Gynecologic Oncology: Services
Ovarian cancer
Ovarian cancer most commonly manifests itself as an abdominal or pelvic mass. The
mass is usually surgically removed through an abdominal incision (laparotomy). The
surgery includes removal of the ovarian mass, uterus, fallopian tubes, omentum and
any visible area of cancer spread. This surgery sometimes requires resection of
a portion of intestine or lymph nodes. In some cases after surgery, the abdominal
cavity will fill with fluid (called ascites) caused by the cancer. Patients are
treated with chemotherapy after surgery.
Questions and Answers
Is ovarian cancer hereditary?
Approximately 5-10 percent of ovarian cancers are considered hereditary. Hereditary
cancer is more likely if there is at least one primary relative (mother, sister
or daughter) under 50 years old who is diagnosed with ovarian cancer. Ovarian cancer
is more common in women who carry the BRCA gene mutation for breast cancer.
Is there a screening test for ovarian cancer?
Since ovarian cancer is rare (1 in 80 women), screening programs have not been successful
in detecting the disease. The best method for detecting ovarian cancer is a pelvic
ultrasound for evaluation of the ovaries.
Can ovarian cancer be cured?
Overall, 25-30 percent of ovarian cancer is cured with surgery and chemotherapy.
More than half of women diagnosed with ovarian cancer in 2007 will survive longer
than five years.
Uterine cancer
Uterine cancers are usually diagnosed by endometrial biopsy or uterine D&C (dilation
and curettage). These cancers are treated by surgical removal of the uterus, tubes
and ovaries, along with pelvic and para-aortic lymph nodes. Most of the time, this
surgery is performed via laparotomy under anesthesia in an operating room. Occasionally,
hysterectomy can be performed vaginally or by laparoscopy. Sometimes patients require
treatment with radiation therapy after recovery from surgery.
Questions and Answers
Is vaginal bleeding after menopause normal?
No. Most women stop having monthly periods after about the age of 50. Once a woman
stops menstruating for six months, she is considered menopausal. Any vaginal bleeding
that occurs after this time requires evaluation by a gynecologist. This evaluation
usually consists of a pelvic exam, pelvic sonogram and an endometrial biopsy or
uterine D&C.
Who is at risk of developing endometrial cancer?
Endometrial cancer usually occurs in postmenopausal women who are overweight and
more often diabetic. Use of hormones, such as estrogen, or treatment with Tamoxifen
for breast cancer prevention also increases the risk for developing endometrial
or uterine corpus cancer.
Cervical cancer
Cervical cancer can be diagnosed by an abnormal Pap smear or pelvic exam. On exam,
the cervix is enlarged and bleeds easily on contact. When the cervical cancer is
small and confined to the cervix, it can be treated surgically by radical hysterectomy
with pelvic lymph node dissection via laparotomy. In more advanced cases, cervical
cancer is treated with a combination of radiation therapy and chemotherapy.
Questions and Answers
Is it true that cervical cancer is caused by a virus?
Yes. Most cervical cancers occur as the result of long-term exposure to the human
papilloma virus, also known as HPV. Men and women are exposed to this virus through
intimate sexual contact. Most individuals develop immunity to the virus, but about
10 percent of the population fails to develop immunity, allowing it to remain in
the genital tract. As a result, precancerous and cancerous tissue changes can occur
in the cervix and other genital tissues. These changes can be detected by Pap smears,
pelvic exams and viral testing.
Can the virus be prevented?
In most cases, yes. A vaccine against the most common types of HPV has been developed.
This vaccine prevents the development of many precancerous and cancerous cervical
changes. The vaccine works best when a woman is vaccinated prior to sexual contact.
The vaccine has been targeted for use in girls and women ages 11 to 25 years.
Can invasive cervical cancer be cured?
Yes. Most cervical cancer can be cured with surgery or radiation therapy, if detected
early.
Vulvar cancer
The vulva is the genital tissue around the vaginal opening. This area can be affected
by skin cancer of the same type found in other parts of the body's squamous cell
or melanoma. Cancers may be associated with itching or bleeding, but are often asymptomatic.
They are usually detected by routine examination and confirmed through a tissue
sample or biopsy. Treatment of vulvar cancer generally involves surgery to remove
the affected area; however, laser treatment is sometimes an option. Advanced vulvar
cancers require treatment with radiation or chemotherapy in rare cases.
Questions and Answers
What is the most common presentation for vulvar cancer?
Most women with vulvar cancer experience genital itching or note a lump or growth
that prompts them to see a physician.
Do genital warts cause cancer?
No. Warts usually occur in young women as a result of intimate sexual contact. They
can be prevented by the HPV vaccine. Growths on the vulva of older women are often
mistaken for warts. A biopsy should be considered in all women over the age 30 who
have growths.
Cancer of the fallopian tube
Cancer of the fallopian tube is extremely rare, accounting for only 0.1 percent
of cancers of the female reproductive tract. The fallopian tube is located in the
female pelvis between the ovary and uterus. Often, cancers of the ovary or uterus
spread to the fallopian tube. Primary cancers of the tube are adenocarcinomas and
usually detected as a pelvic mass similar to ovarian cancer. Only by careful evaluation
of the tube can the diagnosis be established.
Tubal cancers are treated similarly to ovarian cancer. Surgery consists of the removal
of the uterus, tubes, ovaries and omentum. Biopsies of the lining of the abdominal
cavity (called the peritoneum) are taken and lymph nodes are sampled. After surgery,
most patients are treated with intravenous chemotherapy. When the cancer is confined
to the fallopian tube, the cure rate is over 70 percent.
Questions and Answers
Are there any unusual symptoms associated with fallopian tube cancer?
