Androgen deprivation therapy (ADT) has several side effects that can be reduced with a well-balanced diet and a healthy lifestyle. There are some general principles about diet and cancer that one should be aware of. The first one is that a diet, which may help prevent a cancer from occurring, is not likely to cure cancer once cancer has been diagnosed. This is true for prostate cancer. In addition to side effects such as loss of muscle mass and weight gain, men on ADT are also at increased risk of osteoporosis, diabetes, and cardiovascular problems. This chapter outlines how eating healthy can help manage weight and reduce these risk factors. It also provides additional detailed information on specific nutrients that make up an overall diet. Patients often have questions about specific nutritional components in relationship to prostate cancer and cancer risk in general. The chapter also addresses these topics.

This chapter is relevant to both straight and gay men who are either partnered or single. It is also relevant to men whether or not they had already stopped having partnered sex prior to the start of androgen deprivation therapy (ADT). A loss of sexual desire changes most men’s relationships. This chapter includes a section specifically on dating. Whether one participates in partnered sexual activities or not, one will likely notice changes in sexuality during ADT for prostate cancer. This chapter helps one to figure out answers to questions related to sexual desire and sexual function. It provides insights on how to adjust to changes, and how to involve new partner(s) in adapting to these changes. Whether single or partnered, the chapter describes specific exercises that may help one to plan ahead, recognize what is important, and adapt to the impact of ADT on the sexual life.

Couples may be at risk of experiencing deterioration in their relationship when the patient is on androgen deprivation therapy (ADT). One reason this can occur is that couples do not know how to communicate about the changes that are occurring within their relationship. Those who think they must hide their feelings and emotional changes, not only from their partner but also from others, may withdraw. That can include withdrawing from friends and family beyond their intimate partner. In sharp contrast, there are other couples who find that they actually connect more with each other because the experience of having cancer has brought them closer together. Also, couples in which the patient is more physically active show better relational adjustment over the course of being on ADT. Couples therapists often advise folks to pick a place outside the bedroom to discuss the topic of sexual intimacy and emotional needs.

In Androgen deprivation therapy (ADT, commonly called hormone therapy), one begins treatment with drugs that reduce the amount of male hormones, called androgens, in your body. ADT is effective in controlling prostate cancer and treating most of the symptoms associated with prostate cancer. ADT works by reducing testosterone (produced in the testicles), the main hormone that stimulates the growth of prostate cancer cells. Suppressing the amount of testosterone in the body can slow the spread of prostate cancer and significantly reduce the symptoms associated with the disease. Many patients and their loved ones readily accept the side effects of ADT in return for a life-prolonging treatment and recognize the trade-off between some quality of life for quantity of life. Other patients and their loved ones struggle to adjust to the side effects. This book focuses on how one can maintain a good quality of life while on ADT.

Androgen deprivation therapy (ADT) eliminates most of the testosterone in a man’s body. This can lead to many physical effects. This chapter covers the various side effects that one may experience and offers suggestions for dealing with them. Some of these effects are similar or even identical to those experienced by women when they reach menopause. Knowing this may help loved ones understand what men on ADT experience. The side effects covered includes: hot flashes, weaker bones, weight gain, muscle loss, adult onset (type 2) diabetes, metabolic syndrome, cardiovascular risk, daytime fatigue, mild anemia, breast enlargement (gynecomastia) and increased breast or nipple sensitivity, genital shrinkage, and loss of body hair. The official pharmaceutical literature on the LHRH agonists and antagonists lists a large array of other physical side effects that have been infrequently reported by patients on ADT: headache, upset stomach, nausea, diarrhea, constipation, and joint/muscle aches or pains.

A diagnosis of cancer and subsequent adjustment to the effects of cancer treatment often leaves patients and loved ones feeling stressed (emotional distress), which surface as changes in emotions and mood. Both patients and their partners report changes in the emotions of men starting on androgen deprivation therapy (ADT). These are often in the form of mood swings or increased emotional expression, often referred to as emotional lability. It is perfectly normal to experience abrupt mood changes, depression, anxiety, and grief while on ADT. It is important for one to be aware of this and to be open to discussing changes in emotional responses or sensitivity that might occur. ADT may also impact a patient’s cognitive function, which refers to conscious thinking processes such as attention, concentration, and memory. This chapter discusses progressive muscle relaxation to relax the body and mind, and mindfulness meditation practice to cope with increased stress.

