Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you treat a positive margin of vulvar Paget's after radical vulvectomy?
Assuming this is a microscopically-positive margin, I recommend observation after vulvectomy. In most studies, margin status does not correlate strongly with recurrence risk. Our retrospective review of Mayo Clinic data suggested that negative margin status may be associated with a lower risk of rec...
When contouring presacral space for gynecological tumors for IMRT plans, how far inferiorly do you take your contour?
The new contouring atlas came out this month. For presacral node, caudal extent is the beginning of piriform muscle. Small Jr. et al., PMID 32905846
What treatment options would you consider for a metastatic low grade serous ovarian carcinoma that transforms to high grade?
A couple of things to consider for this case, #1 treatment-free interval #2 platinum-free interval #3 bulky disease? #4 recent tumor profiling #5 HRD status? I am assuming that she is motivated to continue treatment. If she had a good and durable response to platinum-doublet in the past then I might...
What adjuvant treatment would you recommend for Stage III vulvar cancer s/p resection with a history of prior radiation treatment for vaginal cancer?
My answer depends on the specifics of the case. Would be important to review the fields and doses. Also depends on what the perineum looks like. Are telangiectasias present with thinned epithelium consistent with significant RT dose? If the previous vaginal lesion involved distal 2/3 of the vagina, ...
Would you offer adjuvant radiation to a patient with a vaginal spindle cell sarcoma s/p modified radical hysterectomy with bilateral sapingoopherectomy with negative margins?
What type of surgery was done? A rare disease, but with close margin at a location where the wider margin is difficult, I would favor adjuvant RT with EBRT plus brachy.
What indications do you use to consider adjuvant radiation therapy for vaginal cancer s/p resection?
If it’s stage 1 disease with negative margin and nodes negative, then observe. If anything more than above, then add EBRT plus brachy.
What chemotherapy would you recommend for a stage IC3 large cell neuroendocrine tumor of the ovary?
The more unusual the disease, the more it is helpful to get more information. First, although not a perfect test, the PET Dotatate may shed more light on prognosis, and thus be helpful in that way. Also, it is not always clear if these are primary or mets from another organ NET. The specialized PET ...
Do you re-test patients who test positive for COVID-19 during or prior to starting cancer treatment?
Here is a summary from the CDC website supporting a 'symptom-based' approach with self-quarantine for ~10-14 days after symptoms (perhaps 21 if severely immunocompromised or severe COVID symptoms) without need for a negative test. From: https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolati...
Would you consider HRT after BSO in a pre-menopausal gBRCA2+ patient who has no intention of ever having prophylactic bilateral mastectomies and who declines chemoprophylaxis?
Yes, I would consider HRT in this patient with several caveats and realizing that there are no data specifically applicable to this situation. Still, one can make inferences from the existing literature. There are well-documented long-term effects and lower survivals in younger women who have had an...
How would you manage a woman with recurrent Paget's disease of the vulva, s/p resection, with most recent pathology showing multiple foci of early invasion?
I would consider assessing for sentinel node because of invasion. Adjuvant RT, if margin is close and/or positive only.