General Gyn

Question 1

What is important history for gyn patients

Answer 1

1. Pregnancy history
2. menstrual history
3. abnormal pap smears
4. menopausal status
5. vaginal bleeding

Question 2

What should the physical exam entail

Answer 2

1. Complete physical exam, including pelvic exam
2. Speculum exam
3. Bimanual exam
4. Should focus on disease extent inferiorly int o the vagina, lateral extent into parametria, posterior extension into uterosacral ligament, rectum
5. Palpation of the inguinal and supraclavicular region

Question 3

Describe general workup

Answer 3

Labs: CBC/CMP, pregnancy test if premenapausal

Biopsy of the lesion

Imaging: CT CAP, MRI of the pelvis (PET is possible)

Consider HIV testing and smoking cessation counselling

Question 4

How do you simulate a gyn patient?

Answer 4

• Headfirst, vac loc bag
• Full and empty bladder scans
• Consider IV contrast
• Fuse with MRI
  If there was vaginal extent on exam, then gold/carbon fiducial markers should be placed

Question 5

What is the dose constraint to bladder?

Answer 5

V45<35%

Question 6

What is the dose constraint to small and large bowel

Answer 6

V40<30%
V45<150cc

Question 7

What is the dose constraint to rectum?

Answer 7

V45<60%
V40<80%

Question 8

What is the dose constraint to bone marrow?

Answer 8

V10<90-95%

Question 9

What is the dose constraint to femoral heads?

Answer 9

V40<15%

Question 10

What is the dose constraint to kidney?

Answer 10

V20<33%
V15<50%

Question 11

What are the expected early toxicities of RT?

Answer 11

1. Diarrhea
2. urinary burning
3. GI upset
4. skin erythema
5. fatigue

Question 12

What are the expected late toxicities of RT?

Answer 12

1. Vaginal scarring/narrowing,
2. fistula formation
3. bowel obstruction
4. bladder damage
5. rectal bleeding
6. osteopenia leading to insufficiency fractures

Question 13

What does follow up entail?

Answer 13

1. 3 month PET
2. Q3 month exam for 1-2 years with imaging
3. Q6 months years 2-3 with scans
4. Annually during years 4-5 with scans