The classic signs and symptoms of a fallopian tube cancer include clear, watery
discharge, irregular vaginal bleeding and pelvic mass.
What are the best tests used to detect fallopian tube cancer?
A pelvic sonogram confirms the presence of a pelvic mass and an elevated CA-125
blood test indicates the possibility of cancer. However, fallopian tube cancer cannot
be distinguished from ovarian cancer unless surgery is performed and the tubal tissue
analyzed in a laboratory.
Vaginal cancer
Vaginal cancers are rare and usually occur in women who have had a hysterectomy.
These are cancers of the lower birth canal located between the cervix and vulva.
Cancers in this area are sometimes detected by Pap smear, but can be detected by
routine pelvic examination. A tissue sample is required to confirm the diagnosis.
Most vaginal cancers are treated with radiation.
Questions and Answers
What are the signs and symptoms of vaginal cancer?
Vaginal cancer usually presents with vaginal bleeding, especially after intercourse.
The cancer can be detected by a Pap smear before it becomes advanced, but is most
often noted as a mass in the vagina at the time of a pelvic exam.
Can vaginal cancer be cured?
Yes. Most cases of vaginal cancer are cured with radiation. Treatment requires the
use of both external beam radiation and intravaginal radiation called brachytherapy.
Cancer of the placenta (trophoblastic neoplasia)
Trophoblastic cancer is a rare type of cancer in which cancer cells grow in the
tissues that are formed following conception. Gestational trophoblastic tumors start
inside the uterus. This type of cancer occurs in women during the years when they
are able to have children. There are two types of gestational trophoblastic tumors:
hydatidiform mole and choriocarcinoma.
With a hydatidiform mole (also called a molar pregnancy), the sperm and egg cells
have joined without the development of a baby in the uterus. Instead, the tissue
that is formed resembles grape-like cysts. Hydatidiform mole does not spread outside
of the uterus to other parts of the body.
If a patient has a choriocarcinoma, the tumor may have started from a hydatidiform
mole or from tissue that remains in the uterus following an abortion or delivery
of a baby. Choriocarcinoma can spread from the uterus to other parts of the body.
A gestational trophoblastic tumor is not always easy to find. In its early stages,
it may look like a normal pregnancy. A woman should see her doctor if she has unusual
vaginal bleeding or if she is pregnant and the baby hasn 't moved at the expected
time.
Questions and Answers
How is a trophoblastic cancer diagnosed?
A trophoblastic cancer is suspected when a woman has a positive pregnancy test without
evidence of a pregnancy within her uterus. In some cases, a woman will have a lung
or brain mass and positive pregnancy test, yet no evidence of pregnancy within the
uterus.
Can a woman get pregnant after being treated for a trophoblastic cancer?
Yes. In most cases, the cancer can be treated with chemotherapy alone, allowing
the uterus, tubes and ovaries to be left in place. It is recommended that women
wait at least a year after completing chemotherapy before trying to get pregnant.
What to Expect After Treatment
Gynecologic Cancer Surgery
Gynecologic patients have surgery performed through the abdomen, vagina or both.
Abdominal surgery is done under general anesthesia. Abdominal surgery can be performed
through a vertical incision that extends from the pubic bone upward toward the breast
bone or though a horizontal incision located above the pubic bone. If a telescope
or laparascope is used, the incision can be limited to multiple small incisions
in the abdominal wall.
Vaginal surgery is performed through the vagina under general or spinal surgery.
This approach allows the vulva, vagina and cervix to be carefully examined. Patients
are placed on their back with their feet in stirrups during surgery. Common vaginal
procedures include uterine D&C, hysteroscopy, vaginal hysterectomy and some
pelvic support procedures.
In general, it takes four to six weeks to recover from major abdominal surgery to
the point that normal activities can be resumed. Recovery time from vaginal surgery
is typically shorter than that of abdominal surgery.
Radiation Therapy
Radiation therapy consists of a high energy invisible field of electromagnetic waves
that are created by a machine called a linear accelerator and directed at a certain
part of the body in a treatment field called a port. Treatments are usually given
in an outpatient setting five days a week for approximately six weeks.
During this time, patients may experience fatigue and an increase in stool and urinary
frequency. Occasionally, skin irritation and redness may result from radiation.
Intracavitary or brachytherapy involves insertion of a device into the vagina and
uterus and then placement of radiation sources into these devices. Patients are
given general anesthesia in an operating room setting for insertion of the radiation
applicator. The radiation sources are subsequently placed into the applicator later
when the patient is returned to her private room. The radiation sources and applicator
are removed in the patient 's room within 24 to 48 hours. Normally, two intracavitary
radiation treatments are planned for cervical or vaginal cancers. Once an area of
the body has been treated with radiation therapy, this area cannot be treated again
without the risk of serious tissue damage.
After radiation is complete, the effects of treatment on tissues may continue for
as long a six months. Long-term side effects of radiation may include vaginal narrowing,
chronic diarrhea or constipation and an increase in urinary frequency. Some patients
have no long-term side effects and some only a few.
More on Radiation Oncology »
Chemotherapy
Chemotherapy involves the administration of chemical agents that poison cancer cells
and, to a lesser degree, normal cells. There are many different chemotherapy agents.
These can be administered intravenously, intramuscularly, intraperitoneally or orally.
Most IV and intraperitoneal regimens are given at three- to four-week intervals.
Most oral regimens consist of daily medication for two to four weeks each month.
Chemotherapy agents may cause nausea, vomiting, hair loss, skin reaction or low
blood counts. These side effects can often be controlled with additional medication.
The side effects stop when treatment has ended. Some of the drugs used for chemotherapy
in gynecologic oncology include Taxol, Carboplatin, Cisplatin, Doxal, Topotecan,
cytoxan and methotrexate.
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& Medical Oncology »