Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
When do you start a vaginal dilator after EBRT to the vaginal canal?
Although I have not reviewed the published data in a while, from my data review ~8 years ago and my own cumulative gynecologic specialty experience, I have fallen into the following paradigm: In the setting of standard EBRT or vaginal cuff brachy, for a patient, in reference to the use of a vaginal ...
How would you treat an isolated para-aortic recurrence while receiving adjuvant pembrolizumab after definitive chemoradiation for cervical cancer?
If the patient has failed while on pembro, I would favor holding/stopping IO and plan for definitive chemo-RT to the para-aortic region with SIB boost with weekly cisplatin.
How do you approach treating oligometastatic endometrial cancer in a patient with good performance status and no local recurrence at the primary site?
For metachronous OM would follow the SBRT approach/principle similar to other primary cancers after systemic treatment.
Is there data to support treating postoperative endometrial pelvic EBRT with a daily dilator in the vaginal canal?
Data is more for GI malignancies on using a vaginal dilator to reduce dose to the anterior vaginal wall and thus the risk of stenosis. With the vagina being a target for endometrial cancer, there is no study using it during RT to show any benefit.Arzola et al., PMID 37898354
How do you manage cancer treatment-related cognitive change or "chemo brain?"
Chemo-brain is a vexing and complicated diagnosis. In most cases, you don't know the baseline neurocognitive function of individuals with cancer. Many conditions that are associated with chemotherapy like fatigue, depression, and aging can mimic chemo-brain. Estimates are that about 20% of individua...
How, if at all, have you incorporated GLP-1 agonists into your fertility-sparing management of patients with EIN or endometrial cancer?
That is a question that needs to be more clearly defined. We have a project in our endometrial SPORE grant that seeks to answer that question. This project is led by Andrea Hagemann at Washington University. In this project, the effect of weight loss, augmented by GLP1 agonists with weight loss coun...
For patients with cervical cancer who otherwise meet criteria for a simple hysterectomy based off SHAPE or GOG-0278 criteria, do you require negative margins on the excisional biopsy specimen to offer simple hysterectomy?
The choice to offer a simple hysterectomy to patients with early-stage cervical cancer is complex. SHAPE did not require negative margins on an excisional biopsy, but there were other key inclusion criteria that I think should be strictly followed if considering a simple hysterectomy. The lesion mus...
How would you manage a patient with unstaged serous endometrial cancer confined to a polyp diagnosed after hysterectomy for postmenopausal bleeding/inability to sample the endometrium?
I think in this case, cell-free DNA can help triage this. If negative, I think offering observation is reasonable, especially if truly only confined to a polyp.
For a BRCA1+ patient with a history of stage IVB endometrioid ovarian carcinoma s/p upfront surgery and adjuvant chemotherapy who has now completed 3 years of maintenance niraparib and is NED, how would you counsel about discontinuing vs continuing PARPi therapy?
Recommendation: I recommend that this patient with Stage IVB ovarian cancer, with a complete response to surgery, chemotherapy, and 3 years of maintenance PARPi, be counseled to discontinue niraparib.Background:The duration of therapy for primary maintenance PARPi should be tailored based on the ass...