Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is your approach to a patient with locally advanced cervical cancer who presents with a fistula (rectal or bladder)?
For bladder fistula, we usually get a bilateral nephrostomy done for diversion and then treat patients with definitive intent with chemo RT with brachy using an interstitial device. We reassess the patient with PET/CT in 3 months and if complete responses, then they get urinary diversion with ideal ...
How aggressively do you approach pelvic treatment for patients with low volume metastatic cervical cancer, but bulky local disease?
For patients with minimal oligometastatic disease, for example, a single lung metastasis or a supraclavicular node, we will often treat all sides definitively. For patients with more significant metastatic disease, we would consider treating the primary with a shortened course of radiation. For exam...
Under what circumstance do you offer a definitive approach to local treatment of a patient with oligomestastatic cervical cancer found on initial staging PET/CT?
FIGO stage IVB Cervical CancerCervical cancer spreads in an orderly fashion predominantly via the lymphatic system and subsequently hematogenous spread to the lung and elsewhere.The FIGO stage IVB cervical cancer includes those with distant nodal metastases (para-aortic or supraclavicular lymph node...
How do you approach the adjuvant treatment for grade 1 endometrial cancer with micrometastasis in a sentinel lymph node if the tumor is otherwise low risk?
Micrometastates is considered N1(mi) and should be treated similarly to N1 disease. I would not observe a patient with micrometastatic nodal disease. Adjuvant therapy as per the institutional practice of chemotherapy +/- EBRT +/- brachytherapy.
In light of new NCCN guidelines that state combination chemotherapy + pelvic RT should be reserved for endometrial cancer of at least stage IIIB, will you recommend EBRT in addition to chemotherapy for stage IIIA endometrial cancers?
Well, this is a little hard.I think it is pretty clear that chemotherapy is really the foundation for treatment of advanced disease. PORTEC-3 looked at women with high risk stage I, stage II, or stage III, or tumors with serous or clear cell histology (very diverse group!) and noted a survival benef...
Would you treat endometrioid adenocarcinoma arising from an endometriosis lesion in a patient with prior hyst/BSO like an ovarian or endometrial primary?
For a patient with prior hyst/BSO and now an endometriosis-associated endometrioid adenocarcinoma, I would start by getting next-generation sequencing and MSI/MMR testing of the tissue specimen that was used to make the diagnosis. This would allow for additional information and the potential use of ...
How do you approach small bowel constraints in the setting of reirradiation?
This is a very tough question to answer. I agree with Dr. @Dr. First Last's answer.The maximum dose for the small bowel during reirradiation can vary depending on various factors such as the previous dose received, the interval between radiation treatments, the purpose of reirradiation (palliative o...
What uterine risk factors do you consider when recommending VBT boost after EBRT?
Since most patients who need EBRT now have high risk disease with more than one adverse factor, we prefer EBRT 45 Gy in 25 followed by 5 Gy x 2 for almost all unless the patient declines brachytherapy.
What post-treatment surveillance strategy do you employ for patients who undergo conservative fertility-sparing surgery for early-stage cervical cancer?
For patients undergoing fertility-sparing surgery for early-stage cervical cancer not dissimilarly to any other patient treated for early-stage cervical cancer. I would recommend that the patient undergo a history and exam, including a pelvic exam, every 3 months for the first 2 years, then every 6 ...
What does bevacizumab contribute in metastatic cervical cancer when used in combination with a platinum doublet + pembrolizumab?
I'm not sure how to answer the question. GOG 240 established paclitaxel/carboplatin/bevacizumab as the standard for first-line therapy for metastatic or recurrent cervical cancer.The BEATcc trial was a subsequent phase III trial for stage IVB, recurrent or metastatic cervical cancer that randomized ...