Teresa P Diaz-Montes

Mercy Medical Center · Gynecologic Oncology

PURPOSE. To compare health-related quality of life (HRQL) in primary ovarian cancer (OC) patients with peritoneal metastases (PM) after undergoing upfront cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) as part of a phase 2 trial (NCT-02124421). METHODS. Patients with stage III/IV high-grade serous OC wer...

This study aimed to evaluate the role of timing in adjuvant chemotherapy initiation in survival outcomes of advanced serous ovarian cancer patients undergoing upfront or interval CRS/HIPEC.

BACKGROUND. Most patients with epithelial ovarian cancer (EOC) present with significant peritoneal spread. We assessed collaborative efforts of surgical and gynecological oncologists with expertise in cytoreductive surgery (CRS) in the management of advanced EOC. METHODS. Using a prospective single-center database (2014–2022), we described the oper...

Objective There are limited treatment options and no consensus on the management of advanced rare ovarian malignancies. Rare ovarian malignancies can present with peritoneal metastases (PM), featuring a similar presentation to more common ovarian subtypes. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effecti...

BACKGROUND. Ovarian carcinosarcoma (OCS) is an uncommon and aggressive malignancy, with poor response to current treatment approaches and no clear guidelines. Our aim is to evaluate the outcomes of an OCS cohort after cytoreduction with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). METHODS. A descriptive cohort study was performed. Patient...

Objectives There are limited treatment options and no consensus on the management of advanced rare ovarian malignancies (ROv). Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for peritoneal metastasis (PM) of non-gynecologic origin and, recently, in epithelial ovarian cancer. However, availa...

Objectives Compared to upfront cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), ovarian cancer patients treated with neoadjuvant chemotherapy (NACT) have higher recurrence rates. It is debated whether this is due to more aggressive disease biology or the quality of surgery. We hypothesized that high extra-abdominal r...

Early Postoperative Hematologic Toxicity after Hyperthermic Intraperitoneal Chemotherapy INTRODUCTION. Despite localized chemoperfusion during cytoreduction with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), absorption through the peritoneum results in poorly defined systemic effects that vary by agent. We compared early postoperative hem...

Introduction. Compared to upfront cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), ovarian cancer patients treated with neoadjuvant chemotherapy (NACT) have higher recurrence rates. It is debated whether this is due to more aggressive disease biology or the quality of surgery. We hypothesized that high extra-abdomina...

BACKGROUND. Interprofessional collaboration can improve patient outcomes in oncology. In advanced ovarian cancer, survival directly depends on complete surgical removal of the tumor and cooperation between surgical specialists might increase this rate. OBJECTIVE. To assess the outcomes of collaborative cytoreductive surgeries (C-CRS) performed join...

Objectives Endometrial cancer with peritoneal metastases may have similar biology to other cancers that respond to treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). We present our experience and provide an extensive literature review of endometrial cancer treated with CRS/HIPEC. Methods A review of a s...

BACKGROUND. Ovarian carcinosarcoma (OCS) is an uncommon and aggressive disease, accounting for only 1-4% of ovarian malignancies. Histopathology is unconventional as components arise from both epithelial and mesenchymal cellular lines. There is limited knowledge about the disease and treatment strategies are extrapolated from other more common gyne...

Background Women 65 years of age or older with epithelial ovarian cancer (EOC) are thought to have a worse prognosis than younger patients. However, no consensus exists concerning the best treatment for ovarian cancer in this age group. This report presents outcomes for patients treated with cytoreductive surgery (CRS) plus hyperthermic intraperito...

Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) after neoadjuvant chemotherapy (NACT) showed promise as initial treatment for stage IIIC (SIII) epithelial ovarian cancer (EOC); however, stage IV (SIV) outcomes are rarely reported. We assessed our experience and outcomes treating newly diagnosed SIV EOC w...

Molecular alterations that contribute to long-term (LT) and short-term (ST) survival in ovarian High-Grade Serous Carcinoma (HGSC) may be used as precision medicine biomarkers. DNA promoter methylation is an early event in tumorigenesis, which can be detected in blood and urine, making it a feasible companion biomarker to somatic mutations for earl...

No consensus has been reached concerning the best treatment for epithelial ovarian cancer (EOC) in patients ≥65.We present our outcomes of elderly patients treated with CRS/HIPEC.

Objective: Uterine sarcomas (USs) are characterized by poor response to systemic chemotherapy and high recurrence rates. This study evaluates whether the use of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) confers survival benefit in comparison with conventional treatment modalities in patients with recurrent US. M...

