Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Should presacral lymph nodes be included in a locally advanced endometrial cancer without cervical involvement with incomplete surgical staging (i.e. no lymph node dissection)?
The pattern of spread for lymphatics draining the uterus tend to follow a predictable pattern generally along one of two primary pathways. Lymph flows from the fundus toward the adnexa and infundibulopelvic ligaments, placing the lower para-aortic lymph node stations as a potential site for spread. ...
What staging procedures do you include for clinically apparent stage I or II ovarian cancer?
My discussion will focus on staging for epithelial ovarian cancer (EOC). Surgical staging has long been considered a pivotal step in the development of a comprehensive treatment plan for patients with apparent early-stage EOC for many reasons:1 A proportion of patients will be upstaged based on stag...
How would you treat an isolated recurrence in the pelvic muscle after prior definitive chemoradiation with brachytherapy boost for vaginal adenocarcinoma?
I would favor SBRT along with systemic treatment for the recurrent disease.
What criteria do you use when choosing an applicator system for cervical brachytherapy patients?
It is all based on institutional experience as dosimetrically there are some differences between the two applicators but would be hard to quantify any clinical outcome difference. There is increasing adoption of ring applicator possibly because of ease and convenience
How would you treat an advanced stage small-cell carcinoma of the ovary, hypercalcemic type? (SCCOHT)?
Small cell carcinoma of the ovary hypercalcemic type (SCCOHT) is an exceptionally rare tumor affecting patients from infancy to at least the fifth decade of life. SCCOHT tumors are characterized by mutations of the SWI/SNF member SMARCA4 that encodes BRG1. Given the rarity of SCCOHT, limited prospec...
Would re-excision of close margins (1 mm) allow a patient to avoid post-op radiation for a patient with metachronous diagnosis of a FIGO Stage IB vulvar cancer who also had a prior contralateral vulvar cancer resected 15 years ago?
Yes, would avoid RT if re-excision is done to get a wider margin.
Would you treat a uterine carcinosarcoma with omental spread with adjuvant whole abdominal radiation?
I would not offer any external beam irradiation for this patient. Even isolated omental spread in uterine carcinosarcoma represents metastatic disease. Thus, they only reasonable option is chemotherapy, usually systemic agents such as carboplatin and paclitaxel or cisplatin and ifosfamide.
How do you incorporate surveillance imaging for patients with ovarian cancer on maintenance therapy?
I typically follow the NCCN guidelines for monitoring/follow up: Visit every 3 months for 2 years, then every 3-6 months for 3 years, then yearly after year 5. CA125 (or other tumor markers) at each visit if initially elevated (with the understanding that CA125 monitoring does not affect survival, ...
How would you prescribe RT dose to post-op vulvar cancer with margins positive for severe dysplasia?
Need to quantify: If this positive dysplasia is dVIN, then I would favor re-excision, as it is high risk factor for local relapse and I don’t know if RT alone would be effective.
What is your approach to adjuvant therapy for a fully resected (contained morcellation and laparoscopic removal), isolated retroperitoneal leiomyosarcoma in a patient with a remote history of a hysterectomy?
I would stage the patient with scans and I would check the resected LMS for estrogen receptor. A fair proportion of uterine LMS are ER+ and I think that is more likely to be true for a late recurrence.If ER-negative, I would not give chemo with no disease to watch. Existing data from randomized clin...