Editor
CN
Purandare
MD, MAO, DGO, DFP, DORCPI, FICOG, FICMCH
Secretary General, FOGSI President, MOGS 2003-04 Jt. Associate Editor, Journal (FOGSI) Vice Dean (Overseas), University of Seychelles (USAIM) Ex. Hon. Professor, GMC,
Mumbai
Consultant O and G, St. Elizabeth Hospital,
Mumbai
Associate Editor
Madhuri Arvind
Patel
MD, DGO
Associate Professor Department of Obstetrics and Gynecology GMC,
Mumbai
Member of Managing Council of MOGS Chairperson of Family Welfare Committee of MOGS,
Mumbai
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Gynecological Cancer
© 2007, CN Purandare, Madhuri Arvind Patel
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition:
2007
9788180619090
Typeset at JPBMP typesetting unit
Printed at Rajkamal Press
5Dedicated to
my two esteemed teachers
Dr GB Belvi (Mumbai, India)
and
Late Dr Fergus Meehan
(Galway, Ireland)
7CONTRIBUTORS
-
Adarsh Bhargava ms (obst. & gyn.), micog, ficmch
-
WHO Fellow Urogynecology (Harvard, USA)
-
Professor and Head, Dept. of Obst. and Gyne.
-
SMS Medical and Superintendent
-
Zanana Hospital
-
Jaipur
-
AK Debdas md, frcog, frcs, ficog
-
Honorary Associate Professor
-
MGM Medical College, Executive Director
-
NA-RI-KE, Jamshedpur
-
Alka Kriplani md, ficog, mams, ficmch, fimsa
-
All India Institute of Medical Sciences
-
Dept. of Obst. and Gyne., Ansari Nagar
-
New Delhi-110029
-
Amalchandra Kataki md
-
Director, Dr B Borooah Cancer Institute
-
Guwahati
-
Amita Marathe md
-
Consultant Obstetrician and Gynecologist
-
Chaitanya Nursing Home
-
Vasai, Mumbai
-
Amita Pandey md, dm-genetics
-
Lecturer, Dept. of Obst and Gyne
-
KG Medical University, Lucknow
-
Amita Suneja md
-
Professor
-
Department of Obstetrics and Gynecology
-
UCMS and GTB Hospital
-
Shahdara, Delhi
-
Anahita R Chauhan md, dgo, dfp
-
Associate Professor
-
Department of Obstetric and Gynecology
-
Seth GS Medical College and KEM Hospital
-
Mumbai
-
Arun H Nayak md, dgo, ficog
-
Fellowship Gynecological Endoscopic Surgery (Korea)
-
Gynecologist and Obstetrician
-
Endoscopic Surgeon
-
BYL Nair Hospital, Mumbai Central
-
Mumbai-8
-
Associate Professor, TN Medical College
-
Mumbai-8
-
Asaranti Kar md, fic path
-
Lecturer, Dept. of Pathology
-
SCB Medical College
-
Cuttack, Orissa
-
Asha Dalal md, dgo
-
Professor and Head
-
Department of Obstetrics and Gynecology
-
BYL Nair Charitable Hospital
-
TN Medical College, Mumbai
-
Behram Anklesaria md, dgo, atmf (usa)
-
Consultant, Obst. and Gyne.
-
Ahmedabad
-
Ex. President of FOGSI
-
BK Smruti md
-
Consultant Medical and Hemato-Oncologist
-
Bombay Hospital Institute of Medical Sciences
-
Assistant Honorary at Cama and JJ Group of Hospitals, Mumbai
-
Chandrawati md, dgo, ms (obst & gyn) dfpa. (eng.) fics ficmch
-
Prof. Emeritus and Ex HOD
-
Dept. of Obst. and Gyne.
-
KGMC, Lucknow
-
Ching Ling Yi md, dgo
-
Asso. Prof.
-
BYL Nair Charitable Trust Hospital TN
-
Medical College, Mumbai.
