Battling gynecologic cancers

UC Irvine physicians fight back with advanced treatments and leading-edge research

Every six minutes, an American woman is diagnosed with ovarian, cervical, endometrial or other type of gynecologic cancer. Of the more than 88,000 American women who will be diagnosed with some form of gynecologic cancer this year, about one-third will die from their disease, according to the American Cancer Society.

UC Irvine Healthcare physicians specializing in gynecologic cancers have spent the past 30 years working to change these numbers through leading-edge treatments, research and development of clinical trials. These gynecology oncologists are at the forefront of medical research and disease management, providing patients with the most advanced treatment options in surgery, chemotherapy and radiation. Home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, one of only 41 in the country, UC Irvine Medical Center is discovering and testing new cancer treatments, many of which have become standards of care across the nation.

"Our mission is to provide a holistic approach to treating women with gynecologic cancers," says Dr. Robert Bristow, director of UC Irvine’s Ovarian Cancer Center and an internationally respected expert in ovarian cancer treatment, including robotic surgery.

"We combine our clinical and research expertise to develop an individual treatment plan for each patient," adds Bristow, who serves as director of gynecologic oncology services for the Chao Family Comprehensive Cancer Center and UC Irvine Medical Center. "Our goal is to maximize a woman’s chances for survival as well as her quality of life during and after treatment."

Cancer of the endometrium, the lining of the uterus, is the most common of the reproductive system cancers, and it is strongly associated with obesity. Often called the silent killer, ovarian cancer is the eighth most common of all cancers, but it is the fifth leading cause of cancer death. For all the gynecologic cancers, the earlier the tumor is detected and treated, the more effective the result. At the cancer center, an integrated team of gynecologic oncologists, medical oncologists, surgical oncologists, radiation specialists and oncology nurses all work together to provide compassionate, state-of-the-art care.

Treatment of gynecologic cancer usually involves a combination of surgery, chemotherapy and radiation. A partial or total hysterectomy (surgical removal of the uterus) may be required and can be performed using minimally invasive laparoscopic or robotic methods, or the conventional open surgical approach.

Experts in robotic surgery

UC Irvine’s gynecologic oncologists are experts in minimally invasive surgical techniques and perform a high volume of robotic surgeries. For uterine, cervical and early-stage ovarian cancer operations, the surgical robot enables doctors to perform more precise and less invasive procedures than ever before. Known for its dexterity in hard to reach places, the surgical robot is equipped with three mechanical arms. The arms are attached to robotic wrists that can move in any direction, far surpassing the ability of human wrists. Pincer-like fingers make it possible for surgeons to perform highly complex surgeries through tiny incisions. Furthermore, the robotic system’s camera produces high-definition, 3-D video images of the entire surgical site—a significant improvement over the limited field of vision images generated in traditional laparoscopic surgery.

The surgical robot also helps gynecologic oncologists perform fertility-sparing procedures for patients with early stage cervical and ovarian cancers. Gynecologic oncologist Dr. Krishnansu Tewari heads up the cancer center’s multidisciplinary program aimed at preserving a women’s fertility. "We offer several leading edge fertility-preserving surgeries as well as fertility-conserving medical therapies for women with gynecologic cancers," says Tewari. "I can’t tell you how rewarding it is to see a woman who has had cancer treatment go on to be cured of cancer and become pregnant."

Tewari is director of research in gynecologic oncology. His research is funded by the National Institutes of Health and he was recently appointed director of the Women’s Cancer Cure ConneXion (WCCC), a unique program that brings together the screening and treatment efforts of clinicians and researchers in breast and gynecologic cancers. "The WCCC comprises the best doctors and most brilliant medical scientists in Orange County with a common goal to reach and deliver curative treatment to women with these cancers," says Tewari.

Of all the gynecologic cancers, only cervical cancer has a screening test. The pap smear is credited with significantly reducing the death rate from cervical cancer. "We don’t yet have an ovarian cancer screening test for the general public, but there are screening and risk-reducing options for women with genetic susceptibility to breast and ovarian cancer," explains Dr. Leslie Randall, gynecologic oncologist. Since no screening methods exist for gynecologic cancers, except cervical, it is especially important to recognize warning signs.

Cancer Specialists Increase Survival

Randall also advocates that patients with gynecologic cancers seek medical care from a gynecologic cancer specialist. "Studies show that survival rates increase for patients with these cancers when they are treated by a gynecologic oncologist, a surgical specialist who is specifically trained to safely perform the often extensive operations and administer complex chemotherapy regimens required for these cancers," explains Randall.

An experienced gynecologic oncologist is more likely to perform cytoreductive surgery, which reduces the number of cancer cells. An extensive operation, it involves cutting out as much and as many of the tumors as possible. "Cytoreduction offers the best chances of long-term survival for women whose cancer has spread outside the reproductive organs to other areas in the abdomen," explains Bristow, an expert in this surgery and co-author of two books on ovarian cancer treatment for medical professionals and two for the general public.

"Women with gynecological cancers are facing life-or-death decisions," says Tewari. "Seeking a place where they have access to the most advanced treatment options and top specialists gives them the best chance of survival. Women with a gynecologic cancer who live in Orange County can find cutting-edge cancer care right here in their neighborhood, at UC Irvine."