Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you repeat somatic tumor testing for ovarian cancer patients after recurrence?
Times are changing and payers will have to fall in line, eventually. At this time, we already know that clonal evolution exists but is poorly understood regarding the timeline. However, if we are going to leverage "precision medicine", then to be precise one has to account for clonal evolution in de...
How would you counsel a patient with extragenital lichens sclerosis on the acute and long term risks of post-lumpectomy radiotherapy?
Lichen sclerosis (LS) is a rare entity, however, there are reports of successful treatment with radiation for various cancers associated with this condition. (Wang et al., PMID 33356763). There is also a suggestion of worse LC in women with vulvar cancer and preexisting LS (Fokdal et al., PMID 34392...
What is your preferred adjuvant regimen for an optimally cytoreduced, stage III low grade serous ovarian carcinoma?
My decision for adjuvant cytotoxic chemotherapy following initial/primary optimal debulking for advanced Stage III Disease is based upon both personal experiences as well as with literature guidance.The initial guiding issues that I use are age and residual disease at completion of therapy. I am ans...
When do you discontinue PARP inhibitor maintenance after complete response to first line chemotherapy in a BRCA+ patient?
I agree with Dr. @Dr. First Last that we have no data for PARPi maintenance beyond 2 years in the first line and would urge people to enroll in clinical trials which look at risks and benefits of longer maintenance, especially in patients harbouring a germline BRCA mutation. With respect to all come...
In a patient with high-risk gestational trophoblastic neoplasia, how would you approach treatment of recurrence at 6 months post EMA-CO?
NCCN guidelines recommend EMA-EP (etoposide, methotrexate, actinomycin-d alternating with etoposide and cisplatin) for patients who have recurrence after a complete response to EMA-CO. Given the pulmonary metastases, I would not recommend hysterectomy as initial therapy. However, if the patient had ...
Would a history of definitive chemoRT for anal SCC change the workup for an ASCUS/HPV negative PAP smear in a patient who has never had an abnormal PAP smear in the past?
Interesting question. We do know that radiation changes can lead to atypia which can interfere with cytological analysis. I would counsel the patient that her current ASCUS/HPV negative pap smear results may have some relation to her prior radiation, but ultimately I would still follow ASCCP guideli...
Is it acceptable to treat vulvar cancers with split course radiation?
Unless the planned course is for palliation, split course is not suggested.
When is pelvic lymph node dissection indicated in vulvar cancers?
GOG 37 established adjuvant RT to pelvis and groins better than PLND for inguinal node positive patients. Pelvic recurrence rates were similar in both arm with the predominant difference being in inguinal recurrence. PLND as part of routine management in vulvar ca is hardly indicated.
How would you counsel a patient regarding possibility of ovarian preservation at time of surgery for malignant mesothelioma initially discovered in a myomectomy specimen and involving peritoneal surfaces?
If the mesothelioma is on the lower grade of the spectrum and the margins negative, I would offer fertility preservation if feasible at surgery. If high grade, I would have a discussion about prognosis with the patient. If all the tumor can be resected with an R0 resection, it should be offered - th...
What is your approach to adjuvant therapy for stage IC low grade serous ovarian cancer s/p full staging with R0 resection?
As reported in the literature, low-grade serous ovarian cancer is not as chemo-sensitive as high grade histology, and the main predictor of survival is successful cytoreduction. In patients with stage Ia, IB I usually recommend surveillance and for patients with stage IC, I would discuss hormonal th...