Sample Syllabus
Items in BLUE are
Required
iii
Welcome to
UPDATE IN THE MANAGEMENT OF OVARIAN
AND ENDOMETRIAL MALIGNANCIES
September 18, 2004
Iris S. and Bert L. Wolstein Research Building
on the campus of
Case Western Reserve University and University Hospitals of Cleveland
Announcements
Messages: The telephone number of the Wolstein Research Building is
216/368-3141. If you are expecting a message, please use that phone number. It
will be brought to the conference registration desk where it will be kept for you.
You may check periodically with the registration assistants.
Evaluation Forms: Please complete the Course Evaluation Form and return it at
the conclusion of the conference. We appreciate your comments and find them
useful for future planning.
Certificate of Attendance:
Physicians will receive a Category 1 Award Certificate in the mail. All others will
receive a Certificate of Attendance at the completion of the program.
Receipts: If you charged your registration to this conference and would like the
receipt, please see the registration assistants.
Educational Etiquette: Set phones, pagers or beepers to silent or vibrate mode or
turn off completely. Do not check e-mail or talk on a cellular phone inside the
meeting room or during any educational session. If you bring a laptop computer to
a session, sit in the back of the room so as not to distract others. Keep
conversations with others to a minimum during education sessions.
Refreshment Breaks and Exhibits: Refreshments will be available in the hall.
Exhibits will be set up outside the meeting room.
iii
Accreditation
Direct (or sole) Sponsorship Statement:
The Case Western Reserve University School of Medicine is accredited by the Accreditation
Council for Continuing Medical Education to provide continuing medical education for
physicians.
The Case Western Reserve University School of Medicine designates this educational activity
for a maximum of ____ AMA PRA Category 1 creditsTM. Physicians should only claim credit
commensurate with the extent of their participation in the activity.
Joint Sponsorship Statement:
This activity has been planned and implemented in accordance with the Essential Areas and
Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the
joint sponsorship of the Case Western Reserve University School of Medicine and [organization
two - an organization not accredited by the ACCME]. The Case Western Reserve University
School of Medicine is accredited by the ACCME to provide continuing medical education for
physicians.
The Case Western Reserve University School of Medicine designates this educational activity
for a maximum of ____ AMA PRA Category 1 creditsTM. Physicians should only claim credit
commensurate with the extent of their participation in the activity.
PROGRAM OBJECTIVES
Following completion of this program, participants will be able to:
1.
Describe future direction in the chemotherapeutic management of ovarian cancer.
2.
Assess the risks and benefits of surgical management for recurrent ovarian cancer.
3.
Review the role of radiation therapy in the management of Endometrial cancer.
4.
Describe theories of endometrial carcinogenesis.
ACKNOWLEDGEMENT
Support for this program has been provided in the form of
unrestricted educational grants by
AMGEN INC.
AVENTIS PHARMACEUTICALS
PFIZER INC
iii
GlaxoSmithKline Oncology
Tibotec Therapeutics
MedImmune Oncology
Ortho-Biotec - Amy Snider
MGI Pharma
Acceptance of funding in support of this program does not constitute
endorsement of any product or manufacturer.
iii
TABLE OF CONTENTS
ANNOUNCEMENTS .....................................................................................................................
CERTIFICATE OF ATTENDANCE .............................................................................................
ACCREDITATION .........................................................................................................................
PROGRAM OBJECTIVES ............................................................................................................
ACKNOWLEDGEMENT ..............................................................................................................
PLANNING COMMITTEE ...........................................................................................................
GUEST FACULTY ........................................................................................................................
CASE COMPREHENSIVE CANCER CENTER FACULTY........................................................
AGENDA ........................................................................................................................................
FADI W. ABDUL-KARIM, MD
Theories of Endometrial Carcinogenesis ....................................................................... 133
ROBERT DeBERNARDO, Jr. MD
Clinical Management of Serous Endometrial Cancer .................................................... 155
NANCY FUSCO, RN, BSN
The End of Life and Symptom Management in Women with Ovarian Cancer............. 189
SHERYL A. KINGSBERG, PhD
The Impact of Gynecologic Cancer and Cancer Treatments on Sexuality .................... 163
ARNO J. MUNDT III, MD
Role of Radiation Therapy in Uterine Cancer ............................................................... 101
PANOS SAVVIDES, MD, PhD, MPH
Chemotherapy in the Elderly Patient ............................................................................... 43
JAMES TATE THIGPEN, MD
Future Directions in the Chemotherapeutic Management of Ovarian Cancer ................... 9
VIVIAN von GRUENIGEN, MD
The End of Life and Symptom Management in Women with Ovarian Cancer............. 189
STEVEN E. WAGGONER, MD
Welcome and Introduction ................................................................................................. 7
Surgical Management of Recurrent Ovarian Cancer ....................................................... 57
GEORGIA L. WIESNER, MD
Genetic Screening and Risk Reduction for Ovarian Cancer ............................................ 85
ROBERT H. YOUNG, MD
Problematic Areas in Ovarian Tumor Pathology with Clinical Implications .................. 67
iii
PLANNING COMMITTEE
Steven E. Waggoner, MD – Chair
Chief, Division of Gynecologic Oncology
MacDonald Women’s Hospital
University Hospitals of Cleveland
Associate Professor of Obstetrics and
Gynecology
Case Western Reserve University
Nancy Fusco, RN, BSN
Chemotherapy/Research Nurse
Program Manager
Division of Gynecologic Oncology
University Hospitals of Cleveland
*Member reported no financial interest relevant to this activity.
