Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you take patients off anticoagulation for tandem and ovoid or tandem and ring procedures?
We don't take them off anti coagulant for intracaviatry alone unless using a hybrid applicator
For a patient with carcinosarcoma of the uterus and an allergic reaction to paclitaxel, would you have any reservations about using docetaxel instead?
While there is no clear data for this in carcinosarcoma, Yes, I would be comfortable using Docetaxel in this scenario. I am extrapolating from ovarian cancer, where the two drugs have similar activity; The SCOTROC trial in ovarian cancer compared Carbo-Paclitaxel vs. Carbo-Docetaxel and found simila...
Would you recommend maintenance therapy with a PARP inhibitor for BRCA+ patients with advanced uterine serous cancer?
This is a data free zone, so I would hesitate to make a recommendation to use a PARP in this setting. Although, theoretically this should work if the patient has BRCA gene mutation. This would be an excellent question to answer in the form of a clinical trial similar to what Fader et al did for HER2...
Do you routinely discuss HRT with patients that have undergone surgical menopause due to treatment of cervical cancer?
Yes, I routinely discuss it with premenopausal patients and it is an important part of their care. If they will be having chemoradiation for a locally advanced cancer, I will discuss pros/cons of ovarian transposition. With adenocarcinomas, some patients do opt for oophorectomy if a radical hysterec...
How would the presence of micro-metastatic disease in multiple sentinel pelvic lymph nodes change your recommendation for adjuvant therapy in a patient with otherwise stage I endometrioid adenocarcinoma?
Currently, we treat like stage III disease with chemotherapy followed by adjuvant EBRT for decreasing LRR and control any residual nodal disease (could be 30% based on FIRES) left behind as had only SNLN done. The outcome appears to be better than macrometastases.If only ITC then no chemo for now bu...
How would you approach nodal assessment in a pregnant patient with new diagnosis of at least stage IB1 cervical SCC?
My preferred approach to nodal assessment in this patient is a robotic pelvic lymphadenectomy in the early second trimester of pregnancy after she has undergone a pelvic MRI without gadolinium.The approach to the patient with early-stage cervical cancer presenting in the first trimester of pregnancy...
How would you manage a cervical cancer patient who develops new oligomet to the spine during primary cis/RT?
The finding of metastatic disease to the spine during primary radiation therapy for cervical cancer suggests the presence of systemic, hematogenous disease at the start of treatment. PET-CT scan and/or bone scan are useful diagnostic tools to detect distant metastases and also to differentiate betwe...
How would you manage a patient with history of locally advanced SCC of the cervix, treated with definitive chemoRT, found to have new lung lesions 6 months post treatment?
All patients with metastatic cervical cancer should first be considered for a clinical trial. This is a condition with limited effective treatment options and also disproportionately affects younger women. It is pivotal clinicians be aware of the rapidly evolving landscape of clinical therapies for ...
How do you treat a Stage II Grade 3 endometrioid endometrial adenocarcinoma?
Depends. Was a lymphadenectomy done? What is the extent of disease in the cervix? Microscopic or clinical lesion? What is the amount of myometrial involvement? Was a hysterectomy done? The answers to the above would dictate therapy.
How do you approach adjuvant treatment for node positive high grade gastric type endocervical adenocarcinoma following radical hysterectomy?
Gastric-type endocervical adenocarcinoma (GEA) was first recognized as a distinct histologic subtype of cervical adenocarcinoma in 2020 by the World Health Organization. Adenocarcinomas account for approximately 25% of newly diagnosed cervical cancer cases worldwide, with GEA comprising around 10% o...