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    Breakthrough Treatments Advance Care for Gynecologic Cancer

    The symptoms seemed so innocuous - feeling bloated, not sleeping well, fatigue - the kinds of maladies any woman might feel on any given day. So it was a shock when last June, 46-year old Christie Stokes, a globe-trotting event marketer and mother of two, discovered she had ovarian cancer.

    "I remember my husband giving me this look, Christie recalls. "He was being strong, but he was stunned as well. Meanwhile, 1 kept thinking how will the kids react? Will I be bald, lying on the sofa? I've always been very strong and I've never been sick. Could I even be a sick person?

    What Is Gynecologic Cancer?
    The term "gynecologic cancer" is an umbrella term that covers ovarian, cervical, uterine and lower-genital, vaginal cancers.

    Dealing wh all these different forms of the disease is John K. Chan, M.D., Denise & Prentis Cobb Hale Endowed Chair of Gynecologic Oncology at Sutter Health's CPMC.

    "The good news is, because of the success of the HPV vaccine, we hope to see fewer cervical cancers," says Dr. Chan. "Uterine cancer is associated wh obesity, so that is actually preventable and treatable, too." Ovarian cancer remains the most challenging, he says, but there is new hope on the horizon.

    Fighting Ovarian Cancer
    Because the symptoms of ovarian cancer are vague and nonspecific, women often get diagnosed after the disease has advanced. "About 70 percent of ovarian cancer is detected in its later stages," says Dr. Chan.

    By this point, treatment can be challenging. In Dr. Chan's experience, the key to a more positive outcome is immediate, aggressive surgery, followed by intensive chemotherapy to help ensure that the cancer will not
    return. "Because if ovarian cancer returns, it frequently becomes chronic, decreasing the chances of a patient being cured," says Dr. Chan.

    In Christie's case, Dr. Chan discovered a tumor on the outside of her ovary. He removed the tumor and then, to be safe, performed a full hysterectomy and a staging procedure to guide systemic treatment.

    "He had told me up front that he would take out any extraneous tissue that the cancer might have touched," says Christie. "It made me feel more confident knowing that I'd have a better chance of beating this disease."

    Following her surgery, Christie began six rounds of chemotherapy, going to the infusion center every week for four months. “The actual procedure wasn’t that rough,” she says, “and the anti-nausea drugs worked amazingly well.” Though she was tired, she found she was able to continue to work, although she curtailed her travel.

    In addition to clinical care, CPMC’s Women’s Health Resource Center offers patients yoga, massage, nurse practitioner consultations, wigs, and a "Look Good, Feel Better" program in conjunction with the American Cancer Society.

    “I did pretty much everything they had to offer,” says Christie, who even did acupuncture. Barb Silver, N.P., manager at the Women’s Health Resource Center, arranged for the acupuncture. “Barb was always there to listen, to answer any questions, big or small—just to care,” says Christie.

    A Record Year for Breakthroughs
    “The wonderful news about gynecological oncology is that 2014 was the best year since 1995 for scientific breakthroughs,” says Dr. Chan. The FDA approved three very promising drugs for the treatment of ovarian and gynecologic cancers, and others are pending.

    “I’ve never seen this many advancements before in my career,” says Dr. Chan. “This is all because of the hard work of clinical trial researchers and patient volunteers who are willing to help us advance medicine so future generations can have more cures.” Currently, he says, CPMC has more gynecologic cancer clinical trials in progress than any other medical center or academic institution in the Bay Area.

    As principal investigator of Sutter’s Cancer Research Consortium, Dr. Chan is working on one of the largest ovarian cancer clinical trials in the country. Using a chemotherapy drug that is known to be tolerated, Dr. Chan describes a study he calls “dose-dense chemotherapy combined with immunotherapy” in which the patient receives a more intensive dose of medicine on a more frequent basis. “So far we’re seeing less specific toxicity and better outcomes,” he says.

    Currently, CPMC trials are also underway to study post-cancer women in the areas of nutrition, exercise and stress management.

