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Education ?

Medical School
American University Of Beirut (2000) *
Foreign school
Memorial Sloan Kettering Cancer Center (2008) *
Surgical Oncology
University of California at Los Angeles (2007) *
Gynecologic Oncology
* This information was reported to Vitals by the doctor or doctor's office.

Awards & Distinctions ?

Excellence in Teaching Award 2007
Excellence in Teaching Award 2004
Administrative Chief Resident 2003-2004
America's Most Compassionate Doctors, 2009 (Rated & awarded by patients)
Outstanding Resident Award 2004
The Society of Surgical Oncology
Berlex Best Resident Teaching Award 2002
Patient's Choice Awards, 2008 - 2009 (Rated & awarded by patients)
Patients' Choice Award (2008 - 2009)
Compassionate Doctor Recognition (2009, 2015)
Top 10 Doctor - State (2014)
On-Time Doctor Award (2009)
Ronald Reagan Ucla Medical Center
The David Geffen School of Medicine at Ucla (2008 - Present)
Assistant Professor
Society of Gynecologic Oncology
American Society of Breast Surgeons
American Board of Obstetrics and Gynecology

Affiliations ?

Dr. Karam is affiliated with 4 hospitals.

Hospital Affiliations



  • Stanford Hospital and Clinics *
    Medical Oncology
    300 Pasteur Dr, Stanford, CA 94305
    Top 25%
  • Good Samaritan Hospital *
    Medical Oncology
    2425 Samaritan Dr, San Jose, CA 95124
    Top 50%
  • Dominican Hospital *
    Medical Oncology
    1555 Soquel Dr, Santa Cruz, CA 95065
  • Lucile Salter Packard Children's Hospital @ Stanford *
    Obstetrician & Gynecologist
    725 Welch Rd, Palo Alto, CA 94304
  • Publications & Research

    Dr. Karam has contributed to 10 publications.
    Title Ovarian Cancer: the Duplicity of Ca125 Measurement.
    Date September 2010
    Journal Nature Reviews. Clinical Oncology

    Since it was first described in 1981, CA125 has held an important role in monitoring patients with ovarian cancer. CA125 is elevated in 80% of patients with epithelial ovarian cancer at initial diagnosis and correlates well with response to therapy. CA125 monitoring is used for the follow up of patients with epithelial ovarian cancer, and elevations in CA125 measurements often antedate any signs, symptoms or radiographic evidence of disease by several months. Unfortunately, data favoring early therapeutic intervention for recurrent ovarian cancer is lacking, especially in patients with isolated CA125 elevations. In asymptomatic patients, elevations in CA125 have been associated with considerable anxiety and deterioration in quality of life without any significant gains in survival. Patients with ovarian cancer should, therefore, be counseled regarding the advantages and shortcomings of intensive CA125 testing. While some patients may benefit from early detection of recurrent disease and be candidates for secondary cytoreductive surgery, others may choose to delay therapy until they develop symptoms of disease recurrence. The results of a clinical trial suggest that withholding treatment in the event of isolated rising CA125 levels will not negatively impact these patients overall survival, highlighting the need for improved salvage therapies for recurrent ovarian cancer.

    Title Predictors of Completion Axillary Lymph Node Dissection in Patients with Immunohistochemical Metastases to the Sentinel Lymph Node in Breast Cancer.
    Date June 2010
    Journal Annals of Surgical Oncology

    Axillary lymph node dissection (ALND) in patients with immunohistochemistry (IHC)-determined metastases to the sentinel lymph node (SLN) is controversial. The goal of this study was to examine factors associated with ALND in IHC-only patients.

    Title Predictors of Completion Axillary Lymph Node Dissection in Patients with Positive Sentinel Lymph Nodes.
    Date August 2009
    Journal Annals of Surgical Oncology

    Completion axillary lymph node dissection (CALND) is routinely performed in breast cancer patients with positive sentinel lymph nodes (SLN). We sought to determine the sociodemographic, pathologic, and therapeutic variables that were associated with CALND.

