C

CA-125 with borderline tumors, 195 genetic structure of, 91, 91f as prognostic factor, 12-13 for screening, 64-65, 91-95 in high-risk women, 103-105 immunostaining of, 97f limitations of, 91

serial measurements of, 93, 93f, 94f with transabdominal ultrasound, 92 with transvaginal ultrasound, 92-93, 92t, 94-95, 95f UKCTOCS trial of, 92t, 93-94, 95f usefulness of, 91-92 Call-Exner bodies, in granulosa cell tumors, 201, 202f Cancer Genetics Network (CGN) screening study, 104-105

Cancer predisposition syndromes. See Hereditary cancer predisposition syndrome(s). Canfosfamide (TLK 286), for recurrent ovarian cancer, 170f CAP regimen, for recurrent ovarian carcinoma, 166t, 167f,

169 Carboplatin for advanced ovarian carcinoma, 156-157, 158f recommendations on, 155f for clear cell carcinoma, 151f for early ovarian carcinoma benefits of, 148t, 153t choice of, 150-151, 151f intraperitoneal, 152t for recurrent ovarian cancer, 168, 168t

Carcinogenesis model clinical and pathologic observations supporting dualistic, 18 molecular evidence supporting, 22-27, 23f in borderline tumors, 17-18, 26, 26t in clear cell carcinoma, 19t, 20, 27 in endometrioid carcinoma, 19t, 20, 27 in malignant Brenner (transitional) tumor, 19t, 20 in malignant mixed mesodermal tumor

(carcinosarcoma), 19t in mucinous carcinoma, 19t, 20, 26-27 in serous carcinoma, 22-26

allelic imbalance and chromosomal instability as, 25-26

apolipoprotein E overexpression as, 25 BRAF and KRAS mutations as, 21, 22-23, 22t, 23f HLA-G overexpression as, 22t, 25 p53 mutation as, 22t, 23f, 24, 24f proliferation (ki-67) index as, 22t in undifferentiated carcinoma, 19t proposal for, 18-21 type I tumors in, 20, 20f clinicopathologic features of, 22t molecular features of, 22t precursors and molecular genetic alterations of, 19t type II tumors in, 20-21, 20f clinicopathologic features of, 22t gross appearance of, 21f microscopic appearance of, 21f molecular features of, 22t precursors and molecular genetic alterations of, 19t Carcinomatosis, peritoneal, imaging of, 76, 76f Carcinosarcoma, carcinogenesis of, 19t, 20 P-Catenin mutations, in endometrioid carcinoma, 27 CGN (Cancer Genetics Network) screening study,

104-105 Chemoprevention defined, 52

in general population, 53-54, 55t for women with increased risk, 55-56, 56t Chemoresistance testing, 175 Chemosensitivity testing, 175 Chemotherapy, 143-159

for advanced ovarian carcinoma, 156-159

equivalency of carboplatin and cisplatin for, 156-157 evolution of platinum and taxane agents for, 156 intraperitoneal, 155f, 158-159, 158f maintenance, 159 neoadjuvant, 159

new combinations and dose schedules for, 157-158, 158f recommendations on, 155f taxanes for, 157 for borderline tumors, 198 for early ovarian carcinoma adjuvant biological and molecular markers with, 152-154, 154t choice of agents for, 150, 150t, 151f for clear cell carcinoma, 151-152, 151f and definition of early cancer, 143-144, 144b duration of, 150-151, 151t efficacy of, 147-149, 148f, 148t, 149t importance of surgical staging for, 146-147, 147b, 149, 149t and natural history of untreated disease, 144-145,

145f, 145t vs. radiation therapy, 151, 152f recommendations on, 144b, 154, 155b and substaging, 143, 144b, 145, 146f, 146t intraperitoneal, 152, 152t, 153f, 153t

