Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is the role of uterine artery embolization (UAE) in patients with locally advanced cervical cancer with emergent bleeding that persists through vaginal packing?
With packing and starting urgent chemo RT, the need for embolization is very limited in our practice. That being said, data suggest if embolization is done, it doesn’t affect efficacy or complication risk of subsequent chemo RT.
Is there a role for progestin therapy to temporize bleeding from endometrial cancer in a patient with an active venous thromboembolism?
In the setting of a newly diagnosed DVT in an otherwise surgically appropriate patient with known endometrial cancer, I would still consider keeping with the standard strategy of proceeding with surgical staging. I would place a filter and proceed with minimally invasive approach, if feasible. Posto...
What is your adjuvant therapy approach for stage II endometrioid endometrial cancer?
For patients with stage II endometrioid endometrial cancer, there are several considerations for adjuvant treatment. I recommend using the NCCN guidelines to guide your patient's case when possible. If there is visible tumor involvement of the cervix prior to surgery, I will perform a radical hyster...
How do you treat cervical cancer with an ovarian metastasis?
This is a data free zone but several papers report a very poor prognosis for these patients. For a limited ovarian met with pelvic localized disease, one may consider chemoradiation and add adjuvant chemotherapy (to follow) but these patients generally fail systemically. Hence, chemotherapy should b...
How would you approach diagnosis of residual ovarian tissue in a patient with ER positive breast cancer, history of BSO, and a rising estradiol level on tamoxifen?
Diagnosing elevated estrogen levels in a patient who has undergone BSO is difficult, since the symptoms are typically very non-specific (e.g., improvement in hot flashes, change in mood). There are multiple potential reasons for elevated estrogen levels following BSO, including an adrenal tumor that...
How do you manage the wide array of emotions like anger and disappointment patients may have when they first learn of an incurable relapse of an early stage cancer?
This is a really tough question and there is no easy or straight-forward answer. When I consider situations like this, however, I try to follow these guidelines: I use initial diagnostic uncertainty to my advantage. A diagnosis of relapse is almost never made instantaneously (a suspicious lesion on...
What is the maximum dose to small bowel you would allow in a single fraction with gynecologic brachytherapy?
There is no absolute number, but for a 5 fraction HDR schedule (5.5-6Gy x 5), we limit 2cc to less than 3 Gy and have accepted up to 4 Gy. We make sure that there is no hot spot touching small bowel loop by varying the filling of the bladder and sometimes using a hybrid applicator if needed to try t...
How do you treat severe vaginal stenosis after radiation in a patient that is already compliant with dilators?
Local estrogen helps a lot. Compliance can be a problem. I suggest that the patient will cover their applicator with estrogen and insert after she goes to bed at night and just leave it in. It will usually come out during the night but this usually beats the patient having to take time out during th...
What is your surveillance approach for outpatient monitoring of ICI myocarditis?
At Memorial Sloan Kettering, we do not use surveillance approach for standard ICI therapy. Troponins may be drawn as part of protocols/clinical trials. We do advocate for baseline troponin, especially if high sensitivity troponin is the assay being used. This helps when patients come in with symptom...
How will you treat an uterine embryonal rhabdomyosarcoma with regional node involvement resected to involved parametrial margins?
It's hard for me to say how I would treat the patient as described without a bit more information and review of the case. So, I will make a few general comments. One major question is, "What is the age of the patient?". And I assume from the question that the parametrial margins were involved. Two t...