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Gynecological Cancer

The Gynecologic Oncology programs of NewYork-Presbyterian Cancer Centers are committed to advancing early detection methods and comprehensive treatment of cervical, endometrial, ovarian, and uterine cancers. Through the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center and the Weill Cornell Cancer Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, multiple disciplines work closely together to gain new understanding of gynecological cancers and develop strategies for care. Patients who come to NewYork-Presbyterian Cancer Centers benefit from the collaboration found in multidisciplinary teams, which meet weekly to review each individual case. These teams – which include specialists in obstetrics and gynecology ob/gyn, gynecologic surgery, medical oncology, radiation oncology, radiology, pathology, nursing, social work, and psychology – oversee diagnostic strategies that are comprehensive and coordinated and design treatment programs that offer the most precise and effective therapy available.

Through NewYork-Presbyterian Cancer Centers, patients will find clinical expertise in:

• evaluation and treatment of early and advanced cancer
• surgery for complex gynecologic malignancies
• genetic counseling and screening for patients at high risk for hereditary breast/ovarian cancer and Hereditary Non-Polyposis Colorectal Cancer Syndrome

Diagnostic Innovations

Earlier and more precise detection of pre-cancerous and cancerous lesions in gynecological cancer is an important focus of NewYork-Presbyterian's gynecological oncologists. The Colposcopy Clinic at NewYork-Presbyterian/Columbia is headed by a renowned cytopathologist, with expertise in detecting pre-invasive cervical cancer.

The NewYork-Presbyterian Hospital is one of a few in the metropolitan area with expertise in laparoscopic staging procedures for endometrial and cervical cancers. With laparoscopy, patients can generally return to their usual routines within two weeks as compared to the more traditional laparotomy procedures, where recovery can take four to six weeks. Not only is there less post-operative pain, a smaller incision, and less wound complications with the laparoscopy procedure, but data is beginning to show that the less invasive procedures are certainly equivalent, and may even have some additional outcome benefits over laparotomy.

Laboratory research conducted through NewYork-Presbyterian/Weill Cornell is showing promise of new screening and diagnostic techniques, including studies on heat- shock proteins for early detection, the use spectroscopy of cervical pap smears in order to increase the precision in reading the type and structure of the malignancy, and the efficacy of PET scan to diagnose and monitor cancer treatment and response to treatment.

Therapeutic Excellence

NewYork-Presbyterian Cancer Centers' clinicians and scientists continue to increase the understanding of gynecologic cancer and are participating in the development of new medications and treatment approaches. The Cancer Centers' involvement in the Southwest Oncology Group (SWOG) and the Gynecologic Oncology Group provide patients with access to a large number of current research protocols involving every type of gynecologic cancer.

As a national leader and a major center for basic and clinical trials, the Cancer Centers have produced and continue to develop significant advances in the field, including:

• precisely targeted medical therapies which profoundly increase effectiveness and diminish or eliminate side-effects
• promising new treatments combining medical and surgical therapies for previously inoperable cancers
• the development of new antibodies for treatment

Laparoscopy

In addition to its application in staging gynecological cancers, NewYork-Presbyterian Hospital's gynecological oncologists are now also using laparoscopy to treat cancers. Laparoscopy is used in the treatment of endometrial cancers, which involves removing the uterus, fallopian tubes, and ovaries, and can be used to perform a lymph node sampling as well to determine the extent of the cancer. Radical hysterectomies for the treatment of cervical cancer can also be performed laparoscopically.

For advanced ovarian cancer, physicians at NewYork-Presbyterian Hospital offer optimal debulking – an aggressive approach to ovarian cancer that is reported to have improved survival. In this surgical procedure, the goal is to remove as much of the tumor as possible, reducing it ideally to less than one centimeter. To accomplish this, surgeons a the Cancer Centers often employ new ultrasound technology, the Cavitron Ultrasonic Aspirator, which uses sound waves to remove tumor growth by crushing the tumor tissue and then suctioning out the remaining fragments. Using this ultrasonic device, tumors that may have attached to the surfaces of other organs, and are technically not as easy to remove, can often be optimally reduced, offering patients a greater chance of survival.

Radiation Therapy

There is a great deal of collaboration between the Hospital's gynecologic oncologists and radiation oncologists. In 1999, they published a study on brachytherapy techniques for patients with locally advanced cervical cancer, including use of laparoscopy in the placement of interstitial radiation. Since then, their technique has become a standard therapy in many hospitals. Through the auspices of RTOG (Radiation Therapy Oncology Group), our radiation oncologists are conducting a study of chemotherapy, radiation therapy, and Cox II inhibitors for the treatment of cervical cancer.

Research

At NewYork-Presbyterian/Columbia, research is being conducted on endometriosis at the molecular-genetic level to determine if ovarian cancer arises in endometriosis. The gynecologic cancer program here has also been enriched by its relationship with Columbia University's Center for Human Reproduction. The establishment of the Henriette Milstein Fellowship has made possible a transitional position from an ob/gyn residency to a gynecological oncology fellowship focused on research. The first fellow to hold the position is working closely with a senior investigator from the Human Reproduction Center looking at the role of angiogenesis (growth of new blood vessels) in ovarian cancer. In addition, research is being done to look at angiogenic factors in endometrial cancer. Specifically, the role of B-catenin and VEGFA in endometrial cancer is being investigated.

Clinical Trials

Through NewYork-Presbyterian/Columbia, a Phase II clinical trial is evaluating the use of interperitoneal chemotherapy followed by intravenous therapy using novel drugs as front-line therapy for optimally debulked ovarian cancer. Another Phase II study is examining the use of neoadjuvant chemotherapy for patients with advanced ovarian disease who are not surgical candidates. Studies sponsored by SWOG are evaluating various new drugs for recurrent ovarian cancer, including single-agent STI- 571 and single-agent irinotecan.

NewYork-Presbyterian/Columbia is the lead institution for a national study looking at a drug called CPT 11. Research is also being conducted on Docetaxel in combination with Carboplatin in the hopes of improving the efficacy of this chemotherapy regimen as well as decreasing toxicity in the treatment of relapsed or hard to treat ovarian cancer. A study evaluating a drug combination of Topotecan and Taxol in patients with incurable cervical cancer is underway.