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Treatment

Factors evaluated include:

  • Stage of your cancer (localized vs. advanced)
  • Pathological and molecular profiling
  • Your general health and treatment goals

Your doctor will discuss the recommended treatment plan with you and, together, you and your doctor will decide on the approach that is right for you.  It may include one or a combination of several of the following types of treatment:

  • Surgery
  • Systemic therapy (a type of chemotherapy that includes targeted therapy)
  • Radiation therapy
  • Palliative care
  • Clinical trials

Surgery  

The goal of gynecologic surgery is to eliminate all traces of disease. The type of surgery that may be used to remove your cancer depends on the size and spread of the tumor and whether or not you plan to have children in the future. Surgery may include the following:

  • Laparoscopic and minimally invasive surgical techniques including da Vinci robotic surgery: The robotic surgical platform offers important advantages, including superior visualization, greater precision and a lower rate of complications.
  • Hysterectomy: The surgical removal of the uterus. Different portions of the uterus, as well as other organs, may also be removed in the same procedure.
  • Oophorectomy:  The surgical removal of one or both ovaries and the fallopian tubes
  • Total hysterectomy and oophorectomy:  Surgery to remove the uterus, cervix and both ovaries and fallopian tubes
  • Open laparotomy and debulking:  If it is not possible to completely remove a tumor, your surgeon may recommend taking out as much as possible.

Systemic Therapy

The latest approach to treating gynecologic cancers involves tailoring treatment to each patient’s cancer and health status and goals. Called systemic therapy, this involves different types of drug treatments as listed below.

The decision to use systemic therapy is based on many factors, including the stage of your cancer, the results from surgery, information on pathology (the tissue evaluation) and your overall condition. Systemic therapies are drugs that travel throughout the body to control, slow or cure your cancer. They include chemotherapy, targeted therapies and endocrine therapy. Systemic therapy may be used alone or in combination with surgery or radiation.

Chemotherapy      

Chemotherapy drugs are used to fight and kill cancer cells. Chemotherapy is associated with side effects, but there are many medications today to help reduce these. Chemotherapy is sometimes given intravenously (by infusion through a vein in your arm or port), via intraperitoneal delivery (into the abdominal cavity) or orally, taken as a pill. Most patients have a series of treatments over several weeks or months.

Chemotherapy can be used in several ways:

  • To decrease the risk of spread of cancer
  • Prior to surgery, to shrink a tumor so it is easier to remove
  • After surgery, to ensure that no cancer cells remain after the tumor has been removed
  • As a palliative therapy, to reduce pain and other symptoms of advanced cancer
  • As maintenance therapy

Targeted Therapy

Targeted therapies work differently from standard chemotherapy. They are typically oral medications that work by “targeting” specific DNA abnormalities within the cancer cells. The target is chosen after a thorough analysis of a patient’s tumor specimen.  Herceptin, which targets HER2, was one of the first targeted therapies.  These are truly personalized cancer medicines.

For more information on targeted therapies: http://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet

Endocrine Therapy

Oral or injectable medications used to block hormones that may be fueling or adding to the growth of cancer cells. 

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

This advanced treatment combines the surgical removal of most visible abdominal tumors with heated, cancer-fighting drugs that are delivered directly into the abdominal cavity.

Used primarily to treat advanced-stage abdominal cancers, HIPEC is an especially powerful treatment for several reasons.  First, cancer cells are more vulnerable to heat than healthy cells. Second, because the chemotherapy is largely isolated to the abdomen, a more potent dose can be delivered. This maximizes the power of the drug while minimizing the toxicity and side effects typically associated with intravenous chemotherapy.

HIPEC is delivered as the second phase of a surgical procedure. During the first phase, your surgical oncologist explores the abdominal cavity to find and remove as much of the cancer as possible. Next your surgeon administers a heated chemotherapy solution that is circulated throughout the abdomen to kill off any remaining cancer cells.

For more detailed information on chemotherapy: http://www.cancer.gov/about-cancer/treatment/types/chemotherapy  

Radiation Therapy

Radiation therapy, the precise and controlled use of radiation to kill cancer cells, can provide effective treatment for cancer. Here at WCHN, our highly skilled radiation oncologists use advanced technology that adapts to your breathing cycle. This ensures accuracy and protects nearby tissue as high doses of radiation therapy are delivered to your cancer. Our techniques include:

High Dose Rate (HDR) brachytherapy:

High Dose Rate (HDR) brachytherapy is a leading-edge treatment that allows radiation oncologists to deliver precise radiation treatment directly to cancerous tumors. This is done by using catheters or applicators inserted into a body cavity or directly into the tissue. It is frequently used in the treatment of cervical and uterine cancers.

External beam radiation

External beam radiation delivers a beam of high-energy x-rays destroy cancer cells. External beam radiation gets its name from the fact that the beams come from an external source (a machine called a linear accelerator) that aims them to the site of the tumor.

We offer several types of external beam radiation:

  • Image-guided radiotherapy (IGRT)
  • Intensity-modulated radiation therapy (IMRT)
  • 3D conformal radiation therapy
  • Volumetric modulated arc therapy (VMAT)

Clinical Trials

Clinical trials are research studies that evaluate the safety and effectiveness of new methods or drugs to treat cancer or procedures to diagnosis or screen for cancer. Participation is always voluntary. WCHN’s research program is part of a premier regional cancer network that includes Danbury, New Milford and Norwalk Hospitals. Clinical trials at WCHN come from a wide variety of sources, including the National Cancer Institute (NCI), pharmaceutical companies, nearby university cancer centers, as well as well as those developed at the WCHN.  Our goal is to offer you the most promising emerging treatments available.

  See Link for available clinical trials

Gynecologic Oncology Program