Skip to main content
SpringerLink
Log in

Gynecologic Oncology

  • Chapter
  • First Online:
Handbook of Consult and Inpatient Gynecology

  • 988 Accesses

Abstract

This chapter provides a broad overview of gynecologic cancers and their surgical treatments. Complications specific to gynecologic oncology patients are reviewed, including neutropenic fever and complications of bowel resections. Assessment and management of infections, bowel obstructions, bowel anastomotic complications, and tumor-related hemorrhage are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, et al., editors. SEER cancer statistics review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site, April 2015. Accessed 25 July 2015

  2. Finch A, Beiner M, Lubinski J, Lynch HT, Moller P, Rosen B, et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1or BRCA2 Mutation. JAMA. 2006;296:185–92.

    Article  CAS  PubMed  Google Scholar 

  3. Martin-Hirsch PL, Wood NJ. Cervical cancer. Am Fam Physician. 2012;85:1186–7.

    Google Scholar 

  4. Williams NL, Werner TL, Jarboe EA, Gaffney DK. Adenocarcinoma of the cervix: should we treat it differently? Curr Oncol Rep. 2015;17:17.

    Google Scholar 

  5. Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, et al. Chapter 33. Endometrial cancer. In: Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, et al. editors. Williams gynecology, 2edn. New York: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=399&Sectionid=41722324. Accessed 06 Sept 2015.

  6. Canavan TP, Cohen D. Vulvar cancer. Am Fam Physician. 2002;66:1269–74.

    PubMed  Google Scholar 

  7. American Cancer Society. Cancer facts & figures 2015. Atlanta: American Cancer Society; 2015. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf. Accessed 6 Sept 2015.

  8. Beller U, Benedet JL, Creasman WT, Ngan HY, Quinn MA, Maisonneuve P, et al. Carcinoma of the vagina. FIGO 26th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006;95:S29–42.

    Article  PubMed  Google Scholar 

  9. Semer DA, Macfee MS. Gestational trophoblastic disease: epidemiology. Semin Oncol. 1995;22:109–12.

    CAS  PubMed  Google Scholar 

  10. Altieri A, Franceschi S, Ferlay J, Smith J, La Vecchia C. Epidemiology and aetiology of gestational trophoblastic diseases. Lancet Oncol. 2003;4:670–8.

    Article  PubMed  Google Scholar 

  11. Zullo MA, Manci N, Angioli R, Muzii L, Panici PB. Vesical dysfunctions after radical hysterectomy for cervical cancer: a critical review. Crit Rev Oncol Hematol. 2003;48:287–93.

    Article  PubMed  Google Scholar 

  12. Roy M, Plante M. Pregnancies after radical vaginal trachelectomy for early-stage cervical cancer. Am J Obstet Gynecol. 1998;179:1491–6.

    Article  CAS  PubMed  Google Scholar 

  13. Sahdev A, Sohaib SA, Wenaden AE, Shepherd JH, Reznek RH. The performance of magnetic resonance imaging in early cervical carcinoma: a long-term experience. Int J Gynecol Cancer. 2007;17:629–36.

    Article  CAS  PubMed  Google Scholar 

  14. Marchiole P, Benchaib M, Buenerd A, Lazlo E, Dargent D, Mathevet P. Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent’s operation): a comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH). Gynecol Oncol. 2007;106:132–41.

    Article  PubMed  Google Scholar 

  15. Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363:943–53.

    Article  CAS  PubMed  Google Scholar 

  16. Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet. 2015;386:249–57.

    Article  PubMed  Google Scholar 

  17. Chang SJ, Hodeib M, Chang J, Bristow RE. Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: a meta-analysis. Gynecol Oncol. 2013;130:493–8.

    Article  PubMed  Google Scholar 

  18. Elattar A, Bryant A, Winter-Roach BA, Hatem M, Naik R. Optimal primary surgical treatment for advanced epithelial ovarian cancer. Cochrane Database Syst Rev. 2011;(8):CD007565.

    Google Scholar 

  19. Wright JD, Herzog TJ, Neugut AI, Burke WM, Lu YS, Lewin SN, et al. Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stage ovarian cancer. Obstet Gynecol. 2012;120:871–81.

