By Jonathan S. Berek MD MMS, Neville F. Hacker AM MD
- Concise, entire insurance guarantees your entry to present wisdom of basic rules, in addition to clinical and surgical procedure for the whole variety of gynecologic cancers: cervical, breast, ovarian, vulvar and vaginal, and uterine.
- Evidence-based, templated chapters pace you on to the data you need.
- Extensively revised, separate chapters at the most recent recommendations in laparoscopy and robotics preserve you as much as date.
- Expert authorship, together with the services of diverse overseas individuals, retains you on the vanguard of your box and is helping you arrange for board exams.
- New illustrations and drawings, in addition to pathology slides and clinically-relevant diagrams, assist you visualize key concepts.
- Complete content material with more suitable navigation
- A robust seek device that attracts effects from content material within the ebook, your notes, or even the web
- Cross-linked pages, references, and extra for simple navigation
- Highlighting software for simpler reference of key content material in the course of the text
- Ability to take and percentage notes with neighbors and colleagues
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Extra info for Berek and Hacker’s Gynecologic Oncology
Screening and surgical prophylaxis are both employed for colonic and extracolonic malignancies. Surveillance and prophylactic surgery should be considered early (between ages 25 and 35), generally 10 years before the earliest onset of cancer in other relatives who have had a Lynch syndrome-related malignancy (77). Transvaginal ultrasound is used as a screening test for endometrial and ovarian cancer, but there is no strong evidence that this decreases mortality from these cancers (81). There is no evidence that CA125 or other blood markers facilitate early detection of endometrial cancer, but CA125 can be justified as a means of screening for Lynch syndromeassociated ovarian cancer in view of the increased incidence.
For example, loss of PTEN in endometrial cancers is associated with increased activity of the PI3 kinase, with resultant phosphorylation of its downstream substrate Akt (105). Mutations in the PTEN gene are associated with endometrioid histology, early stage and favorable clinical behavior (106). PTEN mutations have been observed in 20% of endometrial hyperplasias, suggesting this is an early event in the development of some endometrioid type I endometrial cancers (107). Loss of PTEN may even occur in normal appearing endometrial glands, and it has been proposed that this may represent the earliest event in endometrial carcinogenesis (108,109).
Inherited mutations in MMR genes are responsible for Lynch syndrome. The nucleotide excision repair (NER) and base excision repair (BER) pathways respond to damage caused by DNA damaging agents. Mutations in the POLE gene have been found in a subset of endometrial cancers with the highest mutation rates. HR is a process that provides high-fidelity repair of complex DNA damage such as DNA cross-links, double-strand breaks, single-strand DNA gaps, and DNA interstrand cross-links. Inherited mutations in BRCA1–2 and other genes in the HR pathway cause familial breast/ ovarian cancer susceptibility.