Optimal Female Cancer Patient Treatment
Gynecologic oncology is a medical subspecialty that deals with the treatment of malignancies effecting the female reproductive system, including ovarian cancer, uterine or endometrial cancer, cervical cancer, vulvar cancer and vaginal cancer. Certain other cancers, such as primary peritoneal cancer, are also treated by gynecologic oncologists, since these cancers originated embryologically from the same cells as the ovary and are treated identically to ovarian cancer. Rare cancers such as Gestational Trophoblastic Disease are also expertly managed by our GOA gynecologic oncologists.
Why a Female Cancer Specialist?
Gynecologic cancer patients require a gynecologic oncologist to do their specialized cancer surgeries. Doing these surgeries correctly the first time is essential to maximizing the gynecologic oncology patient’s chances of being cured. The proximity of the uterus, ovaries, vagina and vulva to the surrounding bladder, rectum, ureters, major pelvic blood vessels and lymph nodes necessitates that a gynecologic oncologist does these patients surgeries. Only a gynecologic oncologist is able to remove en bloc (in one piece) portions of the bladder, bowel, vagina or surrounding tissues in order to consistently, safely and successfully remove these cancers, and thus maximize cure rates.
GOA Gynecologic oncologists also provide chemotherapy, newer medications and experimental treatments for their patients. By specializing only in the treatment of gynecologic oncology patients, the gynecologic oncologists are able to keep up with the rapid new treatment changes that are occurring and quickly introduce these new treatments into their GOA patient care. That, in turn, is the key to maximizing and improving cure rates. The Society of Gynecologic Oncology (SGO), a leading medical specialty organization encompassing physicians who have significant experience in the diagnosis and treatment of gynecologic cancers, estimates there are 107,470 new cases of gynecologic malignancy diagnosed annually in the United States. These patients require expert and specialized care and the SGO unequivocally recommends that they be treated by a gynecologic oncologist. Cure rates are higher when gynecologic oncologists are involved in these patients’ care. The American Society of Clinical Oncology (ASCO) is a worldwide organization of medical oncologists, gynecologic oncologists, radiation therapists, and other cancer specialists. ASCO also stated “All patients with suspected stage III and IV invasive epithelial ovarian cancer should be evaluated prior to initiation of therapy”. That is the first step towards maximizing cure rates.
 Siegel, R. L., Miller, K. D. and Jemal, A. Cancer statistics, 2017. CA: A Cancer Journal for Clinicians, 67: 7–30.
 Wright AA, Bohlke K, Armstrong DK, Bookman MA, Cliby WA, Coleman RL, et al. Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline.
Gynecol Oncol 2016;143:3-15.
Each year in the US, approximately 15,000 new cases of cervical cancer are reported with 4,000-5,000 associated deaths. Squamous carcinomas comprise the majority of cases (85%) followed by adenocarcinomas (10-15%), which include the less common adenos-quamous carcinoma, and the remainder of cases comprised of the rarer tumors which includes small cell, sarcomas, lymphomas, and melanomas.
1 in 70 women will develop ovarian cancer during their lifetime. There are approximately 25,000 new cases of ovarian cancer and 14,000 deaths annually. Epithelial ovarian cancer comprises 90% of all ovarian cancers. This translates into 22,500 cases of epithelial ovarian cancer annually. The median age of onset is 61 years.
Uterine cancer is the most common malignancy of the female genital tract, accounting for approximately 30,000 new cases annually and 6,000 deaths. Endometrial cancer is the fourth most common malignancy in women overall, behind breast, lung and colon cancer. The median age at onset is 63 years with up to 25% of cases occurring in pre-menopausal women and 5% in patients younger than 40 years.
Vulvar cancers account for 3-5% of all female genital cancers, and 1% of malignancies in women overall. 2000-3000 new cases are reported annually. The average age at diagnosis is approximately 65 years, but there is a trend toward younger ages at diagnosis.
Primary vaginal cancer represents just 1-2% of malignancies of the female genital tract, with average age of diagnosis at 60 years. The majority of vaginal neoplasms are metastatic lesions from other primary sources.
Gestational Trophoblastic Diseases
Gestational Trophoblastic Disease (GTD) holds a special place in the history of gynecologic oncology. GTD was the first solid cancer cured by chemotherapy. A young doctor John Lewis was a gynecologist working at the NIH in the late 1950s. A new drug, methotrexate (MTX) had recently been developed. NIH doctors first tried treating patients with brain cancers with MTX. It did not work. It was not successful. However, some of these patients did have elevated pregnancy hormone (HCG) levels. This was presumably associated with the brain tumors. The NIH doctors noted that in some brain cancer patients, the HCG levels declined with MTX treatment. They did not know why.