-
Secretary General, FOGSI
-
President, MOGS 2003-04
-
Jt. Associate Editor, Journal (FOGSI)
-
Vice Dean (Overseas), Univ. of Seychelles
-
(USAIM) Ex. Hon. Prof., GMC, Mumbai
-
Consultant O and G, St. Elizabeth Hospital
-
Mumbai
-
Deepika Deka md, micog, ficmch
-
Professor
-
Department of Obstetrics and Gynecology
-
AIIMS, New Delhi
-
Geetha D Balsarkar md, dgo, dnb, fcps
-
Associate Professor
-
Nowrosjee Wadia Maternity Hospital
-
Seth GS Medical College, Parel, Mumbai
-
Harshad Parasnis md, dnb, fcps, dgo
-
Consultant, Gynecologic Oncologist
-
Hon. Associate Professor
-
Bharati Vidyapeeth Medical College
-
Pune
-
Hiralal Konar md (pgi), dnb (ind), mnams, mrcog (london)
-
Associate Professor, Obstetrics and Gynecology
-
NRS Medical College and Hospital, Calcutta
-
Chairperson, Medical Disorders in Pregnancy
-
Committee (FOGSI)
-
Ex. Sr. Vice President, Bengal Obst. and Gyn.
-
Society, Calcutta
-
Vice Chairperson, Organizing Committee
-
AICOG-2007, Calcutta
-
Jasmine Lopez md, dgo
-
Ex. Associate Professor
-
Department of Obstetrics and Gynecology
-
GMC Mumbai
-
Dean, Dr DY Patil Educational Enterprises
-
Rajawadi, Mumbai
-
JJ Vyas ms, facs
-
Senior Consultant Cancer Surgeon
-
Division of Surgical Oncology
-
Bombay Hospital Institute of Medical Sciences
-
Mumbai
-
Madhuri Arvind Patel md, dgo
-
Associate Professor
-
Department of Obstetrics and Gynecology
-
GMC, Mumbai
-
Members of Managing Council of MOGS
-
Chairperson of Family Welfare Committee of MOGS
-
Mandeep Singh md
-
Research Fellow
-
London
-
UK
-
Mehul S Bhansali ms, dnb
-
Surgical Oncologist, Hon. Asst. Prof.
-
Cama and Albless Hospital and Hon.
-
Consultant Jaslok Hospital
-
Mumbai
-
Mukesh Patil md
-
Consultant Gynecologist
-
Mumbai
-
Mukund Tayade ms
-
General Surgeon
-
Prof. GMC and JJ Hospital
-
Mumbai
-
N Vimalamma md, dgo
-
Research Officer
-
Dept. of Obstetrics and Gynecology of AIIMC
-
New Delhi
-
Nagendra Sardeshpande dnb, fcps, dgo
-
Consultant Obstetrician and Gynecologist
-
Brahman Sabha and Dhanwantari Hospitals
-
Mumbai
-
Professor, Nowrosjee Wadia Maternity
-
Hospital, Seth GS Medical College
-
Parel, Mumbai
-
Nikhil Purandare mbbs, mcps
-
Resident O and G, University College Hospital
-
Galway, Republic of Ireland
-
Nozer Sheriar md, dnb, ficog, fcps, dgo
-
Consultant Obstetrician and Gynecologist
-
Holy Family, Masina and Parsee General
-
Hospital, Gynecological Endoscopist
-
Bhatia and BARC Hospital, Mumbai
-
Treasurer, FOGSI
-
Member, Medical Advisory Panel, FPAI
-
Pakhee Aggarwal postgraduate
-
Dept. of Obstetrics and Gynecology
-
Maulana Azad Medical College
-
Lok Nayak Hospital, New Delhi
-
Pankaj Desai md, ficog, ficmch
-
Associate Professor
-
Unit Chief of Dept. of Obst. and Gyne.
