Gynecologic Oncology: Patient Care

The Gynecologic Oncology program at Stanford University Medical Center offers comprehensive treatment options in a highly supportive environment for patients with reproductive tract cancers. Multiple treatment modalities are explored for every patient to determine the optimum individual approach. Access to numerous research protocols and clinical trials of investigational chemotherapeutic agents is available.

Our attending Gynecologic Oncology physicians are Dr. Nelson N.H. Teng, Dr. Jonathan Berek, Dr. Oliver Dorigo, Dr. Amer Karam, and Dr. Shannon MacLaughlan David. At Stanford University Medical Center, the entire Gynecologic Oncology team offers a caring, personalized treatment approach that includes detailed patient education with involvement of the patient, her family, and the referring physician in therapeutic decisions. Recognizing the emotional aspects of a cancer diagnosis, Stanford offers many support services for patients and their families.

Interdisciplinary Team Approach

Patients benefit from the intervention of a highly experienced, interdisciplinary treatment team, composed of gynecologic oncologists, radiation oncologists, medical oncologists, surgical oncologists, and specialized oncologic nurses and social workers. The referring physician, patient, and family are all integral members of the treatment team.

Determination of Treatment Plan

The initial treatment plan for each patient is developed in collaboration with the referring physician. Patients are scheduled within one week of referral and written or telephone updates are provided after every patient visit. The attending physician personally oversees the care and management of every patient and remains in close contact with both the patient and the referring physicians for the duration of care.

Ovarian Cancer

Ovarian cancer patients at Stanford University Medical Center benefit from comprehensive combined modality treatment that focuses on advanced surgical techniques and the most up-to-date chemotherapeutic agents, as described below:

• Meticulous surgical debulking involving the use of state-of-the-art ultrasonic aspirators or laser beams leaves only microscopic residual disease.
• The newest drugs, such as Taxol, are available.
• Our doctors are also investigating the use of intraperitoneal chemotherapy. Direct intraperitoneal administration increases tumor exposure to cytotoxic agents or biological response modifiers, and has been theorized to offer improved survival rates in preliminary studies.
• More about Ovarian Cancer

Other protectors or agents reducing the toxicities of standard chemotherapy are also available.

Cervical Cancer

Stanford offers the most advanced multimodal regimens available:

• Early-stage smaller cancers of the cervix are treated by radical hysterectomy or radiation therapy, based on each patient's health profile.
• For early stage larger cancers of the cervix, we are comparing the relative efficacy of radiation therapy used alone versus radiation followed by surgery. Specific dose levels of radiation are meticulously controlled to provide optimal individualized therapy.
• For patients with locally advanced disease, the focus is on aggressive combined modality treatment involving the use of chemotherapy and radiation sensitizers. These agents potentially augment the efficacy of radiation treatment, mitigate toxic side effects, and increase survival beyond that offered by radiation alone.
• More about Cervical Cancer

Patients with recurrent disease, or those who have not responded to initial therapy, may be candidates for participation in clinical trials of new chemotherapeutic agents or may undergo exenteration surgery, which in recent years has offered significant cure rates due to advances in surgical and supportive techniques. Additionally, intra-operative radiation therapy during surgery can potentially boost cure rates even higher.

Vulvar Cancer

Stanford offers advanced treatment approaches to vulvar cancer focused on maximal conservation of a woman's anatomy while enhancing survival rates.

• Our surgical approach to vulvar cancer is the extremely conservative technique of wide local resection, tailored to the characteristics of the lesion, retaining as much normal tissue and function as possible, rather than conventional en bloc removal of the entire vulva with adjacent nodes. The lymph nodes are removed by separate incision, thereby maximizing rates of primary union and minimizing lymphocyst formation.
• For advanced-stage patients, preoperatively administered chemotherapy with concurrent radiation is used to shrink the tumor, thus reducing the extensiveness of required surgery and potentially offering improved outcome.
• More about Vulvar Cancer

Endometrial (Uterine) Cancer

Treatment approaches for patients with endometrial a cancer are focused on optimizing postoperative therapy. Meticulous surgical staging is initially conducted to determine the extent of spread of the tumor so that therapy can be more precisely tailored.

• The Stanford team employs various postoperative radiation regimens, as well as chemotherapy, for patents with certain high-risk histotypes. Our doctors are also examining wither conventional postoperative pelvic radiation confers specific benefits to ally patients, or whether more selective assessment is indicated.
• For patients with recurrent or advanced cancer, several highly active new chemotherapeutic agents as well as hormonal therapy are available.
• The first studies of papillary serous endometrial carcinoma, performed at Stanford, have identified this particularly virulent form of the cancer and determined that more aggressive therapeutic approaches are needed. Treatment includes whole abdominal radiotherapy in certain locally advanced-stage cases.
• More about Endometrial Cancer

Other Gynecologic Tumors

Treatment options are available for patients with trophoblastic tumors, germ cell tumors, and gynecologic sarcomas. For trophoblastic tumors, a new serum diagnostic assay is currently employed, along with the quantitative BHCG assay. Prophylactic chemotherapy is under investigation to determine its relative benefits for certain high-risk patients.

Several new cytotoxic agents have offered close to 100 percent cure in early-stage germ cell tumors, with the preservation of fertility. Adjuvant chemotherapy and radiation therapy are available for thoroughly debulked and staged gynecologic sarcomas. Other innovative treatments, such as intra-arterial chemotherapy with surgical resection, are used for metastatic and recurrent disease.

• More about Gynecologic Cancers

Patient Education

The Gynecologic Oncology program at Stanford University Medical Center is dedicated to improving the healthcare of women with reproductive cancers by education and early detection. We offer ongoing, individualized education and supportive group sessions to help patients understand and cope with their disease and treatment options. We also provide frequent informational community programs to educate women on reproductive cancers and the importance of early detection.

Our physicians are also available for lecture presentations, tumor board discussions, or workshops on each of the gynecologic cancers and subjects related to cancer care for continuing medical education programs in area hospitals.

The Stanford Health Library offers customized research packets at no charge and requests can be submitted electronically. Information Packet Request Form: Stanford Health Library

To Refer A Patient

To refer a patient, or to obtain further information on the Gynecologic Oncology program at Stanford University Medical Center, please call the Stanford Womens Cancer Center at (650) 498-6004