Women's Health and Education Center (WHEC)

Gynecologic Oncology

List of Articles

  • Quality of Life & Gynecological Malignancies
    In gynecologic oncology, every clinical intervention has two distinct aims. One is to produce objective improvement in the patient's medical condition and second aim, regardless of whether medical improvement is possible, is to produce amelioration of the patient's subjective symptoms. Helping the patient get better and feel better. Communication skills are essential for both. While there has been a dramatic improvement in the cure rate of gynecological malignancies and women survive longer than 5 years, with what is commonly considered a "chronic" cancer. In each phase of the illness -- diagnosis, surgery and chemotherapy with curative intent, remission and survivorship, relapse and sequential chemotherapy, bowel obstruction and end of life; quality of life (QOL) is one of the most important considerations. There has recently been a large increase in studies reporting the assessment of QOL; that has changed the field from descriptive reporting to quantitative science. History and development of QOL evaluation and various approaches to QOL assessment (psychometric based and utility based) are also discussed. It describes strategies for meaningful interpretation of QOL profiles. We hope the science of the study of QOL will be the foundation and confirmation of many of the anticipated advances for patients.

  • Ovarian Cancer: Neo-Adjuvant Chemotherapy & Other Treatment Modalities
    Epithelial ovarian cancer is the most lethal gynecologic malignancy in adult women. Exploratory laparotomy is required for histologic confirmation, staging and tumor debulking and should be performed by a surgeon trained in these aspects of ovarian cancer management. Because of the propensity of epithelial ovarian cancer to spread beyond the confines of the ovary, the majority of patients will require postoperative chemotherapy in an attempt to eradicate residual tissue. With advanced-stage disease (stages III and IV), postoperative combination chemotherapy with a taxane and platinum combination is the standard of care. Such treatment is capable of inducing responses in >70% of patients with residual epithelial ovarian cancer and is also capable of prolonging both disease-free and overall survival. Ongoing efforts to identify anti-angiogenesis compound to incorporate agents with novel mechanisms of action are also discussed. Role of radiotherapy and other modalities are explored. Ultimately, it is hoped, a combination of these approaches will result in an improvement in the survival of patients with this devastating disease.

  • End-of-Life Care: Pain Assessment and Management
    Unrelieved pain is the greatest fear among patients with a life-limiting disease. Physicians should consider the legal ramifications of inadequate pain management and understand the liability risks associated with both inadequate treatment and treatment in excess. As the fifth vital sign, pain should be assessed as frequently as the other vital signs and the findings should be well documented, for easy reference by all members of the healthcare team. This review discusses the etiology of pain at the end of life and issues in effective pain management; assessment of pain accurately through use of clinical tools and other strategies, including the use of an interpreter; and select appropriate pharmacologic and/or non-pharmacologic therapies to manage pain in patients during the end-of-life period.

  • End-of-Life Care: Symptom Management (Part 1)
    Symptom management is an essential element in any care setting, requiring diligent ongoing assessment and evaluation of interactions. Side effects related to treatment of symptoms must be understood and treated. The goals of symptom management for patients near the end of life are to control symptoms, promote meaningful interactions between patients and families, and facilitate peaceful deaths. Optimum treatment of symptoms involves comprehensive assessment and use of drug and non-drug interventions. It is essential that healthcare providers in all settings become prepared to provide quality care at the end of life. The physical comfort measures must continue, including frequent repositioning and oral hygiene. Emotional support of the family is imperative. This document discusses the symptoms: Fatigue and Weakness; Dyspnea; Constipation; Nausea and Vomiting.

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