As a result, cancer cells proceeding through the cell cycle may be more sensitive to chemotherapeutic agents, whereas normal cells in G 0 are protected. This growth pattern disparity underlies the effectiveness of chemotherapeutic agents.
Tumors are characterized by a gompertzian growth pattern Fig. Fundamentally, a tumor mass requires progressively longer times to double in size as it enlarges.
When a cancer is microscopic and nonpalpable, growth is exponential. However, as a tumor enlarges, the number of its cells undergoing replication decreases due to limitations in blood supply and increasing interstitial pressure. The gompertzian growth curve.
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During early stages of tumor expansion, growth is exponential, but with enlargement, tumor growth slows. Consequently, most tumors have completed their exponential growth phase at the time of clinical detection. When tumors are in the exponential phase of gompertzian growth, they should be more sensitive to chemotherapy because a larger percentage of cells are in the active phase of the cell cycle. For this reason, metastases should be more sensitive to Forgot Password?
Advances in Gynecologic Cancer Surgery Continue to Improve Outcomes - The ASCO Post
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Next Chapter. Hoffman B. Robotic-assisted surgery, a computer-based MIS approach, has been adopted widely in the United States and several other countries. Robotics may offer technological and ergonomic benefits that overcome limitations associated with conventional laparoscopy; however, it is not clear that reported claims of superiority translate into improved gynecologic patient outcomes compared with other MIS approaches Hormone therapy remains the most effective treatment for menopausal symptoms but decisions are complex, requiring an assessment of benefits and risks and determination of best treatment type, dose, and duration.
Benefits exceed risks for most women with bothersome menopausal symptoms or high risk for fracture if initiated under age 60 years or within 10 years since menopause.
Long-term mortality and safety data from the Women's Health Initiative is reassuring, with no increase in deaths from cardiovascular disease or cancer compared with placebo after 18 years of follow-up and a trend towards less mortality in those who initiate hormone therapy ages 50 to 59 years Morcellation for Gynecologic Surgery. Morcellation is necessary for many women with fibroids who choose to undergo laparoscopic myomectomy or hysterectomy. After open and laparoscopic myomectomy, myometrial cells can be detected in the abdomen and pelvis.
After morcellation, careful inspection for and removal of tissue fragments and copious irrigation and suctioning of fluid can remove residual tissue with or without the use of containment bags. Leiomyosarcoma has a poor prognosis because of early hematogenous metastasis and has a high propensity for recurrence despite the performance of total abdominal hysterectomy Urinary Incontinence: Evaluation and Management. Urinary incontinence is a major public health issue in the United States with physical, mental, social, and economic repercussions. History and in-office evaluation are paramount to diagnosis and formation of an appropriate treatment plan.
Lifestyle modifications, which include pelvic floor muscle training and behavioral changes, are appropriate for initial management. Patients with overactive bladder syndrome whose symptoms are not adequately controlled with conservative treatment can be offered medical or procedural management Opportunistic infections are those that are either more frequent or more severe as a result of the patient's immunosuppressed condition. Opportunistic infections are, of course, the distinguishing feature of HIV infection, and they can be the cause of serious morbidity and even mortality.
Some opportunistic infections can be prevented by vaccination, for example, pneumococcal infection, meningococcal infection, influenza, hepatitis A and B, and varicella. Other major opportunistic infections require prophylactic antibiotics or antiviral medications Prevention of Obstetrical Infections. Lymphadenectomy in the Management of Gynecologic Cancer. Among nearly all gynecologic cancers, knowing whether the cancer has metastasized to lymph nodes impacts the ultimate management of the cancer.
Lymph node status assists in cancer staging, prognostication, guidance of surgical intervention and adjuvant therapy, and removal of positive lymph nodes may be therapeutic in some cancers. Surgical staging through lymph node removal and pathologist assessment is standard of care for most gynecologic cancers. This section reviews the anatomic lymphatic drainage patterns of each gynecologic organ and the evolution and current practice of surgical lymph node assessment along the spectrum of gynecologic cancers Obstetric hemorrhage remains a leading cause of severe maternal morbidity and mortality in the United States.
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The National Partnership for Maternal Safety Consensus Bundle on Obstetric Hemorrhage presented a framework to help focus standardization and improvements efforts for obstetric hemorrhage. New York state implementation efforts, tools that may help translate the bundle into practice, and remaining challenges, are described Clinical Controversies in Cervical Cancer Screening. The purpose of this article is to address several of the most controversial issues associated with cervical cancer screening recommendations in light of historical and evolving data. In this article, we will explore the controversies around the age at which to initiate and exit screening, human papilloma virus testing alone as a primary screening approach, and the impact of human papilloma virus vaccination on cervical cancer rates There have been rapid advances in precision medicine since the Human Genome Project was completed in , including several noteworthy advances in Women's Health.
This includes significant advances in predicting individualized cancer risk based on hereditary cancer genetic testing, with the number of known cancer-predisposition genes extending well beyond BRCA1 and BRCA2. This has been coupled with gene-specific management guidelines for several gynecologic cancers.
In addition, genetic testing can also inform therapy selection for women with gynecologic cancers Advances in the management of human immunodeficiency virus infection during pregnancy have led to improved maternal health and significant declines in rates of mother-to-child transmission of human immunodeficiency virus.
A critical contributor to this success has been the development of better tolerated, safer, and more convenient antiretroviral medication regimens.