A National Cancer Institute-designated Comprehensive Cancer Center

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Gynecological Cancers

Gynecologic Oncology Program - Our Approach
As a dedicated team of gynecologic oncology experts, we focus on compassionate, patient-centered, leading-edge care to save the lives of women.

A diagnosis of a gynecologic cancer is life-altering. The Gynecologic Oncology Program at City of Hope offers a unique approach for women diagnosed with all types of gynecologic cancer (cervical, ovarian, endometrial/uterine). Our expert team of physicians and laboratory researchers provides an integrated approach to treatment. These professionals work together to turn innovative scientific discoveries into more effective treatments for gynecologic cancers so we can improve our patients’ lives today.  At City of Hope, we focus on the patient as a whole, treating both the physical and emotional changes that a gynecologic cancer diagnosis can bring, while also addressing the needs of partners and families.

City of Hope’s Comprehensive Cancer Center is a member of the National Comprehensive Cancer Network, and our doctors are instrumental in creating evidence-based guidelines and are dedicated to providing the best cancer care available. City of Hope is one of the top programs in the nation for gynecologic cancer care as ranked by U.S. News & World Report.Our multidisciplinary team of dedicated surgeons, medical and radiation oncologists, nurses, genetic counselors, and social workers provides compassionate, individualized care as well as access to state-of-the-art technologies and treatments.

We tailor treatment according to the individual patient’s cancer characteristics.
 
  • We recognize that gynecologic cancer is different for every patient, and that each woman needs her own personalized treatment plan. We tailor our treatments to the patient according to age, genetics, psychosocial and spiritual needs.

 

  • Doctors in our world-renowned Clinical Cancer Genetics Program provide comprehensive consultations in cancer screening and prevention by assessing the cancer risk for individuals and families. They provide recommendations to prevent as well as detect gynecologic cancers at their earliest and most curable stage. This includes identifying patients at high risk for ovarian cancer who may be treated by curative oopherectomy by our surgeons.

 

  • We use state of-the-art imaging for accurate and rapid diagnosis and surgical planning to maximize the benefit of irradiation for gynecologic cancers, while minimizing unnecessary exposure.

 

  • We offer the latest modalities of tumor-debulking surgeries, minimally invasive robotic surgery, oncoplastic surgery, and reconstructive surgery to provide optimal cancer surgery and the best cosmetic outcomes.
 
  • We offer leading-edge fertility-sparing options for young women who want to preserve their fertility after treatment.
 
  • We are one of an elite number of gynecologic cancers programs in the country to routinely use intraperitoneal (IP) chemotherapy and/or heated intraperitoneal chemotherapy (HIPEC) to treat ovarian cancer, which can greatly improve the outcomes for women with advanced disease.
 
  • Through our drug-development program, we are constantly developing and evaluating new drugs, including immunotherapeutics and natural compounds, to better treat early-stage cancers and advanced metastatic disease.
 
  •  We assess the needs of cancer patients and family members using biopsychosocial screening that addresses the biological, psychological and social factors that all play a significant role in the lives of women diagnosed with cancer.
 
  • All gynecologic cancer patients can participate in our Survivorship Program. At City of Hope, care does not end after completion of treatment. Our doctors and researchers are working to develop resources to help improve the quality of life for survivors, and all patients are able to participate in ongoing long-term research related to life after cancer.
 
Combining the power of collaboration with a dedication to compassion, we seek to save the lives of women.
 
 
 
 

About Gynecologic Cancers

Gynecologic cancer is any cancer that begins in a woman's reproductive organs. There are five main types of gynecologic cancers defined by where they originate: cervical, ovarian, uterine, vaginal, and vulvar.
 
This type of cancer begins in the cervix, which is the lower, narrow end of the uterus (also called the womb). The incidence of cervical cancer has decreased sharply as Pap screenings have become more prevalent, and more than 75 percent of women can have good outcomes after current treatments.
This type of cancer begins in the ovaries, which are on either side of the uterus. Ovarian cancer is the eighth most common cancer among women with an estimated 22,280 new cases of ovarian cancer diagnosed in the U.S. in 2012. Ovarian cancer accounts for three percent of all new cancers in women.
There are many different types of ovarian cancer, which can be grouped into three categories:
  • Epithelial ovarian cancer: This is the most common type of ovarian cancer. It begins in the cells on the surface of the ovary or in the fallopian tubes.
  • Germ cell ovarian cancer: This is an uncommon type of ovarian cancer. It begins in egg-producing cells of the ovaries. This type of cancer is more common for young women (ages 10-29).
  • Sex cord-stromal ovarian cancer: This is a rare form of ovarian cancer that develops in the connective tissue cells that hold the ovaries together and make female hormones.
     
