Table Of ContentBerek & Hacker’s
Gynecologic
Oncology
Sixth Edition
Jonathan S. Berek, MD, MMS
Laurie Kraus Lacob Professor
Director, Stanford Women’s Cancer Center
Stanford Cancer Institute
Chair, Department of Obstetrics and Gynecology
Stanford University School of Medicine
Stanford, California
Neville F. Hacker, AM, MD
Professor of Gynaecologic Oncology
Conjoint, University of New South Wales
Director, Gynaecologic Cancer Centre
Royal Hospital for Women
Sydney, Australia
Illustrations and design by
Deborah Berek, ma
Tim Hengst, cmi, fami
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6th edition
Copyright © 2015 Wolters Kluwer
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. Copyright © 2005 by Lippincott
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Library of Congress Cataloging-in-Publication Data
Berek & Hacker’s gynecologic oncology / [edited by] Jonathan S. Berek, Neville F. Hacker ; illustrations
and design by Tim Hengst, George Barile, Deborah Berek. – 6th edition.
p. ; cm.
Berek and Hacker’s gynecologic oncology
Gynecologic oncology
Includes bibliographical references and index.
ISBN 978-1-4511-9007-6 (alk. paper)
I. Berek, Jonathan S., editor. II. Hacker, Neville F., editor. III. Title: Berek and Hacker’s gynecologic
oncology. IV. Title: Gynecologic oncology.
[DNLM: 1. Genital Neoplasms, Female. 2. Genitalia, Female–physiopathology. WP 145]
RC280.G5
616.99′465–dc23
2014032705
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This work is no substitute for individual patient assessment based upon healthcare professionals’ exami-
nation of each patient and consideration of, among other things, age, weight, gender, current or prior medi-
cal conditions, medication history, laboratory data and other factors unique to the patient. The publisher
does not provide medical advice or guidance and this work is merely a reference tool. Healthcare profes-
sionals, and not the publisher, are solely responsible for the use of this work including all medical judg-
ments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional
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To Deborah and Estelle, and to our patients, from whom we are always
learning, and who continue to inspire us with their courage.
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Contributors
Spencer R. Adams, MD Michael J. Campion, MD
Assistant Clinical Professor Director of Preinvasive Disease
Department of Internal Medicine Gynaecological Cancer Centre
UCLA David Geffen School of Medicine Royal Hospital for Women
Internal Medicine Hospitalist Sydney, Australia
Director of Perioperative Medical Services
Los Angeles, California Karen Canfell, DPhil
Associate Professor
Frédéric Amant, MD, PhD
Lowry Cancer Research Centre
Head, Scientific Section of Gynecological Oncology Prince of Wales Clinical School
Catholic University of Leuven University of New South Wales
Staff Member, Gynecological Oncology Sydney, Australia
University Hospitals of Leuven
Leuven, Belgium David Cibula, MD, PhD
Professor
Barbara L. Andersen, PhD
First Faculty of Medicine
Professor Charles University
Department of Psychology Chair, Gynecologic Oncology Centre
James Cancer Hospital General University Hospital in Prague
Solove Research Institute Prague, Czech Republic
The Ohio State University
Columbus, Ohio Daniel W. Cramer, MD
Professor
Walter F. Baile, MD
Department of Obstetrics, Gynecology and
Professor Reproductive Biology
Department of Behavioral Science and Psychiatry Harvard Medical School
Psychiatrist and Director Brigham and Women’s Hospital
Program for Interpersonal Communication and Boston, Massachusetts
Relationship Enhancement
MD Anderson Cancer Center Catherine M. Dang, MD
University of Texas
Associate Director
Houston, Texas
Wasserman Breast Cancer Risk Reduction Program
Department of Surgery
Andrew Berchuck, MD
Cedars-Sinai Medical Center
Professor and Director Los Angeles, California
Department of Obstetrics and Gynecology
Division of Gynecologic Oncology Oliver Dorigo, MD, PhD
Duke University School of Medicine
Associate Professor and Director
Durham, North Carolina
Division of Gynecologic Oncology
Director, Mary Lake Polan
Ross S. Berkowitz, MD
Gynecologic Oncology Research Laboratory
William H. Baker Professor of Gynecology Department of Obstetrics and Gynecology