Key Clinical Message Peritoneal sarcomatosis from uterine sarcoma is a rare disease with no effective treatment and poor prognosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has successful results in peritoneal carcinomatosis from gastrointestinal/gynecological origins. We show that CRS/HIPEC is safe, feasible...

Objective: Uterine sarcoma (US) is a rare tumor representing 1% of female genital tract malignancies. Peritoneal sarcomatosis (PS) after US, diminishes median overall survival (OS) and progression-free survival (PFS) with cytoreductive surgery (CRS) alone, with or without systemic chemotherapy is <1 year and 6 months, respectively. A multi-institu...

Primary peritoneal carcinoma (PPC) is rare tumor, traditionally treated with surgical debulking and systemic chemotherapy (SC) with 30% five-year survival rate. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) may improve long-term survival. Thirty patients with PPC were identified. Twenty-three patients underwent CRS...

Clinically useful molecular tools to triage women for a biopsy upon referral to colposcopy are not available. We aimed to develop a molecular panel to detect cervical intraepithelial neoplasia (CIN) grade 2 or higher lesions (CIN2+) in women with abnormal cervical cytology and high-risk HPV (HPV+). We tested a biomarker panel in cervical epithelium...

We set out to develp novel workflows to identify panels of methylated human papilloma virus (HPV) and human genes that can discriminate between CIN2+ and normal/CIN1 patients in liquid prep samples and in Transrenal DNA (TrDNA) isolated from urine. Using Human DNA methylation arrays and massively parallel Next Generation Sequencing (NGS) for Discov...

Latino women in the United States have the highest cervical cancer incidence rate, yet the highest death rate from cervical cancer is among Black women. The disproportionate burden of cervical cancer in the United States is primarily due to lack of screening, among the medically underserved, regardless of race or ethnicity. Rural and inner city wom...

Human Papilloma Virus (HPV) testing is increasingly used for cervical cancer screening in conjunction with cervical cytology. Although privacy, cultural, and infrastructure issues challenge the effective implementation of HPV testing for cervical cancer screening worldwide, several countries have already implemented HPV testing in their screening p...

Objectives: The aim of this study was to screen for depression and anxiety and to assess well-being among women diagnosed with gynecologic malignancies, identify factors associated with elevated depressive or anxiety symptoms, and further characterize the needs of those with elevated anxiety or depressive symptoms. Methods/materials: Women prese...

The interactions between neoplastic cells and their tumor microenvironment (TME) have become increasingly evident. Cancer-associated fibroblasts (CAFs) and M2 macrophages (M2 Mθ) are important components of the TME that have been recognized to orchestrate tumor-promoting inflammation and thereby tumor growth and progression. Here, we aim to determi...

Objectives: The aim of this study was to determine if a gynecologic cancer patient's comfort level discussing end-of-life care issues with her caregivers is related to her death anxiety level. Materials/methods: Gynecologic oncology clinic patients were asked to rate their degree of agreeability with 4 statements regarding comfort level discussi...

Improvements in robotic surgical technology have refined the surgical devices and instrumentation, revolutionizing the approach to gynecologic surgery by overcoming the limitations of conventional laparoscopy. The advantages of robotic surgery over conventional laparoscopy have resulted in a more commonly adopted procedure by which gynecologic surg...

To determine the response of complex atypical hyperplasia (CAH) and well differentiated endometrioid adenocarcinoma of the uterus (WDC) to progestin therapy and whether pre-treatment estrogen and progesterone receptor status predicts outcome. We performed a retrospective review encompassing women treated with progestin therapy for CAH or WDC at two...

PURPOSE The purposes of this study are to evaluate the prognostic value of posttreatment PET/CT in predicting survival of patients with ovarian carcinoma and to determine the incremental value of combining posttreatment PET/CT with CA-125 in predicting patient survival. METHOD AND MATERIALS This was an IRB approved retrospective study. From July 2...

Highlights • This is the first case report of inflammatory myofibroblastic tumor in the literature to present with extrauterine disease. • A prompt work-up of symptoms may have precluded a tumor debulking procedure.

HPV testing is increasingly used for cervical cancer screening in conjunction with cervical cytology. Privacy, cultural, and infrastructure issues challenge the effective implementation of HPV testing in cervical cancer screening. The detection of circulating HPV DNA from urine can be useful for cervical cancer screening. We captured and sequenced...

