Principles of Cancer Treatment Series: Surgery & Gynecologic Oncology
In the previous issue, I discussed the principles of radiation oncology. This month, we continue our series on the principles of cancer treatment as Dr. Terri B. Pustilnik explains the principles of one aspect of surgical oncology—gynecological oncology. Cancer surgery is often complex and requires sophisticated techniques. One major development over the last decade has been the further refinement in minimally invasive surgery with the use of robotic technology. This has enabled the surgeon to achieve the desired clinical result with less morbidity for the patient.
-Vivek S. Kavadi, M.D.
By Dr. Terri B. Pustilnik
Cancer treatments encompass four broad categories: surgery, chemotherapy, radiation therapy, and anti-hormonal therapy. For patients with gynecologic cancers, one or a combination of these options may be used. Surgery often plays an important role both in initial treatment and in the recurrent setting. The specific modality or combination of treatments used depends not only on where the cancer originated, but also if it has spread beyond the original site, known as metastatic disease.
A gynecologic oncologist is a subspecialist who treats patients with gynecological cancers, which include ovarian, cervical, uterine, and vulvar cancers. Gynecologic oncologists have a unique perspective because they have experience in treating women from birth throughout their lives. Not only have they completed a four year residency in OB/GYN, but they also trained an additional four years in gynecologic oncology, which consists of performing radical cancer surgeries, administering chemotherapy, and aiding in the planning process of radiation therapy. Gynecologic oncology is the only remaining specialty which truly treats the whole person.
During the initial visit with the gynecologic oncologist, an exam will be performed, and the patient’s medical history will be reviewed. After any appropriate radiographic studies have been ordered, the final treatment plan will be made.
Most early stage cancers can be removed in a minimally invasive way, and patients go home either the same day or within 24 hours after the procedure. More advanced stage gynecologic cancers may still require an open surgery. The goal of surgery is to remove all the cancer that can be seen and felt. If metastatic disease is present, chemotherapy will likely be needed post-operatively. Sometimes radiation therapy may also be used.
Many advances in gynecologic surgery have occurred over the past 10 to 20 years. These important improvements have made a big difference in women of all ages afflicted with gynecologic cancers. As our field advanced, we began to place a high priority on not only increasing survival and cure rates, but also on improving patients’ quality of life, preventing side effects and preserving fertility in women of child-bearing age. Specific advances include:
Minimally invasive radical surgery (or key hole surgery), due to the improvements in surgical tools and computer-aided technology such as robotic surgery.
Ovarian preservation at the time of surgery, in younger women when appropriate
Egg harvesting prior to surgery.
Preserving cosmetics when possible by performing less disfiguring procedures
Preventing cancers by performing risk reduction surgery for patients with known genetic defects such as the BRCA 1 or 2 genes.
Gynecologic cancers are most curable when detected early. We encourage all women to have regular gynecologic care and report to your physician any unusual symptoms such as a change in menstrual cycle, postmenopausal bleeding, or abdominal bloating. We also would like to eradicate cervical cancer and encourage the use of the HPV vaccine.
Dr. Terri B. Pustilnik is a gynecologic oncologist at Texas Oncology—Deke Slayton Cancer Center, 501 Medical Center Blvd., Webster, Texas; Texas Oncology—Houston Medical Center, 7515 South Main St., Suite 740, Houston, Texas; and Texas Oncology–Sugar Land, 1350 First Colony Blvd., Sugar Land, Texas.