Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
In light of GOG-252, are there any situations where IP chemotherapy would be preferable following debulking of advanced epithelial ovarian cancer?
In GOG-252, the control arm (arm 1) was the dose-dense Japanese GOG (JGOG) regimen, compared to two IP-based arms (arm 2, IP carboplatin, and arm 3, IP cisplatin). As stated in our OGR, interpretation of the negative results of this study is difficult for several reasons. All three arms in GOG-252 r...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
When, if ever, would you recommend risk reducing BSO in patients with moderate penetrance breast cancer germline mutations?
RAD51C, RAD51D, and BRIP1 are all associated with significant risks of ovarian cancer and are appropriate for consideration of prophylactic oophorectomy, albeit perhaps at a slightly later age than BRCA1 and BRCA2. ATM and PALB2 may be associated with ovarian cancer risks that are similar to that of...
Should our selection for neoadjuvant chemotherapy in ovarian cancer patients change in light of COVID-19?
I see this as a two-pronged question where the response may vary based on the specific clinical situation, circumstances of the hospital, and status of the epidemic locally and regionally, along with available resources associated with the rapidly evolving COVID-19 pandemic. There is no question pri...
How should you manage a coronavirus infected/suspected patient who is receiving radiotherapy and cannot interrupt or delay their cancer treatment?
Hi Everyone, I agree with all the comments—this is certainly a fluid situation. We have not had a confirmed COVID-19 case, but we have developed a plan. If it is deemed a known COVID-19 patient, and it is elected to continue treatment by the treating physician, the treatment will happen at the end o...
What measures should we take regarding routine follow-up visits for well patients in surveillance during the coronavirus pandemic?
3-6 months.
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...
In patients with advanced endometrial cancer who you plan to treat with chemotherapy + immunotherapy (per GY018 or RUBY), how and when do you utilize adjuvant EBRT and/or brachytherapy?
Reading the question at face value - does advanced endometrial cancer mean stage IVB? III/IVA? If IVB, there is not routinely a role of 'adjuvant' EBRT or BT.Given the discussion of adjuvant therapy, I presume the question is asking for the small fraction of RUBY and GY-018 patients who were stage I...
For patients with cervical cancer who otherwise meet criteria for a simple hysterectomy based off SHAPE or GOG-0278 criteria, do you require negative margins on the excisional biopsy specimen to offer simple hysterectomy?
The choice to offer a simple hysterectomy to patients with early-stage cervical cancer is complex. SHAPE did not require negative margins on an excisional biopsy, but there were other key inclusion criteria that I think should be strictly followed if considering a simple hysterectomy. The lesion mus...
Which endometrial cancers do you choose to send POLE testing on, assuming you cannot check it on everyone?
This is a great question for two main reasons: Resource utilization What am I going to do with the data I would choose to send POLE testing on patients where you think the data might impact your care... the challenge with that is that we lack strong prospective data to support de-escalation. With th...