Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What adjuvant therapy would you recommend for FIGO stage IC2 (or greater) mucinous tumor of the ovary?
This is an interesting and not so infrequent case which poses many questions before answers can be given:1. Must rule out metastases from the GI tract. Has she had an EGD and colonoscopy as well as a detailed view of the pancreas and gallbladder by CT scan? Was an appendectomy performed? What is the...
What are the preferred treatment options for platinum resistant clear cell ovarian carcinoma?
We often offer these patients a clinical trial, if one is available. Unfortunately, platinum resistant ovarian cancers have low response rates to chemotherapy, and clear cell cancers are particularly resistant. Doxil, weekly paclitaxel, gemcitabine, and bevacizumab are all reasonable options.
How would you manage a localized stage IV squamous cell carcinoma of vagina involving the posterior vaginal wall and full thickness of the anterior rectal wall?
I would get staging scans including PET and MRI and plan for definitive chemo RT with a final boost, most likely with IMRT, to 66 to 70 Gy.
Would you consider initiation of bevacizumab maintenance in a patient with primary ovarian cancer after optimal debulking surgery and standard carbo/taxol if they did not receive bevacizumab beginning with the carbo/taxol?
This is a complicated question. Dr. Burger presented the final results of GOG 218 at ASCO in 2018; there was no OS benefit for the addition of avastin in the upfront setting. Despite this presentation, the FDA awarded avastin approval in this setting at around the same time; a seeming contradiction....
Is it reasonable to only treat the inguinal nodes and not the pelvic nodes in an unresectable cT1cN0 vulvar SCC at the clitoris?
If lesion is superficial one can but if thick lesion based on drainage pattern would favor both inguinal region and lower pelvic nodes
Is there a benefit to EBRT for recurrent solitary fibrous tumor/ hemangiopericytoma in patient with multiple sites of intrapelvic recurrence?
Thank you for this question. Solitary fibrous tumors, as you know, are quite rare and the mainstay of treatment is surgery if feasible. The role of adjuvant (or definitive) radiation and/or chemotherapy has been used sporadically and thus has not been well established.In this case, if there are a re...
What doses would you treat the primary and lymph nodes in node positive vulvar cancer patient with incidentally found focal SCC in a field of VIN3?
I would treat the primary and inguinal nodes if no additional surgery and SNLN planned. Dose to primary is a function of microscopic or macroscopic disease left behind: 54-56 Gy if microscopic but 60 or above if macroscopic.
What interventions besides lubricants do you advise to improve sexual satisfaction for patients s/p ChemoXRT for cervical cancer?
Advise a multimodal approach Additional strategies: 1) Vaginal dilator therapy. Additional visits outside of follow-ups may improve adherence 2) Vaginal moisturizers - Replens, Vitamin E oil, etc. This is outside of water-based lubricants during sexual activity 3) Topical estrogens (many of these pa...
How do you decide when to offer post-operative adjuvant treatment for a stage IC1 ovarian granulosa cell tumor?
The postoperative management of stage IC granulosa cell tumor of the ovary remains controversial. In early-stage granulosa cell tumors, the major factors that have been studied in terms of risk of relapse have included tumor size, nuclear atypia, mitotic count, and rupture. Unfortunately, there is n...
How do you manage BRCA wild-type patients with an incidental STIC found at the time of an opportunistic salpingectomy?
I would consider having the pathology reviewed to be sure they agree with STIC, and also that they do not see invasive cancer. I would make sure the patient has had comprehensive genetic testing, as we have seen STICs even with non-BRCA genes. Regardless of genotype, but depending on the age of the ...