JoAnn Z. Glick, MSN, RN
Lecturer and Coordinator
Frances Payne Bolton School of Nursing
Center for Research and Scholarship
Case Western Reserve University
*Member reported no financial interest relevant to this activity.
Vivian von Gruenigen, MD
Assistant Professor of Obstetrics and
Gynecology
University Hospitals of Cleveland
Case Western Reserve University
*Member reported no financial interest relevant to this activity.
*Member reported no financial interest relevant to this activity.
GUEST FACULTY
Arno J. Mundt III, MD
University of Illinois at Chicago
1801 W. Taylor Street, C-400
Chicago, Il 60612
Phone 773 / 702-6870
Fax: 773 / 702-0610
E-mail: amundt@radonc.uchicago.edu
Center H. Young, MD
Robert
Massachusetts General Hospital
Department of Pathology – WRN 2-246
55 Fruit Street
Boston, MA 02114
* Presenter reported no financial interest relevant to this
presentation.
* Presenter reported no financial interest relevant to this
presentation.
James Tate Thigpen, MD
University of Mississippi Medical Center
Department of Medical Oncology
2500 North State Street
Jackson, MS 39216
Phone: 601 / 984-5590
Fax: 601 / 984-5599
E-mail: jtthigpen@worldnet.att.net
* Dr. Thigpen is on the speaker’s bureau of Bristol-Myers
Squibb, GlaxoSmithKline, Eli Lilly, Ortho-Biotech, Intermune,
MedImmune, Amgen, and Tibotech. He is a consultant for BristolMyers Squibb, GlaxoSmithKline, Novartis, Eli Lilly, OrthoBiotech, Intermune, Cell Therapeutics, Aventis, Telik, Tibotech,
and Sanofi.
iii
CASE COMPREHENSIVE CANCER CENTER FACULTY
Fadi W. Abdul-Karim, MD
Chief, Division of Anatomic Pathology
University Hospitals of Cleveland
11100 Euclid Avenue
Cleveland, OH 44106-5077
Phone: 216 / 844-1807
Fax: 216 / 844-1810
E-mail: Fadi.Abdul-Karim@uhhs.com
Panos Savvides, MD, PhD, MPH
Ireland Cancer Center
University Hospitals of Cleveland
11100 Euclid Avenue
Cleveland, OH 44106-5055
Phone: 216 / 844-5946
Fax: 216 / 844-1256
E-mail: ssp14@case.edu
* Presenter reported no financial interest relevant to this
presentation.
* Presenter reported no financial interest relevant to this
presentation.
Robert DeBernardo, Jr. MD
University Hospitals of Cleveland
MacDonald Room 7029
11100 Euclid Avenue
Cleveland, OH 44106Phone: 216 / 844-5011
Fax: 216 / 844-8772
E-mail: Robert.Debernardo@uhhs.com
Vivian von Gruenigen, MD
Division of Gynecologic Oncology
University Hospitals of Cleveland
MacDonald Room 7128
11100 Euclid Avenue
Cleveland, OH 44106-5034
Phone: 216 / 844-5011
Fax: 216 / 844-8772
E-mail: Vivian.VonGruenigen@uhhs.com
* Presenter reported no financial interest relevant to this
presentation.
* Presenter reported no financial interest relevant to this
presentation.
Nancy Fusco, RN, BSN
University Hospitals of Cleveland
MacDonald Room 7128
11100 Euclid Avenue
Cleveland, OH 44106
Phone: 216 / 844-1661
Fax: 216 / 844-8596
E-mail: Nancy.Fusco@uhhs.com
Steven E. Waggoner, MD
Division of Gynecologic Oncology
University Hospitals of Cleveland
MacDonald Room 7128
11100 Euclid Avenue
Cleveland, OH 44106-5034
Phone: 216 / 896-5011
Fax: 216 / 896-8772
E-mail: Steven.Waggoner@uhhs.com
* Presenter reported no financial interest relevant to this
presentation.
* Presenter reported no financial interest relevant to this
presentation.
Sheryl A. Kingsberg, PhD
Department of Obstetrics and Gynecology
University Hospitals of Cleveland
MacDonald Room 5034
11100 Euclid Avenue
Cleveland, OH 44106-5034
Phone: 216 / 844-5078
Fax: 216 / 844-3797
E-mail: Sheryl.Kingsberg@uhhs.com
Georgia L. Wiesner, MS, MD
Center for Human Genetics
University Hospitals of Cleveland
11100 Euclid Avenue
Cleveland, OH 44106-6055
Phone: 216 / 844-7236
Fax: 216 / 844-7497
E-mail: Georgia.Wiesner@uhhs.com
* Presenter is on the speakers bureau of Forest
Pharmaceuticals and receives grant research support from
GlaxoSmithKline.
* Presenter reported no financial interest relevant to this
presentation.