    A Trio of Promising Advances
    Other improvements in the treatment of gynecologic cancer include: enhanced forms of minimally invasive, highly precise surgical techniques; cellular immunotherapy; and extremely personalized drug therapies.

    With advances in gynecologic surgery, doctors can use tiny ports to operate through dime-size incisions, helping patients recover more quickly. Many Sutter Health doctors, including Dr. Chan, are skilled in robotic and minimally invasive surgeries.

    “The robot has a firefly-type light on the end of it, which illuminates the patient’s lymph nodes,” explains Dr. Chan. “We can see the nodes clearly in the midst of the operation and remove only the cancerous areas. This means fewer complications and more rapid healing.” Additionally, radiation therapy now targets only the affected area, offering pinpoint accuracy.

    Cellular immunotherapy is also big news. Traditional chemotherapy was used to “poison” the cancer cells. “Now we take the patient’s own cancer-fighting cells out of their bodies, grow them in the lab, then reintroduce them back into the woman’s body,” says Dr. Chan. “So instead of poisoning the tumor, we use the woman’s own immune cancer-fighting cells to attack and block vessels that feed the tumor. This results in significantly less risk and toxicity.”

    Last, oncology professionals are using targeted biologic therapy. “Not every drug works on every patient,” says Dr. Chan.

    Using specialized diagnostic tools to identify specific genomic characteristics of each tumor, oncologists can hone in on and select only the most effective drugs for that individual.

    No Two Alike
    Dr. Chan emphasizes that each patient’s age, cell type, stage of cancer, etc., is unique. “And there are so many ways available now to attack cancer,” he says. “It’s not a slam dunk.” That’s why treatment is tailored specifically to each woman.

    “This is a message of hope,” he continues. “But it’s also a message of need. Never before have we had this ability to understand cancer and its mutations so well. But, because funding is disappearing, we now have the least amount of money for further research. Clinical trials are expensive, he says, sometimes costing over $1 billion to bring a single drug from concept to completion. “We need help from the community—from patients, the government and advocacy groups—to bring these new agents to fruition if we’re to improve our cure rates.”

    An Optimistic Outlook
    Now finished with surgery and chemotherapy for ovarian cancer, Christie Stokes of San Francisco, alongside her husband Nick, says "Everyone at CPMC provided outstanding care and I'm so grateful. I never felt alone."

    Christie finished chemotherapy in December and says she’s already feeling better. Her last scan in January was clear and, according to Dr. Chan, her chances are very strong that she will never have to deal with ovarian cancer again.

    “Everyone at CPMC provided outstanding care and I’m so grateful,” says Christie. “I never felt alone. There was so much support through CPMC and my community of friends. It makes you a better person in a way because you can see how truly good people are.”

    Warning Signs of Ovarian Cancer

    The symptoms of ovarian cancer are subtle and easy to miss, and there is no routine screening test available. What makes it difficult to detect
    is that any one of these symptoms could be caused by non-cancerous conditions. But telltale signs to watch for include:

    • Persistent abdominal bloating, indigestion or nausea that does not resolve
    • Changes in appetite, often a loss of appetite or feeling full sooner
    • Feelings of pressure in the pelvis or lower back
    • Needing to urinate more frequently
    • Changes in bowel movements
    • Increased abdominal girth
    • Feeling tired or low energy
    Routine gynecologic care and annual pelvic exams are currently the best way to screen for symptoms of ovarian cancer. If you have a family history of ovarian cancer or any other risk factors, you may want to talk with your doctor about genetic testing and other steps to minimize your risk.

    How You Can Help

    Innovative research is crucial to the future treatment of women with gynecologic cancers and CPMC’s Dr. John Chan is known worldwide for his work developing innovative new therapies. “We’re making great progress,” he says, “but the irony is, as our knowledge about how to create better treatments is increasing, funding for the research is going down dramatically.”

    To invest in this pioneering, potentially life-saving research, or to underwrite the supportive services patients receive at the Women’s Health Resource Center, please contact Leslie Watanabe at watanal@SutterHealth.org.