Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you classify extensive LVSI in endometrial cancer?
There are various definitions floating around but one with an outcome in the absence of nodal dissection is from PORTEC group showing the significance of 4 or more vessels involved.Peters et al., PMDI 34261899 Our data questions the true significance of substantial LVSI > 1 vessel as used in previou...
Do you perform pap smears as part of the surveillance of patients with a history of cervical or vaginal cancers who had radiation as part of their treatment?
I personally do not routinely perform pap testing for patients with a prior history of cervical or vaginal cancer who have had prior radiation. The main driver for me in this decision is that the results we receive from Pap testing often show abnormalities that are not reflective of recurrence or de...
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
What is your approach to adjuvant treatment of surgically staged, deeply invasive grade 3 endometrioid endometrial cancer with no lymph node involvement?
It depends on p53 and LVSI status. If wild-type and no LVSI, I would recommend discussion with radiation oncology regarding VBT vs EBRT. If aberrant p53, I treat as uterine serous (chemotherapy with vaginal brachy or EBRT), and with extensive LVSI, I would recommend EBRT, chemotherapy, or CRT.
How would you treat bilateral groin recurrence of vulvar small cell neuroendocrine carcinoma in a patient who has previously had pelvic and groin radiation?
I would start with chemo-immunotherapy, like in pulmonary small cell, as this is likely to be the tip of the iceberg. If no prior groin surgical exploration, this can be considered by gyn/onc. If not, I would consider focal reirradiation of any residual disease after chemotherapy during IO maintenan...
Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?
For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.
In patients getting concurrent chemo-immunotherapy for locally advanced cervix cancer, would you hold immunotherapy during the 2.5-3 weeks of brachytherapy?
Pembro is continued throughout the course of treatment. Initially, every 3 weeks for 5 cycles with concurrent chemo RT plus brachy and then every 6 weeks for 15.
When do you initiate vaginal cuff brachytherapy treatment after hysterectomy for early stage endometrial cancer?
We usually start vaginal cuff treatment 5-6 weeks after hysterectomy. If adequately healed, may start at 4 weeks but not before. Rarely more than 8 weeks. For patients receiving vaginal cuff treatment plus chemotherapy, we still give cuff treatment within 6 weeks. There is no reason to delay because...
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When treating endometrial cancer patients with a combination of chemotherapy and vaginal cuff brachytherapy, when do you deliver cuff brachy?
I prefer, most of the time, between the cycles of chemotherapy (1 to 3) based on logistics.