Department of Obstetrics, Gynecology and Stanford University School of Medicine
Reproductive Biology Director, Gynecologic Cancer Care Program
Harvard Medical School Stanford Women’s Cancer Center
Director of Gynecologic Oncology Stanford Cancer Institute
Co-Director, New England Trophoblastic Disease Center Stanford, California
Brigham and Women’s Hospital
Dana Farber Cancer Institute
Boston, Massachusetts
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Contributors
Patricia J. Eifel, MD Walter H. Gotlieb, MD, PhD
Professor Professor
Department of Radiation Oncology Department of Oncology
MD Anderson Cancer Center Department of Obstetrics and Gynecology
University of Texas McGill University
Houston, Texas Director of Gynecology
Segal Cancer Center
Patricia Eshaghian, MD Jewish General Hospital
Assistant Clinical Professor of Medicine Montreal, Canada
Division of Pulmonary and Critical Care Medicine
UCLA David Geffen School of Medicine Kenneth D. Hatch, MD
Santa Monica, California Professor
Department of Obstetrics and Gynecology
Michael L. Friedlander, MBChB, PhD University of Arizona School of Medicine
Conjoint Professor of Medicine University Medical Center
University of New South Wales Tucson, Arizona
Director of Medical Oncology
The Prince of Wales Hospital Michael R. Hendrickson, MD
Consultant Medical Oncologist Professor Emeritus
Royal Hospital for Women Department of Pathology
Sydney, Australia Stanford University School of Medicine
Director of Surgical Pathology
Stéphanie Gaillard, MD, PhD Stanford Health Care
Assistant Professor Stanford, California
Division of Medical Oncology
Duke Cancer Institute Ian Jacobs, MBBS, MD
Durham, North Carolina Vice Chancellor
University of New South Wales
Alexandra Gentry-Mararaj, PhD Sydney, Australia
Senior Research Associate
Department of Women’s Cancer Amer Karam, MD
EGA Institute for Women’s Health Associate Clinical Professor
University College London Associate Director and Director of Outreach
England, United Kingdom Division of Gynecologic Oncology
Department of Obstetrics and Gynecology
Arnando E. Giuliano, MD Stanford University School of Medicine
Clinical Professor of Surgery Stanford Women’s Cancer Center
UCLA David Geffen School of Medicine Stanford, California
Executive Vice Chair
Department of Surgery Reza Khorsan, MD
Cedars-Sinai Medical Center Assistant Professor of Medicine
Los Angeles, California Department of Medicine
UCLA David Geffen School of Medicine
Donald P. Goldstein, MD Los Angeles, California
Professor Nephrologist, Department of Medicine
Department of Obstetrics, Gynecology and Santa Monica-UCLA Medical Center
Reproductive Biology Santa Monica, California
Harvard Medical School
Co-Director, New England Trophoblastic Disease Center
Brigham and Women’s Cancer Center
Boston, Massachusetts
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Contributors
Christina S. Kong, MD Usha Menon, MD
Associate Professor Head, Department of Gynaecological Oncology
Department of Pathology Gynaecological Cancer Research Centre
Stanford University School of Medicine Institute for Women’s Health
Director of Cytopathology Consultant Gynaecologist
Stanford Health Care University College London
Stanford, California England, United Kingdom
Roger M. Lee, MD Roseanne Moses, MMed, MBBS
Assistant Clinical Professor Senior Staff Specialist
Department of Internal Medicine Palliative Medicine
UCLA David Geffen School of Medicine Gynaecological Cancer Centre
Los Angeles, California Royal Hospital For Women
Santa Monica-UCLA Medical Center New South Wales, Australia
Santa Monica, California
Jennifer A. M. Philip, PhD, MMed, MBBS
J. Norelle Lickiss, MD
Associate Professor
Clinical Professor Center for Palliative Care
University of Sydney University of Melbourne
Consultant Emeritus Deputy Director, Palliative Medicine
Royal Prince Alfred Hospital, Camperdam & St. Vincent’s Hospital
Royal Hospital for Women Melbourne, Australia
New South Wales, Australia
Joshua Z. Press, MD, MSc
Teri A. Longacre, MD
Gynecologic Oncologist
Professor Pacific Gynecology Specialists
Department of Pathology Division of Oncology and Pelvic Surgery
Stanford University School of Medicine Seattle, Washington
Associate Director of Surgical Pathology
Stanford Health Care Norman W. Rizk, MD
Stanford, California
Berthod and Bell N. Guggenhime Professor in Medicine
