Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
For a medically inoperable clinically-staged FIGO IA endometrial cancer with serous, clear cell or other non-endometrioid, high-risk histology treated with EBRT alone, would you cover elective lymph nodes, or treat the uterus alone?
I would utilize a combination of EBRT and HDR-BT as well as adjuvant chemotherapy, if medically fit for such. If declining brachytherapy, recent reports on SBRT for GYN cancers as a boost modality can help guide planning to avoid excess toxicity risk.The ESGO/ESTRO guidelines have a section for medi...
How do you manage a patient with cervical cancer who has FDG uptake in bilateral ischial tuberosities with lytic areas on CT correlate, and also has a history suspicious for untreated polymyalgia rheumatica with chronic symptoms in the same anatomic locations?
I would be very interested in the opinion of a rheumatologist regarding the etiology of the lytic disease in the ischial tuberosities. A decision should be made on whether to biopsy one of these lesions. My suspicion is that it is unrelated to cervical cancer, but that possibility needs to be consid...
How would you treat recurrent endometrial carcinoma with a presentation of inguinal and external iliac adenopathy?
I would treat with definitive intent with either surgery followed by (chemo) RT or definitive (chemo) RT targeting the pelvic at least up to the common iliac and bilateral inguinal region.
How would you manage a patient with low-volume non-invasive endometrioid carcinoma that is found in both the endometrium and ovary (pN0)?
Isolated ovarian involvement in endometrial cancer is uncommon, and previous data from the Gynecologic Oncology Group and other single-institution series suggest that it occurs in less than 5% of patients. (Creasman et al. Cancer, 1987; Lin et al. Gynecol Oncol, 2015) Adnexal involvement when presen...
In a patient with stage IVB HER2 3+ high-grade serous endometrial cancer who had disease confined to a polyp and "microscopic" omental metastases, how long would you continue maintenance trastuzumab after chemotherapy?
Two years or until progression
Would focal clear cell features change your management for a grade 2 endometrial adenocarcinoma?
We do know clear cell predicts for worse outcome but don’t know volume required for it to be independent factor. In clinical trial they require at least 10 percent of volume to be clear cell not based on outcome but more on consensus. In our practice, if they have focal clear cell I would at least o...
Would uterine perforation at the time of hysterectomy push you to recommend pelvic RT in a patient who would otherwise receive cuff brachytherapy?
It very likely would. I suppose that various factors could impact the decision, including the usual prognostic factors, patient's general condition and co-morbidities, etc. But, yes, a uterine perforation at the time of hysterectomy would represent another risk factor that would push me to be more a...
In what situations would you perform a sentinel lymph node biopsy for cervical cancer?
At my institution we currently consider doing sentinel lymph node dissections for all patients with FIGO stage IA2-IB2 (2018 staging system) who have normal appearing nodes on CT scan. Our protocol utilizes indocyanine green (ICG) tracer and the near infrared detection with ultrastaging. If one side...
What are your next steps in management for a patient with endocervical adenocarcinoma s/p radical trachelectomy with a positive pelvic lymph node noted on final pathology?
With any surgically resected cervical cancer (whether nodal assessment followed a traditional approach/radical hysterectomy or nodal assessment followed by a fertility sparing approach/radical trachelectomy), when there are positive nodes on final pathology, our tumor board recommends following Pete...
Do you recommend adjuvant therapy for early stage (IB) high grade endometrial stromal sarcoma?
Tanner et al., PMID 22750260 demonstrated that these cancers have an exceptionally poor prognosis. Since there are no randomized trials, utilization of both adjuvant radiotherapy and chemotherapy with carboplatin/taxol or gemcitabine/taxotere would seem appropriate. As with endometrioid cancers of t...