    Title Extreme Drug Resistance Assay Results Do Not Influence Survival in Women with Epithelial Ovarian Cancer.
    Date July 2009
    Journal Gynecologic Oncology

    Extreme drug resistance (EDR) assays have been used to identify chemotherapy regimens that are least likely to be of clinical benefit in the treatment of epithelial ovarian cancer (EOC). We sought to examine the impact of EDR assay-guided therapy on the outcome of patients with EOC in the primary and recurrent settings.

    Title Patients with a History of Epithelial Ovarian Cancer Presenting with a Breast And/or Axillary Mass.
    Date March 2009
    Journal Gynecologic Oncology

    A breast and/or axillary mass in a patient with epithelial ovarian cancer (EOC) may be due to an EOC breast metastasis or a second primary breast cancer. We sought to review our experience with patients with a history of EOC presenting with a breast and/or axillary mass to determine if clinical features differed between these entities.

    Title Secondary Cytoreductive Surgery for Isolated Nodal Recurrence in Patients with Epithelial Ovarian Cancer.
    Date March 2007
    Journal Gynecologic Oncology

    OBJECTIVES: To evaluate the feasibility and associated survival outcome of secondary cytoreductive surgery in patients with isolated lymph node recurrence of epithelial ovarian cancer. METHODS: Twenty-five patients with epithelial ovarian cancer who underwent secondary cytoreductive surgery for isolated lymph node recurrence were identified from tumor registry databases. Demographic, diagnostic, operative, pathologic, and follow-up data were abstracted retrospectively. Overall survival was calculated using the Kaplan-Meier method. RESULTS: The median age at time of primary surgery for ovarian cancer was 55 years; 72% of patients had FIGO III/IV disease, and all had high-grade tumors. All patients received platinum-based chemotherapy following primary surgery. The median time from completion of primary chemotherapy to nodal recurrence surgery was 16 months (range=6 to 40 months). The distribution of nodal involvement was pelvic=12% (n=3), para-aortic=60% (n=15), inguinal=20% (n=5), peri-cardiac=4% (n=1), and pelvic plus para-aortic=4% (n=1). The maximal nodal tumor diameter ranged from 1.5 cm to 14 cm, with a median of 3.0 cm. Optimal secondary cytoreductive surgery (residual disease </=1 cm) was achieved in 100% of patients. The median estimated intra-operative blood loss was 100 cc (range=10 cc to 600 cc). The length of hospitalization ranged from 2 days to 10 days, with a median of 4 days. There was no instance significant postoperative morbidity. At a median post-recurrence follow-up time of 19 months, 8 patients (32%) have died of the disease, 7 (28%) are alive with disease, and 10 (40%) patients are without evidence of disease. For the entire study population, the median post-recurrence OS after secondary cytoreduction of recurrent nodal disease was 37 months. CONCLUSION: Complete optimal secondary cytoreductive surgery for recurrent epithelial ovarian cancer presenting as isolated node metastases is achievable in the majority of cases and is associated with a favorable long-term survival outcome.

    Title Tertiary Cytoreductive Surgery in Recurrent Ovarian Cancer: Selection Criteria and Survival Outcome.
    Date March 2007
    Journal Gynecologic Oncology

    OBJECTIVES: Studies of tertiary cytoreductive surgery (TCS) in recurrent epithelial ovarian cancer are limited, and appropriate patient selection remains a clinical challenge. We sought to evaluate the impact of TCS on survival and to determine predictors of optimal tertiary resection. METHODS: Between January 1997 and July 2004, 47 women with recurrent epithelial ovarian cancer underwent TCS at two institutions. All patients received initial platinum and taxane-based chemotherapy following primary cytoreductive surgery. Clinico-pathologic factors and survival were retrospectively abstracted from medical records. Optimal TCS was defined as microscopic residual disease. RESULTS: Thirty of 47 (64%) patients underwent optimal TCS. Size of tumor implants<5 cm on preoperative imaging was the only significant predictor of achieving optimal TCS. Overall survival after TCS was statistically longer in patients with microscopic versus macroscopic residual disease (24 versus 16 months, p=0.03). After controlling for age, time to progression and optimal TCS, only the presence of diffuse disease at tertiary exploration remained a significant poor predictor of survival. However, in a cohort of patients with limited disease implants, multivariate analysis indicated that optimal TCS retained prognostic significance as a positive predictor of survival. Twelve patients (26%) experienced severe postoperative complications, including six with pulmonary embolism, four with fistulae and two with postoperative myocardial infarctions. CONCLUSIONS: Size of disease implants on preoperative imaging may guide the selection of candidates for TCS. In those patients with limited disease implants at laparotomy, optimal TCS is associated with improved survival.

