Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is your radiotherapy plan for stage IVA (cT4) cervical SCC with the tumor completely obliterating the bladder trigone?
I would follow the same schedule. After concurrent chemo RT, I would use HDR brachy with a hybrid applicator to achieve a D90 of 85 Gy or above to the HR-CTV and avoid any hotspot in the bladder wall. Part of the bladder wall in the trigone area receives a therapeutic dose.
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...
How are you approaching patient selection for relacorilant + nab-paclitaxel (ROSELLA) in platinum-resistant ovarian cancer?
Relacorilant + nab-paclitaxel is now FDA-approved as of March 2026 and NCCN-listed as a preferred regimen for platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer, and notably does not require biomarker selection — making patient selection primarily based on clinical a...
How would you treat an isolated para-aortic recurrence while receiving adjuvant pembrolizumab after definitive chemoradiation for cervical cancer?
If the patient has failed while on pembro, I would favor holding/stopping IO and plan for definitive chemo-RT to the para-aortic region with SIB boost with weekly cisplatin.
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 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...
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...
What is your approach to an incidental diagnosis of low risk endometrial cancer in a patient who underwent minimally invasive hysterectomy with uterine morcellation with gross intra-operative tumor spillage?
Little guidance is available in the literature on the optimal management of a patient with a low grade endometrial cancer who had a minimally invasive procedure with uterine morcellation and gross tumor spillage. Fortunately, this situation is not common. Wright et al. estimated the risk of occult m...
Would you recommend adjuvant chemotherapy for a patient with serous endometrial cancer initially treated with neoadjuvant radiation due to cervical involvement precluding surgical resection who is now s/p hysterectomy/BSO/LND/omentectomy with only small amount of residual disease confined to the endometrium?
Yes, assuming adequate performance status and no contraindications, I would recommend adjuvant postoperative chemotherapy for any patient requiring neoadjuvant treatment with uterine serous carcinoma that has any residual disease found at the time of hysterectomy.For the patient in this case, she in...
What is your approach to IV fluid management for the treatment of hypercalcemia of malignancy?
At this point, I believe one can use either saline or lactated Ringer's. There is some evidence that low-chloride-containing solutions have advantages in general, which may well be the case, but we need more data on that. The amount of calcium in LR is very small and should not make a difference (1....