This type of cancer begins in the uterus, the pear-shaped organ in a woman's pelvis where the fetus grows when a woman is pregnant. Cancer of the uterus is the most common cancer of the female reproductive organs in the United States, with an estimated 47,000 new cases in 2013. Nearly 80 percent of these women will have good outcomes after treatment.
 
Vaginal cancer
This type of cancer begins in the vagina, the channel between the bottom of the uterus and the outside of the body.
 
Vulvar cancer
This type of cancer begins in the vulva, the outer part of the female genital organs. When vulvar cancer is detected early, it is highly curable.
 
The Gynecologic Oncology Program at City of Hope treats all types of gynecologic cancers.

Risk Factors

The risk of gynecologic cancers varies depending on the cancer type, with uterine and ovarian cancer more common than other types. The exact causes of gynecologic cancers are not known, but understanding the risk factors may help you take preventative measures to reduce the likelihood of developing a disease.
 
General
  • Age: Most cases of gynecological cancer are found in women who are middle-aged or older. Two-thirds of women diagnosed with ovarian cancer are 55 or older.
  • Childbearing status: Women who have never had a pregnancy are at increased risk of ovarian cancer. Scientists believe that the high number of lifetime ovulations in women who don’t have children is what increases risk. However, taking oral contraceptives at some point during your life, which reduces your number of lifetime ovulations, may decrease risk of ovarian cancer. Breast-feeding can also reduce the risk.
     
Lifestyle
  • Obesity: Being overweight increases your risk of uterine and ovarian cancers.
  • Smoking: Smoking may weaken the cells of the cervix, vulva and vagina, increasing the likelihood that abnormal cells will advance to cervical cancer, vulvar cancer, or vaginal cancer.
     
Genetics
  • Family history of gynecologic cancer or other cancers: If your mother, sister or daughter has been diagnosed with a gynecologic cancer, you are at increased risk. Your risk is also increased if you have a family history of other cancers, including breast cancer, colon cancer and rectal cancer.
  • Inherited gene mutations: Women with mutations in certain genes or whose families have genetic syndromes that increase risk of several types of cancer are at increased risk for gynecologic cancers. Mutations in the genes BRCA1 and BRCA2 increase the risk of ovarian cancer. A syndrome known as hereditary non-polyposis colorectal cancer (Lynch syndrome) increases the risk of ovarian cancer and uterine cancer.
     
Previous treatments or conditions
  • Radiation therapy: Women who have had radiation to the pelvic area are at a higher risk of developing a gynecologic cancer.
  • Hormone therapy: Menopause hormone therapy using both estrogen and progesterone is associated with an increased risk. Exposure in the womb to diethylstilbestrol (DES). This synthetic estrogen was prescribed to pregnant women until 1971 to relieve complications of pregnancy. It is now known that offspring of women who took this drug are at increased risk of cervical cancer and vaginal cancer.
  • Diabetes: Women with diabetes have a higher risk of developing uterine cancer. HIV or another condition that weakens the immune system: These conditions increase the risk of cervical, vulvar and vaginal cancers.
  • HPV infection: Infection with the human papillomavirus (HPV) can increase the risk of cervical, vaginal and vulvar cancers. HPV often does not cause any symptoms and infects at least half of all sexually active people at some point in their lives. Not every woman who gets HPV will develop gynecological cancer.
  • History of abnormal Pap smears: Women who have had abnormal Pap smears (pre-cancerous conditions) have increased risk of gynecologic cancers.
  • Tamoxifen: Taking this drug, often used to prevent breast cancer in women at high risk for that disease, slightly increases risk of uterine cancer.

Diagnosis

An accurate and thorough diagnosis is important so that your gynecologic oncology team can develop the best treatment plan for you. Your highly skilled team will use the most advanced and powerful diagnostic imaging technologies and laboratory techniques to plan your personalized treatment.

Imaging
 
Imaging studies give your gynecologic oncology team important information about changes that may be occurring in your reproductive organs.
 
Computed tomography (CT) scan
This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
 
Positron emission tomography (PET) scan
PET scan uses a small amount of radioactive substance to look for evidence of cancer in the body.

Magnetic resonance imaging (MRI) scan
Women who are at extremely high risk for developing gynecologic cancer because of family history, genetics or prior treatment may require closer screening with a pelvic MRI. A pelvic MRI scan is a highly sensitive imaging test that uses powerful magnets and radio waves to create pictures of the reproductive organs and surrounding tissue. It does not use radiation.
 
