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“It takes a village” is a familiar phrase. Nevertheless, it describes the level of care women with gynecologic cancer require — and the vast resources available to them within the Froedtert & the Medical College of Wisconsin Gynecologic Cancer Program.

“Gynecologic cancers require an especially sensitive approach,” said Beth Erickson, MD, radiation oncologist and MCW faculty member, referring to the five types of gynecologic cancer — ovarian, uterine, cervical, vaginal and vulvar. “The procedures take time, handling the social factors that affect health take time, and these factors are often intertwined, complicated by diverse needs of various socio-economic groups.”

To address the multiplicity of patient needs, the gynecologic cancer team includes surgical, medical and radiation oncologists, plus many other clinical experts all dedicated to gynecologic cancers. If desired, the Froedtert & MCW Reproductive Medicine Center helps women explore fertility options.

“They are our ‘army’ of wonderful experts who help us do what we do,” Dr. Erickson said.

Internationally Recognized Gynecologic Cancer Expertise

While gynecologic cancer specialists provide today’s latest treatments, they are also researching tomorrow’s protocols.

"Immunotherapy is playing an emerging role,” said Denise Uyar, MD, gynecologic oncologist and MCW faculty member.

“We are interested in combining immunotherapy with other treatments to enlist the body’s own immune system in fighting these tumors.”

Other advanced treatments for gynecologic cancer range from surgery to chemotherapy to radiation therapy, used individually or in combination. Surgery may be done using minimally invasive and robotic-assisted methods. Combination chemotherapy and radiation therapy (chemoradiation) is another treatment option and is an area where the team has internationally recognized expertise.

“For example, if cervical cancer has spread beyond small lesions and we can’t remove it completely with surgery, we get better outcomes with a combination of cisplatin and radiation therapy,” Dr. Uyar said. “Cisplatin increases the effectiveness of the radiation therapy to eliminate cancer cells.”

This complex regimen is intensive and requires specialized expertise to manage.

After this first regimen of external beam radiation, patients receive a second round of radiation therapy called image-guided brachytherapy.

“Our team was one of the first to pioneer magnetic resonance image-guided brachytherapy and, as part of an international group, developed guidelines that are now viewed as the standard of care,” Dr. Erickson said. “External beam radiation combined with image-guided brachytherapy is curative in the majority of women we treat.”

Brachytherapy allows delivery of an optimal dose of radiation to the tumor while the organs near the cervix — bladder, rectosigmoid colon, small bowel — are avoided as much as possible. Exacting planning precedes each treatment. Dr. Erickson uses MRI scans following applicator placement to identify the tumor’s location in relation to other organs and guide the positioning of the applicators and the dose distribution around the tumor.

“We fine-tune the radiation therapy plan to each woman’s individual anatomy each time we do it, giving what’s left of the tumor after external radiation therapy a high dose while avoiding exposing important organs to the same dose,” Dr. Erickson said.

“With all that we offer, our goal is to restore women to health so they can be cured and live their best possible life. That’s the rainbow we’re always pursuing.”

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