    Title Argon Beam Coagulation Facilitates Management of Placenta Percreta with Bladder Invasion.
    Date October 2003
    Journal Obstetrics and Gynecology

    BACKGROUND: Placenta percreta with bladder invasion is a rare but potentially lethal complication of pregnancy. CASE: A multigravida, with a history of two prior cesarean deliveries, presented with complaints of heavy vaginal bleeding near term. She had been previously diagnosed with an anterior placenta previa. A placenta percreta with bladder invasion was confirmed on cystoscopy. The patient underwent a successful cesarean hysterectomy using the argon beam coagulator. CONCLUSION: Argon beam coagulation may successfully help manage placenta percreta with bladder invasion while minimizing blood loss.

    Title Factors Associated with Fetal Demise in Fetal Echogenic Bowel.
    Date December 2001
    Journal American Journal of Obstetrics and Gynecology

    OBJECTIVE: The purpose of this study was to determine risk factors associated with intrauterine fetal demise in fetuses with unexplained echogenic bowel that is diagnosed in the second trimester. STUDY DESIGN: A retrospective case-control study compared fetuses with echogenic bowel and fetal demise with fetuses with echogenic bowel who were live born. Fetuses affected with cystic fibrosis, aneuploidy, or congenital infection and fetuses diagnosed with major anomalies were excluded. Variables examined in the determination of risk factors for intrauterine fetal demise included intrauterine growth restriction, oligohydramnios, elevated maternal serum alpha-fetoprotein levels, and elevated maternal serum beta-hCG levels. Statistical analysis was performed with the Fisher exact test, Student t test, and logistic regression analysis. RESULTS: One hundred fifty-six fetuses met the inclusion criteria. There were 9 cases of intrauterine fetal demise and 147 live born control fetuses. The median gestational age of intrauterine fetal demise was 22.0 weeks (range, 17-39 weeks). Intrauterine growth restriction occurred more frequently in cases of intrauterine fetal demise than in live born infants (22.2% vs 0.7%; P =.009), as did oligohydramnios (44.4% vs 2.0%; P <.001) and elevated maternal serum alpha-fetoprotein levels (80.0% vs 7.7%; P: =.001). With the use of logistic regression analysis, elevated maternal serum alpha-fetoprotein was the strongest independent risk factor that was associated with intrauterine fetal demise (odds ratio, 39.48; 95% CI, 11.04%-141.25%). CONCLUSION: In our series, there was a 5.8% incidence of intrauterine fetal demise in fetuses with unexplained echogenic bowel. Elevated maternal serum alpha-fetoprotein is the strongest predictor of fetal demise in fetal echogenic bowel.

    Title Determinants of Outcome in Elderly Patients with Positive Sentinel Lymph Nodes.
    Journal American Journal of Surgery

    BACKGROUND: Older women are less likely to receive standard of care treatment for breast cancer. METHODS: We examined variables that affected the outcome of elderly patients >/=70 years old among 1,470 patients with invasive cancer with positive sentinel lymph nodes (SLNs). RESULTS: Elderly patients were less likely to undergo mastectomy, completion axillary node dissection (ALND), adjuvant chemotherapy, and radiotherapy (RT) following breast-conserving therapy (BCT) compared with patients <70 years old. The 5-year risk of disease progression and cumulative incidence of breast cancer-specific deaths were not significantly different for both groups. On multivariate analysis, hormone receptor-negative status, number of metastatic lymph nodes, high nuclear grade, and tumor size were the factors independently associated with increased risk of disease progression. CONCLUSIONS: Tumor factors were the primary determinants of breast cancer outcomes in our cohort. Elderly patients are less likely to receive aggressive surgical interventions and adjuvant therapy because of perceived life expectancy.

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