-
Medical College, Baroda
-
PK Sekharan md
-
Former Professor and Head
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Dept. of Obstetrics and Gynecology
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Medical College, Calicut, Kerala
-
PK Shah md, dgo, dfp, fcps
-
Prof. and Unit Head, Dept. of Ob/Gyn
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LTM Medical College and LTMG Hospital
-
Sion, Mumbai
-
Hon. Deputy Secretary General, FOGSI
-
President, Mumbai Ob/Gyn Society (MOGS)
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Vice President, Indian Federation of Ultrasound in Medicine and Biology (IFUMB)
-
Editor, Ob/Gyn. Today Journal
-
Prakash Bhatt md
-
Consultant, Obs/gyn, Surat
-
Third Vice President (FOGSI)-2005
-
Pratima Kadam md, dgo, dnb
-
Lecturer
-
Dr RN Cooper Hospital
-
Mumbai
-
Priti Kumar mbbs, md, micog
-
Consultant Obstetrician and Gynecologist
-
Sunflower Medical Center
-
Lucknow
-
Pushkar Ingle md (radiotherapy), dnb
-
Lecturer
-
Dept. of Radiotherapy and Oncology
-
Cama and Albless Hospital
-
Mumbai
-
Rajalaxmi Walavalkar md, dnb, fcps, dgo, dfp
-
Specialist Registrar O and G
-
St. Mary's Hospital
-
Portsmouth
-
UK
-
Rajendra A Kerkar md mrcog
-
Division of Gynecological Oncology
-
Tata Memorial Hospital
-
Mumbai
-
Rajendra M Saraogi md, ficog, fcps, dgo
-
Hon. Prof., Seth GS Medical College
-
Mumbai
-
Hon. HOD, Dr RN Cooper Hospital
-
Mumbai
-
Hon. Consultant, Dr BL Nanavati Hospital, Mumbai
-
Director, Saraogi Hospital
-
Mumbai
-
Rupal Dedhia md
-
Consultant Radiation Oncologist
-
Lady Ratan Tata Medical and Research Center
-
Mumbai
-
Sadhana Tayade md
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Superintendent of Cama and Albless Hospital
-
Mumbai
-
Specialist Registrar, Dept. of Obst. and Gyn.
-
Severn Wessex and Peninssula Deanery
-
Bristol
-
UK
-
Sanjay Gupte md, ficog, llb
-
Prof. of BJ Medical College
-
Sassoon General Hospital
-
Pune
-
Sarita Bhalerao md, dgo, fcps, dnb, mrcog
-
Consultant Obstetrician and Gynecologist
-
Bhatia and Guru Nanak Hospital
-
Mumbai
-
Sharmila Agarwal md, dnb
-
Consultant Radiation Oncologist
-
Cama and Albless Hospital, Mumbai
-
Jaslok Hospital and Research Center, Mumbai
-
Lady Ratan Tata Medical and Research Center
-
Mumbai
-
Sneha Shah mbbs, drm, dnb, (nuclear medicine)
-
Physician, Tata Memorial Hospital
-
Mumbai
-
Soumil J Vyas ms, dnb, frcs (edin), mnams, m.med (surg)
-
Assistant Surgeon
-
Division of Surgical Oncology
-
Bombay Hospital Institute of Medical Sciences
-
Mumbai
-
Suchitra N Pandit b. pharm, md, dnb, dfp, mrcog, mnams
-
Assoc. Prof. and Unit Chief
-
Dept. of Obs. and Gyn, LTMG Hospital
-
Sion, Mumbai
-
Sumana G md, dnb
-
Senior Resident
-
AIIMS, New Delhi
-
Suneeta Mittal md, fams, frcog, ficog, fimsa
-
Prof. Head, Dept. of Obst. and Gyn, AIIMC
-
Director in-charge, WHO Collaborative
-
Center for Research in Human Reproduction
-
Vice President Elect (FOGSI)-2007
-
Suvarna Khadilkar md, dgo, ficog
-
Associate Professor
-
GMC and JJ Hospital, Mumbai
-
Chairperson, Menopause Comm. MOGS
-
Jt Asst Secretary, Journal of Ob/gyn of India
-
Tushar Kar md, micog, ficmch
-
Fellow Laporoscopic Surgery (USA)
-
Asst. Prof. and Laparoscopic Surgeon
-
Dept. of Obst. and Gyn.