Ultrasound
Ultrasound uses high-frequency sound waves to examine reproductive organs. An ultrasound may be used to distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer. For a better view of the ovaries, a special ultrasound device may be inserted into the vagina (transvaginal ultrasound).

Biopsy
 
A biopsy is a test in which a sample of tissue or fluid is obtained through a needle or by removing a piece of tumor, which is then examined using a microscope. By examining the piece of tumor under the microscope, we can answer questions about the specific composition of the tissue.
 
Blood tests
 
The laboratory may check the level of several substances, including Cancer Antigen 125, which is found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of ovarian cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration for monitoring a woman's response to ovarian cancer treatment and for detecting its return after treatment.

Treatments

City of Hope is at the forefront of gynecologic cancer treatment. For women needing medical intervention, we take a comprehensive and aggressive approach to treatment offering state-of-the-art surgical, medical, and radiation therapies, including many that are not yet available to the general public. Our Supportive Care and long-term follow-up programs help women and their families manage the process of treatment and recovery.

City of Hope uses a multidisciplinary approach to treat gynecologic cancers. Our surgeons, medical and radiation oncologists, and laboratory researchers collaborate closely throughout treatment to ensure gynecologic cancer patients receive the best care possible.
 
 
 
Surgery

City of Hope offers the latest advances in the surgical management provided by specialty trained gynecologic oncology surgeons. The scope of surgery is determined by the type, size, and location of the cancer.

For women with gynecologic cancers, in particular ovarian cancer, our goal is to locate and remove as much of the tumor tissue as possible. This type of procedure, known as “debulking” surgery, helps us to understand the extent of the cancer in the ovaries and elsewhere in the abdomen, and allows us to remove all of the visible cancer.  Ultraradical debulking, a surgery in which as much cancer as possible is removed, followed with chemotherapy gives patients the best chance of a cure. We are experts in this procedure.
 
When appropriate for patients, our specialists utilize minimally invasive surgery with advanced technologies such as laparoscopy and the da Vinci S Surgical System with robotic capabilities that allow for greater precision. We are one of a select number of gynecologic oncology programs in the country to routinely offer this surgery.  These surgeries feature small incisions, potentially less blood loss, less pain, shorter hospital stay and recovery time, fewer complications, and a quicker return to normal activities.
 
Our team of world-class specialists offers the latest modalities for gynecological organ preservation, and we offer leading-edge fertility-sparing options for young women who want to preserve their fertility after treatment.
 
For women at high risk of developing gynecologic cancer, we offer a preventative surgery called salpingo-oophorectomy, which involves the surgical removal of the ovaries and fallopian tubes. This procedure can reduce the chance of ovarian and related cancers by as much as 80% in women at high risk.
 
Medical Oncology
 
Medicines that slow or stop the growth of cancer cells are often included in a patient’s treatment plan. These drugs travel through the bloodstream and are able to kill any small cancer cells that have leaked into the blood and may take root in other parts of the body. We offer the best treatments available and are constantly investigating promising new treatments, including novel chemotherapies, endocrine therapies, and immunotherapies to help save the lives of our patients.

Patients with small tumors or early-stage gynecologic cancers may receive chemotherapy alone, or before or after surgery. Neoadjuvant chemotherapy is given before surgery to help shrink the tumor. Adjuvant chemotherapy is administered after debulking surgery in order to “mop up” any remaining disease.  Patients may also be given hormonal therapies.

Patients with large primary tumors may be considered for neoadjuvant treatment. Patients with more advanced disease may also be candidates for new strategies developed to slow the spread of cancer. These may include combinations of standard drugs, investigational and targeted therapies or other options.
 
Intraperitoneal (IP) chemotherapy
We are one of only a select number of gynecologic oncology programs in the country to routinely use intraperitoneal (IP) chemotherapy and heated intraperitoneal chemotherapy (HIPEC) to treat ovarian cancer. IP chemotherapy and HIPEC deliver drugs directly into the abdomen during or after surgery. This type of chemotherapy can greatly improve the outcomes for women with advanced disease.
 
Radiation Therapy
 
Radiation therapy is often used in treating gynecologic cancers. It may be used as a stand-alone treatment for early-stage cancer, or in combination with surgery and other treatments in more advanced cases, to help reduce the chance of cancer recurrence. We also offer new investigational treatments for appropriately selected patients.
 
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. We use two types of radiation therapy used to treat gynecologic cancers:
 
  • External beam radiation therapy uses a machine outside the body to send radiation toward the cancer.
  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters that are placed into or near the cancer.
     