    Article  PubMed  Google Scholar 

  20. Marnitz S, Köhler C, Müller M, Behrens K, Hasenbein K, Schneider A. Indications for primary and secondary exenterations in patients with cervical cancer. Gynecol Oncol. 2006;103:1023–30.

    Article  PubMed  Google Scholar 

  21. Stanhope CR, Symmonds RE. Palliative exenteration – what, when, and why? Am J Obstet Gynecol. 1985;152:12–6.

    Article  CAS  PubMed  Google Scholar 

  22. Höckel M, Dornhöfer N. Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol. 2006;7:837–47.

    Article  PubMed  Google Scholar 

  23. De Hullu JA, Hollema H, Lolkema S, Boezen M, Boonstra H, Burger MP. Vulvar carcinoma. The price of less radical surgery. Cancer. 2002;95:2331–8.

    Article  PubMed  Google Scholar 

  24. Aviki EM, Esselen KM, Barcia SM, Nucci MR, Horowitz NS, Feltmate CM, et al. Does plastic surgical consultation improve the outcome of patients undergoing radical vulvectomy for squamous cell carcinoma of the vulva? Gynecol Oncol. 2015;137:60–5.

    Article  PubMed  Google Scholar 

  25. Salgarello M, Farallo E, Barone-Adesi L, Cervelli D, Scambia G, Salerno G, et al. Flap algorithm in vulvar reconstruction after radical, extensive vulvectomy. Ann Plast Surg. 2005;54:184–90.

    Article  CAS  PubMed  Google Scholar 

  26. Argenta PA, Lindsay R, Aldridge RB, Siddiqui N, Burton K, Telfer JR. Vulvar reconstruction using the “lotus petal” fascio-cutaneous flap. Gynecol Oncol. 2013;131:726–9.

    Article  PubMed  Google Scholar 

  27. Abu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C, et al. The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol. 2006;103:714–8.

    Article  PubMed  Google Scholar 

  28. Gaarenstroom KN, Kenter GG, Trimbos JB, Agous I, Amant F, Peters AA, Vergote I. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. Int J Gynecol Cancer. 2003;13:522–7.

    Article  CAS  PubMed  Google Scholar 

  29. Rockson SG. Diagnosis and management of lymphatic vascular disease. J Am Coll Cardiol. 2008;52:799–806.

    Article  PubMed  Google Scholar 

  30. Lenz HJ. Management and preparedness for infusion and hypersensitivity reactions. Oncologist. 2007;12:601–9.

    Article  CAS  PubMed  Google Scholar 

  31. Hapani S, Chu D, Wu S. Risk of gastrointestinal perforation in patients with cancer treated with bevacizumab: a meta-analysis. Lancet Oncol. 2009;10:559–68.

    Article  CAS  PubMed  Google Scholar 

  32. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:e56–93.

    Article  PubMed  Google Scholar 

  33. Bodel P. Generalized perturbations in host physiology caused by localized tumors. Tumors and fever. Ann N Y Acad Sci. 1974;230:6–13.

    Article  CAS  PubMed  Google Scholar 

  34. Kurzrock R. The role of cytokines in cancer-related fatigue. Cancer. 2001;92:1684–8.

    Article  CAS  PubMed  Google Scholar 

  35. Zell JA, Chang JC. Neoplastic fever: a neglected paraneoplastic syndrome. Support Care Cancer. 2005;13:870–7.

    Article  PubMed  Google Scholar 

  36. Colwell J. Stomal and peristomal complications. In: Colwell J, Goldberg M, Carmel J, editors. Fecal and urinary diversions: management principles. St. Louis: Mosby; 2004.

    Google Scholar 

  37. Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007;13:432–7.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Antosh DD, Grimes CL, Smith AL, Friedman S, McFadden BL, Crisp CC, et al. A case–control study of risk factors for ileus and bowel obstruction following benign gynecologic surgery. Int J Gynaecol Obstet. 2013;122:108–11.

    Article  PubMed  Google Scholar 

  39. Cliby WA. Abdominal incision wound breakdown. Clin Obstet Gynecol. 2002;45:507–17.

    Article  PubMed  Google Scholar 

  40. Carlson MA. Acute wound failure. Surg Clin North Am. 1997;77:607–36.

    Article  CAS  PubMed  Google Scholar 

  41. Madsen G, Fischer L, Wara P. Burst abdomen – clinical features and factors influencing mortality. Dan Med Bull. 1992;39:183–5.

