LWBK1006-23 LWW-Govindan-Review December 12, 2011 19:10
Chapter 23•Gynecologic Cancers 329stage. Patients are typically followed after adjuvant therapy and evalu-
ated for recurrence with pelvic examination and serum CA-125. One-
third of recurrences in patients with early-stage disease have recurrence
with disease apparently confined to the pelvis. Isolated vaginal and pelvic
recurrences are important to identify because these patients have a favor-
able cure rate with therapy. Patients with systemic disease would rarely
be cured, and treatment is palliative.Answer 23.2.32. The answer is C.
The Gynecologic Oncology Group (GOG) has conducted several ran-
domized trials in patients with advanced or recurrent endometrial cancer.
GOG-177 demonstrated the combination of cisplatin, doxorubicin, and
paclitaxel to have an improved progression-free and overall survival ben-
efit that was statistically significant. This regimen had a response rate
of 57% compared with 34% in the cohort treated with cisplatin and
doxorubicin alone. Ifosfamide plus paclitaxel is a regimen that has been
developed and demonstrated superiority in uterine carcinosarcomas.Answer 23.2.33. The answer is C.
There are many different types of uterine sarcomas, including endometrial
stromal sarcoma, leiomyosarcoma, malignant mixed mullerian tumor,
and adenosarcoma. They each have differing presentations and prognosis.
Typically all are treated surgically when possible. Adjuvant therapy is con-
troversial, but there does not appear to be a survival benefit to adjuvant
radiation therapy for most uterine sarcomas. Uterine leiomyosarcoma has
been shown to have a reasonable response to chemotherapy. The com-
bination of gemcitabine and docetaxel in a group of previously treated
patients demonstrated a response rate of 53%.Answer 23.2.34. The answer is A.
GTN includes rare gynecologic tumors that represent less than 1% of
gynecologic malignancies. These tumors are potentially life-threatening
but usually should be highly curable when treated appropriately. The
most common pathologic entity in GTN is complete hydatidiform mole.Answer 23.2.35. The answer is D.
Beta-hCG is an extremely sensitive and specific marker used in the man-
agement of these patients. Patients are typically followed post evacuation
with weekly beta-hCG determinations. The diagnosis of persistent GTN
is based on the following: a plateau in the level for at least 3 weeks, a 10%
or greater increase in the level for three or more values during a 2-week
time period, persistence of beta-hCG levels greater than 6 months after
evacuation, or histologic evidence of choriocarcinoma.Answer 23.2.36. The answer is C.
Phantom hCG has only recently been recognized. Heterophile antibodies
interfere with some immunoassays used to determine hCG levels. This has