The Role Of Gynecologic Oncologists In The Management Of Gynecologic Cancers

Every hour, approximately 10 women in the United States will be diagnosed with a cancer of the reproductive organs. Virtually all women are at risk; more than 80,000 mothers, grandmothers, wives, sisters and daughters will be diagnosed with a gynecologic cancer this year. These diseases do not have to be fatal. Access to specialty care for women with cancers of the reproductive organs can greatly improve the odds of survival, the disease-free interval, and the overall quality of life. Gynecologic oncologists can play a key role in assuring these women achieve optimal outcomes when facing potentially deadly gynecologic cancers.

What is a Gynecologic Oncologist?

Gynecologic oncologists are cancer surgery specialists who have additional training and education in the biology and pathology of gynecologic cancers as well as the very latest forms of treatment for these diseases, including surgery, chemotherapy, radiation and other therapies.

Gynecologic oncologists have completed a four-year residency in obstetrics and gynecology, plus an additional three years or more of subspecialty fellowship training in a program approved by the American Board of Obstetrics and Gynecology (ABOG). Surgeons who refer to themselves as gynecologic oncologists should be board certified or eligible for board certification by the ABOG.

Board certification programs are specifically designed to teach the critical skills necessary for the medical and surgical management of women with diagnosed or suspected gynecologic cancer. This intense training includes the development of the skills needed to perform such complex surgeries as radical and non-radical pelvic operations, reconstructive procedures, gastrointestinal surgery, and urinary tract operations. A significant portion of the training emphasizes the determination of the proper procedure, as well as how to minimize and manage all treatment complications. Training also encompasses the use of intravenous, intraperitoneal and oral chemotherapy, as well as brachytherapy and other current forms of radiotherapy.

Gynecologic oncologists focus exclusively on cancer, performing many complicated cancer surgeries on a daily basis. This high volume of complex surgeries allows them to gain a level of knowledge and expertise that cannot be achieved by surgeons who only deal with the disease occasionally. Gynecologic oncologists are among the most comprehensively trained and experienced cancer specialists of all, providing the highest level of care possible for women facing cancer of the reproductive organs.

Research Shows Gynecologic Oncologists Provide The Highest Level Of Surgical Care For Patients, Achieving Optimal Outcomes

Major clinical studies over the past 20 years have conclusively and consistently demonstrated that gynecologic oncologists deliver the optimal level of surgical care for women with cancers of the reproductive organs, significantly improving patients’ disease-free intervals and overall survival rates.

Accurate Staging & Optimal Tumor Debulking Are Critical For Positive Outcomes
The key to successful treatment for gynecologic cancer, as with most cancers, is properly staging the disease and removing as much of the tumor as possible. Staging and surgery are critical factors in patient outcomes, as they provide the foundation for the entire treatment program that follows.

Countless studies have shown the superiority of surgical staging and debulking by a gynecologic oncologist

Research On Staging
In a major study evaluating the completeness of surgical staging of women with early ovarian cancer, researchers concluded nearly half of the women were inadequately staged by general Ob/Gyns or general surgeons. Gynecologic oncologists did complete staging 97% of the time, Ob/Gyns 52% of the time, and general surgeons 35%. (1)

Additional studies within the past 10 years have reconfirmed the superiority of surgical staging in patients with early and advanced stages of ovarian cancer whose surgery was performed by a gynecologic oncologist. (2)

Research On Tumor Debulking
Gynecologic oncologists were almost five times more likely to completely debulk ovarian tumors than were non-specialist surgeons, according to a major study on the management of ovarian cancer. Many general surgeons only performed a biopsy in some cases, leaving patients with a greater likelihood of retaining residual disease larger than two centimeters after the operation. (3)

A 2002 study reconfirmed that the additional training gynecologic oncologists receive results in optimal resection rates that are 50 to 60 percent higher than in other surgical specialties. (4)

Optimal Survival Rates Are Achieved By Gynecologic Oncologists

Over the last decade, many studies have demonstrated dramatically improved survival rates for patients whose surgeries were done by gynecologic oncologists. These studies suggest several factors may be involved in the increased outcomes, including the surgical oncologists’ comfort with performing more aggressive surgery, more success in removing the majority of the tumor, and more effective chemotherapy due to less residual disease. (5)

One of the first comprehensive studies on surgical subspecialty training and survival outcomes clearly showed considerable advantages for women whose surgery was performed by a gynecologic oncologist. (6) The results are shown below:

______________________________________________________________
Ovarian Cancer: Importance of Surgeon

Included 1,866 women with ovarian cancer

Conclusions: Significant advantages for those women managed by
gynecologic oncologists
» More likely to have optimal cytoreduction
» Reduction in death by 25% (p=0.005) compared to Ob/Gyn and general surgeons
______________________________________________________________

This study also revealed other important information, including:

» A mean survival rate one-third longer for patients operated on by gynecologic oncologists than those treated by Ob/Gyns.
» A increase in mean survival from 13 months to 18 months for Stage III cancer patients who were treated by gynecologic oncologists as opposed to those treated by gynecologists.