    CAS  PubMed  Google Scholar 

  42. Riou JP, Cohen JR, Johnson Jr H. Factors influencing wound dehiscence. Am J Surg. 1992;163:324–32.

    Article  CAS  PubMed  Google Scholar 

  43. Eisenkop SM, Spirtos NM, Lin WC. Splenectomy in the context of primary cytoreductive operations for advanced epithelial ovarian cancer. Gynecol Oncol. 2006;100:344–8.

    Article  PubMed  Google Scholar 

  44. Magtibay PM, Adams PB, Silverman MB, Cha SS, Podratz KC. Splenectomy as part of cytoreductive surgery in ovarian cancer. Gynecol Oncol. 2006;102:369–74.

    Article  PubMed  Google Scholar 

  45. Faro C, Faro S. Postoperative pelvic infections. Infect Dis Clin North Am. 2008;22:653–63.

    Article  PubMed  Google Scholar 

  46. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.

    Article  PubMed  Google Scholar 

  47. Fischerova D. Urgent care in gynaecology: resuscitation and management of sepsis and acute blood loss. Best Pract Res Clin Obstet Gynaecol. 2009;23:679–90.

    Article  PubMed  Google Scholar 

  48. Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstet Gynecol. 2013;121:654–73.

    Article  PubMed  Google Scholar 

  49. Beilman GJ, Dunn DL, Beilman GJ, Dunn DL, Beilman, Greg J, David L. Dunn. Surgical infections. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al. editors. Schwartz’s principles of surgery, 10 edn. New York: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=980&Sectionid=59610847. Accessed 11 June 2015.

  50. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    Article  PubMed  Google Scholar 

  51. Lange H, Jäckel R. Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. Eur J Surg. 1994;160:381.

    CAS  PubMed  Google Scholar 

  52. Megibow AJ. Bowel obstruction. Evaluation with CT. Radiol Clin North Am. 1994;32:861–70.

    CAS  PubMed  Google Scholar 

  53. Heinberg EM, Finan MA, Chambers RB, Bazzett LB, Kline RC. Postoperative ileus on a gynecologic oncology service – do abdominal X-rays have a role? Gynecol Oncol. 2003;90:158–62.

    Article  PubMed  Google Scholar 

  54. Frager DH, Baer JW, Rothpearl A, Bossart PA. Distinction between postoperative ileus and mechanical small-bowel obstruction: value of CT compared with clinical and other radiographic findings. AJR Am J Roentgenol. 1995;164:891–4.

    Google Scholar 

  55. Desser TS, Gross M. Multidetector row computed tomography of small bowel obstruction. Semin Ultrasound CT MR. 2008;29:308–21.

    Article  PubMed  Google Scholar 

  56. Hayakawa K, Tanikake M, Yoshida S, Urata Y, Inada Y, Narumi Y, et al. Radiological diagnosis of large-bowel obstruction: nonneoplastic etiology. Jpn J Radiol. 2012;30:541–52.

    Article  PubMed  Google Scholar 

  57. Gerhardt RT, Nelson BK, Keenan S, Kernan L, MacKersie A, Lane MS. Derivation of a clinical guideline for the assessment of nonspecific abdominal pain: the Guideline for Abdominal Pain in the ED Setting (GAPEDS) Phase 1 Study. Am J Emerg Med. 2005;23:709–17.

    Article  PubMed  Google Scholar 

  58. Frager D, Rovno HD, Baer JW, Bashist B, Friedman M. Prospective evaluation of colonic obstruction with computed tomography. Abdom Imaging. 1998;23:141–6.

    Article  CAS  PubMed  Google Scholar 

  59. Gjelsteen AC, Ching BH, Meyermann MW, Prager DA, Murphy TF, Berkey BD, et al. CT, MRI, PET, PET/CT, and ultrasound in the evaluation of obstetric and gynecologic patients. Surg Clin North Am. 2008;88:361–90.