DISCLOSURE STATEMENT: The policy of the Case School of Medicine CME Program (Case)
requires that the Activity Director, planning committee members and all activity faculty (that is,
anyone in a position to control the content of the education activity) disclose to the activity
participants all relevant financial relationships with commercial interests. Disclosure will be made
to activity participants prior to the commencement of the activity. Case also requires that faculty
iii
make clinical recommendations based on the best available scientific evidence and that faculty
identify any discussion of “off-label” or investigational use of pharmaceutical products or medical
devices.
MEDICAL DISCLAIMER
Medicine is an ever-changing science. As new research and clinical experience broaden our
knowledge, changes in treatment and drug therapy are required. The authors have checked with
sources believed to be reliable in their efforts to provide information that is complete and generally
in accord with the standards accepted at the time of publication.
Although every effort is made to ensure that this material is accurate and up-to-date, it is provided
for the convenience of the user and should not be considered definitive. Since medicine is an everchanging science, neither the authors nor the Case Western Reserve School of Medicine nor any
other party who has been involved in the preparation or publication of this work warrants that the
information contained herein is in every respect accurate or complete, and they are not responsible
for any errors or omissions or for the results obtained from the use of such information.
Readers are encouraged to confirm the information contained herein with other sources. This
information should not be construed as personal medical advice and is not intended to replace
medical advice offered by physicians. The Case School of Medicine will not be liable for any direct,
indirect, consequential, special, exemplary, or other damages arising therefrom.
AGENDA
7:30 AM
Registration & Continental Breakfast
7:45 - 8:00
Welcome and Introduction
Steven E. Waggoner, MD
8:00 – 8:45
Future Directions in the Chemotherapeutic Management of
Ovarian Cancer
James Tate Thigpen, MD
8:45 – 9:30
Chemotherapy in the Elderly Patient
Panos Savvides, MD, PhD, MPH
9:30 – 10:15
Surgical Management of Recurrent Ovarian Cancer
Steven E. Waggoner, MD
10:15 – 10:30
BREAK
10:30 – 11:15
Problematic Areas in Ovarian Tumor Pathology with Clinical
Implications
Robert H. Young, MD
iii
11:15 – 12:00
Genetic Screening and Risk Reduction for Ovarian Cancer
Georgia L. Wiesner, MS, MD
12:00 – 12:15
Panel Discussion
Panos Savvides, MD, PhD, MPH
James Tate Thigpen, MD
Steven E. Waggoner, MD
Georgia L. Wiesner, MD
Robert H. Young, MD
12:15 – 1:15
LUNCH
1:15 – 2:00
Role of Radiation Therapy in Uterine Cancer
Arno J. Mundt III, MD
2:00 – 2:30
Theories of Endometrial Carcinogenesis
Fadi W. Abdul-Karim, MD
2:30 – 3:00
Clinical Management of Serous Endometrial Cancer
Robert DeBernardo, Jr. MD
3:00 – 3:15
Panel Discussion
Fadi W. Abdul-Karim, MD
Robert DeBernardo, Jr. MD
Arno J. Mundt III, MD
3:15 – 3:30
BREAK
3:30 – 4:15
The Impact of Gynecologic Cancer and Cancer Treatments on
Sexuality and Relationships
Sheryl A. Kingsberg, PhD
4:15 – 4:45
The End of Life and Symptom Management in Women With
Ovarian Cancer
Vivian von Gruenigen, MD
Nancy Fusco, RN, BSN
4:45 – 5:00
Panel Discussion
Nancy Fusco, RN, BSN
Sheryl A. Kingsberg, PhD
Vivian von Gruenigen, MD
5:00 – 5:15
Closing Remarks
iii
STEVEN E. WAGGONER, MD
Associate Professor, Obstetrics and Gynecology, Case Western Reserve University
Chief, Division of Gynecologic Oncology, University Hospitals of Cleveland
Steven Waggoner received his doctor of medicine from the University of Washington, Seattle and
completed a residency in obstetrics and gynecology at the University of Chicago Lying-In Hospital.
He was a research fellow in the Department of Obstetrics and Gynecology at Georgetown University
Medical Center, Vincent T. Lombardi Cancer Research Center, Washington, DC, and Laboratory of
Biology, Division of Cancer Etiology, National Cancer Institute, Bethesda, Maryland and completed
his gynecologic oncology fellowship at Georgetown University Medical Center.
Dr. Waggoner has received numerous honors and awards including the American Cancer Society
Clinical Oncology Career Development Award. He is a member of many professional associations
including the American Society of Clinical Oncology, The Society of Surgical Oncology and is a
Fellow, American College of Obstetrics and Gynecology. Dr. Waggoner is a peer-reviewer for
Obstetrics and Gynecology, Cancer, Annals of Family Medicine and The Lancet to name a few.
Dr. Waggoner has published more than 60 peer-reviewed articles, numerous book chapters and
reviews and more than 50 abstracts.
WELCOME AND INTRODUCTION
iii
JAMES TATE THIGPEN, MD
Professor of Medicine and Director, Division of Medical Oncology
Department of Internal Medicine, University of Mississippi Medical Center
James Tate Thigpen received his doctor of medicine from the University of Mississippi School of
Medicine and completed a straight medical internship at Strong Memorial Hospital, University of
Rochester and a residency at the University of Mississippi.