Recent international guidelines recommend that individuals diagnosed and treated for cancer exercise for 30 minutes per session, three times a week. Because of androgen deprivation therapy (ADT) side effects, it is especially important for men on ADT to strive for regular exercise. Men on ADT often gain weight and experience a decrease in muscle mass, bone density, strength, and overall energy levels. These can contribute to a decreased sense of well-being and quality of life. These side effects persist throughout the course of ADT, which may be for many years, and they often continue after ADT is discontinued. Regular exercise is the single most important lifestyle factor that can minimize the negative effects of ADT and help to maintain or recover overall quality of life. In addition to the positive physical effects of exercising, there are other positive effects on psychological well-being, including reducing fatigue and the risk of depression.

This chapter outlines basic diagnosis, workup, staging, and treatment of cervical cancer. It recommends specific surgical and adjuvant therapies reflecting the most current standards of care. The most common symptom of cervical cancer is abnormal vaginal bleeding specifically, postcoital and intermenstrual bleeding, menorrhagia, and PMPB. Other symptoms include pelvic fullness/pain, unilateral leg swelling, bladder irritability, and tenesmus. Cervical cancer is also commonly asymptomatic, found only following an abnormal Pap smear, colposcopic exam, or cervical biopsy. Common signs of advanced cervical cancer are a fungating cervical mass, unilateral leg edema, and obstructive renal failure. The pretreatment workup of cervical cancer begins with a history and physical exam. The treatment of cervical cancer may involve the use of surgery, chemotherapy, XRT, targeted therapy or a combination of therapies. Finally, the chapter summarizes the evidence-based medicine in support of recommended treatments.

This chapter outlines basic diagnosis, workup, staging, and treatment of tubo-ovarian cancers. It recommends specific surgical and adjuvant therapies reflecting the most current standards of care. Upon review of pathogenesis for high-grade serous adnexal cancers and reflecting standard clinical practice, ovarian, fallopian tube, and PPCs have now been classified uniformly as HGSTOC. Sex cord stromal and GCT are classified separately and considered to originate from the ovary itself. The pretreatment workup includes a history and physical examination, LN survey, and laboratory tests, including a CBC, CMP, coagulation profile, CA 125, and other indicated tumor markers. Colonoscopy and EGD can be considered based on symptoms. Primary treatment can be surgical, PDS or with NACT. Surgery usually consists of an exploratory laparotomy, abdominal cytology, hysterectomy, BSO, omentectomy, and cytoreduction.

Uterine corpus cancer is the most common female gynecologic cancer in the United States, with an estimated 65,950 cases and 12,550 deaths in the United States in 2022. Currently, endometrial AC is the most common malignancy of the female genital tract and ranks as the fourth most common cancer in females. Risk factors for endometrial cancer include the triad of obesity, diabetes, and HTN. Most women present with abnormal uterine bleeding. Other presenting signs and symptoms can be menorrhagia, intermenstrual bleeding, pain, pyometria, hematometria, and an abnormal Pap smear. Treatment is primarily surgical staging to include pelvic washings, total hysterectomy, BSO, assessment of lymph nodes, omentectomy and peritoneal biopsies, and surgical debulking of extrauterine/metastatic disease. Recurrent disease can be broken into local recurrence or distant recurrence. Postoperative HRT, namely estrogen, has been studied for QOL and risk of recurrence.

Vulvar cancer represents 3% to 5% of all female genital cancers and 1% of all malignancies in women. In 2022, there are 6,330 new cases and 1,560 deaths predicted. The average age at diagnosis is 65 Y, although it is trending toward a younger age. Clinical features include pruritus, ulceration, or a mass. Squamous cell carcinoma represents 85% of all vulvar cancers. Other histologic types are basal cell carcinoma, AC, sarcoma, and verrucous carcinoma and melanoma. Malignant melanoma represents 5% of vulvar cancers. There are four histologic subtypes of melanoma: superficial spreading, lentigo, acral, and nodular. Pretreatment workup includes a physical exam with careful evaluation of the vagina and cervix. Biopsy for diagnosis should occur at the center of any suspicious area. The risk for local recurrence is close surgical margins. Nivolumab alone for squamous cell cancers or in combination with ipilimumab for melanoma has been shown to be beneficial.

Vaginal cancer represents 1% to 2% of all female genital tract malignancies. The median age at diagnosis is 60 Y. Most vaginal cancers are metastatic lesions from other sites, including the cervix, uterus, breast, GTD, and the GI tract. Primary vaginal cancers are commonly found in the upper one third of the vagina, often in the posterior fornix. Symptoms include vaginal discharge, vaginal bleeding, tenesmus, pelvic pain, bladder irritation, and pelvic fullness. Risk factors for vaginal cancer include HPV infection, chronic vaginal irritation, prior treatment for cervical cancer, and a history of DES. The pretreatment workup is colposcopy of the entire genital tract and physical examination. Diagnosis is via biopsy often guided with colposcopy. It may be necessary to perform an EUA with cystoscopy and proctoscopy. CXR, IVP, cystoscopy, proctoscopy, and barium enema are FIGO-approved diagnostic studies.

