Ask the Expert: Gynecologic Oncology
Beverly Hannah Ortiz, MD Surgeon, Gynecologic Oncology, St. Charles Hospital
There are only about 1,200 board-certified gynecologic oncologists across the nation. What particular skills and knowledge do these specialists have?
Dr. Ortiz: Gynecologic Oncologists treat cancers of the female reproductive organs. We are fully trained as OB/GYNs. Then we train for an extra 3 to 4 years in Gynecologic Oncology. This includes abdominal general surgery, chemotherapy, radiation oncology, molecular biology and cancer genetics. We are the surgery back-up for gynecologists. In addition to cancer surgery, we do surgery on complex benign diseases such as fibroids, endometriosis, complex ovarian cysts and suspicious masses that could be cancerous.
How do you address the anxiety that many patients could experience upon being referred?
Dr. Ortiz: When patients come into the office and realize they are in a cancer practice, they get very nervous. Our first task is to explain what a gynecologic oncologist does and remind them that, no matter what, their cancers are completely treatable and survivable. This treatment may require surgery, chemotherapy or radiation. I remind patients that it is a journey that we will take together. No question is trivial. We want them to understand what will happen and take time to describe every aspect of their care. We encourage questions and involve family members. Our goal is to reassure and respect - to help people face the challenge.
Robotic surgery is increasingly used in many surgical disciples. Is this the case in gynecological oncology?
Dr. Ortiz: There are generally multiple ways to accomplish anything, and surgery is no different. I give my patients all of their options and explain why one is better than the other for them. Robotic surgery really has become the mainstay of gynecological oncology because it gives us much more vision and dexterity when working in difficult spaces. With the DaVinci, I have the precision needed to remove the uterus’s sentinel lymph node, which lives on blood vessels and dictates whether the other lymph nodes in that chain are cancerous. The ability to remove that specific node reduces the risk of the surgery and can translate into less lymphedema and shorter hospital stays. I do still perform laproscopic surgery for something that is benign. In addition, surgeries for ovarian cancers continued to be performed as open surgeries, which are surgeries that require incisions. There is also a whole body of data, hot off the presses in 2018 and 2019, that says unequivocally, if you are going to perform surgery for cervical cancer, it needs to be performed as an open surgery, rather than a robotic surgery.
What about genetics and genetic testing for gynecological cancers?
Dr. Ortiz: Genetically, there is a lot of overlap between cancers. We know about at least five genes that are associated with an increased risk for not only breast and ovarian cancer, but also pancreatic cancer. There is another whole set of genes where the risk for uterine, colon, and some ovarian cancers overlap. So when looking at family history and considering genetic testing, it is important to look at all types of cancers experienced in your family, in the men as well as in the women. Any doctor’s office is the right place to bring up the subject of genetic testing because your primary care physician might not.