Highlights • Dedifferentiated endometrioid adenocarcinoma is characterized by the coexistence of an undifferentiated carcinoma and a low-grade endometrioid adenocarcinoma. • Given its histological appearance, this tumor can be mistaken for other less aggressive tumors. • The possibility of undifferentiated carcinoma should be considered in endom...

To evaluate the influence of distance on access to high-volume surgical treatment for patients with uterine cancer in Maryland. The Maryland Health Services Cost Review Commission database was retrospectively searched to identify primary uterine cancer surgical cases from 1994 to 2010. Race, type of insurance, year of surgery, community setting, an...

It takes two: How shared experiences can influence postoperative recovery and adaptation - Volume 12 Issue 4 - Teresa P. Díaz-Montes

•85% of cervical cancer cases occur in developing countries where it is the first or second cause of cancer-related death.•CONEP is a Central America initiative focused on education and training for the prevention and treatment of gynecologic cancers.

To review perioperative care in gynecologic oncology with special emphasis on areas of controversy. Major gynecologic surgery still represents the cornerstone of management among women diagnosed with gynecologic malignancies. The implementation of clinical guidelines can significantly impact perioperative morbidity and mortality. Preoperative evalu...

Introduction. Ovarian cancer is the deadliest gynecologic cancer in the United States. There is limited data on presentation and outcomes among Hispanic women with ovarian cancer. Objective. To investigate how ovarian cancer presents among Hispanic women in the USA and to analyze differences in presentation, staging, and survival between Hispanic a...

End-of-life care (EOLC) decision-making plays a prominent role in the field of Gynecologic Oncology. Gynecologic oncologists are unique among surgical oncologists because they often become their patient's primary provider and are responsible for the patient's surgical and medical management. As a result, a close bond forms between the physician and...

Objectives: To assess the importance and desired timing of end-of-life care (EOLC) discussions among women with gynecologic cancer. Methods: A questionnaire related to EOLC issues was distributed to patients with gynecologic cancer. Answers were analyzed via SPSS using descriptive statistics. Contingency analysis was done to evaluate for differe...

Objectives: To evaluate the impact of the introduction of checklists at the daily progress note to improve patient care among gynecologic oncology patients. Methods: A progress note incorporating checklists that were pertinent for our patient population was developed with input obtained from all staff involved on patients care. The form was appr...

Highlights ► Vulvar basal cell carcinoma is a rare tumor. ► This report highlights the presentation of vulvar basal cell carcinoma in a very young, non-White patient. ► The importance of provider vigilance and timely biopsy of vulvar lesions is highlighted.

The aim of this study was to determine if comprehensive surgical staging is a better predictor of outcome than incomplete staging for women with stage I noninvasive or minimally invasive (≤3 mm) uterine serous carcinoma (USC). Retrospective chart review was used to identify patients undergoing hysterectomy at the Johns Hopkins Hospital from 1989 to...

Robotic surgery has been used increasingly for the management of benign or malignant gynecologic conditions. Vaginal hemorrhage after hysterectomy is fairly uncommon. Uterine artery pseudoaneurysm is a rare phenomenon causing late onset hemorrhage that could be potentially life-threatening. This case describes the management of vaginal bleeding due...

The goal of this study is to determine the feasibility of intravenous gemcitabine and an intraperitoneal platinum agent in the treatment of patients with ovarian cancer. We performed a retrospective chart review of patients with primary, persistent or recurrent ovarian cancer, who received intravenous gemcitabine and an intraperitoneal platinum age...

The syndrome consisting of primary hypothyroidism, precocious puberty, and massive ovarian cysts was termed Van Wyk and Grumbach syndrome in 1960. Little is known about the effect of the cysts on ovarian tumor markers. A 12-year-old Caucasian female presented with headaches and fatigue. Imaging to evaluate her headaches revealed a pituitary macroad...

The number of elderly women diagnosed with gynecologic cancer is increasing. This paper reviews the current trends in the management of elderly gynecologic cancer patients. Our goal is to identify critical issues that must be weighed when selecting treatment for elderly gynecologic oncology patients. As individuals continue to achieve longer lifesp...

The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries. Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gy...

Purpose. To characterize volume-based care of uterine cancer among women aged ≤50 years. Methods. The Maryland Health Service Cost Review Commission database was accessed for uterine cancer surgical cases from 1994 to 2005. Cross-tabulations and logistic regression models were used to evaluate for significant associations among volume-based care an...

