Expertise and Advanced Treatment Options
Help Women with Gynecologic Cancers
A cancer diagnosis affects a woman’s body, but it can also affect her lifestyle — and that of her family. Women must make critical decisions regarding treatment that can put routine activities on hold for weeks, or months. It can be an uncertain and even frightening time.
Physicians at the Froedtert & the Medical College of Wisconsin Gynecologic Oncology Program specifically tailor treatments to help put women’s minds at ease. Because patients are considered part of the healthcare team, each woman is fully informed about her options, so she can make appropriate decisions regarding her own care. There is also support during and after treatment to help patients cope with the experience.
Each year, more than 80,000 women in the United States are diagnosed with cancer involving the ovaries, uterus, cervix, vulva, vagina, or fallopian tubes. Gynecologic cancers can strike at any age, but early and appropriate treatment can help women beat the odds. Through a compassionate, multidisciplinary approach, the Gynecologic Oncology team at Froedtert & the Medical College of Wisconsin gives patients every possible advantage.
A team of experts follows patients from screening to diagnosis, treatment and after-care. Three fellowship-trained gynecologic oncologists — Janet Osborne, MD, David Boruta, MD, and Denise Uyar, MD — work directly with specialists in radiation oncology, radiology, pathology and nursing to develop personalized treatment plans, all in a single setting. The team meets weekly to review each case and recommend the best course of treatment. In addition, each patient has access to a dedicated nurse practitioner, a psycho-oncology clinical nurse specialist, cancer dietitian, social worker and others throughout the experience.
For Helen Kindig, choosing a treatment plan for her endometrial cancer — a cancer that affects the lining of the uterus — posed a true a dilemma. At 91, she knew a conventional hysterectomy with removal of lymph nodes for cancer staging would mean a long recovery, something that could impact her independent lifestyle as severely as the disease itself. But when Helen met Dr. Osborne, the division director for the Gynecologic Oncology Program, she learned she was a candidate for a less invasive surgery called laparoscopy. “This option made all the difference,” Helen says. “Without it, I might have gone ahead with the more conventional surgery, but I would have given it a lot of thought. At my age, you look at things differently than when you’re 30.”
With laparoscopic hysterectomy and staging, the surgeon makes a few small incisions in the abdomen, instead of one large incision. Although the laparoscopic method is much less invasive, the same tissues — uterus, ovaries and fallopian tubes, and lymph nodes – are removed. Patients are thoroughly screened first to determine whether they’re appropriate candidates. The type of cancer, its grade and stage, as well as a woman’s general health, previous surgeries and current lifestyle are all considered.
Helen, a former teacher, carefully researched the procedure with her son, a physician. “I’m convinced it’s the skill of the surgeon that really matters,” Helen says, “and we felt we were in the best of hands with Dr. Osborne.” A day after the surgery, Helen was up and walking. “My daughter stayed with me the first night, but after that I didn’t need any help,” Helen says. “The best part was I had no pain. I think this particular surgery is a miracle and such a wonderful gift to women.”
Dr. Osborne counseled Helen on follow-up care, based in part on the results of her lymph node surgical staging. Done at the same time as the hysterectomy, complete surgical staging involves the removal and pathologic evaluation of pelvic and abdominal lymph nodes. The evaluation tells a gynecologic oncologist how far the cancer has spread and how aggressively the disease must be treated.
The American College of Obstetricians and Gynecologists now recommends complete lymph node surgical staging as a standard of care in the treatment of endometrial cancer. Prior to the recommendation, the standard treatment was complete hysterectomy followed by radiation treatments as a precautionary measure based on certain risk factors. However, this treatment option meant some women whose cancer did not require radiation therapy were overtreated, while others who had a more aggressive stage of the disease were undertreated.
“Data from scientific studies shows it is to the patient’s advantage to have the staging done,” Dr. Osborne says. “Women whose disease has spread beyond the uterus can receive targeted therapies, such as radiation or chemotherapy that can lead to better outcomes. Staging can also spare some women from excessive treatments that are not beneficial.” The physicians at the Froedtert & the Medical College of Wisconsin Gynecologic Oncology Program surgically stage all women undergoing surgery for any type of gynecologic cancer. As with laparoscopic surgery, surgeons who perform lymphadenectomy to remove lymph nodes for surgical staging require advanced training.
Presented with post-surgery options, Helen is now on hormone therapy, administered by Dr. Osborne, who is well experienced with the nuances of medical oncology in relation to reproductive cancer. Helen declined more aggressive therapies and is comfortable with her treatment decision.
Roberta Isaacson, one of Dr. Boruta’s patients, is also comfortable with the decision she made concerning follow-up care for early stage ovarian cancer. Just one week after her diagnosis and referral to Dr. Boruta, Roberta was in his office discussing treatment options. The community liaison for a homecare agency and mother of three school-aged children decided to undergo a laparoscopic hysterectomy, removal of her ovaries and surgical staging. “I considered following with chemotherapy,” Roberta says. “Dr. Boruta created a diagram with routes I could take and thoroughly explained each,” Roberta says. “He also cited new studies that show when a woman has complete surgical staging indicating cancer has not spread, which was the case with me, the benefits of chemotherapy are uncertain. At that point, I chose surgery only.”
Roberta will continue to see Dr. Boruta every three months for the next two years, and every year after that. As for her laparoscopic surgery, Roberta says, “It was absolutely amazing. I was in the hospital overnight and back to work in just three weeks. And I was very pleased with how quickly Dr. Boruta was able to see me after my referral.”
A more extensive procedure called a radical hysterectomy is used in the treatment of some early stage cervical cancers. Dr. Osborne was the first in Wisconsin to perform the procedure laparoscopically. She and Dr. Boruta are among a handful of surgeons in the region who are trained to perform laparoscopic radical hysterectomies.
The Gynecologic Oncology Program is designed to make it easier for women to make decisions regarding initial care. Dr. Boruta is confident the program also makes it easier for women to receive follow-up care. “We’re pleased to have the skill set needed to offer women advanced procedures such as laparoscopic surgery, but our program is good for patients in other ways as well. It’s nice to have one doctor who is in charge of not only surgical issues, but follow-up for years through recovery. Patients develop a relationship with our team, and know they always have someone to turn to for answers, so they feel nothing has been missed.”
Helen Kindig agrees. “Dr. Osborne was so professional, and so patient and willing to listen. She didn’t make decisions for me, but she made it as easy as possible for me to make my own.”
Source: Froedtert Today
Date: March 2006