Senior Associate Dean for Clinical Affairs
Paul M. Maggio, MD
Stanford University School of Medicine
Assistant Professor Chief Medical Officer
Department of Surgery Stanford Health Care
Stanford University School of Medicine Stanford University School of Medicine
Co-director, Critical Care Medicine Stanford, California
Stanford Health Care
Stanford, California Samuel A. Skootsky, MD
Chief Medical Officer
Maurie Markman, MD
UCLA Faculty Practice Group and Medical Group
Clinical Professor of Medicine Professor of Medicine
Drexel University College of Medicine UCLA David Geffen School of Medicine
President of Medicine and Science Los Angeles, California
Cancer Treatment Centers of America
Philadelphia, Pennsylvania M. Iain Smith, MD
Assistant Clinical Professor
G. Larry Maxwell, MD
Department of Medicine
Professor of Obstetrics and Gynecology UCLA David Geffen School of Medicine
Virginia Commonwealth University School of Medicine Los Angeles, California
Chair, Department of Obstetrics and Gynecology
Inova Fairfax Hospital Anil K. Sood, MD
Falls Church, Virginia
Professor
Department of Gynecologic Oncology
MD Anderson Cancer Center
Houston, Texas
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Contributors
Kathryn L. Terry, ScD Jan B. Vermorken, MD, PhD
Assistant Professor Emeritus Professor of Medical Sciences
Obstetrics, Gynecology, and Reproductive Biology Antwerp University
Harvard Medical School Antwerp, Belgium
Associate Epidemiologist Consultant in Medical Oncology
Brigham and Women’s Hospital Antwerp University Hospital
Boston, Massachusetts Edegem, Belgium
Laszlo Ungar, MD Kristen C. Williams, MA
Professor Department of Psychology
Department of Obstetrics and Gynecology James Cancer Hospital
Albert Szentgyorgyi Medical University Solove Research Institute
Head, Metropolitan Gynecological Service The Ohio State University
St. Stephen and Jahn Ferenc Hospitals Columbus, Ohio
Budapest, Hungary
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Foreword to the First Edition
Close to the beginning of this century, William Osler observed, “The practice of medicine is an art,
based on science.” That brief characterization of our profession rings true, even as we approach
the next century in the midst of brilliant, accelerating scientific discovery.
Some aspects of the art—including compassion and the basic skills of history taking and physical
examination—are, or should be, common to all physicians and remain largely unchanged by a
century of research. In other ways, the “art,” which can also be translated as “craft” from the
original Greek work “techne,” has been greatly enlarged and diversified by science and technology.
Thus, the special skills required by a gynecologic oncologist derive not only from experience and
practice, but also from the proliferation of knowledge in many branches of science. Indeed, it is
mainly the developments of science in obstetrics and gynecology—and in some other disciplines—
that have evolved the clinical subspecialty of gynecologic oncology.
The art and the science are connected not only by ancestry, however. Their relationship continues
to be an interdependent one. One of the ever-expanding glories of medicine is that what is learned
in the laboratory can enhance learning at the bedside and what is learned from experience with
patients helps to shape and direct scientific inquiry.
Doctors who remain lifelong students are exhilarated by these interconnections and make the best
teachers of clinical medicine. It is in the scholarly tradition that Jonathan S. Berek and Neville F.
Hacker, with contributions from distinguished colleagues in their own discipline and in fields that
bear upon it, have brought together the salient information required to develop the acumen and
skills that enable clinicians to understand and to care for women suffering from tumors.
Practical Gynecologic Oncology reflects the indivisibility of art and science in medicine. The two
editors—one in Los Angeles and one in Sydney—worked and studied together for 7 years in the
same hospital and laboratories and remain mutually helpful intellectual allies on opposite shores
of the Pacific Ocean.
Sherman M. Mellinkoff, MD
Dean Emeritus
Professor of Medicine
UCLA David Geffen School of Medicine
Los Angeles, California
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