    Article  PubMed  Google Scholar 

  60. Bosscher MR, van Leeuwen BL, Hoekstra HJ. Surgical emergencies in oncology. Cancer Treat Rev. 2014;40:1028–36.

    Article  CAS  PubMed  Google Scholar 

  61. Kirchheiner K, Nout RA, Tanderup K, Lindegaard JC, Westerveld H, Haie-Meder C, et al. Manifestation pattern of early-late vaginal morbidity after definitive radiation (chemo) therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: an analysis from the EMBRACE study. Int J Radiat Oncol Biol Phys. 2014;89:88–95.

    Article  PubMed  Google Scholar 

  62. Geisler JP, Denman BJ, Cudahy TJ, Lee TH, Geisler HE. Ovarian carcinoma presenting as intra-abdominal hemorrhage. Gynecol Oncol. 1994;53:380–1.

    Article  CAS  PubMed  Google Scholar 

  63. La Fianza A, Cassani C, Ori Belometti G. Intralesional hemorrhage in Krukenberg tumor: a case report and review of the literature. J Ultrasound. 2013;16:89–91.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45.

    Google Scholar 

  65. Okabayashi T, Hanazaki K. Overwhelming postsplenectomy infection syndrome in adults – a clinically preventable disease. World J Gastroenterol. 2008;14:176–9.

    Google Scholar 

  66. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58:e44–100.

    Google Scholar 

  67. Flowers CR, Seidenfeld J, Bow EJ, Karten C, Gleason C, Hawley DK, et al. Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2013;31:794–810.

    Article  PubMed  Google Scholar 

  68. Tejero E, Mainar A, Fernández L, Tobío R, De Gregorio MA. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum. 1994;37:1158–9.

    Article  CAS  PubMed  Google Scholar 

  69. Carpenter CF, Gilpin N. Peritonitis, spontaneous bacterial and secondary. In: Pham PA, Auwaerter PG, Bartlett JG, Johns Hopkins M, editors. Johns Hopkins ABX guide: diagnosis and treatment of infectious diseases [e-book]. Burlington: Jones and Bartlett Learning; 2012. Available from: eBook Collection (EBSCOhost), Ipswich. Accessed 20 Sept 2015.

    Google Scholar 

  70. Phitayakorn R, Delaney CP, Reynolds HL, Champagne BJ, Heriot AG, Neary P, et al. Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg. 2008;32:1147–56.

    Article  CAS  PubMed  Google Scholar 

  71. Bovill E, Banwell PE, Teot L, Eriksson E, Song C, Mahoney J, et al. Topical negative pressure wound therapy: a review of its role and guidelines for its use in the management of acute wounds. Int Wound J. 2008;5:511–29.

    Article  PubMed  Google Scholar 

  72. Walters MD, Dombroski RA, Davidson SA, Mandel PC, Gibbs RS. Reclosure of disrupted abdominal incisions. Obstet Gynecol. 1990;76:597–602.

    CAS  PubMed  Google Scholar 

  73. Keepanasseril A, Suri V, Prasad GR, Gupta V, Bagga R, Aggarwal N, et al. Management of massive hemorrhage in patients with gestational trophoblastic neoplasia by angiographic embolization: a safer alternative. J Reprod Med. 2011;56:235–40.

    PubMed  Google Scholar 

  74. Biswal BM, Lal P, Rath GK, Mohanti BK. Hemostatic radiotherapy in carcinoma of the uterine cervix. Int J Gynaecol Obstet. 1995;50:281–5.

    Article  CAS  PubMed  Google Scholar 

  75. Geisler JP, Denman BJ, Cudahy TJ, Lee TH, Geisler HE. Ovarian carcinoma presenting as intra-abdominal hemorrhage. Gynecol Oncol. 1994;53:380–1.

    Google Scholar 

  76. La Fianza A, Cassani C, Ori Belometti G. Intralesional hemorrhage in Krukenberg tumor: a case report and review of the literature. J Ultrasound. 2013;16:89–91.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, USA

    Emily M. Hinchcliff MD

  2. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA

    Emily M. Hinchcliff MD

Authors
  1. Emily M. Hinchcliff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emily M. Hinchcliff MD .

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Hinchcliff, E.M. (2016). Gynecologic Oncology. In: Handbook of Consult and Inpatient Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-27724-0_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27724-0_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27722-6

  • Online ISBN: 978-3-319-27724-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation