Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would the findings of a synchronous T1a ovarian endometrioid adenocarcinoma affect your treatment recommendation for a IB, G2 uterine endometrioid adenocarcinoma and LVSI?
These cases are always difficult to know if it is synchronous primary or metastatic disease and sometimes pathologist are able to clarify and other times not. Outcome is significantly better if they are synchronous primary as it appears to be the case here. If ovarian surgical staging is done, I wou...
How would you approach radiation in a patient with IIIC2 SCC of the cervix with a history of ileoanal reanastomosis and j pouch?
Depends a bit on the specifics of the case (e.g. how big is the cervix?), but in general, I would limit the pelvic dose to around 40 Gy and push the brachytherapy dose a bit higher. For the brachytherapy, the use of image guidance potentially provides an opportunity for further limiting the dose to ...
Would you consider staging lymph node dissection for a patient referred for stage IA endometrial cancer and MELF pattern on final pathology?
With no other risk factors like LVSI, grade 2 or 3, or outer half myometrial invasion, I recommend surveillance.
What is your preferred surgical management of an endometrial cancer with clinically apparent extension to the cervix?
Given in this scenario with clinically apparent cervical extension and an MRI negative for parametrial involvement, I would want to also ensure the nodes appear normal making the disease consistent with FIGO stage II disease. In this scenario, if the patient does clinically have disease limited to t...
In which circumstances would you offer adjuvant brachytherapy to a surgically staged patient with endometrial cancer if they have received prior pelvic external beam radiation therapy for a non-gynecologic pelvic tumor?
Assuming that adjuvant treatment is clearly indicated based on pathology findings, I would likely offer it, with some caveats. Ideally, the previous RT would have been delivered on an adjuvant basis with a dose of 50 Gy or less to the vaginal cuff area. Rather than the typical 700 cGy x 3 fractions,...
Do you offer surgery for patients with early stage cervical cancer who you suspect will need adjuvant radiation regardless of surgical pathology results?
Very exophytic tumors in very young women can be treated nicely even if greater than 5 cm without radiation if pet negative and careful patient selection by pelvic exam in my experience.
When, if ever, would you perform Her2 testing in serous intraepithelial neoplasia of the endometrium?
It's not known whether HER2 expression or amplification is definitely prognostic for EIN, but I suspect it is and we know it is for stage I uterine serous carcinoma. Seeing HER2 expression in EIN makes me concerned about the possibility of a more aggressive disease. We're currently studying this at ...
What is your approach to the adjuvant treatment for stage IA grade 2 endometrioid adenocarcinoma without LVSI whose molecular classification is p53 abnormal (MMR intact, POLE wild type)?
These attached guidelines recommend consideration of chemo if IA with myometrial invasion. From a radiation perspective, I do brachy alone with consideration of chemotherapy. Concin et al., PMID 33397713
What are your top takeaways from SGO 2023?
There were many great presentations at SGO 2023 along with a few practice changing presentations. Two pivotal randomized phase III clinical trials enrolled advanced, metastatic endometrial cancer patients. Each demonstrated dramatic benefit with the addition of immunotherapy to chemotherapy (followe...
How would you treat a patient with synchronous locally advanced cervical and ovarian cancers?
At a minimum, I would favor removing the ovarian mass and peritoneal and omental bx to get an idea about ovarian cancer (stage 1 or stage III). Based on that, you may start with chemo first (like carbo and taxol) for the ovarian cancer, and assess local response of cervical cancer then definitive ch...