Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How would you manage a patient with unstaged serous endometrial cancer confined to a polyp diagnosed after hysterectomy for postmenopausal bleeding/inability to sample the endometrium?
I think in this case, cell-free DNA can help triage this. If negative, I think offering observation is reasonable, especially if truly only confined to a polyp.
For a BRCA1+ patient with a history of stage IVB endometrioid ovarian carcinoma s/p upfront surgery and adjuvant chemotherapy who has now completed 3 years of maintenance niraparib and is NED, how would you counsel about discontinuing vs continuing PARPi therapy?
Recommendation: I recommend that this patient with Stage IVB ovarian cancer, with a complete response to surgery, chemotherapy, and 3 years of maintenance PARPi, be counseled to discontinue niraparib.Background:The duration of therapy for primary maintenance PARPi should be tailored based on the ass...
When do you include the mesorectum for definitive cervical cancer patients getting concurrent chemoradiation followed by brachy?
I would also include it if there is direction invasion into the mesorectum or EMVI.
What measures should we take regarding routine follow-up visits for well patients in surveillance during the coronavirus pandemic?
3-6 months.
What is your response to the question, "Is this terminal?"
Thanks for this question, it's really important. This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life. Let's talk about them in sequence. 1). At diagnosis: When a person is first diagnosed, this question is part of "getti...
Would you consider giving vaginal estrogen to a patient with a history of low grade, early-stage endometrial cancer who has had a vaginal cuff recurrence (treated with radiation)?
Yes, I would consider this... after a discussion with the patient regarding the pros and cons. Ultimately, it would be her decision. The risks would also be dependent on the time of recurrence and the institution of the vaginal estrogen. Systemic absorption should be small. The biggest risk would be...
What treatment would you recommend for a healthy patient with an 8 cm central pelvic recurrence of leiomyosarcoma not involving any vital structures, associated with an FDG-avid 1 cm external iliac LN?
Assuming in good health, I would consider an attempt at resection. Worst case, you can’t, and you aren’t any worse off. I have debulked these before and found them often to be surprisingly resectable without high morbidity. Then I would make sure to test for ER/PR, and if positive, follow that with ...
Do you perform routine cystoscopy after hysterectomy for gynecologic cancer staging?
No. Compared to no cystoscopy, there is no change in change in rate of delayed urinary injury -which, when performing cystoscopy routinely, is ostensibly what you are trying to avoid.
For a patient with IIIC1 (micromets), MSI-high, Grade 2 endometrial adenocarcinoma who has undergone full surgical staging, do you recommend adding immunotherapy to adjuvant chemotherapy + radiation?
Short answer: No, I do not recommend adjuvant CT/IO + RT for this patient based on the patient's risk factors in the prompt, and the data below. Should the patient have recurrent/metastatic disease following adjuvant CT + RT/VCBT, then I/O + CT is a good option. Ongoing trials hope to answer this qu...
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...