Dr. Thigpen is Group Vice Chair for Science and Chair of the Protocol Committee for the
Gynecologic Oncology Group, a position he has held for 28 years. He is a member of a number of
professional organizations including the American College of Physicians, Southwest Oncology
Group and the American Society of Hematology where he has fulfilled many roles.
Dr. Thigpen has authored more than 250 peer-reviewed articles in professional publications and has
been an invited presenter nationally and internationally.
FUTURE DIRECTIONS IN THE CHEMOTHERAPEUTIC
MANAGEMENT OF OVARIAN CANCER
Upon completion of this session, participants will be able to:
1.
Describe the current standard for the role of systemic therapy in the management of
ovarian carcinoma.
2.
Discuss current research directions seeking to improve systemic therapy for ovarian
carcinoma.
iii
PANOS SAVVIDES, MD, PhD, MPH
Assistant Professor of Medicine, Division of Hematology/Oncology
Case Western Reserve University, University Hospitals of Cleveland
Panos Savvides received his doctor of medicine from the University of Athens Medical School
where he was also a resident in internal medicine and a research fellow and fellow in hematology.
He studied at the New England Medical Center with a fellowship in clinical care research,
hematology-oncology, and a clinical and research fellowship in the Divisions of HematologyOncology and Clinical Care Research. He also completed a residency in internal medicine at Mount
Auburn Hospitals/Harvard Medical School.
Dr. Savvides was awarded the Young Investigator Award from the Eastern Cooperative Oncology
Group and is a member of several professional societies including the American Society of
Hematology, the American Society of Cancer Research and the American Society of Clinical
Oncology.
Dr. Savvides has published several peer-reviewed articles in professional journals.
CHEMOTHERAPY IN THE ELDERLY PATIENT
Upon completion of this session, participants will be able to:
1.
Explain how increasing age influences toxicity of chemotherapy
2.
Contrast biologic age from chronological age.
3.
Identify variables to consider when calculating chemotherapy doses.
4.
Describe ongoing basic and clinical research in this field.
iii
STEVEN E. WAGGONER, MD
Associate Professor, of Gynecology, Case Western Reserve University
Chief, Division of Gynecologic Oncology, University Hospitals of Cleveland
Steven Waggoner received his doctor of medicine from the University of Washington, Seattle and
completed a residency in obstetrics and gynecology at the University of Chicago Lying-In Hospital.
He was a research fellow in the Department of Obstetrics and Gynecology at Georgetown University
Medical Center, Vincent T. Lombardi Cancer Research Center, Washington, DC, and Laboratory of
Biology, Division of Cancer Etiology, National Cancer Institute, Bethesda, Maryland and completed
his gynecologic oncology fellowship at Georgetown University Medical Center.
Dr. Waggoner has received numerous honors and awards including the American Cancer Society
Clinical Oncology Career Development Award. He is a member of many professional associations
including the American Society of Clinical Oncology, The Society of Surgical Oncology and is a
Fellow, American College of Obstetrics and Gynecology. Dr. Waggoner is a peer reviewer for
Obstetrics and Gynecology, Cancer, Annals of Family Medicine and The Lancet to name a few.
Dr. Waggoner has published more than 60 peer-reviewed articles, numerous book chapters and
reviews and more than 50 abstracts.
SURGICAL MANAGEMENT OF RECURRENT OVARIAN CANCER
Upon completion of this session, participants will be able to:
1.
Describe the natural history of recurrent epithelial ovarian cancer.
2.
Summarize peer-reviewed literature concerning this issue.
3.
List characteristics of patients likely to benefit from surgery for recurrent cancer.
4.
Discuss alternatives to surgery.
iii
ROBERT H. YOUNG, MD
Professor of Pathology, Harvard Medical School
Director of Anatomic Pathology, Massachusetts General Hospital
Robert Young received his doctor of medicine from Trinity College, Dublin University where he
was Senior House Officer in Histopathology and Morbid Anatomy in the School of Pathology. He
continued his education with a residency in pathology at the Massachusetts General Hospital where
he was Chief Resident in Pathology and a Junior Faculty Clinical Fellow, American Cancer Society.
Dr. Young is a member of a number of professional societies including the International Academy of
Pathology and the American Society of Clinical Pathologists and serves on the editorial boards of
numerous professional journals such as the International Journal of Gynaecological Cancer, Journal
of Urologic Pathology and Annals of Diagnostic Pathology.
PROBLEMATIC AREAS IN OVARIAN TUMOR PATHOLOGY
WITH CLINICAL IMPLICATIONS
Upon completion of this session, participants will be able to:
1.
Discuss problems associated with distinguishing borderline ovarian neoplasms from
carcinomas on microscopic examination.
2.
Identify criteria that prevent misclassification of metastatic cancer in the ovary as a
primary ovarian tumor.
iii
Robert H. Young, MD
References
Serous Neoplasms
1. Bell DA, Scully RE. Serous borderline tumors of the peritoneum. Am J Surg Pathol
14:230-239, 1990.
2. Gilks CB, Bell DA, Scully RE. Serous psammocarcinoma of the ovary and peritoneum. Int
J Gynecol Pathol 9:110-121, 1990.
3. Katzenstein AA, Mazur MT, Morgan TE, Kao M-S. Proliferative serous tumors of the
ovary. Histologic features and prognosis. Am J Surg Pathol 2:339-355, 1978.
