Just Diagnosed With Cancer: Treatment Options for Gynecologic Cancers

Every five minutes, a woman will be diagnosed with gynecologic cancer and more than 33,000 will die from the disease this year, according to the Foundation for Women’s Cancer. The goal of Gynecologic Cancer Awareness Month in September is to raise awareness of the various types of gynecologic cancer, which include cervical, ovarian, uterine/endometrial, vaginal and vulvar cancer. 

Three Miami Cancer Institute experts hosted a virtual community health webinar on September 16 to highlight the different treatment options for two of the most common gynecological cancers⁠—endometrial and cervical. John Paul Diaz, M.D., deputy chief of Gynecologic Oncology and director of Minimally Invasive Surgery, talked about surgical options; Eleftheria Kalogera, M.D., gynecologic oncologist, discussed systemic therapies; and Jessika Contreras, M.D., radiation oncologist, presented radiation therapy options. 

Surgical Treatment 

Treatment options for gynecological cancer depend on the type and stage of the cancer, says Dr. Diaz. “Surgery is not always the answer,” he explained. “Our multidisciplinary care team collaborates to create a personalized, comprehensive care plan for each patient.” 

When surgery is part of a patient’s treatment protocol, the goals of the procedure include establishing a diagnosis; removing the affected organ; staging the cancer; and tailoring the treatment. 

The most commonly performed surgeries for endometrial and cervical cancer include:

• Total hysterectomy, which involves the removal of the uterus and cervix; and
• Total hysterectomy bilateral salpingo-oophorectomy, which is the removal of the uterus, cervix, both fallopian tubes and both ovaries.

Miami Cancer Institute has one of the largest minimally invasive gynecologic surgical programs in the region and holds a designation as a center of excellence in minimally invasive gynecologic surgery by the American Association of Gynecologic Laparoscopists. Robotic-assisted surgery, a technologically advanced form of minimally invasive surgery, is often used to treat gynecologic cancers.  

“Robotic surgery uses sophisticated robotic instrumentation that act like surgical hands,” Dr. Diaz explained. “The precision of this surgery shortens a patient’s recovery time.” 

With minimally invasive surgery, patients have small incisions, experience less pain, need minimal pain medications, return to work and activities faster and can initiate adjuvant therapy earlier, explains Dr. Diaz. The Institute also executes an Enhanced Recovery after Surgery program, which facilitates recovery and enables most patients to return home the same day as their surgical procedure. 

When a gynecological cancer diagnosis threatens a women’s dreams of having children, minimally invasive and fertility sparing techniques can improve obstetrical outcomes without compromising oncologic safety. “Our team works together to coordinate a patient’s cancer and fertility care,” Dr. Diaz said.  

Systemic Therapy

The systemic therapies most commonly used in the treatment of gynecologic cancer are chemotherapy and hormonal therapy, says Dr. Kalogera. Chemotherapy kills fast-growing cells, while hormonal therapy blocks hormones that may be causing a cancer to grow. Other systemic therapies for gynecologic cancers include immunotherapy and targeted therapies. 

“The three treatment modalities⁠—surgery, systemic therapy and radiation therapy⁠—can be performed at different times during a patient’s course of treatment, depending on the type and stage of cancer and the patient’s health status, goals and treatment plan,” said Dr. Kalogera. “The gynecologic oncologist serves as the ‘quarterback’ of the cancer treatment team, but, truly, the patient is the most important team member.” 

When chemotherapy is part of a patient’s treatment protocol, it can be used:

• After other treatments, to kill cancer cells (adjuvant);
• To prepare for other treatments (neoadjuvant);
• To treat the cancer without other treatments;
• To keep cancer from coming back (maintenance); and
• To ease signs and symptoms of cancer (palliative).

Chemotherapy is most commonly given intravenously in an outpatient chemotherapy infusion unit and can also be given in an inpatient setting on a per-occasion basis. Some chemotherapeutic drugs may be taken by mouth in the form of pills or administered directly inside the abdominal cavity. Hormonal therapy is administered by mouth, locally or injection. 

Patients undergoing chemotherapy can experience nausea, vomiting, loss of appetite, fatigue, diarrhea/constipation, hair loss, increased risk of infection and bruising/bleeding. Dr. Kalogera says that most of these symptoms can be either completely prevented or treated and will subside after treatment ends.  

Radiation Therapy 

Radiation therapy uses beams of intense energy, such as X-ray or proton, to kill cancer cells.  

Radiation can be delivered using external beam radiotherapy or internal radiation therapy, called brachytherapy. In some cases, a patient’s treatment plan may include both forms of radiation therapy, says Dr. Contreras.   

For the treatment of endometrial and cervical cancer, external beam radiotherapy is often delivered in the form of intensity modulated radiation therapy. This highly precise technique delivers a radiation dose according to the three-dimensional shape of the tumor, avoiding radiation exposure to neighboring normal tissues.

Brachytherapy involves placing a source of radiation in or near the cancer using an applicator. The Miami Cancer Institute team uses advanced imaging, such as MRI, prior to and during brachytherapy treatment to precisely target the tumor. 

“Image-guided brachytherapy allows for the delivery of radiation directly to the area of the tumor or disease while sparing the surrounding tissue and organs,” Dr. Contreras explained.  “Compared with external beam therapy alone, the addition of brachytherapy to treat cervical cancer has been proven to reduce local recurrence and improve overall survival.”

Patients with gynecological cancer who seek treatment at Miami Cancer Institute benefit from the collaborative care of an integrated team of specialists, explains Dr. Contreras. “It’s extremely important for patients to choose specialists who have experience treating their specific type of cancer.”