-
SCB Medical College, Cuttack
-
Chairperson of Oncology Committee
-
Uddhav Raj Dudhedia md fcps dgo
-
Consultant Gynecological Endoscopic and Minimal Access Surgeon
-
Dr LH Hiranandani Hospital, Mumbai
-
Vanita S Raut md, dgo
-
Professor, Department of Obstetrics and Gynecology
-
Seth GS Medical College and KEM Hospital
-
Mumbai
-
Vijay C Pawar md, dgo, fcps
-
Senior Registrar, Dept. of Obst. and Gyn.
-
LTMG Hospital, Sion, Mumbai
-
Vinita Das md, ficog
-
IMSP Fellow in High Risk Pregnancy
-
UT South Western Medical Center
-
Dallas Tx USA
-
Department of Obstetric and Gynecology
-
Project Director, KGMU. SIFPSA
-
Director, Postpartum Programme
-
In-charge, Infertility Unit Officer
-
In-charge, HRRC (Human Reproduction Research Center) KG Medical University
-
Lucknow, India
-
Professor and Head of Unit
-
Officer In-charge
-
ICMR Regional Center for Research in Human
-
Reproduction
-
Department of Obstetrics and Gynecology
-
Seth GS Medical College and KEM Hospital
-
Mumbai
-
Yogesh V Kulkarni md, dnb
-
Clinical Research Fellow
-
Division of Gynecological Oncology
-
Tata Memorial Hospital
-
Mumbai
It is a great pleasure to have the opportunity to write the foreword for this excellent and much needed book Gynecological Cancer.
Gynecological cancers constitute the major burden of cancer in women in India, accounting for nearly 30 percent of all cancers in women. In the last decade, there has been an explosion of new evidence pertaining to gynecological cancers - in the form of randomized controlled trials and meta-analyses, which has forced us to redefine the treatment protocols for these cancers, with the aims of improvement in outcome as well as preservation of organ, function and fertility in suitable patients. I am happy that this publication has tried to look at all the available evidence pertaining to these cancers.
It is clear from the published literature that outcome of women with gynecological cancers is related to subspecialty training of the treating clinician. Women afflicted with these cancers should ideally be treated by those with appropriate level of expertise – either Gynecologic Oncologists or Gynecologists with special interest and training in Gynecologic Oncology. This book should prove valuable to both Gynecologic Oncologists and Gynecologists with special interest in Gynecologic Oncology by providing a comprehensive overview of the current state of the art in Gynecologic Oncology. It includes the underlying concepts, discusses the current state of our knowledge and practice and provides the reader with information sufficient to understand new developments that will affect the future of this subspecialty. It is conducive to both easy reference and complete reading. The book also employs a pragmatic approach towards application of new technological advances to developing countries like India.
This book incorporates contributions from expert authors from different fields, underscoring the importance of a multidisciplinary approach to the management of gynecological cancers. The knowledge of the information in this book is essential to all individuals concerned with the challenges of gynecological cancers.
I must congratulate Dr CN Purandare for his vision and efforts in bringing out this excellent review of Gynecological Cancers. As a practicing Gynecologic Oncologist, I look forward to having this important reference source close at hand as I engage in the increasingly complex clinical care of patients afflicted with gynecological cancers.
Dr Hemant B Tongaonkar
Professor & Head
Division of Gynecologic Oncology
Tata Memorial Hospital, Mumbai
President, Association
13PREFACE
When you are interested in something, you do it only because it is convenient; when you are committed, you accept only results, not excuses.
Kenneth Blanchard
It has been my longtime desire to write a comprehensive book on gynecological oncology. A gynecologist interested in the field of oncology or an oncologist practicing purely in the field of gynecology needs to study and concentrate in depth to give justice to the patient in terms of better five years survival rate and quality of life.
Unfortunately both a General Gynecologist and a General Oncosurgeon treat many cases resulting in a poor outcome for the patient.
Keeping this in mind an extensive coverage is given to all subjects so that this desktop book is a ready reckoner to all concerned to give optimal treatment.
The editors have taken special care to maintain the continuity throughout the book with up-to-date information.
I thank all the contributors to this book for taking pains in order to make this book a reality.
CN Purandare