4. Burks RT, Sherman ME, Kurman RJ. Micropapillary serous carcinoma of the ovary. A
distinctive low-grade carcinoma related to serous borderline tumors. Am J Surg Pathol
20:1319-1330, 1996.
5. Seidman JD, Kurman RJ. Subclassification of serous borderline tumors of the ovary into
benign and malignant types. A clinico-pathologic study of 65 advanced stage cases. Am J
Surg Pathol 20:1331-1345, 1996.
6. Bell DA, Weinstock MA, Scully RE. Peritoneal implants of serous borderline tumors:
Histologic features and prognosis. Cancer 62:2212-2222, 1988.
7. Eichhorn JH, Bell DA, Young RH, Scully RE. Ovarian borderline tumors of solid,
micropapillary, and cribriform types: A study of 42 cases. Am J Surg Pathol 23:397-409,
1999.
8. Tavassoli FA. Serous tumor of low malignant potential with early, stromal invasion (serous
LMP with microinvasion). Modern Pathology 1:407-413, 1988.
9. Bell DA, Scully RE. Ovarian serous borderline tumors with stromal microinvasion: A
report of 21 cases. Hum Pathol 21:397-403, 1990.
10. Segal GH, Hart WR. Ovarian serous tumors of low malignant potential (serous borderline
tumors). The relationship of exophytic surface tumor to peritoneal "implants". Am J Surg
Pathol 16:577-583, 1992.
11. Bell KA, Smith Sehdev AE, Kurman RJ. Refined diagnostic criteria for implants associated
with ovarian atypical proliferative serous tumors (borderline) and micropapillary serous
carcinomas. Am J Surg Pathol 25:419-432, 2001.
12. Gershenon DM, Silva EG. Serous ovarian tumors of low malignant potential with
peritoneal implants. Cancer 65:578-585, 1990.
13. Lim-Tan SK, Cajigas HE, Scully RE. Ovarian cystectomy for serous borderline tumors: A
follow-up study of 35 cases. Obstet Gynecol 72:775-781, 1988.
14. Clement PB, Young RH. Florid mesothelial hyperplasia associated with ovarian tumors. A
potential source of error in tumor diagnosis and staging. Int J Gynecol Pathol. 12:51-58,
1993.
15. Biscotti C, Hart WR. Peritoneal serous micropapillomatosis of low malignant potential
(serous borderline tumors of the peritoneum). A clinicopathologic study of 17 cases. Am J
Surg Pathol 16:467-475, 1992.
16. Bell DA, Longacre TA, Prat J et al. Serous borderline (low malignant potential, atypical
proliferative) ovarian tumors: Workshop perspectives. Human Pathol 35:934-948, 2004.
17. Seidman JD, Soslow RA, Vang R, et al. Borderline ovarian tumors: diverse contemporary
viewpoints on terminology and diagnostic criteria with illustrative images. Human Pathol
35:918-944, 2004.
iii
18. Silverberg SG, Bell DA, Kurman RJ et al. Borderline ovarian tumors: Key points and
workshop summary. Human Pathol 35:910-917, 2004.
Mucinous Neoplasms
19. Young RH, Gilks CB, Scully RE. Mucinous tumors of the appendix associated with
mucinous tumors of the ovary and pseudomyxoma peritonei: A clinicopathological analysis
of 22 cases supporting an origin in the appendix. Am J Surg Pathol 15:415-429, 1991.
20. Seidman JD, Elsayed AM, Sobin LH, Tavassoli FA. Association of mucinous tumors of the
ovary and appendix. A clinicopathologic study of 25 cases. Am J Surg Pathol 17:22-34,
1993.
21. Prayson RA, Hart WR, Petras RE. Pseudomyxoma peritonei. A clinicopathologic study of
19 cases with an emphasis on site of origin and nature of associated ovarian tumors. Am J
Surg Pathol 18:591-603, 1994.
22. Ronnett BM, Kurman RJ, Zahn CM, Shmookler BM, Jablonski KA, Kass ME, Sugarbaker
PH. Pseudomyxoma peritonei in women: a clinicopathologic analysis of 30 cases with
emphasis on site of origin, prognosis, and relationship to ovarian mucinous tumors of low
malignant potential. Hum Pathol 26:509-524, 1995.
23. Ronnett BM, Shmookler BM, Diener-West M, Sugarbaker PH, Kurman RJ.
Immunohistochemical evidence supporting the appendiceal origin of pseudomyxoma
peritonei in women. Int J Gynecol Pathol 16:1-9, 1997.
24. Ronnett BM, Zahn CM, Kurman RJ, Kass ME, Sugarbaker PH, Shmookler BM.
Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis: A
clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features,
site of origin, prognosis, and relationship to "Pseudomyxoma Peritonei". Am J Surg Pathol
19:1390-1408, 1995.
25. Misdraji J, Yantiss RK, Graeme-Cook FM, et al. Appendiceal mucinous neoplasms. A
clinicopathologic analysis of 107 cases. Am J Surg Pathol 27:1089-1103, 2003.
26. Szych C, Staebler A, Connolly DC, et al. Molecular genetic evidence supporting the
clonality and appendiceal origin of pseudomyxoma peritonei in women. Am J Pathol
1999;154:1849-55.