The way the radiation therapy is given depends on the type and stage of the cancer being treated.
 
Intensity modulated radiation therapy (IMRT)
IMRT targets tumors with pencil-thin “beamlets” of radiation. By sculpting the radiation to precisely match the tumor’s contours, a higher dose can be delivered to the cancer while avoiding unnecessary exposure of healthy tissues. Treatment with IMRT may also minimize certain side effects.
 
Click on the links to learn more about treatments for cervical cancer,   endometrial/uterine cancer or ovarian cancer .
 

Clinical Trials

In City of Hope’s Gynecologic Oncology Program, physicians collaborate extensively with laboratory scientists to develop and evaluate new therapies designed to treat gynecologic cancers and improve the likelihood of cure. Many of these new treatment approaches are only available at City of Hope. As a patient here, you may qualify to participate in a clinical trial of one of these new therapies. We offer access to a wide variety of clinical trials, including new chemotherapy and targeted therapies, hormone therapies, and surgical approaches to treating gynecologic cancers.
 
To learn more about our clinical trials, click here .
 
We are also deeply invested in research to better understand gynecologic cancers, the well-being of patients, and the needs of patients and their family members.
 
Some of the research questions we strive to answer include:
  • Why is there often a rapid and diffuse spreading of cancers from primary gynecologic malignancy sites?
  • Why are some cancers resistant to chemotherapy?
  • What are the potential long-term side effects for cancer survivors and how can we prevent or minimize them?
  • How can treatment of sexual dysfunction be addressed both physically and psychologically?
  • How can the use of psychotherapeutic interventions play a larger role in helping women cope emotionally during and after treatment?
 
Some of our most exciting current research projects include:
 
  •  Evaluating expression patterns of genes and potential protein targets from individual patient’s cancer stem cells.
  • Characterizing circulating tumor cells in patients with locally advanced and metastatic disease.
  •  Decoding mechanisms of resistance to therapeutic agents.
  • Identifying and interfering with unfavorable activations of genes and transcriptional and signal transduction pathways by studying microRNAs and a host of epigenetic modulatory components.
  • Developing novel therapeutics to treat metastasis.
  • Studying the role of STAT3, a protein highly activated in cancer cells, and developing drugs that block the tumor-regulating protein.
  • Examining the role of PARP inhibitors, a class of drugs that block a cancer cell’s ability to repair DNA damage caused by chemotherapy and radiation therapies. These drugs could make those treatments more effective.
  •  Studying a modified version of a PET scan that utilizes a special imaging agent to identify cervical cancer.
  •  Improving counseling and other support services for women at high risk of developing cancer who make the difficult decision to undergo preventative oophorectomies.
  •  Developing educational programs focused on the impact of HPV vaccination to reduce the risk of cervical cancer.
  • Studying survivorship with a focus on quality-of-life issues, prevention of secondary cancers, and other survivorship issues.
  •  Determining the role of diet and exercise in preventing the recurrence of ovarian cancer.
  •  Evaluating ways to decrease long-term side effects of gynecologic surgery.

Gynecologic Cancers Team

Support This Program

We deliver exquisite care at the leading edge of cancer treatment. It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts - and those of our supporters today -- have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies - helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact:

Janet Morgan

Senior Director
Phone: 213-241-7250
Email: jmorgan@coh.org

 
 
The Positive Image Center is where licensed cosmetologists support and assist patients with building and maintaining self-confidence in their appearance. Services are free and provide a forum in which patients can access wig fittings and stylings and discuss cosmetic techniques.
 
Cooper Finkel Women’s Health Center
Many gynecological cancer and breast cancer  services at City of Hope are provided at the Rita Cooper Finkel and J. William Finkel Women's Health Center. Here, women receive the highest quality care, whether seeking prevention and screening services or coping with a cancer diagnosis.
Treatments and Clinics
A national leader in cancer treatment and prevention, City of Hope is steadfast in its drive to offer more positive outcomes to patients everywhere. Our research innovations become advances in patient care without delay, because people fighting cancer need better options – now.

To make an appointment for yourself, a family member or a friend, please complete and submit our Become a Patient Request Form, or call City of Hope at
800-826-HOPE (4673).
The Sheri & Les Biller Patient and Family Resource Center embodies the heart and soul of City of Hope’s mission to care for the whole person.
Situated just northeast of Los Angeles, City of Hope combines the best science and the most innovative and highly compassionate patient care. Stretched across more than 100 acres in the City of Duarte, lushly landscaped gardens surround state-of-the-art facilities.
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