R

Racial differences, in incidence of ovarian cancer, 3, 3t Radiation therapy for early carcinoma, 150, 150t for germ cell tumors, 215 for granulosa cell tumors, 205 for platinum-resistant ovarian cancer, 174 Radiofrequency ablation (RFA), for hepatic metastases, 118, 118f

Rectosigmoid resection, for advanced-stage epithelial cancer, 114, 116-117 Recurrent ovarian cancer borderline, 199

central vs. pelvic sidewall, 80-81 chemotherapy for 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 factors taken into account in management of, 189, 189b germ cell, 215-217 granulosa cell, 204-205 imaging of, 79-82, 79f, 80f CT for, 79-81, 79f FDG-PET for, 81-82, 82f MRI for, 79-81, 79f, 80f ongoing research on, 175-176 platinum-resistant vs., 163-165, 165b secondary cytoreduction for, 179-189 defined, 180

factors predicting success of, 189, 189b

Recurrent ovarian cancer (Continued) 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 after surgery in advanced carcinoma, 124-125, 126f in early carcinoma, 144-145, 145f, 145t, 146t Referral, for genetic assessment, 39b, 49 Relative risk (RR), of breast and ovarian cancer in mutation carriers, 88, 88t Reproductive risk factors, for ovarian cancer, 3-5, 6t, 52-53

Residual disease, after cytoreductive surgery, as prognostic factor, 11-12, 12f, 13t Resistive index (RI), on spectral Doppler, 65-67 RFA (radiofrequency ablation), for hepatic metastases, 118, 118f Risk factors, 3-7 environmental, 7 genetic, 5-7, 7t reproductive, 3-5, 6t, 52-53 Risk of Ovarian Cancer Algorithm (ROCA) in general population, 95 in high-risk women, 105, 105b Risk reduction, prevention and, 60-61, 61t Risk reduction factors, for ovarian cancer, 53 Risk reduction strategies, for BRCA mutations, 42-43 Risk-reducing surgery, 132-133, 132f ROCA (Risk of Ovarian Cancer Algorithm) in general population, 95 in high-risk women, 105, 105b Rokitansky nodule, 71, 72f

RR (relative risk), of breast and ovarian cancer in mutation carriers, 88, 88t

Salpingo-oophorectomy for advanced-stage epithelial cancer, 113-117, 114f,

115f, 116f bilateral prophylactic for BRCA mutations, 42 in general population, 56-57 for hereditary nonpolyposis colorectal cancer, 46 in high-risk population, 57-60, 61t procedure for, 58, 58f-59f and risk reduction, 132-133, 132f vs. screening, 102, 104, 104b for borderline tumor, 197 for germ cell tumors, 135, 136t for granulosa cell tumors, 202 Salvage surgery, for recurrent malignant germ cell tumors, 138

Saturated fat consumption, as risk factor for ovarian cancer, 7 SBTs (serous borderline tumors) in carcinogenesis model, 17-18 molecular genetic changes in, 26t Schiller-Duval body, in endodermal sinus tumors, 212, 212f

SCOTROC study, 157

Screening, 87-106 for BRCA mutations, 42-43 challenges of, 89-90 characteristics of good test for, 89, 89b defined, 88

general population, 90-102 CA-125 for, 91-95 genetic structure of, 91, 91f 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 multiple markers for, 95-96, 96b, 97f, 98f multiplex assays for, 101 proteomic techniques for, 96-101, 99t, 100t Risk of Ovarian Cancer Algorithm in, 95 transvaginal ultrasound for, 90-91, 90f with CA-125, 92-93, 92t, 94-95, 95f validation of biomarker panels for, 101-102 in high-risk women, 102-105

CA-125 and transvaginal ultrasound for, 103-105 vs. prophylactic surgery, 102, 104, 104b recommendations on, 102 Risk of Ovarian Cancer Algorithm in, 105, 105b UKFOCSS trial of, 105 imaging for, 64-65 principles of, 88-89, 89b SCTATs (sex cord tumors with annular tubules), 208-209 Secondary cytoreduction, 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 Second-look surgery, 124, 125f SELDI-TOF (surface-enhanced laser desorption and ionization time-of-flight mass spectrometry), for screening, 97-98, 99t, 100t Sensitivity, of screening test, 89

Serous adenocarcinoma, metastatic to omentum, 75, 75f Serous borderline tumors (SBTs) in carcinogenesis model, 17-18 molecular genetic changes in, 26t Serous carcinoma carcinogenesis of, 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 clinical and pathologic observations on, 18 high-grade, 18, 19t, 20-21 HLA-G overexpression as, 22t, 25 low-grade, 18, 19t, 20 micropapillary, 18, 23, 25 p53 mutation as, 22t, 23f, 24, 24f proliferation (ki-67) index as, 22t serous borderline tumors in, 17-18 high-grade carcinogenesis of, 18, 19t, 20-21

Serous carcinoma (Continued)

clinicopathologic features of, 22t gross appearance of, 21f microscopic appearance of, 21f molecular features of, 22t low-grade carcinogenesis of, 18, 19t, 20 clinicopathologic features of, 22t molecular features of, 22t Serous cystadenocarcinoma, 70 Serous cystadenofibroma, 70, 70f Serous cystadenoma, 70 Sertoli-Leydig cell tumors (SLCTs), 206-208 ablative treatment for, 208 diagnosis of, 207, 207f epidemiology of, 206 etiology of, 206 imaging of, 73, 73f pathology of, 207, 208f presentation of, 206, 206f surgical treatment for, 207 surveillance for, 208 survival rates in, 203t Sex cord tumors with annular tubules (SCTATs), 208-209

