Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How does positive peritoneal washings factor into your treatment decisions regarding pelvic radiation and/or chemotherapy?
At this point, for patients who lack other adverse factors, we do not change management based on positive cytology for endometrioid histology.
How would you manage a female in her 40s with stage III cervical cancer with hydronephrosis and Crohn's disease?
I would treat with definitive chemo RT minimizing bowel exposure as much as I can with IMRT (adaptive if possible so can treat with tighter margin and IGBT) and inform the patient about the risk of complications.
What is your protocol for conscious sedation during T&O insertion?
I have used many forms of anesthesia for cervix HDR and all have some disadvantage. For the last couple of years I have moved to spinal anesthesia which has been ideal for our workflow. Patients receive a single dose of bupivicaine via CRNA/anesthesia team in our in brachy suite. The provides about ...
Do you continue Megestrol in a patient with inoperable endometrial cancer during definitive radiation therapy?
I usually stop megace as definitive RT takes care of bleeding and disease . This also reduces risk of megace induced side effects
Would you use different EBRT field edge for an HIV positive patient with FIGO IIIC1 (2018) cervical cancer with positive bilateral external iliac nodes?
In any situation I would not favor bony landmark and use anatomical vascular landmarks. This is a review article in Seminars in Radiation Oncology summarizing nodal RT for cervical ca written with North American and European collaboration.
How would you treat an isolated port recurrence of an early stage cervical patient s/p WLE?
In limited cases we have managed this with surgery and chemoRT as definitive treatment
How do positive pelvic washings influence your decision to administer adjuvant therapy to early stage endometrial cancer who otherwise meets no criteria for adjuvant therapy?
<60y/o, grade 1 endometrioid endometrial cancer. TLH, BSO, sentinel nodes. Stage IA, focal LVSI, 20% myometrial invasion, negative sentinel nodes, positive pelvic washings. Positive pelvic washings are an adverse prognostic sign in patients with other high-risk features. This patient has low risk...
How would you approach an inoperable, elderly, frail patient with high risk endometrial cancer?
May be less toxic, unless patient is "inoperable" because of high anesthesia risks, making endometrial brachy risky.
How does the presence of microcystic elongated and fragmented (MELF) invasion impact post operative treatment of Stage IA FIGO grade 1 endometrial cancer?
MELF pattern may be associated with under-assessment of LVSI. In the setting of surgical assessment of nodes, we don’t change treatment recommendations just based on MELF pattern.
What is your fertility-sparing management of a stage IA1 cervical squamous cell carcinoma following a LEEP with negative margins and focal LVSI?
NCCN guidelines state that stage IA1 with negative margins and positive LVSI can be treated with: radical trachelectomy + pelvic lymphadenectomy (consider sentinel LN mapping) OR with repeat cone biopsy or trachelectomy with pelvic lymphadenectomy (consider sentinel LN mapping). Preoperatively, phys...