Facing the Challenge TogetherKaren Corlyn thought she was dying. It was November 2009, and the retired Milwaukee teacher had just been told she had a rare, aggressive endometrial cancer with a survival rate of just 10 percent.
Karen had always been a healthy woman and slipped easily into menopause. But just as she was adjusting to life as a post-menopausal woman, her period started again.
“The first time it happened, I was relatively calm,” Karen said. “The second time, I called my gynecologist, who brought me in immediately. I had never seen him as concerned before.”
The gynecologist ordered an ultrasound and biopsy of the endometrium, the lining of the uterus. A week later, Karen said, “it came back cancer — a very, very serious cancer.”
Karen’s gynecologist referred her to a local physician.
Because the pathology report showed a combination of common endometrial cancer and papillary serous carcinoma, an extremely rare and aggressive cancer, the physician recommended an open abdominal hysterectomy followed by chemotherapy and radiation.
Karen was looking at extensive surgery and a six- to eight-week recovery period, followed by months of chemotherapy and radiation. Karen asked the physician if she had any other options and whether he worked with a team of doctors. She was not satisfied with the answer and became convinced a second opinion was an absolute necessity.
Meanwhile, she started looking up flights to Florida. She wanted to see her father, brother and daughter, all of whom live in Florida, one more time.
Karen returned to her gynecologist, who recommended Froedtert & The Medical College of Wisconsin. Karen scheduled an appointment with Janet Rader, MD, FACOG, a Medical College of Wisconsin gynecologic oncologist and chair of the Department of Obstetrics and Gynecology. A gynecologic oncologist is a doctor who specializes in treating cancers of the female reproductive tract, including cervical, vaginal, ovarian and endometrial cancers.
“Dr. Rader was new to the area at that time,” Karen said. “But I looked her up on the Internet and was impressed with her credentials.”
Dr. Rader brings with her more than 20 years of experience, including expertise in treating cervical, ovarian and endometrial cancers. She’s written more than 140 articles and 20 book chapters. She has served on numerous national expert committees in relation to gynecologic cancer, serves on a number of editorial boards and has a long record of research support from the National Cancer Institute and the American Cancer Society.
Three days later, Karen met Dr. Rader and was impressed with her professionalism. “I felt comfortable the moment we met,” Karen said. “We were laughing during my first exam. Talk about making a connection!”
Dr. Rader had misgivings about Karen’s initial diagnosis. “She told me it’s not typical to see low grade endometrial and serous cancer together,” Karen said. Dr. Rader sent for the tissue samples and asked two different pathologists who specialize in gynecologic cancers at Froedtert & The Medical College to review the slides. The pathologists agreed there was no presence of serous cancer.
Karen felt like she’d been given her life back.
“In that moment,” she said, “my survival rate jumped from 10 to 98 percent.” The woman who had been planning a trip to Florida to say her final goodbyes was now anticipating a hopeful future.
All For OneAt Froedtert & The Medical College, a team of specialists coordinated Karen’s care. From the two pathologists who reviewed Karen’s tissue samples to the doctors who planned her treatment, Karen was surrounded by experts who specialize in the care of women with gynecologic cancers. The Gynecologic Cancer Program team includes three other gynecologic oncologists in addition to Dr. Rader: Janet Osborne, MD, William Bradley, MD, and Denise Uyar, MD. Behnaz Behmaram, MD, a pathologist, Beth Erickson-Wittmann, MD, and Tracy Kelly, MD, Medical College of Wisconsin radiation oncologists, also specialize in gynecologic cancers. Although Karen did not require radiation therapy, her case was reviewed by the entire team before treatment was confirmed.
“We have a lot of people thinking about cancer,” Dr. Rader said. “We have cancer boards (tumor boards and conferences). We have access to research and clinical trials. We’ll debate what percentage of a tumor is a certain type, because we want to know the intricacies. It’s not enough to know that it’s endometrial cancer. We want to know what kind of endometrial cancer, so we can tailor treatment to the patient.”
After reviewing the specifics of Karen’s case, Dr. Rader and the rest of the team recommended a minimally invasive hysterectomy. Karen didn’t need chemotherapy or radiation treatments. Dr. Rader developed Karen’s treatment plan based on the latest scientific research and input from the program’s other specialists.
