399Reference Material

SURVEILLANCE VISIT CHECKLIST: CHECKLIST FOR SURVEILLANCE OF GYNECOLOGIC MALIGNANCIES

Patient name _________________________________________

Visit date ____________________________________________

Disease site and stage __________________________________

Date of diagnosis/surgery _______________________________

Date treatment completed _______________________________

•   Symptoms review and treatment side effects

•   Pain (abdominal or pelvic, hip or back)

•   Abdominal bloating

•   Vaginal bleeding (also rectum, bladder)

•   Weight loss

•   Nausea and/or vomiting

•   Cough or shortness of breath

•   Lethargy/fatigue

•   Swelling of abdomen or leg(s)

•   Sexual dysfunction

•   Neuropathy

•   Fatigue

Physical examination

•   General physical examination

•   Lymph node assessment (axillary, supraclavicular, and inguinal)

•   Pelvic examination (vulvar, vaginal speculum, bimanual, and rectovaginal exam)

Tumor markers _______________________________________

Disease status

•   No evidence of disease

•   Suspect recurrence

•   Radiographic imaging ______________________

•   Biopsy __________________________________

•   Refer to gynecologic oncologist _______________

Routine health maintenance

Breast cancer screening

•   Yearly clinical breast examination _______________

•   Mammogram _____________________________

•   Every 1 to 2 years starting with ages 40 to 49 years, then yearly

•   Colon cancer screening

400•   Colonoscopy or flexible sigmoidoscopy __________

•   Every 5 to 10 years beginning at the age of 50 years

Genetic screening

•   Not indicated

•   Recommended/completed _____________________

Menopausal assessment

     Osteoporosis prevention

     Calcium (1,200–1,500 mg) and vitamin D (800 IU)

     Bone mineral density testing: begin at the age of 65 years or sooner if on glucocorticoid therapy (World Health Organization [WHO] criteria can be used for reference)

Smoking cessation

     Weight maintenance (exercise, diet)

GYNECOLOGIC ONCOLOGY REFERRAL PARAMETERS

ENDOMETRIAL CANCER

•   Biopsy confirmed endometrial cancer of any grade

PELVIC MASS

•   Presence of, or concern for, advanced disease

        Omental caking (imaging-guided biopsy can be helpful).

        Pleural effusion (cytology from thoracentesis can be helpful).

        Ascites (cytology from paracentesis can be helpful).

        Elevated tumor marker(s): American Congress of Obstetricians and Gynecologists (ACOG) recommends referral for a premenopausal CA-125 greater than 200 and postmenopausal CA-125 greater than 35.

•   A clinically suspicious pelvic mass:

        Simple and larger than 8 to 10 cm.

        Larger than 4 cm and:

         Fixed

         Nodular

         Bilateral

         Excrescences

         Solid components

•   Premenarchal girls with a pelvic mass

•   Postmenopausal women with a suspicious mass or elevated tumor markers.

•   Suspicious findings include a solid mass, a simple mass greater than 8 to 10 cm, or a complex mass. ACOG recommends referral for a CA-125 above 35

•   Perimenopausal women with an ovarian mass, particularly when associated with an elevated CA-125

•   Young patients who have a pelvic mass and elevated tumor markers (CA-125, alpha fetoprotein [AFP], human chorionic gonadotropin [hCG], lactate dehydrogenase [LDH])

•   A suspicious pelvic mass found in a woman with a significant family or personal history of ovarian, breast, or other cancers (one or more first-degree relatives)

401CERVICAL CANCER

•   A biopsy (conization or directed) confirming invasive carcinoma.

•   Women with suspicious cervical lesions should be biopsied before referral

VAGINAL CANCER

•   Biopsy confirmed invasive vaginal cancer.

•   Women with suspicious vaginal lesions should be biopsied before referral. Suspicious lesions include the following:

        Nonhealing ulcers.

        Bartholin’s gland: persistent cysts in women over 40.

        Exophytic lesions.

VULVAR CANCER

•   Biopsy confirmed invasive vulvar cancer.

•   Women with suspicious vulvar lesions should be biopsied before referral. These suspicious lesions include the following:

        Nonhealing ulcers.

        Areas of chronic pain or pruritus.

        Areas of pigment change.

        Grossly enlarged lesion.

•   Depending on practitioner’s comfort level:

        Women with multifocal, complex, and/or recurrent vulvar intraepithelial neoplasia (VIN) 3.

        Women with Paget’s disease of the vulva.

GESTATIONAL TROPHOBLASTIC DISEASE

•   Referral should occur after evacuation of the molar pregnancy if there is evidence of persistent trophoblastic disease/gestational trophoblastic disease (GTD):

        GTD (low or high risk).

        Choriocarcinoma.

        Placental site trophoblastic tumor.

        Epithelioid trophoblastic tumor.

If there is evidence of metastatic disease at initial diagnosis, referral should occur immediately.

PERFORMANCE STATUS SCALES

GYNECOLOGIC ONCOLOGY GROUP (GOG)/EASTERN COOPERATIVE ONCOLOGY GROUP (ECOG)/WHO/ZUBROD (1)

     0: asymptomatic (fully active, able to carry on all pre-disease activities without restriction)

     1: symptomatic but completely ambulatory (restricted in physically strenuous activity but ambulatory and able to carry out light or sedentary work)

     2: symptomatic, less than 50% in bed during the day (ambulatory, capable of all self-care, unable to carry out any work activities. Up and about more than 50% of waking hours)

402     3: symptomatic, greater than 50% in bed, but not bedbound (capable of limited self-care, confined to bed or chair 50% or more of waking hours)

     4: bedbound (completely disabled. Cannot perform any self-care. Totally confined to bed or chair)

     5: dead

KARNOFSKY PERFORMANCE STATUS SCALE RATING CRITERIA (%)

     100: normal; no complaints; no evidence of disease.

     90: able to carry on normal activity; minor signs or symptoms of disease.

     80: normal activity with effort; some signs or symptoms of disease.

     70: cares for self; unable to carry on normal activity or do active work.

     60: requires occasional assistance, but is able to care for most personal needs.

     50: requires considerable assistance and frequent medical care. Unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly.

     40: disabled; requires special care and assistance.

     30: severely disabled; hospital admission is indicated although death not imminent.

     20: very sick; hospital admission necessary; active supportive treatment necessary.

     10: moribund; fatal processes progressing rapidly.

     0: dead.

ADVERSE EVENT GRADING

Common Terminology Criteria for Adverse Events (CTCAE): ctep.cancer.gov/reporting/ctc.html

RESPONSE EVALUATION CRITERIA IN SOLID TUMORS—INCLUDING IMMUNOLOGIC RECIST

Tumor response is measured via Response Evaluation Criteria in Solid Tumors (RECIST) guidelines version 1.1, 2009 (2). These are WHO criteria for measuring tumor response.

DEFINITION OF DISEASE

•   Measurable disease—the presence of at least one measurable lesion. If the measurable disease is restricted to a solitary lesion, its neoplastic nature should be confirmed by cytology/histology.

•   Measurable lesions—lesions that can be accurately measured in at least one dimension with longest diameter (LD) ≥20 mm using conventional techniques or ≥10 mm by spiral CT scan.

•   Nonmeasurable lesions—all other lesions, including small lesions (LD <20 mm with conventional techniques or <10 mm with spiral CT scan), that is, bone lesions, leptomeningeal disease, ascites, pleural/pericardial effusion, inflammatory breast disease, lymphangitis cutis/pulmonis, cystic lesions, and also abdominal masses that are not confirmed and followed by imaging techniques.

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