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By J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, John Curtin

(Martin Dunitz) manhattan Univ., ny urban. Atlas for postgraduates keen on the surgical administration of gynecological malignancy. contains a complete description of the vast majority of investigative and surgeries required of the gynecological oncologist. provides transparent written and pictorial guide. comprises colour hand-drawn illustrations and pictures.

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In two screening programmes involving 983 women with a family history of ovarian cancer, CA125 was elevated (35 U/ml or more) in 11% of cases. No case of invasive ovarian cancer was detected (Muto et al 1993, Karlan et al 1993). Women in the high-risk population who request screening should be counselled about the current lack of evidence for the efficacy of both CA125 and ultrasound screening and the associated risk of false positive results. Many will still opt for screening despite understanding the risks and limitations.

Bolger BS, Dabbas M, Lopes A et al (1997) Prognostic value of preoperative squamous cell carcinoma antigen level in patients surgically treated for cervical carcinoma, Gynecol Oncol 65:309–13. Bon GG, Kenemans P, Verstraeten R et al (1996) Serum tumour marker immunoassays in gynaecologic oncology: establishment of reference values , Am J Obstet Gynecol 174:107–14. Bonfrer JM, Gaarenstroom KN, Kenter GG et al (1994) Prognostic significance of serum fragments of cytokeratin 19 measured by Cyfra 21–1 in cervical cancer, Gynecol Oncol 55:371–5.

3-fold relative risk of death compared with patients with normal preoperative levels. Thus, preoperative determination of serum TATI may have a place in the pretreatment evaluation of patients with advanced ovarian cancer (Venesmaa et al 1994). Other serum markers Multiple serum markers have been assessed in isolation and in various combinations in women with ovarian cancer, both in the context of screening and in assessing prognosis and monitoring response and recurrence. The most significant finding is that in women with ovarian cancer, no single agent or combination has emerged as having a clear clinical advantage over CA125, except in specific tumour subtypes such as germcell tumours with yolk sac or chorionic elements and granulosa cell tumours (Table 2).

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