Ep. 79 Gynecologic Cancer Surveillance: Best Practices & Updates with Dr. Ritu Salani

Does catching cancer earlier with surveillance always translate to better outcomes for gynecologic cancer patients? On this episode of BackTable Women’s Health, hosts Dr. Mona Guo and Dr. Marcia Ciccone interview Dr. Ritu Salani, Professor of OBGYN at UCLA and lead author of the updated SGO surveillance clinical practice statements. They discuss how post–curative-intent surveillance has evolved amid limited prospective evidence, review the latest guidelines, and highlight the real-world challenges of balancing early detection, patient safety, and cost. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:05 - Evolving Guidelines and Consensus 10:02 - Lead-Time Bias and Cost Considerations 12:05 - Maintenance Therapy and Surveillance Nuances 14:44 - Ovarian and Endometrial Cancer: Imaging vs Exam 20:24 - Key Takeaways from the TOTEM Trial 24:04 - Future Tools, Lifestyle Counseling, and Shared Care 27:21 - Cytology, HPV Testing, and Post-Radiation Surveillance 31:13 - Hormone Therapy Considerations 34:37 - ctDNA and MRD Testing 37:39 - Emerging Technologies and Limitations 43:22 - Rapid Fire Takeaways 45:33 - Closing Thoughts --- More about this episode The conversation explores practice variability, the lack of clear survival benefits from routine imaging and tumor markers, and the risks of cascade testing and lead-time bias. Dr. Salani reviews the TOTEM trial data for endometrial cancer, the importance of symptom review and pelvic exams (especially for lower genital tract cancers), and the reduced role of cytology, even in cervical cancer after radiation. They also discuss shared-care models, lifestyle counseling, hormone therapy considerations, and the promise and limitations of emerging technologies like ctDNA and MRD testing during maintenance therapy. --- Resources TOTEM Trial https://ascopubs.org/doi/abs/10.1200/jco.22.00471 2010 Ovarian Cancer CA-125 Trial https://pubmed.ncbi.nlm.nih.gov/20888993/ Society of Gynecologic Oncology Clinical Practice Statement on Surveillance https://pubmed.ncbi.nlm.nih.gov/41308226/ --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app