27. Rutgers JL, Scully RE. Ovarian mullerian mucinous papillary cystadenomas of borderline
malignancy. A clinicopathologic analysis. Cancer 61:340-348, 1988.
28. Michael H, Sutton G, Roth LM. Ovarian carcinoma with extracellular mucin production:
Reassessment of "pseudomyxoma ovarii et peritonei". Int J Gynecol Pathol 6:298-312,
1987.
29. Chaitin BA, Gershenson DM, Evans HL. Mucinous tumors of the ovary. A
clinicopathologic study of 70 cases. Cancer 55:1958-1962, 1985.
30. Lee KR, Scully RE. Mucinous tumors of the ovary. A clinicopathologic study of 196
borderline tumors (of intestinal type) and carcinomas, including an evaluation of 11 cases
with `pseudomyxoma peritonei'. Am J Surg Pathol 24:1447-64, 2000.
31. Ronnett BM, Seidman JD. Mucinous tumors arising in ovarian mature cystic teratomas.
Relationship to the clinical syndrome of pseudomyxoma peritonei. Am J Surg Pathol
27:650-7, 2003.
32. Ronnett BM, Shmookler BM, Sugarbaker PH, Kurman RJ. Pseudomyxoma peritonei: New
concepts in diagnosis, origin, nomenclature, and relationship to mucinous borderline (low
malignant potential) tumors of the ovary. Anat Pathol 2:198-226, 1997.
iii
33. Ronnett BM, Kajdacsy-Balla A, Gilks CB, et al. Mucinous borderline ovarian tumors:
Points of general agreement and persistent controversies regarding nomenclature, diagnostic
criteria, and behavior. Human Pathol 35:949-960, 2004.
34. Lee KR, Young RH. The distinction between primary and metastatic mucinous carcinomas
of the ovary: Gross and histologic findings in 50 cases. Am J Surg Pathol 27:281-292,
2003.
iii
GEORGIA L. WIESNER, MS, MD
Associate Professor of Genetics and Medicine, Case Western Reserve University
Director, Center for Human Genetics, University Hospitals of Cleveland
Dr Georgia L. Wiesner received her MS in Biochemical Genetics in 1981 from the University of
Minnesota Graduate School and subsequently received her MD from the University of Minnesota
Medical School in 1985. She completed her residency in Internal Medicine in 1988 and served as
Chief Medical Resident for the Veterans Administration Medical Center and the Department of
Medicine at the University of Minnesota in 1989. After completing her fellowship in Medical
Genetics at the University of Minnesota in 1992, she became an Instructor of Medicine. In 1994, she
joined the Case Western Reserve University faculty as an Assistant Professor and was promoted to
Associate Professor in July 2001. In 2003, she was appointed Director to the Center for Human
Genetics at University Hospitals of Cleveland and Case Western Reserve University
Dr. Wiesner is board certified by the American Board of Medical Genetics and by the American
Board of Internal Medicine. She is an active member of the American Society of Human Genetics
(ASHG) and the American College of Medical Genetics (ACMG) where she is a member of the
Professional Practice and Guidelines committee and the adult common disease special interest
group. Dr. Wiesner is actively involved in medical education and serves as a member of the
American Board of Medical Genetics (ABMG) and on the American College of Graduate Medical
Education Genetics Residency Review Committee. She is the editor-in-chief of the PDQ.
GENETIC SCREENING AND RISK REDUCTION FOR OVARIAN CANCER
Upon completion of this session, participants will be able to:
1.
Recognize a high-risk patient profile for developing ovarian cancer.
2.
Describe the screening methods currently available for ovarian cancer.
3.
List the risk reduction options for women with high genetic risk for ovarian cancer.
iii
ARNO J. MUNDT III, MD
Medical Director, University of Illinois at Chicago
Associate Professor, University of Chicago
Arno James Mundt III received his doctor of medicine from the University of Michigan Medical
School. He completed an internship in the Department of Internal Medicine and a residency in the
Department of Physical Medicine and Rehabilitation at George Washington University and a
fellowship in the Department of Radiation and Cellular Oncology at the University of Chicago
Hospitals.
Dr. Mundt serves on a number of committees including the Clinical Trials Review Committee and
the Gynecology Oncology Group, Radiation Oncology Committee.
ROLE OF RADIATION THERAPY IN UTERINE CANCER
Upon completion of this session, participants will be able to:
1.
Relate historical background on the use of radiation for endometrial cancer.
2.
Summarize recent clinical trials concerning radiation therapy in localized and
metastatic endometrial cancer.
3.
Describe how the surgeon can help the radiation oncologist.
4.
Define the challenges in conducting clinical research to solve ongoing controversies.
iii
FADI W. ABDUL-KARIM, MD
Professor of Pathology, Case Western Reserve University
Chief, Division of Anatomic Pathology, University Hospitals of Cleveland
Fadi Abdul-Karim received his doctor of medicine at the American University of Beirut. He
continued his training at Case Western Reserve University, Institute of Pathology, with a residency
in anatomic pathology and a fellowship at the University of Texas System Cancer Center, M.D.
Anderson Hospital and Tumor Institute.
