Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When a patient with a preexisting rheumatic disease and on immunotherapy begins to flare, how do you decide if this is an underlying rheumatic disease activity versus an immunotherapy related adverse event?
If the symptoms/signs are similar to their prior flares of their rheumatic disease, then it is likely a flare. Over 50% of patients with autoimmune diseases flare on immune checkpoint inhibitor therapy if you look at systematic literature reviews of the limited published data. If symptoms are unrela...
Would you consider definitive radiation therapy (EBRT + interstitial HDR) in lieu of pelvic exenteration for a vaginal spindle cell sarcoma?
I would not favor definitive RT unless not a surgical candidate but sometimes have been able to do EBRT plus brachy after gross total excision to avoid exenteration.
Would you consider adding adjuvant vaginal cuff brachytherapy for a FIGO 1A endometrial cancer, G1, no LVSI, based on the presence of extensive lower uterine segment involvement?
It’s not an absolute indication for adjuvant brachy with small absolute benefit.
How would you manage a dehiscent vaginal cuff 2 months after vaginal cuff brachytherapy?
It has to be a combination of surgery and radiation. Partial small dehiscence can sometimes be managed conservatively otherwise, most need surgical fixation.
How would you treat a recurrent ovarian malignant mixed Mullerian tumor on the pelvic side wall?
I would treat with IMRT and IGRT with total dose equivalent to 66 Gy based on OAR dosimetry to buy time without chemo and improve PFS.
What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?
Immune checkpoint inhibitors (ICIs) can cause myositis (ICI-myositis). Since ICIs can also induce hypothyroidism, myopathy secondary from hypothyroidism can also be associated with ICI therapy. Different from thyroid myopathy, patients with ICI-myositis barely have myoedema or muscle pseudohypertrop...
Is adjuvant RT recommended for a Bartholin's gland SCC s/p piecemeal resection with deep invasion and negative ipsilateral LN dissection?
I agree with Dr. @Dr. First Last that it is a function of margin status. However, with deep invasion and piecemeal resection, I think that margin status would be difficult to determine. A small lesion may be able to be reresected but many times, because of the location in the bartholins gland, the t...
If a premenopausal woman underwent a hysterectomy with unilateral SO with final pathology demonstrating an intact mucinous borderline tumor with negative washings, would you take her back for surgical staging?
No, I would not take her back. NCCN guidelines affirm that a patient with incompletely staged, or incompletely resected borderline tumor may be observed if CT chest, abdomen, and pelvis reveals no residual tumor. Surveillance should be sufficient.
Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?
Dexamethasone has better CNS penetration compared to prednisone and thus its established use for managing vasogenic edema. However, it has the most suppressive effect on ACTH, causes relatively more steroid myopathy and has less mineralocorticoid effect compared to prednisone hence, the general use ...
How do you manage real-time release of pathology and radiology results to oncology patients following enaction of the CURES act?
Even prior to the Cures Act, I worked in a place where lab and imaging results were immediately available to patients through their smartphone app. A few memorable encounters: Patient 1 - told me his favorable PSA result when I walked in the room and basically told me the plan going forward, (which ...