Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What are your top takeaways from SGO 2026?
A pivotal theme of SGO 2026 was the dramatic rise in ADCs in every gynecologic cancer, from front-line to recurrent disease. Along with notable updates for several studies, data from others were treatment-defining. (1)The following studies were selected for further review.Ovarian Cancer: Low-grade s...
What chemotherapy would you consider to treat platinum resistant high grade serous ovarian cancer in patients with a low grade MDS from prior platinum/PARPi?
Before making a recommendation to this patient, a basic understanding of treatment related MDS/AML is needed, along with a clarification of the meaning of “low risk of progression to acute myeloid leukemia (AML)”. My main goal would be to avoid therapy with a demonstrated risk of treatment related M...
How would you manage a patient with recurrent, high-grade leiomyosarcoma involving the pelvis after salvage exenteration, but who has a focally positive anterior margin?
Ideally, plan for intraoperative radiation or surface brachytherapy at time of surgery.
For a patient with advanced serous fallopian tube carcinoma involving the uterus, cervix, and vagina who is now s/p interval debulking surgery, would you offer adjuvant vaginal brachytherapy if the upper vaginectomy margin was positive?
I would not. For advanced serous ovarian cancer, the risk of peritoneal recurrence is very high. I do not feel that vaginal brachytherapy would meaningfully affect recurrence rate or prognosis. If the patient has future isolated recurrence at the vagina, I might consider systemic therapy + radiation...
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
Anorexia/cachexia is often distressing to patients and families and it is this distress that is the target of many of the interventions for this syndrome as there are, in general, no effective therapies. Patients and families are routinely battling over the lack of eating as this causes further disc...
What is your approach to an incidental diagnosis of low risk endometrial cancer in a patient who underwent minimally invasive hysterectomy with uterine morcellation with gross intra-operative tumor spillage?
Little guidance is available in the literature on the optimal management of a patient with a low grade endometrial cancer who had a minimally invasive procedure with uterine morcellation and gross tumor spillage. Fortunately, this situation is not common. Wright et al. estimated the risk of occult m...
Would you recommend adjuvant chemotherapy for a patient with serous endometrial cancer initially treated with neoadjuvant radiation due to cervical involvement precluding surgical resection who is now s/p hysterectomy/BSO/LND/omentectomy with only small amount of residual disease confined to the endometrium?
Definitely.
What resources/ancillary staff do you utilize for school re-entry after cancer treatment to decrease anxiety, improve self-confidence, and support emotional functioning?
Facilitating school re-entry for children and adolescents undergoing cancer treatment is an important component of comprehensive care. Maintaining engagement in school can help preserve a sense of normalcy and mitigate feelings of isolation and loneliness. However, the transition back to school may ...
What is the best treatment for a medically inoperable endometrial adenocarcinoma of the uterus FIGO 1, grade 1, type 1?
I would get a pelvic MRI to assess tumor size and myometrial involvement. If small volume (2 cm or smaller) with superficial invasion then use brachy alone, otherwise EBRT plus brachy. The type of brachy is based on uterine width: If the width is less than 5 cm: single tandem and cylinder. Otherwise...
What is your approach to uterine perforation during the time of brachytherapy implant for cervical cancer?
First off, I think uterine perforations occur a lot more frequently and easily than we previously accounted for. I learned how to perform brachytherapy using purely orthogonal X-rays, with dosing and dwell position times based on measured distances from the applicators, and all of the focus was plac...