Dr. Abdul-Karim is a member of many professional societies including The International Academy
of Cytology, the American Society of Clinical Pathologists and the International Society of
Gynecologic Pathology. Dr. Abdul-Karim serves on national committees such as the American
Society Clinical Pathologist Quality Management Cytopathology Checkpath Committee and the
RISE National Advisory Board-Cytopathology to name two. He is a member of the Acta Cytologica
Editorial Advisory Board.
Dr. Abdul-Karim had directed workshops and courses and been an invited presenter at numerous
professional meetings. He has published over 140 peer-reviewed articles in professional journals
and several book chapters.
THEORIES OF ENDOMETRIAL CARCINOGENESIS
Upon completion of this session, participants will be able to:
1.
Discuss the current limitation of morphologic assessment of endometrial cancer.
2.
Contrast Type 1 and Type 2 endometrial cancer.
3.
Relate what “special studies” are currently available to pathologists that could assist
in the clinical management of the patient.
iii
Fadi W. Abdul-Karim, MD
References
1. Mutter GL: Diagnosis of premalignant endometrial disease. J Clin Pathol 2002;55:326-331.
2. Orbo A, Nilsen MN, Arnes MS, Pettersen I, and Larsen K: Loss of expression of MLH1, MSH 2,
MSH6, and PTEN related to endometrial cancer in 68 patients with endometrial hyperplasia. Int J
Gynecol Pathol 22:141-148, 2003.
3. van den Bos M, van den Hoven M, Jongejan E, van der Leif F, Michels M, Schakenraad S, Aben K,
Hoogerbrugge N, Ligtenberg M, van Krieken JH: More differences between HNPCC-related and
sporadic carcinomas from the endometrium as compared to the colon. Am J Surg Pathol
2004;28:706-711.
4. Watanabe J, Nishizaki R, Jobo T, Kamata Y, Hata H, Nishimura Y, Fujisawa T, Okayasu I, and
Kuramoto H. Expression of tumor suppressor gene product p14ARF in endometrioid adenocarcinoma
of the uterine corpus. Int J Gynecol Pathol 23:234-240, July 2004.
5. Sherman ME: Theories of endometrial carcinogenesis: A multidisciplinary approach. Mod Pathol
2000;13(3):295-308.
6. Mutter GL: 1. Histopathology of genetically defined endometrial precancers. Int J Gynecol Pathol,
19:301-309, October 2000.
7. Sherman MD, Devesa SS: Analysis of radial differences in incidence, survival, and mortality for
malignant tumors of the uterine corpus. Cancer 2003;98:176-86. Published 2003 by the American
Cancer Society.
8. An HJ, Logani S, Isacson C, and Ellenson LH: Molecular characterization of uterine clear cell
carcinoma. Modern Pathology (2004) 17, 530-537.
9. Silverberg SG: Problems in the differential diagnosis of endometrial hyperplasia and carcinoma.
Mod Pathol 2000;13(3):309-329.
10. Broaddus RR, Lynch PM, Lu KH, Luthra R, and Michelson SJ: Unusual tumors associated with the
hereditary nonpolyposis colorectal cancer syndrome. Modern Pathology (2004)17, 981-989.
11. Wheeler DT, Bell KA, Kurman RJ, and Sherman ME: Minimal uterine serous carcinoma. Am J Surg
Pathol 24(6):797-806, 2000.
12. Thompson L, Chang B, and Barsky SH: Monoclonal origins of malignant mixed tumors
(carcinosarcomas). Am J Surg Pathol 20(3):277-285, 1996.
13. Alkushi A, Lim P, Coldman A, Huntsman D, Miller D, and Gilks CB: Interpretation of p53
immunoreactivity in endometrial carcinoma: Establishing a clinically relevant cut-off level. Int J
Gynecol Pathol 23:129-137, April 2004.
14. Soslow RA, Pirog E, and Isacson C: Endometrial intraepithelial Carcinoma with associated
peritoneal carcinomatosis. Am J Surg Pathol, 24(5):726-732, 2000.
15. Peiro G, Mayr D, Hillemanns P, Lohrs U, and Diebold J: Analysis of HER-2/neu
amplification in endometrial carcinoma by chromogenic in situ hybridization, HER-2/neu,
p53 and Ki-67 protein expression, and outcome. Modern Pathology (2004) 17, 277-287.
iii
ROBERT DeBERNARDO, Jr. MD
Assistant Professor, Case Western Reserve University
Physician, Division of Gynecologic Oncology, University Hospitals of Cleveland
Robert DeBernardo, Jr. received his doctor of medicine from Temple University School of Medicine
and completed a residency in obstetrics and gynecology in the Department of Obstetrics and
Gynecology at Johns Hopkins Hospital and a fellowship in gynecologic oncology in the Department
of Gynecologic Oncology at Massachusetts General Hospital. He was a research fellow at the
Vincent Center for Reproductive Research at Massachusetts General Hospital and a research
assistant in the Department of Anatomy at Temple University School of Medicine.
Dr. DeBernardo has published peer-reviewed articles in Cancer Research and the Journal of Pelvic
Surgery and has presented at a number of professional meetings including the New England
Association for Gynecologic Oncologists and the Society of Gynecologic Oncologist.
Dr. DeBernardo has won honors and awards for his research such as the President’s Presenter Award
2002, Outstanding Abstract, Society for Gynecologic Investigation and the Dianon Prize, Trainee
Award: Best Abstract from 22nd Annual Meeting, New England Association for Gynecologic
Oncologists.
