Gynecologic oncology in Savannah
The gynecologic oncology program at the Memorial Health Curtis and Elizabeth Anderson Cancer Institute cares for women with pre-cancer or cancer of the reproductive system. Some of our specialized services include:
- Treatment of gynecologic pre-cancers, including vulvar dysplasia, vaginal dysplasia, cervical dysplasia and uterine hyperplasia
- Treatment of gynecologic cancers, including vulvar, vaginal, cervical, uterine, fallopian tube, ovarian and primary peritoneal
- Bowel and urinary tract resection, diversion and reconstruction
- Cervical loop electrosurgical excision procedure (LEEP) and cold knife conization
- Gynecologic Oncology Group clinical trial access
- Hysterectomy, including extrafascial and radical hysterectomy
- Minimally invasive and robotic surgery
- Pelvic exenteration
- Pelvic, para-aortic and inguinal lymph node dissection
- Radical cytoreductive surgery for advanced gynecologic cancers
- Vesico-vaginal and recto-vaginal fistula repair
Our office is open from 8:30 a.m. to 5 p.m., Monday through Friday. Patients are seen on an appointment-only basis. Call (912) 350-8603 to request an appointment.
When to call a gynecologic oncologist
Any woman diagnosed with a gynecologic cancer should seek the expertise of a gynecologic oncologist. Some gynecologic cancers have no symptoms at all and can only be detected with a Pap test, blood work or biopsy. However, the following conditions may be a sign that something is wrong.
- Abnormal bleeding, including bleeding between periods, bleeding after intercourse, bleeding after menopause and unusually heavy or prolonged bleeding
- Frequent, urgent, difficult or painful urination
- Unusual vaginal discharge or discharge with an unusual color or odor
- Pain during intercourse
- Pain, pressure or a mass in the lower abdomen or pelvic area
- Constantly feeling swollen, bloated, full or experiencing ongoing gas, indigestion, nausea, diarrhea or constipation
- Severe burning, itching or pain in the genital area
- Skin changes on the vulva
- Unexplained weight loss
- Feeling very tired all of the time or experiencing shortness of breath
The first step is to do an appropriate cancer staging operation, which includes removal of the ovaries and all other involved tissues to resect the cancer to a minimal amount. A gynecologic oncologist is best qualified to perform this surgery. For all patients, except those with very early ovarian cancer, chemotherapy is recommended after surgery. The cycles are usually three to four weeks apart and are recommended for six to eight courses. Most prescribe the current gold-standard combination chemotherapy of paclitaxel/carboplatin.
At Memorial Health, we offer women the opportunity to participate in clinical trials to treat ovarian cancer. These trials are conducted through the National Gynecologic Oncology Group. In selected cases of recurrence, such as tumor isolated to certain nodes, radiation may be suggested. Finally, if large recurrences are seen on imaging studies, a “second look” operation may be needed to remove the affected areas.
In the U.S., about 5,600 women die each year from cancer of the cervix. Since the advent of the Pap smear, death rates from cervical cancer have decreased significantly. If women have routine Pap smears, this type of cancer is more than 90 percent preventable.
Based on this information, two organizations – the American Cancer Society (ACS) and American College of Obstetricians and Gynecologists (ACOG) – have published guidelines for Pap smears. The ACS and ACOG state that the first Pap smear should occur at age 21 or three years after a woman begins having sexual intercourse, with a yearly Pap test until age 30. Then, women should have the test every two to three years as long as they have had three consecutive tests with normal results.
The ACS recommends discontinuing routine Pap smears at age 70 with three consecutive years of normal results. The ACOG says no discontinuation based on two reasons:
- Pap smear screening of women over age 65 would increase five-year survival rate by 65 percent.
- Gland cell cancers occur twice as often in women within three years of a normal Pap. Most gynecologists recommend annual Pap smears.
Over a woman’s lifetime, there is a 1.8 percent chance of developing epithelial ovarian cancer. Fortunately, only five to seven percent of patients with epithelial ovarian cancer have an inherited form of the disease. This means that most patients have a sporadic, non-inherited form of the disease.
Determining ovarian cancer risk for women depends upon family history. For example, if only one first-degree relative (a mother or sister) has the disease, then a daughter’s risk of developing ovarian cancer is approximately three to five percent. However, if more than one first-degree relative or multiple family members in several generations (grandmothers, aunts, cousins, etc.) have either breast or ovarian cancer, then there might be a higher risk of developing ovarian cancer.
In fact, these patients may have an inheritable form of breast/ovarian cancer caused by mutations in the BRCA 1 and 2 genes. This is why it is important to provide as much family history as you can when visiting your physician.
Bleeding or spotting six to 12 months after periods have stopped is abnormal. Possible causes include polyps, use of unopposed estrogen, use of tamoxifen (a drug given during breast cancer treatment), thinning of the vagina or – the most serious cause – cancer of the lining of the uterus. This endometrial cancer is the fourth most common cancer in women. All post-menopausal women with bleeding should have an endometrial biopsy to rule out cancer.
Some physicians also use an ultrasound to evaluate the endometrial thickness. It is not enough to simply have a Pap smear, as this test may miss as many as 50 percent of all endometrial cancers.
The best way to accurately diagnose endometrial cancer is to perform a D&C (a procedure that removes tissue from the lining of the uterus for testing), with or without a hysteroscopy (a procedure that involves inserting a small scope into the uterus so the doctor can visualize the lining).
It is a blood test that checks for a protein called cancer antigen (CA) 125. The protein is made by some, but not all ovarian cancers. When a woman is diagnosed with ovarian cancer, physicians may check to see if she has an elevated CA-125 level prior to surgery and chemotherapy.
By checking the levels throughout treatment, physicians can tell how well the treatment is working. A normal CA-125 level is less than 35. Several large studies have shown that checking for CA-125 as an ovarian cancer screening tool is not useful. The reason is that many other non-cancerous diseases can also cause abnormal levels of CA-125.
An abnormal Pap smear does not necessarily mean that a woman has cervical cancer. It does, however, suggest that a woman may have an infection or a pre-cancerous lesion. After an abnormal Pap smear, a physician may prescribe antibiotics, repeat the Pap smear or move directly to a colposcopic evaluation.
By further examining the cervix with a colonoscopy exam, the physician will know whether or not a biopsy is necessary. As a screening tool, the Pap smear has drastically reduced the number of cervical cancer cases by finding problems in a pre-cancerous stage. This allows doctors to prescribe better fertility sparing treatments.