Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you sample radiologically negative paraaortic nodes in cervical cancer patients with clinically positive pelvic nodes prior to initiating primary chemoradiation?
Possible options in PET-positive pelvic nodes and negative PA nodes: Treat at least the entire common iliac chain, including the aortic bifurcation nodal region, which is 1 level above the affected pelvic nodes. Treat the subrenal PA region prophylactically, especially if the common iliac region or ...
With COVID-19 worries, are you more likely to offer women with endometrial cancer vaginal cuff brachytherapy over EBRT?
I would treat with brachy alone, as even in a non COVID environment with her comorbidities, the benefit of EBRT is minimal in terms of survival.
What adjuvant therapy do you recommend for comprehensively staged, stage II, FIGO grade 3 deeply invasive endometrial cancer?
I would strongly consider external beam therapy and adjuvant chemotherapy.
Would you consider robotic lymph node dissection and parametrectomy for a patient with incidental stage 1A2 cervical cancer after simple hysterectomy?
I would not consider a parametrectomy, but I would definitely do a lymph node evaluation. Depending on risk factors such as tumor size, presence of LVSI, and depth of invasion, I would start with a PET scan. Rates of positive lymph nodes can be as high as 8-10% for these early-stage cancers. If ther...
Do you ever offer minimally invasive surgery for treatment of early stage cervical cancer?
I do not offer minimally invasive surgeries to cervical cancer patients regardless of tumor size based on the RCT data. I think there is also sufficient retrospective data to question this approach in even smaller tumor sizes and do not feel comfortable offering this to patients given the concern fo...
How would you treat cervical stump SCC involving bladder, pelvic nodes, and port-site metastasis in a patient post-laparoscopic hysterectomy?
No standard approach. If good KPS, would favor treating with definitive chemo RT with EBRT plus interstitial plus weekly cisplatinum. For port site recurrence depending on volume, would favor local excision vs. definitive RT dose.
How does positive p53 staining influence your recommendation for adjuvant therapy in comprehensively staged early (stage IA or IB), grade 2, endometrioid endometrial cancers?
It does not influence my recommendations. If a study is available to potential study the risk conferred by P53, I would offer it to my patient.
Would you offer brachytherapy for a patient with metastatic cervical cancer s/p 30Gy/10 fx to the pelvis followed by chemotherapy who only has isolated disease in the cervix?
Control of central pelvic disease in cervical cancer is a main goal of treatment, regardless of whether the patient has metastatic disease or not. This is important for maintaining quality of life. Death from central pelvic disease is very unpleasant. Therefore, I recommend brachytherapy in this pop...
Do you modify your treatment for a patient with ulcerative colitis needing vaginal brachytherapy?
For adjuvant treatment, I switch to 6 Gy x 5 to surface to reduce total dose to rectum instead of 7 Gy x 3 at 5 mm. Also, sometimes I have used a multichannel cylinder to off load Isodose line from rectum based on anatomy. By doing as above d2cc of rectum is usually in the 10 Gy range which is way l...
When, if ever, would you consider ovarian preservation in a premenopausal patient with high grade endometrial carcinoma?
It depends on the extent of disease i.e., is it superficial invasion or deep invasion? Were the nodes evaluated? How old is the patient? The answer could be yes or no depending on the above.