Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
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.
How would you counsel a young patient regarding HRT after BSO for Stage IIIA1 serous borderline tumor?
How would you counsel a young patient regarding HRT after BSO for Stage IIIA1 serous borderline tumor?Path significant for micropapillary features and micro-invasionBOT: borderline ovarian tumorsBOT: serous borderline ovarian tumorLGSOC: low grade serous ovarian cancerHGSOC: high grade serous ovaria...
How would a focus of anaplastic carcinoma change your approach to adjuvant therapy for a premenopausal patient with stage IC mucinous borderline tumor of the ovary?
I would recommend complete surgical staging; the key is whether or not the woman has disease outside of the ovary. Although we assume mucinous tumors are unlikely to spread via LN, there is new information about the type of mucinous cancers and that risk. The key is the surgical stage. If she is a t...
For an optimally cytoreduced, stage III ovarian carcinosarcoma, would you offer bevacizumab maintenance after completion of adjuvant carboplatin/taxol?
For an optimally cytoreduced patient with Stage III ovarian carcinosarcoma, I would not add bevacizumab unless the patient was "optimal" at interval surgery and had neoadjuvant and adjuvant use of bevacizumab with chemo and then to be continued in maintenance. The use of bevacizumab with chemo in th...
Is there a role for external radiation and/or brachytherapy in stage IVB vaginal cancer aside from palliation?
I would offer palliative RT. Quad shot to the site of symptomatic disease (primary and gross node).
Can the inguinal and pelvic nodal RT be omitted for FIGO IVA unresectable vulvar cancer with a negative bilateral inguinal nodal dissection?
In my opinion, the answer is a qualified "yes." Has the patient had a PET scan that is negative, except for the primary vulvar lesion? If so, this argues in favor of omitting inguinal and pelvic LN's since the negative predictive value of PET for adenopathy in gyn cancers is consistently reported to...
What is the anterior expansion for the paraaortic CTV in endometrial and cerivcal cancer?
Usually, around 5mm with editing based on the patient's anatomy and fixed organs like the duodenum. Kabolizadeh, Fulay and Beriwal - PMID 23849691
Do you repeat somatic tumor testing for ovarian cancer patients after recurrence?
Times are changing and payers will have to fall in line, eventually. At this time, we already know that clonal evolution exists but is poorly understood regarding the timeline. However, if we are going to leverage "precision medicine", then to be precise one has to account for clonal evolution in de...
How would you counsel a patient with extragenital lichens sclerosis on the acute and long term risks of post-lumpectomy radiotherapy?
Lichen sclerosis (LS) is a rare entity, however, there are reports of successful treatment with radiation for various cancers associated with this condition. (Wang et al., PMID 33356763). There is also a suggestion of worse LC in women with vulvar cancer and preexisting LS (Fokdal et al., PMID 34392...