Chemotherapy (Continued) for germ cell tumors, 215-216 for granulosa cell tumors, 202-205, 203f intraperitoneal for advanced ovarian carcinoma, 155f, 158-159, 158f for early ovarian carcinoma, 152, 152t, 153f, 153t hyperthermic, for recurrent ovarian carcinoma, 188-189

for platinum-resistant ovarian cancer, 174

chemoresistance and chemosensitivity testing in selection of, 175 potential agents for, 171b for recurrent ovarian cancer hyperthermic intraperitoneal, 188-189 second-line combination vs. single-agent, 167-170, 167f, 168t, 169f considerations in selection of, 165, 165b goals of, 165, 165b non-platinum, 170-174, 171b, 171f, 172f, 173f platinum-based vs. non-platinum regimen for, 166,

166t, 167f reactions to, 166-167, 168, 168f, 169f reasons for not using platinum-based therapy in, 166, 166b sequential delivery of, 170

treatment-free interval and response to, 164, 164f, 164t third-line, 169, 170t for Sertoli-Leydig cell tumors, 208 Choriocarcinomas, gross and microscopic appearance of, 212

Chromosomal instability, in carcinogenesis, 25-26 Cisplatin for advanced ovarian carcinoma, 156-157, 158f intraperitoneal, 158, 158f recommendations on, 155f for borderline tumors, 198 BRCA genes and, 35-36 for early-stage cancer benefits of, 148t, 153t choice of, 150, 150t intraperitoneal, 152, 152t vs. radiation therapy, 150, 150t for germ cell tumors, 215 for recurrent ovarian cancer, 166t, 167f Classification, of ovarian cancer, 17-18 Clear cell borderline tumor, molecular genetic changes in, 26t

Clear cell carcinoma carcinogenesis of, 19t, 20, 27 chemotherapy for, 151, 151f imaging of, 71, 71f Clinical presentation, of ovarian cancer, 7-9, 8t Clitoromegaly, due to Sertoli-Leydig cell tumors, 206, 206f

Coffee-bean nuclei, in granulosa cell tumors, 201 Colectomy, for hereditary nonpolyposis colorectal cancer,

Collision tumor, imaging of, 74-75 Colonoscopy, for hereditary nonpolyposis colorectal cancer, 46

Color Doppler ultrasound, for detection and characterization of tumor, 65-67, 66f Colorectal cancer hereditary nonpolyposis (See Hereditary nonpolyposis colorectal cancer (HNPCC)) metastatic, 75, 75f

Computed tomography (CT) for recurrent disease, 79-81, 79f for secondary cytoreduction, 185-186 for specific tumor characterization, 68 for staging, 77-78, 78f Cumulative risk, of breast and ovarian cancer, in BRCA

carriers, 102, 102f Cyclophosphamide (Cytoxan)

for advanced ovarian carcinoma, 156 for borderline tumors, 198 for early-stage cancer, 153t choice of, 151f intraperitoneal, 152t for germ cell tumors, 215 for recurrent ovarian cancer, 166t, 167f Cyst rupture, in early-stage epithelial cancer, 127, 127t, 128f

Cystadenocarcinoma, serous, 70 Cystadenofibroma, serous, 70, 70f Cystadenoma benign mucinous, 70 benign serous, 70 Cystectomy, for borderline tumor, 197 Cytoreductive surgery benefits of, 180, 180b clinical and theoretical background of, 179-180 defined, 110

for germ cell tumors, 137-138, 137t, 214-215 interval, 122-123, 123t, 124f predictors, 121-122

principles of, 109-111, 110f, 111f, 112f recurrence after, 124-125, 126f residual disease as prognostic factor after, 11-12, 12f, 13t secondary, 179-189 defined, 180

factors predicting success of, 189, 189b optimal, 186-187

patient selection for, 181-185, 181b, 189t disease-free survival in, 181-183, 182f extent of disease and ascites in, 183-184, 183b, 184f other factors in, 185

variables related to adjuvant chemotherapy and response in, 185 preoperative evaluation and imaging for, 185-186 procedures, complications, and outcome of, 186-187, 187t survival after, 187, 187t, 188, 188f Cytoxan. See Cyclophosphamide (Cytoxan).

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