Dr. Chapa’s OBGYN Clinical Pearls

In our previous episode, we covered the revised FIGO ovarian cancer staging which now includes fallopian tube and peritoneal malignancies. In this episode, we will cover the FIGO guidelines regarding the management of OVFTP cancer. What role do PARP inhibitors play? Does treatment for asymptotic recurrence based on CA125 help? Can tamoxifen be used in recurrent malignancy? Let’s find out… Now.

The lifetime risk of a woman in the USA developing ovarian cancer is approximately 1 in 70. Malignant tumors of the ovaries occur at all ages with variation in histologic subtype by age. For example, in women younger than 20 years of age, germ cell tumors predominate, while borderline tumors typically occur in women in their 30s and 40s—10 or more years younger than in women with invasive epithelial ovarian cancers, which mostly occur after the age of 50. About 23% of gyn cancers are ovarian, but 47% of all deaths from cancer of the female genital tract occur in women with ovarian cancer. In this podcast we will summarize the new FIGO classification system for ovarian cancer which now includes malignancies of the fallopian tube and peritoneum (OVFTP).

Dive into the complexities of adjuvant therapy for endometrial carcinoma. Discover the pivotal roles of radiation and chemotherapy in treatment regimens. Learn whether progestin therapy is a viable option. The discussion wraps up with a chilling look at the implications of discovering endometrial cancer after a hysterectomy meant for benign conditions. It's a rollercoaster of insights aimed at navigating some challenging scenarios in gynecological oncology.

Endometrial carcinoma, the most prevalent gynecological cancer, often presents with abnormal vaginal bleeding, particularly in postmenopausal women. The 2018 FIGO guidelines shed light on crucial risk factors like obesity and estrogen levels. Insights into the differences between type 1 and type 2 cancers are explored, alongside the importance of surgical staging and preoperative assessments. The discussion also emphasizes lymphovascular space invasion and its pivotal role in prognosis, laying the groundwork for subsequent treatment options.

In this Part 2, we will review the pathological reports which may influence cervical cancer clinical staging. We will also summarize the 2018 FIGO treatment guidelines. In brief: For stage 1A1-1B1: surgery is recommended; Stage 1B2-IIA1: surgery or radiation may be used; Stage 1B3-IVA: concurrent chemoradiation is standard; Stage IVA may need an exenteration; and Stage IVA is managed with chemoradiation.

Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for diagnosis and management of cervical cancer. The FIGO Gynecologic Oncology Committee, in 2018, revised the Cervical Ca staging system based on these advances. Imaging evaluation may now be used in addition to clinical examination where resources permit. The revised staging permits the use of any of the imaging modalities according to available resources, i.e. ultrasound, CT, MRI, positron emission tomography (PET), to provide information on tumor size, nodal status, and local or systemic spread. In this session, which is Part 1, we will review the pathogenesis, epidemiology, symptomatology, and 2018 FIGO revised cervical cancer staging system. We will leave management of cervical cancer for Part 2.

While offering OTC birth control may be controversial here in the U.S., it is a non-issue in many other countries. China, India, Greece, Turkey, Mexico, Brail, Portugal, South Africa, Korea and Russia are a few of the countries where women can get birth control pills without a prescription. Is that safe? What about the risk of VTE? Should there be an age restriction? In this episode, we will highlight the October 2019 ACOG committee opinion (788) on over-the-counter access to hormonal contraception.

We all recommend it! The influenza vaccine. However, when asked specific questions about the vaccination, a fair number of healthcare providers will not know the answers. Is personal egg-allergy a contraindication? Can everybody receive the intranasal vaccine? What about pregnant women? In this podcast, we will cover the Advisory Committee on Immunization Practice (ACIP) guidelines for vaccination for the 2019- 2020 influenza season.

Eclampsia is a life-threatening pregnancy complication, defined as the new onset of seizures during pregnancy with a concomitant diagnosis of preeclampsia. Clinicians often ask patients with suspected preeclampsia about headaches, visual changes, or epigastric pain. Are the symptoms predictive of eclampsia? In this session, we will review the soon to be published (systematic review) evaluating the current literature regarding signs and symptoms that occurred before the onset of eclampsia and estimate their predictive value. Are they enough to determine who does/does NOT get MagSulfate? Let’s see.

The prevalence of obesity is at an all-time high in the United States, and the obesity rate among women is 40%, with 9.8% of women having class III obesity (BMI 40 or higher). As a result, obesity is a frequent and severe comorbidity of pregnancy. Whether or not incisional negative pressure wound therapy reduces wound morbidity is an important question for obstetricians and patients. In this podcast, we will summarize the key findings from a soon to be released RCT from my Alma Mater, UT Southwestern, investigating whether or not negative pressure devices applied at CS in obese patients prevents wound morbidity...or not.