CLINICAL MANAGEMENT OF SEROUS ENDOMETRIAL CANCER
Upon completion of this session, participants will be able to:
1.
Relate the natural history of serous endometrial cancer.
2.
Defend extended surgical staging of serous cancers.
3.
Explain the role of adjuvant therapy for localized serous cancers.
4.
Describe current post-operative therapy for metastatic or recurrent cancer.
iii
SHERYL A. KINGSBERG, PhD
Associate Professor, Departments of Reproductive Biology and Psychiatry
Case Western Reserve University
Clinical Psychologist, Department of Obstetrics and Gynecology
University Hospitals of Cleveland
Sheryl A. Kingsberg is a clinical psychologist and Associate Professor in both the Departments of
Reproductive Biology and Psychiatry at Case Western Reserve University School of Medicine.
Since 1991, she has served as Staff Psychologist of the Department of Obstetrics and Gynecology at
University Hospitals of Cleveland. In this capacity Dr. Kingsberg directs inpatient and outpatient
psychological care, as well as providing clinical supervision to medical students and psychiatry
residents. She also devotes significant time to conducting clinical research and teaching medical
students and residents.
Dr. Kingsberg earned her doctorate from the University of South Florida in Tampa (1989). Since
1989, Dr. Kingsberg has been a member of the American Psychological Association, and from 1992
on she has been an active member of the American Society for Reproductive Medicine (ASRM), the
Society for Sex Therapy and Research (SSTAR), the North American Menopause Society NAMS),
the North American Society for Psychosocial Obstetrics and Gynecology (NASPOG), and the
Society for Behavioral Medicine (SBM). She is currently the Chairwoman of the ASRM Sexual
Medicine Special Interest Group’s Bylaws Committee and is serving on RESOLVE’s Embryo
Donation Advisory Board.
THE IMPACT OF GYNECOLOGIC CANCER AND CANCER
TREATMENTS ON SEXUALITY AND RELATIONSHIPS
Upon completion of this session, participants will be able to:
1.
Describe the impact of gynecologic cancer, treatments and normal aging on sexual
desire and sexual functioning in women and men.
2.
Identify the components of sexual desire.
3.
Outline the changes in sexual functioning and relationships that occur as a result of
illness and with aging.
4.
Demonstrate ways to help healthcare providers enhance their communication with
patients regarding sexual function.
iii
VIVIAN von GRUENIGEN, MD
Assistant Professor, Department of Reproductive Biology
Case Western Reserve University, University Hospitals of Cleveland
Vivian von Gruenigen received her doctor of medicine from Wright State University. She
completed a fellowship in gynecology oncology at the University of Texas Southwestern Medical
Center and a residency and internship in obstetrics and gynecology at Akron City Hospital,
Department of Obstetrics and Gynecology.
Dr. von Gruenigen received the CREOG Annual National Faculty Award for Excellence in Resident
Education, University Hospitals of Cleveland/Case Western Reserve University, Surgeon of the
Year, Department of Obstetrics and Gynecology, Aultman Hospital, and the American Association
for Cancer Research Travel Award to name a few.
Dr. von Gruenigen is a member of several professional societies including the American College of
Obstetricians and Gynecologists (Fellow), the American Association of Cancer Research (elected
membership) and the Society of Gynecologic Oncologists. She serves on many professional
committees such as the Medical Advisory and Program Committee of the Cleveland Hospice of the
Western Reserve, the Ethics Committee, University Hospitals of Cleveland and serves on the Board
of Directors, Akron General Medical Center.
She is an ad hoc journal and research proposal reviewer for the Gynecologic Oncology Journal and
the Women’s Oncology Review and has published in many peer-reviewed journals. She has been an
invited presenter at many national professional meetings.
NANCY FUSCO, RN, BSN
Chemotherapy/Research Nurse and Program Manager
Division of Gynecologic Oncology, University Hospitals of Cleveland
Nancy Fusco earned her Bachelor of Science degree in Nursing in 1990 from The Ohio State
University. She has worked in Gynecology Oncology for 14 years and in clinical research for 12
years. Currently, she is the Gynecology Oncology Chemotherapy/Research Nurse Program Manager
for University Hospitals of Cleveland at the Ireland Cancer Center.
She is active in the Gynecologic Oncology Group (GOG) and sits on three committees. She has
been the nurse contact on over 15 GOG protocols. She was a member of the Oncology Nursing
Society lecture faculty in 2002-2003, lecturing on recurrent ovarian cancer. She has also been a
member of the Alza and Ortho Biotech Nurses Advisory Boards. She is published in several
journals including Proc ASCO, Gynecology Oncology, Journal of Clinical Oncology, and the
International Journal of Gynecologic Cancer.
iii
THE END OF LIFE AND SYMPTOM MANAGEMENT IN
WOMEN WITH OVARIAN CANCER
Upon completion of this session, participants will be able to:
1.
Relate the philosophy and organization of palliative and hospice care.
2.
Discuss the presentation of end of life in ovarian cancer patients.
3.
Apply palliative interventions that may be needed in symptomatic women with
ovarian cancer.
iii
APPENDIX
iii