Patient-Centered Approach Offers Latest Treatments For Gynecologic Cancers

This article is a part of University of Maryland Rounds, which features clinical and research updates from the University of Maryland School of Medicine and University of Maryland Medical Center. See more Rounds articles.

A devastating diagnosis with deadly ovarian cancer recently brought a woman in her 40s to University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC). With young children at home, the southern Maryland resident wasn't convinced the standard chemotherapy she'd received at her local hospital was enough to ensure that her cancer would go into remission - an ever-present possibility for advanced ovarian malignancies.

But after leading-edge treatment at UMGCCC with intraperitoneal chemotherapy, which injects cancer-destroying drugs directly into the abdominal cavity, the patient has achieved complete remission. "It's a very aggressive treatment that's more effective than standard chemotherapy for ovarian cancer, and it isn't available in her community," says Gautam Rao, MD, an assistant professor of obstetrics, gynecology and reproductive sciences and surgery at University of Maryland School of Medicine.

Such innovative approaches to gynecologic cancers, as well as a multidisciplinary tumor board and expanding clinical trials program, have fueled the huge recent growth of the Division of Gynecologic Oncology, which encompasses UMGCCC and University of Maryland Medical Center (UMMC). About 125 patients with cancers of the reproductive system were treated here in 2013, a 135% jump in cases since 2006.

UTERINE CANCER INCREASING

A multidisciplinary gynecologic oncology team that includes oncologists, radiologists, pathologists, nurse practitioners, genetic counselors, social workers, dieticians and others evaluates and treats the full spectrum of gynecologic malignancies. Uterine cancer is most often seen at UMGCCC, followed by ovarian and cervical cancers, Dr. Rao explains.

But the team also tackles vaginal and vulvar cancers, along with suspected or pre-invasive cases of all of these conditions. Additionally, screening and surveillance programs are offered for women at risk of ovarian, uterine or cervical cancer and women with abnormal Pap tests and ovarian cysts or masses.

Uterine cancer — diagnosed in nearly 53,000 women in the United States each year, according to the American Cancer Society — is becoming more prevalent nationally as well as in the Baltimore region largely because of the obesity epidemic, explains Dana Roque, M.D., assistant professor of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine.

About two-thirds of Americans are either overweight or obese, according to national statistics, and the risk of uterine cancer is higher in those with more fat cells, which serve to store cancer-fueling estrogen.

“We treat many patients with advanced ovarian cancer, since we lack adequate screening tests for early detection,” says Dr. Roque, who came to UMMC last summer. “While survival rates have improved since the 1970s due to novel chemotherapeutic strategies, it’s unfortunately often a disease that continues to present at stage III or IV.”

Dr. Rao notes that Baltimore’s large underserved patient population contributes to a higher-than-normal prevalence of cervical cancer because many women in this group don’t receive regular screenings.

TUMOR BOARD INDIVIDUALIZES TREATMENT

A multidisciplinary tumor board comprised of a variety of gynecologic oncology specialists review patients’ cases each week, Dr. Rao says. Notably, this comprehensive approach doesn’t include just the medical facts pertaining to each patient.

“Each case is discussed to formulate an individualized treatment plan, and we develop an understanding of other aspects such as a patient’s barriers to accessing care,” Dr. Roque says. “We also review concurrent medical problems that might contribute to our particular treatment approach.”

That same comprehensive approach extends to Drs. Rao and Roque’s participation in both surgery and chemotherapy for their patients who undergo both types of treatments. In many hospitals, different specialists hand off these tasks, but UMMC offers greater continuity, which patients find comforting. “It’s a strength that ultimately adds to their care,” Dr. Roque says.

UMMC offers a full spectrum of treatments for gynecologic cancers, ranging from radical and minimally invasive surgeries; reconstructive and fertility-sparing surgery, when appropriate; chemotherapy; various types of internal and external radiation therapies; and evaluation and treatment for patients at high genetic risk of gynecologic malignancies.

Leading-edge treatments available here that often can’t be found in other centers include intraperitoneal chemotherapy for ovarian cancer along with targeted drugs for ovarian malignancies. These newer drugs attack specific molecules expressed by ovarian tumors, avoiding bothersome side effects from conventional chemotherapy, which kills healthy cells along with diseased cells.

But that doesn't mean patients from outside the immediate area can’t benefit from UMMC’s expertise.

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