Gynecology Oncology 8 Week Curriculum and Reading List

All residents on the UWMC Gyn Oncology and Swedish Gyn service will receive an email at the beginning of each week alerting them to the topic of the week and the educational objectives related to the topic. These are listed above. Residents are expected to read on these topics and can expect to be asked questions in a Socratic fashion (ie Pimping) about all aspects of this topic on rounds and in the OR. The chapters noted correspond with the Berek Gyn Oncology textbook. The competency-based educational objectives are posted on MedHub but the knowledge-based objectives that should guide your reading are listed below.

Source

1. Practical Gynecologic Oncology by JS Berek and NF Hacker Residents should use this as a primary source.
2. Principles and Practice of Gynecologic Oncology by WJ Hoskins, CA Perez, RC Young
3. ACOG Reading (can be accessed through the ACOG Compendium or at ACOG.org for a more current and comprehensive list).
4. Atlas of Clinical Gynecology: Contemporary Clinical Management of Gynecologic Malignancies by BE Greer, FJ Montz

Topic 1 Chemotherapy (Chapter 4: Chemo/mechanisms/pharmacology/complications)

• Common chemotherapeutic agents used to treat gynecological malignancies, the major side effects, and management of these side effects
• Describe the indications for therapy, mechanism of action, potential complications of carboplatin, paclitaxel, cisplatin, adriamycin, bleomycin
• Describe the mechanism of action of cytotoxic chemotherapy
• Describe the risk of secondary malignancies following chemotherapy.
• Evaluate patients for side effects from chemotherapy
• Know the chemotherapy drugs used for gyn cancer, common toxicities, methods/medications to control toxicities, interaction with other medical conditions, and how these affect/limit other cancer treatment
• Order/ interpret appropriate pre-, post-operative tests, and for those on chemotherapy
• Prescribe treatment for common side problems such as nausea/vomiting and pain control
• Understand therapeutic index & how to find the toxicities and drug interactions of other drugs 

Topic 2 Radiation (Chapter 5)

• Describe standard dose/schedule for gyn cancers, and rationale for the use of teletherapy (external beam) vs brachytherapy (implants), and associated complications.
• General radiation principles and the most common complications
• Understand the importance of adequate oxygenation, transfusion for low hemoglobin, smoking cessation, concurrent sensitizing chemotherapy during radiation therapy
• Understand the importance of finishing the prescribed radiation course on time, and the consequences of a protracted treatment course
• Understand the relationship between prior surgery and radiation complications

Topic 3 Endometrial Cancer and Sarcoma (Chapter 10)

• Describe treatment and patterns of failure for uterine sarcomas
• Describe Type 1 and Type 2 endometrial cancer
• Know appropriate salvage treatment options for recurrent endometrial cancer
• Know how the prognosis of synchronous endometrial and ovarian tumors compares to an endometrial cancer metastatic to the ovary
• Know risk factors for endometrial hyperplasia, appropriate evaluation, and risk of underlying endometrial cancer, and treatment options.
• Know the relationship between endometrial cancer and colorectal cancer in patients with HNPCC syndrome
• Understand differences in staging and treatment for uterine sarcomas compared with uterine carcinomas
• Understand the prognosis of endometrial cancer of endometrioid histology vs. papillary serous or clear cell histology
• Understand the relative role of surgery, radiation, chemotherapy and hormonal therapy in the treatment of endometrial cancer
• Uterine cancer: appropriate evaluation of abnormal uterine bleeding, pretreatment evaluation of endometrial cancer, and management of endometrial hyperplasia.
• Uterine Cancer: recognize risk factors for endometrial hyperplasia and cancer, epidemiology of endometrial cancer, describe type 1 and 2 endometrial cancer, HNPCC syndrome.