If the scientific data had suggested a different type of surgery, or additional benefit to giving chemotherapy and radiation, Dr. Rader would have worked with her colleagues to develop a different treatment plan for Karen. The specialists within the Gynecologic Cancer Program offer a complete range of treatment to fit each individual, including robotic and other minimally invasive options and traditional open surgery. The gynecologic oncologists are also experienced in providing different types of chemotherapy, such as intraperitoneal, in which chemotherapy drugs are put directly into the abdominal cavity through a thin tube to target tumors directly. Had radiation therapy been part of Karen’s plan, Dr. Erickson might have included one of several options in highly targeted radiation treatment, such as high dose rate brachytherapy, image-guided brachytherapy or Tomotherapy®. And because Gynecologic Cancer Program physicians are also active in national research initiatives, clinical trials are an option for eligible patients.
In Karen’s case, based on pathology reports and the input of all specialists on the team, Dr. Rader concluded treatment beyond surgery was unnecessary and potentially damaging.
An Extra HandKaren underwent a minimally invasive hysterectomy in November 2009. “Instead of a large incision, plus chemotherapy and radiation, Dr. Rader did a robotic-assisted hysterectomy through tiny incisions,” Karen said. “It was amazing. I went in on a Monday afternoon and went home Tuesday night, right after dinner.”
A laparoscopic hysterectomy like Karen’s only requires small incisions that are later dressed with small adhesive bandages. Various instruments, including a video camera for visibility, are inserted through the incisions; the doctor then manipulates the surgical tools to remove the uterus and, if necessary, the ovaries.
Dr. Rader performed Karen’s hysterectomy using a robotic assisted approach — the da Vinci® Surgical System. The technology improves physicians’ visual field and increases range of motion, allowing physicians to manipulate surgical tools in a way that would be impossible for the unaided human hand.
“Without the robot, we can only move the instruments in a couple of directions. With the robot, we have the ability to move instruments in many different directions,” Dr. Rader said. Dr. Rader notes that roboticassisted surgery may not be the best option for every patient. Each must be carefully evaluated to determine the optimal surgical method based on the individual’s cancer stage, risk and personal priorities.
The benefits of robotic-assisted laparoscopic hysterectomy are many: less blood loss, decreased chance of infection, a shorter hospital stay, minimal scarring, shortened recovery time and less pain. Karen said she felt almost no pain.
“When I got out of surgery, the nurses gave me a button to push to deliver pain medication. I wasn’t feeling pain, but I pushed it one time, just in case, before going to sleep and then never again,” Karen said.
Rapid RecoveryThe surgery confirmed Dr. Rader’s assessment: Karen’s cancer was a simple endometrial cancer, stage 1A, with no involvement of the uterine wall. Chemotherapy and/or radiation would have provided no additional benefit.
One day after surgery, Karen was home. A few days later, she celebrated Thanksgiving with her family. “It was the most grateful Thanksgiving we ever had,” Karen said. Within two weeks, she was back to her normal routine. She continues to see Dr. Rader for periodic follow-up appointments, but remains cancer-free.
According to Dr. Rader, while Karen’s treatment was relatively simple, her case illustrates the importance of a highly qualified cancer team. “Karen’s outcome isn’t the result of an unusual surgery or great new drug,” Dr. Rader said. “It was simply a matter of the right physicians doing the right things, at the right time, in the right sequence.”
“I probably would have survived if I’d gone with the first treatment plan,” Karen said. “But there’s no telling what all the radiation and chemotherapy would have done. Getting a second opinion improved my quality of life.”
Medical College of Wisconsin cancer physicians, Dr. Rader said, are highly specialized: “Our physicians are up on the latest research and clinical trials; they’re able to tweak treatment protocols, tailoring them to the specific cancer of a specific patient.”
“We’re so lucky Dr. Rader came to Milwaukee,” Karen said. “She is an amazing woman and a phenomenal doctor. We’re incredibly fortunate to have Froedtert & The Medical College of Wisconsin right here.”
Source: Froedtert Today
Date: May 2010
Online Editor(s): Robin Schultz