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10 Questions About Gynecologic Cancer

Q and A with Barbara Buttin, MD

A gynecologic cancer diagnosis can include ovarian, uterine, cervical or vaginal cancers and risk factors and recommended treatments differ accordingly. Gynecologic oncologist Barbara Buttin, MD, answered the most common questions from women about what a diagnosis means and which treatment is right for you.

1. Can the type of surgeon I select make a difference for my advanced ovarian cancer surgery?

Yes. For women undergoing surgery, studies have shown that gynecologic oncologists can more accurately diagnose and determine how much cancer is in the body, which is critical for receiving the most appropriate and advanced treatments. Gynecologic oncologists are also more likely to optimally debulk during surgery, meaning they will remove as much of the tumor as possible to increase the effectiveness of chemotherapy. Both accurate diagnosis and optimal debulking have been correlated with improved survival in women with ovarian cancer.

2. Is aggressive treatment worth it when I was told my advanced ovarian cancer is not curable?

Yes. It is worth going through aggressive treatment. Ovarian cancer is extremely sensitive to chemotherapy and more than half of women with advanced stage disease see remission. The treatment is generally not very toxic and quickly addresses many symptoms associated with the cancer. Surgery in addition to chemotherapy only increases the success rates of the treatment. Women with advanced ovarian cancer can live many years with good quality of life, long-term remission and even a complete cure.

3. Is primary peritoneal cancer a gynecologic cancer?

Yes, primary peritoneal cancer appears in the lining of the abdominal organs and is essentially identical to ovarian cancer, with the same success rate and treatment recommendations by gynecologic oncologists.

4. My doctor recommended a hysterectomy for my endometrial cancer, do I need more extensive surgery?

A: This is a common misperception. While it is true that most endometrial cancers in the uterine lining are not very aggressive, a small proportion of them can be life-threatening if not treated correctly. A gynecologic oncologist has the experience to treat these cancers and can decide whether a patient needs a simple hysterectomy or more extensive surgery or treatment. Initial treatment of endometrial cancer is crucial. If given a chance to recur, this disease is usually no longer curable.

5. I was hoping to start a family when I was diagnosed with endometrial cancer and told to have a hysterectomy. Can I receive alternative treatment and still have children?

A: Yes. If you have a small tumor that is not an aggressive subtype, it is possible to treat it with hormone therapy. If the cancer regresses after several months, it is possible to stop treatment and attempt pregnancy. However, endometrial cancer usually comes back if treated conservatively and ultimately will require removal of the uterus. A gynecologic oncologist can help guide you through the risks and benefits of fertility-sparing treatments and help develop a treatment plan that is right for you.

6. I was diagnosed with cervical cancer even though I have always had normal Pap smears. Is that possible or is there some mistake?

Unfortunately, it can happen, especially with cancers high up in the cervical canal that can sometimes evade detection by Pap smear. An annual pelvic exam is still extremely important for this reason. Luckily, most early cervical cancers have a high cure rate when treated appropriately.

7. My mom had ovarian cancer in her 50s. Am I at risk?

Having a family member, especially a first-degree relative, with ovarian cancer, does increase your risk. About 10 percent of all ovarian cancer cases are related to an inherited gene mutation that increases your risk for ovarian as well as breast cancer. Both you and your mom can get tested for this. Knowing that you have an inherited predisposition can help you take active measures to prevent them including prophylactic surgery and increased surveillance options.

8. Can I find out if an ovarian mass is cancerous before surgery?

Unfortunately, there is no accurate way to predict whether an ovarian mass is benign or malignant short of having it removed. Blood tests can help measure the risk and are used by gynecologists to determine if a patient with an ovarian mass or cyst should be referred to a gynecologic oncologist for surgery. The best way to manage these masses is surgical removal of the affected ovary, with a pathologist present. If ovarian cancer is diagnosed during surgery, a gynecologic oncologist can determine if the cancer has spread beyond the ovary. When in doubt it is best to have a gynecologic oncologist involved in the decision-making before surgery.

9. Is chemotherapy as part of a clinical trial for ovarian cancer a good option?

Yes. Participation in clinical trials allows women access to the latest treatments while still getting the current standard-of-care therapy as well. No patient under these circumstances is getting an ineffective placebo. If a treatment used in trial becomes the new standard of care, you are among the first to benefit. On the other hand, if you receive the standard treatment instead of the new agent as part of the trial, you have not lost anything by participating. Patients in clinical trials usually get extra-careful disease surveillance and frequent follow-up visits. Participation remains voluntary even after you begin a treatment.

10. How do I know clinical trials are safe and fair?

Recent high-profile concerns in gene therapy trials have focused public attention on the safety of clinical trials. Cancer clinical trials are tightly regulated and closely monitored for safety and must follow a detailed plan, approved by the Institutional Review Board before put in practice. Many trials assign patients to a treatment arm randomly or by chance to eliminate any possible bias and obtain valid results.