For patients with gynecologic cancer, research shows that receiving treatment from a gynecologic oncologist right from the start improves patient outcomes. Does that mean every patient with gynecologic cancer needs to be treated full-time at a National Cancer Institute-designated cancer center, like the Fred Hutchinson Cancer Center? Not necessarily.
According to Fred Hutch gynecologic oncologist Barbara Goff, MD, an initial consultation is important. But patients can typically receive some treatments in their community.
“Once we evaluate the patient and establish their treatment strategy, we frequently partner with community oncologists to provide care closer to home,” she says. “This is especially helpful for patients who live outside the Seattle area.”
Gynecologic oncologists offer a holistic approach to care. Their varied responsibilities include:
“Patients benefit from having a surgeon who can manage all aspects of their cancer care and understands all the new treatments,” says Dr. Goff. “By performing the right surgery, selecting the right chemotherapy, using genetic testing to select targeted therapies, and connecting patients with clinical trials, we are slowly improving patient survival.”
Many treatment options exist for patients with gynecologic cancers. Surgery is often the main approach and surgical experience is key, says Dr. Goff.
“For ovarian cancer, the cure rate doubles if the surgeon removes all visible disease versus leaving even a centimeter of disease behind,” she says. “Gynecologic oncologists specialize in complex surgical procedures and are skilled in achieving more complete tumor removal.”
Gynecologic oncologists also offer a broad range of treatment options. Through the Fred Hutch Gynecologic Oncology Program, patients have access to treatments not widely available across the Pacific Northwest, including:
Robotic surgery is a minimally invasive option for certain cancers, such as endometrial cancer. Gynecologic oncologists are able to perform very complex surgeries robotically. And because the incisions are small, patients recover faster, experience less pain and usually go home the next day.
“Faster recovery also allows us to initiate treatment sooner than if we were performing surgery through a large abdominal incision,” she says.
Fred Hutch surgeons collaborate with experts across UW Medicine to deliver the highest quality care. Dr. Goff frequently draws upon this resource to provide patients the surgical interventions they need during one operation.
Additional surgical teams may include:
• Hepatobiliary surgeons if a tumor impacts the liver
• Plastic surgeons to achieve the best cosmetic outcomes
• Urological surgeons to create special urinary conduits
According to a recent study, clinical trials through the National Clinical Trials Network generated 14.2 million additional life years to people with cancer between 1980 and 2020. Of the trials included in the study, nearly 20% involved gynecologic cancers.
Fred Hutch is a national leader in cancer research that brings innovative therapies from the bench to the bedside. Community oncologists play an essential role in identifying and referring patients who could benefit from a clinical trial.
Exciting areas of research include the use of immunotherapy and targeted therapy to treat gynecologic cancers, says Dr. Goff.
“For example, ovarian cancer is very good at evading the immune system,” she says. “Research by Fred Hutch physician and UW Medicine Cancer Vaccine Institute principal investigator John Liao, MD, PhD is looking at ways to make these cancers more visible to the immune system.”
Though the availability of clinical trials changes rapidly, examples of leading-edge trials physicians are currently working on at Fred Hutch include:
HIPEC is a treatment doctors apply after cytoreductive surgery for cancers that develop in or have spread to the peritoneum. It's a unique approach that can help control some advanced gynecologic cancers, including ovarian, fallopian tube and peritoneal cancers.
In HIPEC, the surgeon delivers chemotherapy heated to approximately 106 degrees Fahrenheit into the peritoneal cavity. The solution circulates for about 90 minutes, destroying remaining cancer cells.
Cytoreduction with HIPEC is complex and requires advanced skills. At Fred Hutch, a dedicated and experienced multidisciplinary team of specialists and support staff plan and perform the procedure and manage follow-up care.
IORT is an important treatment option for patients with cervical and endometrial cancers. “We use IORT when we can’t surgically remove a gynecologic tumor or we can only perform partial resection,” says Dr. Goff.
IORT is a highly specialized technique that applies precise bursts of radiation to the tumor during surgery. It requires a multidisciplinary team in the operating room, including several physicists and radiation oncologists who work with the surgeon to plan the radiation.
Intraperitoneal chemotherapy is a post-surgical treatment for some patients when surgery removes all visible ovarian, fallopian tube or peritoneal cancer. Patients receive a series of chemotherapy treatments through an access port directly into the abdominal cavity.
“We don’t use intraperitoneal chemotherapy as often as we used to,” says Dr. Goff. “Many cancer centers no longer offer this treatment. We have retained our program for patients who can benefit from it.”
The Breast and Ovarian Cancer Prevention (BCOP) Clinic at Fred Hutch helps patients who carry a gene linked to cancer, such as BRCA1 or BRCA2, or have a significant family history. Physicians and genetic counselors work with patients, providing education about their cancer risk and listening to their values and preferences.
Each patient receives a personalized screening and prevention plan. Patients can take this screening algorithm back to their local physician to follow.
If a patient opts for surgery to reduce their gynecologic cancer risk, Dr. Goff and her colleagues offer their expertise to ensure the best outcomes. “We make sure the tissue is processed correctly to identify occult cancers, which are not uncommon,” she says.
The Fred Hutch service area extends beyond Washington state into Wyoming, Alaska, Montana, Idaho, Oregon, Hawaii. Fred Hutch physicians offer leading-edge treatments and clinical trials. The gynecology team works with referring physicians so patients can receive as much care as possible near home.