Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you approach nodal assessment in a pregnant patient with new diagnosis of at least stage IB1 cervical SCC?
My preferred approach to nodal assessment in this patient is a robotic pelvic lymphadenectomy in the early second trimester of pregnancy after she has undergone a pelvic MRI without gadolinium.The approach to the patient with early-stage cervical cancer presenting in the first trimester of pregnancy...
How would you manage a cervical cancer patient who develops new oligomet to the spine during primary cis/RT?
The finding of metastatic disease to the spine during primary radiation therapy for cervical cancer suggests the presence of systemic, hematogenous disease at the start of treatment. PET-CT scan and/or bone scan are useful diagnostic tools to detect distant metastases and also to differentiate betwe...
How would you manage a patient with history of locally advanced SCC of the cervix, treated with definitive chemoRT, found to have new lung lesions 6 months post treatment?
All patients with metastatic cervical cancer should first be considered for a clinical trial. This is a condition with limited effective treatment options and also disproportionately affects younger women. It is pivotal clinicians be aware of the rapidly evolving landscape of clinical therapies for ...
How do you treat a Stage II Grade 3 endometrioid endometrial adenocarcinoma?
Depends. Was a lymphadenectomy done? What is the extent of disease in the cervix? Microscopic or clinical lesion? What is the amount of myometrial involvement? Was a hysterectomy done? The answers to the above would dictate therapy.
How do you approach adjuvant treatment for node positive high grade gastric type endocervical adenocarcinoma following radical hysterectomy?
Gastric-type endocervical adenocarcinoma (GEA) was first recognized as a distinct histologic subtype of cervical adenocarcinoma in 2020 by the World Health Organization. Adenocarcinomas account for approximately 25% of newly diagnosed cervical cancer cases worldwide, with GEA comprising around 10% o...
In mismatch repair deficient recurrent endometrial cancer eligible for single agent PD-1 inhibitor, do you prefer pembrolizumab or dostarlimab and why?
From KEYNOTE-158, single agent Pembrolizumab (anti-PD1) in dMMR recurrent endometrial cancer patients (N=79), ORR 48% (14% CR and 34% PR). Median PFS was 13.1 months. In this study, adverse events happened in 76% of patients. 12% had G3-4 toxicity. 7% discontinued for toxicities. 7% had G3-4 immunot...
How do you manage a patient with an endocervical cancer indeterminate for endometrial or cervical origin status post TAH/BSO and sentinel node biopsy?
P16 and CEA positivity (although focal) favor cervical cancer. Can also do high risk HPV and p53 as suggested. Either way, the patient looks like they had a simple hysterectomy done and would favor EBRT plus brachy (would consider adding weekly cisplatinum if the overall picture is cervical).
For patients with endometrial cancer, should tumor size be included as a risk factor for recurrence?
Tumor size is not currently used in staging for endometrial cancer.There have been some retrospective studies that suggest a higher rate of local recurrence and recurrence-free survival in patients with endometrial cancer and a larger tumor size (>2-2.5 cm). (Sozzi et al., PMID 29489475) (Han et al....
Do you add chemotherapy to pelvic radiation and brachytherapy for an isolated vaginal cuff recurrence of endometrial cancer?
We offer concurrent cisplatinum with EBRT to high grade or bulky vaginal diseasehttps://www.ncbi.nlm.nih.gov/pubmed/25241996
What treatment would you offer a patient with metastatic cervical cancer to the supraclavicular nodes with a complete clinical response in her nodes, but a 3 cm residual in the cervix?
Patients with stage IV disease because of s/c node only, we treat with definitive intent covering all pre chemo disease with combination of EBRT and brachy, based on limited series for WSU and Korea showing a subset has long disease free interval with potential for cure.