Topic 4 Ovarian Cancer (Chapter 11)

• Describe the role and type of chemotherapy (IV and intraperitoneal) for epithelial ovarian cancer
• Describe chemotherapy and clinical course of "platinum sensitive" vs. "platinum resistant" epithelial ovarian cancer vs treatment of low malignant potential tumors
• Describe inherited syndromes that increase a woman's risk of developing ovarian cancer
• Describe the pre operative workup of a suspicious adnexal mass
• Describe the role of intraperitoneal chemotherapy for ovarian cancer
• Know appropriate salvage treatment options for recurrent ovarian cancer Ovarian Cancer: describe inherited syndromes that increase the risk, role of CA 125 and ultrasound in screening.
• Understand inheritance patterns for breast and gynecologic cancer, need for testing an affected family member, and recommendations for BRCA 1/BRCA 2 testing
• Understand the relationship between fallopian tube cancer and BRCA1/2 germ line mutations
• Understand the role of CA125/ultrasound in the diagnosis and management of primary and recurrent ovarian cancer

Topic 5 Ovarian germ cell and stromal tumors (Chapter 12)

• Describe the adjuvant treatment of patients with ovarian sarcoma
• Describe the chemotherapy of germ cell and stromal ovarian cancer, which do not require adjuvant chemotherapy, and modifications to therapy required to preserve fertility as well as risk of these modifications.
• Describe the epidemiology of germ cell ovarian cancer and role of BHCG, AFP and other tumor markers in the diagnosis and management of primary and recurrent germ cell ovarian cancer
• Describe what primary tumors most commonly metastasize to the ovary, the relative presentation of tumors metastatic to the ovary vs. primary ovarian cancer, and treatment of metastatic ovarian cancer
• Understand the relative role of surgery, radiation, chemotherapy and hormonal therapy in the treatment of ovarian stromal neoplasms
• Describe the surgical approach to a patient with putative germ cell, stromal cancers, ovarian sarcoma, or fallopian tube cancers
• Understand the relative role of surgery, radiation, chemotherapy and hormonal therapy in the treatment of low malignant potential, early stage, and advanced stage epithelial, germ cell, and stromal ovarian cancers and fallopian tube cancers.

Topic 6 Cervical Cancer (Chapter 9)

• Cervical Cancer: epidemiology, role of HPV in the pathogenesis, value of HPV vaccination, typical progression and time course Describe the rationale for treatment of early stage cervical cancer and consequences of inappropriate simple hysterectomy in cervical cancer
• Know the essential items to maximize success in cervical cancer chemo-radiation and options for salvage therapy of recurrent cervical cancer
• Know the value of HPV vaccine in the prevention of cervical dysplasia
• Understand clinical relevance of viral oncogenes
• Know that, by definition, if the cancer involves the vulva or cervix the lesion is not a vaginal cancer

Chapter 7 Vulvar and Vaginal Cancers (Chapters 13, 14)

• Know evaluation of suspicious vulvovaginal lesions and treatment options of preinvasive vulvar lesions
• Understand psychosexual consequences of diagnosis/treatment of VIN, VAIN, vulvovaginal cancer.
• Understand the prognosis of vulvovaginal cancer and how the treatment and prognosis varies when the histology is not of squamous histology
• Know anagement of suspicious vulvovaginal lesions and known preinvasive lesions
• Understand risk of progression from neoplasia to malignancy
• Demonstrate an understanding and sensitivity to the psychosexual consequences of the diagnosis and treatment of vulvovaginal cancer
• Know that, by definition, if the cancer involves the vulva or cervix the lesion is not a vaginal cancer

Chapter 8 Gestational Trophoblastic Disease/Breast Cancer (Chapter 15)

• Describe the epidemiology, genetics, clinical manifestations, preoperative evaluations of gestational trophoblastic disease and distinguish between partial vs complete mole (histologic, cytogenetic findings).
• Describe the role of ultrasound, quantitative BHCG titer, Chest X-ray, Thyroid function tests and CT scan in the evaluation of gestational trophoblastic disease
• Understand "phantom HCG"
• Describe management and follow up plan for patients diagnosed with hydatidiform mole and understand risk of malignancy
• Describe the diagnosis of malignant GTD and associated risk factors
• Classification of malignant GTD into good prognosis and poor prognosis groups, chemotherapy, and for survival and future fertility.
• Know chemotherapy regimens for treatment of low risk metastatic GTD, high risk metastatic GTD and post molar GTD
• Evaluation of breast signs/symptoms potentially related to a malignancy
• Impact of pregnancy on diagnosis, treatment and prognosis of breast cancer
• Know risk factors for developing breast cancer, screening recommendations, evaluation of signs/symptoms related to cancer.
• Know the impact of pregnancy on diagnosis, treatment and prognosis of breast cancer
• Risk factors for developing breast cancer and screening recommendations
• Demonstrate an understanding and sensitivity to the psychosexual consequences of the diagnosis and treatment of breast cancer