Objective. To assess current practice, advise minimum standards, and identify educational gaps relevant to genetic screening, counseling, and testing of women affected by gynecologic cancers.Methods. The Society of Gynecologic Oncology (SGO) organized a multidisciplinary summit that included representatives from the American College of Obstetricians and Gynecologists (ACOG), the American Society Clinical Oncology (ASCO), the National Society of Genetic Counselors (NSGC), and patient advocacy groups, BrightPink and Facing our Risk of Cancer Empowered (FORCE). Three subject areas were discussed: care delivery models for genetic testing, barriers to genetic testing, and educational opportunities for providers of genetic testing.Results. The group endorsed current SGO, National Comprehensive Cancer Network (NCCN), and NSGC genetic testing guidelines for women affected with ovarian, tubal, peritoneal cancers, or DNA mismatch repair deficient endometrial cancer. Three main areas of unmet need were identified: timely and universal genetic testing for women with ovarian, fallopian tube, and peritoneal cancers; education regarding minimum standards for genetic counseling and testing; and barriers to implementation of testing of both affected individuals as well as cascade testing of family members. Consensus building among all stakeholders resulted in an action plan to address gaps in education of gynecologic oncology providers and delivery of cancer genetics care. (C) 2017 Published by Elsevier Inc.

Pregnancies post trachelectomy and pelvic radiation therapy is possible. Such pregnancies are at very high risk of complications and should be managed by an experienced multidisciplinary team.

Superior vena cava syndrome is an infrequently noted complication associated with gynecologic malignancy. Three cases illustrate modern diagnostic and management methods. Patients developed superior vena cava syndrome secondary to mediastinal metastatic endometrial carcinoma, uterine leiomyosarcoma, and secondary to thrombosis induced by a subclavian hyperalimentation catheter. Awareness of this condition on oncology units and by physicians using central venous catheters is important to afford the prompt diagnosis and appropriate management of this life-threatening condition.

Intravenous urography (IVU) was performed in 289 patients at the time of diagnosis of malignant gestational trophoblastic disease (GTD). Ninety-five percent of these studies were normal, and none of the urologic abnormalities detected provoked alteration of the patients' tumor-related therapy. In the detection of renal metastases, false-positive and false-negative intravenous urograms were encountered. It is concluded that IVU lacks sufficient sensitivity and specificity in the detection of renal metastatic GTD; alternate screening methods are recommended.

A detailed clinicopathologic study of 21 patients with uterine leiomyosarcoma was undertaken. The diagnosis of leiomyosarcoma was made for those uterine smooth muscle tumors showing cellular atypia and 5-9 mitoses per 10 high-powered fields (M/10 HPF) and those with 10 or more M/10 HPF. Using these strict pathologic criteria to define leiomyosarcoma, menopausal status, margin type (pushing vs infiltrating), tumor size, grade, location, and the presence of vascular invasion and/or hemorrhage were not associated with prognosis. The 5-year survival rate was 25%. Survival rates were not improved by the use of adjuvant chemotherapy in those patients rendered free of gross disease by initial surgery.

The rates of regression of human chorionic gonadotropin (hCG) in patients with complete hydatidiform moles, partial hydatidiform moles, and nonmolar abortions were compared. No difference in rates of regression was found among the three groups, but levels of hCG immediately after uterine evacuation were significantly higher in the group with complete hydatidiform moles. Differences in the time required for hCG levels to become undetectable were attributed to the difference in the degree of initial elevation of hCG.