Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you consider high para-aortic nodes above the renal vessels to be locally advanced or metastatic in cervical cancer?
It sounds like you are asking how aggressively to treat patients with para-aortic nodal spread. My limit for "para-aortic" or "regional LAD" is usually anything below the diaphragm. I generally think of and treat these patients as advanced stage III.I would also advocate for definitively treating ce...
How do you approach staging for a patient with adult granulosa cell tumor, grossly confined to one ovary, and desiring a fertility sparing procedure?
A fertility sparing approach may be considered in this patient as long as a restaging surgical procedure demonstrates no obvious evidence of metastatic disease. The procedure should include a careful inspection of peritoneal surfaces, peritoneal biopsies, and partial omentectomy. Systematic pelvic a...
After an optimal tertiary cytoreduction for recurrent granulosa cell tumor previously treated with BEP and hormonal therapy, would you recommend systemic chemotherapy?
Yes, I would give adjuvant therapy. I would go with carbo taxol. The MD Anderson people have been using this regimen for some time. It is less toxic and appears to be as active as BEP. I think Jubilee Brown published a paper on this subject recently. This exact meeting was not specifically addressed...
How would you manage a patient with history of stage IIIC HGSOC after secondary cytoreduction of isolated inguinal node recurrence 12 years after primary treatment?
Difficult case. Could just observe if the lymph node is an isolated recurrence with no extracapsular extension. If extracapsular extension, could offer standard chemotherapy again, or just single agent carboplatin to minimize side effects x 6 cycles. This patient should have been extra-sensitive to ...
Is there a role for SBRT with vaginal melanoma?
With proximity of rectum, urethra, and vulva, we favor 3DCRT or IMRT to 45-50 Gy at 2.5 Gy per fraction with and without brachy based on response.
Would you treat a vulvar SCC with definitive chemoRT with 50.4 Gy IMRT then boost the GTV with en face with electrons to ~6400?
There is no "one fits all" for vulvar cancer, which is a complex disease with varying disease presentations. The ideal method of boost and the dose depends on the size, location, histology, and other factors. We used to use en face electron boosts much more frequently before we began using IMRT. It ...
Would you alter neoadjuvant chemotherapy regimen for a high grade small cell neuroendocrine carcinoma of the ovary if she has already received cycle 1 of carbo/taxol?
Small cell neuroendocrine tumors of the ovary are rare and of poor prognosis. There are several steps I would take in a situation like the one described in the vignette. Discuss poor prognosis with the patient. Rule out occult primary that is not ovarian. Get early involvement of medical oncologis...
How would you adjust therapy for a patient with high risk, stage III choriocarcinoma (lung mets) in the context of renal insufficiency (Cr 3.8)?
Risk score might dictate chemo regimen. There are dose adjustments for Methotrexate & Cytoxan based on renal function for MAC which you could use if risk score 7 or 8. I’d follow MTX levels & dose folinic acid until nontoxic MTX levels. If higher score I’d use EMA +/- CO. Consider neupogen on off-ch...
How do you manage cancer treatment-related cognitive change or "chemo brain?"
Chemo-brain is a vexing and complicated diagnosis. In most cases, you don't know the baseline neurocognitive function of individuals with cancer. Many conditions that are associated with chemotherapy like fatigue, depression, and aging can mimic chemo-brain. Estimates are that about 20% of individua...
What chemotherapy would you utilize for a metastatic dysgerminoma diagnosed in the second trimester of pregnancy?
Cisplatinum, Etoposide, Bleomycin