Other research confirms these findings. A meta-analysis of data from several major studies concluded that when surgery was performed by a gynecologic oncologist, the patient’s median survival time was 50% longer than women whose surgery was done by a general gynecologist or other surgeon lacking experience in optimal debulking procedures. (7)

Numerous other studies could be cited, all drawing fairly similar conclusions: staging, surgery and disease management from a gynecologic oncologist can significantly improve patient outcomes for women with gynecologic cancers.

Cancer Care Northwest’s Gynecologic Oncology Team

Melanie K. Bergman, M.D.
Gynecologic Oncologist

Dr. Melanie Bergman is a fellowship-trained gynecologic oncologist. She attended Colgate University in New York for her undergraduate training, and then completed her medical degree at the Medical College of Virginia in Richmond, VA. She trained as a resident in obstetrics and gynecology at Akron General Medical Center in Akron, Ohio and went on to complete a three-year fellowship in gynecologic oncology at Yale University in New Haven, Connecticut. She is board certified in obstetrics and gynecology, and board eligible for gynecologic oncology certification.

Elizabeth A. Grosen, M.D.
Gynecologic Oncologist

Dr. Elizabeth Grosen was the first gynecologic oncologist to establish a full-time practice in the Inland Northwest. She received her M.D. degree from the University of Washington. After two years of general surgery residency at Huron Road Hospital in Cleveland, Ohio, she completed her residency in obstetrics and gynecology at the University of Arizona Medical Center in Tucson. She then completed a fellowship in gynecologic oncology at the University of California Medical Center in Orange, California. Dr. Grosen served on the faculty of the University of Wisconsin for six years. She is board certified in obstetrics and gynecology, as well as gynecologic oncology. She is included on the prestigious Best Doctors In America ™ list for 2004 and 2006.

Radiation Oncologists Are A Critical Part Of The Team
Today’s complex treatment modalities for gynecologic cancers often require the involvement of a radiation oncologist. Our treatment team includes several of these highly skilled specialists who are trained in the newest treatments for gynecologic cancers. They work closely with our gynecologic oncologists as part of an integrated team, assuring optimal outcomes and the highest quality of care for our patients.

Our gynecologic oncology nurses, Gena, RN, BSN, OCN, and Deb, RN, are key members of our gynecologic cancer treatment team. They have an in-depth knowledge of gynecologic cancers, surgical nursing, and other forms of treatment the patient is likely to encounter. They provide valuable clinical assistance to our physicians, coordinate and manage patient care, act as patient advocates, and play a critical role in meeting the many special needs of women with gynecologic cancer.

Our cancer fellowship-trained gynecologic oncologists are unique to the Inland Northwest, and we are pleased to serve as a regional resource for physicians as well as patients.

References:

1. McGowan et al. Ob/Gyn (1985). Online, Gynecologic Cancer Foundation, 7 Apr. 2006.< http://www.thegcf.org >.
2. Podratz, K.C., Gynecologic Oncology: On the Eve of the New Millennium, Gynecologic Oncology, 74, 157-162 (1999).
3. Junor, E.J., Hole, D.J., Gillis, C.R., Management of Ovarian Cancer: Referral to a Multidisciplinary Team Matters, British Journal of Cancer. 70(2) 363-370 (1994)
4. Bristow, R.E., Tomacruz, R.S., Armstrong, D.K., et al: Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: A meta analysis. Journal of Clinical Oncology 20: 1248-1259, 2002.
5. Junor, E.J., Hole, D.J., McNulty, L., Mason, M., young, J. Specialist Gynaecologists and Survival Outcome in Ovarian Cancer: A Scottish national Study of 1866 Patients, British Journal of Obstetrics and Gynecology. 106, 1130-1136 (1999).
6. Ibid.
7. Bristow and Tomacruz.