GTD describes a group of tumors that arise from trophoblastic cells. This is usually the result of an abnormal fertilization event and includes molar pregnancy, choriocarcinoma, PSTT and ETT. Risk factors for a molar pregnancy include age (<15 Y or >45 Y of age), history of a prior mole, and Asian ethnicity. Complete and partial moles are usually diagnosed at the time of uterine evacuation. Histopathology is the main diagnostic method. Other abnormal pregnancies/fetuses can be mistaken for a partial mole. These include Turner’s, Beckwith-Wiedemann, and Edward’s syndromes. The pre-treatment workup of GTD is a pelvic US and a CXR. At diagnosis, reimaging with a CT of the chest, abdomen, and pelvis and MRI of the brain should be obtained. If there is uterine hemorrhage, vaginal packing, blood transfusion, and emergent uterine artery embolization can be performed.

Sexual dysfunction is common in patients who are undergoing diagnosis of and treatment for gynecologic malignancies. This is due to pain, discomfort, bleeding, and/or psychological stress that may make intimacy difficult. Sexual disorders are typically not screened for effectively, thus masking the problem. Even for patients in whom sexual dysfunction is identified, there is little support to manage the problem. Comprehensive screening questionnaires have been validated as effective screening tools for different sexual disorders. Sexual disorders can be classified into four disorders: desire disorder, arousal disorder,orgasm disorder, and pain disorder. Ovarian protection during chemotherapy has been investigated. It is important to discuss the risk of infertility and fertility preservation options in those patients anticipating cancer treatment. Address fertility preservation as early as possible before treatment starts. The ovaries are the most radiosensitive organs; w only 5 to 15 Gy of radiotherapy causes sterility.

Cancer occurs in one woman per every 1,000 live births, with approximately 4,000 cases of concurrent pregnancy and maternal malignancy each Y. The most common cancer in pregnancy is breast cancer. The most common cancer of the female reproductive system in pregnancy is cervical cancer. If a malignancy is diagnosed after fetal viability, treatment can be delayed until the late second trimester, third trimester, or after delivery, depending on the specific clinical situation. XRT has different effects on a fetus depending on the stage of fetal development at the time of radiation exposure. Chemotherapy should be discontinued at 35–36 weeks’ gestational age to allow for a 3-week period for cytopenias to resolve before delivery. Cervical cancer occurs in approximately 1.4– to 4.6 per 100,000 pregnancies. Ovarian neoplasms are detected at 0.2 to 3.8 cases/100,000pregnancies. Other gynecologic malignancies are quite rare during pregnancy such as vaginal cancer, vulvar cancer, and endometrial cancer.

This chapter begins with the general definitions, measures of central tendency, and measures of dispersion of statistics. There are two methods used to analyze data. Descriptive statistics communicate results, but do not generalize beyond the sample. Inferential statistics communicate the likelihood of these differences occurring by a chance combination of unforeseen variables like the null hypothesis, significance level, standard error, sensitivity, specificity, and attributable risk. Surrogate endpoints are often chosen instead because of proposed study length, study cost, and known etiologic associations with the primary endpoint. There are a number of randomization techniques that can be applied: simple/coin toss, sequential digits, permuted blocks, stratified blocks, dynamic randomization, systemic nth; cluster, census, matching, restriction, quota, volunteer, cross-over, split body, and factorial. Eligibility criteria are the criteria used to determine which patients to enroll in a study. These criteria serve four functions: scientific benefit, safety, logistic considerations, and regulatory considerations.

This chapter discusses the gynecologic oncology referral parameters for endometrial cancer, pelvic mass, cervical cancer, vaginal cancer, vulvar cancer, and gestational trophoblastic disease. It also presents details on performance status scales such as gynecologic oncology group, Karnofsky Performance Status Scale rating criteria, and adverse event grading. The chapter discusses response evaluation criteria in solid tumors, including immunologic recist. Tumor response is measured via Response Evaluation Criteria in Solid Tumors guidelines. These are World Health Organization criteria for measuring tumor response.CT and MRI are currently the best available and reproducible methods used to measure selected target lesions. All measurable lesions up to a maximum of two lesions per organ and five lesions in total, representative of all involved organs, should be identified as target lesions and recorded and measured at baseline. Target lesions should be selected on the basis of their size and their suitability for accurate repeated measurements.