Sex cord-stromal tumors, 199-209 advanced-stage, 200 classification of, 199, 199t clinical manifestations of, 199-200 epidemiology of, 199

granulosa-stromal cell tumors as, 200-206 epidemiology of, 200 fibromas as, 203t, 205-206 granulosa cell tumors as, 201-205 adjuvant therapy for, 202-204, 203f diagnosis of, 201 epidemiology of, 201 etiology of, 201

histology and pathology of, 201, 202f presentation of, 201 prognostic factors for, 202 recurrence of, 204 subtypes of, 201

surgical treatment for, 202, 203f surveillance for, 204 survival rates in, 202-204, 203t thecomas as, 203t, 205 gynandroblastomas as, 209 imaging of, 73 prognosis for, 200

Sertoli-Leydig cell tumors (androblastomas) as, 206-208 ablative treatment for, 208 diagnosis of, 207, 207f epidemiology of, 206 etiology of, 206 pathology of, 207, 208f presentation of, 206, 206f surgical treatment for, 207 surveillance for, 208 survival rates in, 203t sex cord tumor with annular tubules as, 208-209 surgery for, 138, 139f surveillance for, 200 survival rates in, 203t treatment for, 200 Signs, of ovarian cancer, 9 Skates, Steven, 105

SLCTs. See Sertoli-Leydig cell tumors (SLCTs). Smoothing techniques, for disease-free interval and secondary cytoreduction, 182, 182f

Soluble mesothelin-related protein (SMRP), for screening, 96

Specificity, of screening test, 89 Spectral Doppler analysis, for detection and characterization of tumor, 65-67, 66f Splenectomy, for advanced-stage epithelial cancer, 119,

119f, 120f, 121f Stage, as prognostic factor, 9, 10b, 11f Staging imaging for, 76-79 CT as, 77-78, 78f distant metastases in, 77 FDG-PET as, 78, 78f fused PET-CT as, 78, 78f intraperitoneal dissemination in, 76, 76f lymph node metastases in, 76-77 MRI as, 77-78 laparoscopic, 131, 131t surgical, 129-130, 129f and adjuvant chemotherapy, 146-147, 147b, 149, 149t for borderline tumors, 134, 197-198 for malignant germ cell tumors, 135 Surface-enhanced laser desorption and ionization time-offlight mass spectrometry (SELDI-TOF), for screening, 97-98, 99t, 100t Surgery, 109-139 for advanced-stage epithelial cancer, 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 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 for borderline tumors, 133-135, 196-198 extent of, 197

intraoperative frozen section in, 196-197 staging in, 134, 197-198 for early-stage epithelial cancer, 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 with, 129-130, 129f for germ cell tumors, 135-138, 136t, 137t, 214-215,

214f prophylactic for BRCA mutations, 42 defined, 52

in general population, 56-57, 57t for hereditary nonpolyposis colorectal cancer, 46 in high-risk population, 57-60, 61t procedure for, 58, 58f-59f and risk reduction, 132-133, 132f vs. screening, 102, 104, 104b risk-reducing, 132-133, 132f for sex cord-stromal tumors, 138, 139f Surgical cytoreduction benefits of, 180, 180b clinical and theoretical background of, 179-180 for germ cell tumors, 137-138, 137t, 214-215 interval, 122-123, 123t, 124f

Surgical cytoreduction (Continued) optimal defined, 110 predictors, 121-122 principles of, 109-111, 110f, 111f, 112f recurrence after, 124-125, 126f secondary 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 Surgical debulking. See Surgical cytoreduction. Surgical staging, 129-130, 129f and adjuvant chemotherapy, 146-147, 147b, 149, 149t for borderline tumors, 134, 197-198 for malignant germ cell tumors, 135 Surveillance for borderline tumors, 198 for germ cell tumors, 216 for granulosa cell tumors, 204 for Sertoli-Leydig cell tumors, 208 for sex cord-stromal tumors, 200 Survival rate factors influencing. See Prognostic factor(s). with ovarian cancer, 3 Symptoms, of ovarian cancer, 7-9, 8t

Talcum powder use, as risk factor for ovarian cancer, 7 Tamoxifen for BRCA mutation carriers, 43 for granulosa cell tumors, 205 Taxanes for advanced ovarian carcinoma, 156, 157 for granulosa cell tumors, 205 Teratomas immature diagnosis of, 213 epidemiology of, 210

gross and microscopic appearance of, 211-212, 211f imaging of, 72 surgery for, 136t surveillance for, 216 mature, imaging of, 71-72, 72f

Thecomas, 203t, 205

Thoracic metastases, imaging of, 78, 78f

TLK 286 (canfosfamide), for recurrent ovarian cancer,

170f Topotecan for advanced ovarian carcinoma, 157-158, 158f for recurrent ovarian cancer, 170, 170f, 172f-173f Transabdominal ultrasound, for screening, 92 Transforming growth factor-b receptor type II, in clear cell carcinoma, 27 Transitional tumor, carcinogenesis of borderline, 26t malignant, 19t, 20 Transvaginal ultrasound (TVUS)

for detection and characterization of tumor, 65-67, 66f for screening, 64-65 with CA-125, 92-93, 92t, 94-95, 95f in general population, 90-91, 90f in high-risk women, 103-105 Tubal ligation, for risk reduction in general population, 57, 57t

Tumor biology, as prognostic factor, 13 Tumor debulking. See Surgical cytoreduction. Tumor marker(s) with adjuvant chemotherapy, 152-154, 154t for screening, 95-96, 96b, 97f, 98f multiplex arrays of, 101 validation of panels of, 101-102 TVUS. See Transvaginal ultrasound (TVUS).

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