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Dactinomycin, for germ cell tumors, 215 Death rate, from ovarian cancer, 1, 2f, 87 Debulking surgery. See Cytoreductive surgery. Descriptive Evaluation of Preoperative Selection Kriteria for Operability in Recurrent Ovarian Cancer (DESKTOP) trial, 181-182, 183, 185 Diaphragm resection, for advanced-stage epithelial cancer,

117, 117f, 118f Disease-free survival (DFI), and patient selection for secondary cytoreduction, 181-183, 182f Distant metastases, imaging of, 77 DNA banking, 49

Docetaxel, for advanced ovarian carcinoma, 157, 158f recommendations on, 155f Doppler ultrasound, for detection and characterization of tumor, 65-67, 66f "Double determinant" assays, 101

Doxorubicin (Adriamycin)

for advanced ovarian carcinoma, 156 for recurrent ovarian cancer, 166t, 167f Doxorubicin liposomal (Doxil)

for advanced ovarian carcinoma, 157-158 for recurrent ovarian cancer, 169, 170-172, 172f-173f as third-line therapy, 170t Dysgerminomas adjuvant therapy for, 215 diagnosis of, 213 epidemiology of, 210

gross and microscopic appearance of, 211, 211f imaging of, 72 surgery for, 136t surveillance for, 216

Early ovarian carcinoma adjuvant chemotherapy for 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 defined, 143-144, 144b intraperitoneal chemotherapy for, 152, 152t, 153f, 153t low-risk vs. high-risk, 143, 144b substages of, 143, 144b, 145, 146f, 146t surgery for, 127-132 cyst rupture and, 127, 127t, 128f fertility preservation with, 130 intraoperative frozen-section analysis with, 131-132 recurrence after, 144-145, 145f, 145t, 146t role of laparoscopy in, 131, 131t surgical staging of, 129-130, 129f importance of, 146-147, 147b, 149, 149t Embryonal carcinoma, surgery for, 136t En bloc pelvic resection, 113-117, 114f, 115f, 116f Endodermal sinus tumors diagnosis of, 213 epidemiology of, 210

gross and microscopic appearance of, 212, 212f surgery for, 136t Endometrioid borderline tumor, molecular genetic changes in, 26t Endometrioid carcinoma carcinogenesis of, 19t, 20, 27 imaging of, 71-72, 72f Environmental risk factors, for ovarian cancer, 7 Epidemiology, of ovarian cancer, 1-3, 2f, 2t, 51, 87 Epithelial ovarian cancer (EOC) imaging of, 70-71, 70f surgery for advanced-stage, 109-127

diaphragm resection in, 117, 117f, 118f en bloc pelvic resection in, 113-117, 114f, 115f, 116f interval cytoreduction in, 122-123, 123t, 124f liver resection in, 118, 118f lymph node resection in, 121, 122f palliative, 125-127

predictors of optimal cytoreduction with, 121-122

Epithelial ovarian cancer (EOC) (Continued)

principles of cytoreduction in, 109-111, 110f, 111f, 112f recurrent, 124-125, 125f second-look, 124, 125f splenectomy in, 119, 119f, 120f, 121f surgical principles for, 111-113 early-stage, 127-132 cyst rupture and, 127, 127t, 128f fertility preservation with, 130 intraoperative frozen-section analysis with, 131-132 role of laparoscopy in, 131, 131t surgical staging with, 129-130, 129f of low malignant potential, 133-135 Estradiol, in granulosa cell tumors, 204 Estrogen replacement therapy, and ovarian cancer, 4-5, 6t

Ethnic differences, in incidence of ovarian cancer, 3, 3t Etoposide, for germ cell tumors, 217

Familial syndrome(s), 33-49

and autosomal dominant inheritance, 34-35, 35f epidemiology of, 33, 34f, 52, 53t genetic assessment for, 47 and DNA banking, 49 genetic counseling process in, 47-48, 47f and genetic discrimination, 48 of minors, 48 referral for, 39b, 49 hereditary breast and ovarian cancer as, 35-43 BRCA genes in, 5-7, 35-36, 37f features and risks of, 7t, 36-39 genetic testing for, 39-41, 39b, 40f, 41f and lifetime risk of ovarian cancer, 52, 53t screening and risk reduction for, 42-43 hereditary nonpolyposis colorectal cancer as, 44-46 features and risks of, 44 genetic testing for, 44-46, 44b, 45b and lifetime risk of ovarian cancer, 52, 53t management of, 46 and prevention, 52 Family history in genetic counseling, 47, 47f of ovarian cancer, 5-7, 7t Fat consumption, as risk factor for ovarian cancer, 7 FDG-PET. See 18Fluorodeoxyglucose positron emission tomography (FDG-PET). Fertility-sparing surgery for borderline tumor, 197 for early-stage epithelial cancer, 130 for germ cell tumors, 135-136, 136t, 214 for granulosa cell tumors, 202 Fibromas, 205-206 imaging of, 73-74 survival rates in, 203t Fibrous tumors, imaging of, 73-74, 73f, 74f FIGO (International Federation of Gynecology and

Obstetrics) staging system, 9, 10b, 11f 18Fluorodeoxyglucose positron emission tomography (FDG-PET) for recurrent disease, 81-82, 82f for secondary cytoreduction, 186 for specific tumor characterization, 68-69, 69f for staging, 78, 78f Follicle-stimulating hormone (FSH), and granuloma cell tumors, 201 Founder mutations, 7 in BRCA genes, 41, 41f, 52

Frozen section analysis of, 131-132 of borderline tumor, 196-197 FSH (follicle-stimulating hormone), and granuloma cell tumors, 201 Fused PET-CT

for recurrence, 81-82, 82f for secondary cytoreduction, 186 for staging, 78, 78f

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