2009) Phase II prospective study of paclitaxel and carboplatin in older patients with newly diagnosed Mullerian tumors. Gynecol Oncol 112(2):394–399PubMedCrossRefGoogle Scholar
  164. 164.
    Wethington SL, Herzog TJ, Seshan VE et al (2008) Improved survival for fallopian tube cancer: a comparison of clinical characteristics and outcome for primary fallopian tube and ovarian cancer. Cancer 113(12):3298–3306PubMedCrossRefGoogle Scholar
  165. 165.
    Schwartz PE (1995) Neoadjuvant chemotherapy for advanced ovarian cancer. J Gynecol Tech 1:175–180Google Scholar
  166. 166.
    Schwartz PE, Rutherford TJ, Chambers JT et al (1999) Neoadjuvant chemotherapy for advanced ovarian cancer: long-term survival. Gynecol Oncol 72:93–99PubMedCrossRefGoogle Scholar
  167. 167.
    Markman M (2008) Predictive value of neoadjuvant chemotherapy for the clinical utility of subsequently performed major cancer surgery. Curr Oncol Rep 10(6):447–448PubMedCrossRefGoogle Scholar
  168. 168.
    Chi DS, Schwartz PE (2008) Cytoreduction vs. neoadjuvant chemotherapy for ovarian cancer. Gynecol Oncol 111(3):391–399PubMedCrossRefGoogle Scholar
  169. 169.
    Morrison J, Swanton A, Collins S et al (2007) Chemotherapy ­versus surgery for initial treatment in advanced ovarian epithelial cancer. Cochrane Database Syst Rev 4:CD005343PubMedGoogle Scholar
  170. 170.
    Le T, Alshaikh G, Hopkins L et al (2006) Prognostic significance of postoperative morbidities in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy and delayed primary surgical debulking. Ann Surg Oncol 13(12):1711–1716PubMedCrossRefGoogle Scholar
  171. 171.
    Hou JY, Kelly MG, Yu H et al (2007) Neoadjuvant chemotherapy lessens surgical morbidity in advanced ovarian cancer and leads to improved survival in stage IV disease. Gynecol Oncol 105(1):211–217PubMedCrossRefGoogle Scholar
  172. 172.
    Moore KN, Reid MS, Fong DN et al (2008) Ovarian cancer in the octogenarian: does the paradigm of aggressive cytoreductive surgery and chemotherapy still apply? Gynecol Oncol 110(2):133–139PubMedCrossRefGoogle Scholar
  173. 173.
    Markman M (2008) Pharmaceutical management of ovarian cancer: current status. Drugs 68(6):771–789PubMedCrossRefGoogle Scholar
  174. 174.
    Tebes SJ, Sayer RA, Palmer JM et al (2007) Cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecol Oncol 106(3):482–487PubMedCrossRefGoogle Scholar
  175. 175.
    FIGO Committee on Gynecologic Oncology (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynecol Obstet 105:103–104CrossRefGoogle Scholar
  176. 176.
    Odicino F, Pecorelli S, Zigliani L, Creasman WT (2008) History of the FIGO cancer staging system. Int J Gynecol Obstet 101(2):205–210CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Dan-Arin Silasi
    • 1
  • Peter E. Schwartz
  • Thomas J. Rutherford
  1. 1.Department of Obstetrics and Gynecology/Gynecologic OncologyYale University School of Medicine/Yale New Haven HospitalNew HavenUSA

Personalised recommendations