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The importance of finding a specialist for gynecologic cancer

September is Gynecologic Cancer Awareness Month. The American Cancer Society estimates there will be nearly 92,000 new cases of gynecologic cancer diagnosed in the United States in 2013. At the same time, there are about 1000 board-certified gynecologic oncologists in the US (Society for Gynecologic Oncology). If you have gynecologic cancer, it’s important to have a gynecologic oncologist as part of your cancer team.

What is a gynecologic oncologist?

A gynecologic oncologist is an obstetrician/gynecologist who specializes in the diagnosis and treatment of cancers of the female reproductive system, including cervical, ovarian, uterine, vaginal and vulvar cancers.

What training is involved in becoming a gynecologic oncologist?

To become a gynecologic oncologist, a physician must complete four years of medical school followed by a four-year residency program in obstetrics and gynecology, and an additional three- to four-year clinical fellowship in gynecologic oncology. This specialized training includes mastering highly technical surgical procedures, administering chemotherapy, and learning the techniques of radiation therapy.

Who should see a gynecologic oncologist?

Any woman with a gynecologic cancer should see a gynecologic oncologist if at all possible. In fact, women should see a specialist as early in the process as possible, says Dr. Justin Chura, Medical Director of Gynecologic Oncology at Cancer Treatment Centers of America in Philadelphia.

“Any woman with a known or suspected gynecologic cancer should be seen by a gynecologic oncologist from the start. Patients who have their first procedure by someone other than a gynecologic oncologist may not receive the most optimal surgery for the disease,” says Dr. Chura. “With cancer you don’t often get a second chance, so you want an optimal treatment plan from the beginning,” he adds.

This means even if you haven’t been diagnosed but are facing surgery for a suspicious mass, it’s wise to find a gynecologic oncologist to perform the procedure, as the quality of your initial surgery can influence your long-term outcomes. If you’ve already had surgery with a gynecologist or general surgeon, it’s not too late. A gynecologic oncologist can help you plan next steps.

Why is it important for a woman with gynecologic cancer to see a specialist?

Gynecologic cancers are complex and treatment often involves multiple modalities such as surgery, chemotherapy and radiation. A gynecologic oncologist is specially trained to diagnose and treat these types of cancers, as well as premalignant conditions that lead to gynecologic cancer. They see women with gynecologic cancers every day, and have developed the skills and judgment required to perform procedures on the reproductive system.

“Gynecologic oncologists provide a level of expertise that’s different from other oncologists, who may treat a variety of cancers like breast, colon, pancreatic, liver, and others. The only cancers gynecologic oncologists treat are gynecologic cancers. That narrow focus is beneficial,” says Dr. Chura.

Research suggests that women with ovarian cancer who are treated by a gynecologic oncologist tend to have better outcomes than those who are not. “At the end of the day, gynecologic cancer patients do better when treated by a specialist—they have better outcomes. Gynecologic oncologists are very focused on these particular cancers. Even with an uncommon gynecologic cancer, we know the latest research in those areas,” says Dr. Chura.

What unique skills can a gynecologic oncologist offer to a woman with gynecologic cancer?

Gynecologic oncologists are trained in providing comprehensive, multidisciplinary care. Finding the exact stage of the cancer is vital to planning the most appropriate treatment. Gynecologic oncologists are trained to perform accurate staging surgery and cytoreductive (debulking) surgery to find and remove tumors that have spread in the pelvic and abdominal areas.

Another advantage to seeing a gynecologic oncologist is that one doctor can manage all your treatment. Following surgery, a gynecologic oncologist can administer chemotherapy if needed. “Because a gynecologic oncologist can perform surgery and administer chemotherapy, it allows for continuity of care. We can develop a long-term relationship with the patient. Most doctors either do surgery or provide chemotherapy. We do both,” says Dr. Chura.

For example, for patients with ovarian cancer that has spread through the abdomen, there is an option of giving chemotherapy directly in the abdominal cavity. Called intraperitoneal (IP) chemotherapy, this technique of delivering chemotherapy to the site of cancer may improve survival for patients with ovarian cancer. Unfortunately, many patients with ovarian cancer are not offered this treatment option.

A gynecologic oncologist also understands the impact of cancer and its treatment on a woman’s life, including future childbearing, sexuality, physical and emotional well-being, and family dynamics. They can work with the rest of your cancer team to address all of your needs throughout treatment.

What should gynecologic cancer patients look for when selecting a cancer treatment facility?

“When selecting a cancer treatment facility, gynecologic cancer patients should look for the availability of fellowship-trained gynecologic oncologists. They should also make sure that the facility treats a high volume of women with gynecologic cancer and that the gynecologic oncologists do a lot of procedures,” says Dr. Chura.

He adds, “A woman with gynecologic cancer should make sure she understands her treatment options and how treatment can impact her quality of life, survival and risk of recurrence, as well as what can be done to lower those risks.”

Many gynecologic cancer patients are concerned about how treatment will affect sexual function, and younger patients often have concerns about fertility. Women should make sure the facility they choose addresses the many aspects of the disease. In addition, family members are often a critical part of the gynecologic cancer patient’s care team, so a facility that partners with caregivers is important.

Why is an integrated approach important for gynecologic cancer patients?

“For any cancer patient, it’s beneficial to find an integrated model where doctors are treating the whole patient, not just the disease,” says Dr. Chura. “With so many cancers, body image issues, sexual function issues, menopause symptoms, and even emotional distress can all impact a patient’s quality of life. Women should have a team that can address these concerns, with an understanding of the whole patient.”

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