To describe the technique and short-term post-operative outcomes associated with diaphragm full-thickness resection (FTR) and intraoperative trans-diaphragmatic decompression of the resultant pneumothorax (TDDP). All patients undergoing cytoreductive surgery for primary or recurrent ovarian cancer between 8/1/98 and 7/30/09 were retrospectively ide...

Objectives: The objective of this study was to determine the ability of patients with advanced ovarian cancer to tolerate intraperitoneal (IP) chemotherapy after having undergone optimal cytoreductive surgery (OCRS) requiring splenectomy. Study design: Forty-one (41) consecutive patients with stage III ovarian cancer who had undergone either primar...

The aim of this study was to determine if in vitro extreme drug resistance (EDR) to platinum and/or taxane chemotherapy was predictive of patient response to intraperitoneal (I.P.) chemotherapy in patients with stage III or recurrent epithelial ovarian cancer (EOC). Fifty-six patients were retrospectively identified who underwent optimal cytoreduct...

The objective of this study was to utilize computed tomographic peritoneography (CTP) to assess distribution prior to intraperitoneal chemotherapy for advanced müllerian cancer. Nineteen patients were submitted to CTP. A novel 6-point peritoneal distribution index was developed and applied to the patients prospectively. The median peritoneal distri...

To compare the survival impact of diagnosing recurrent disease by routine surveillance testing versus clinical symptomatology in patients with recurrent epithelial ovarian cancer (EOC) who have achieved a complete response following primary therapy. We identified all patients who underwent primary surgery for EOC at two institutions between 1/1997...

Positive volume-outcome relationships exist for cancers treated with technically complex surgery, including ovarian cancer. However, contemporary patterns of primary surgical care for ovarian cancer according to hospital and surgeon case volume remain poorly defined. The Maryland Health Service Cost Review Commission database was accessed for annua...

To evaluate the impact of surgeon and hospital case volume, and other related variables, on short-term outcomes after surgery for ovarian cancer. The Maryland Health Service Cost Review Commission database was accessed for ovarian cancer surgical cases including both oophorectomy and any staging/cytoreductive surgical procedure from 2001 to 2008. M...

To identify immunosuppressive elements present in ovarian cancer associated ascites. Ascites and plasma were obtained from ovarian, primary peritoneal or fallopian tube cancer patients. Surface markers were identified by fluorescence-activated cell sorting (FACS). Cytokine and chemokine concentrations were measured with LINCOplex microarrays. Antig...

To describe the operative technique and associated clinical outcomes of patients undergoing rectosigmoid colectomy as a component of secondary cytoreductive surgery for recurrent ovarian cancer. Consecutive patients undergoing rectosigmoid colectomy for recurrent epithelial ovarian cancer between 1/01 and 12/07 were retrospectively identified and c...

Uterine artery embolization (UAE) allows treatment of recalcitrant fibroids, but does not provide a surgical specimen. In the rare instance that a uterine mass represents a uterine leiomyosarcoma (LMS), UAE may delay diagnosis. We report a case of a 45-year-old woman who underwent resection of a substernal mass five years after UAE. Pathology demon...

To characterize primary surgical care for women with ovarian cancer aged </=50 years versus > 50 years. A statewide hospital discharge database was used to identify women undergoing primary surgery for ovarian cancer from 1990 to 2000. Logistic regression models were used to evaluate differences in demographic characteristics and short-term outcome...

To evaluate the feasibility and impact on cost to the U.S. healthcare system of implementing a clinical pathway for Pap test utilization in screening and surveillance of gynecologic cancers in a university-based gynecologic oncology practice. Baseline data were collected for Pap test utilization between 1/1/04 and 6/30/05 and prospectively compared...

To evaluate the safety, feasibility, and economic impact of a clinical pathway, including rapid diet advancement, for patients undergoing rectosigmoid colectomy as part of cytoreductive surgery for advanced ovarian and primary peritoneal cancers. Between 8/1/98 and 6/30/06, 64 consecutive patients met study inclusion criteria. Using case-control me...

We sought to determine the incidence of mesenteric lymph node metastases in patients undergoing rectosigmoid resection for epithelial ovarian carcinoma and to evaluate the potential contribution of sigmoid mesocolectomy toward achieving complete surgical cytoreduction. Pathology results for patients undergoing rectosigmoid colectomy for epithelial...

To characterize the primary surgical care and short-term outcomes for uterine cancer in women age > or = 80 years compared to younger women. A statewide hospital discharge database was used to identify women that underwent primary surgery for uterine cancer from 1994 to 2005. Logistic regression models were used to evaluate for significant differen...