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School of Medicine
Through the Johns Hopkins Kelly Gynecologic Oncology Service, experts from various divisions and expertise form multidisciplinary teams to evaluate, treat and follow patients with gynecologic cancer. Specialized programs are available through the Johns Hopkins Ovarian Cancer Center and Cervical Dysplasia Center.
Gynecologic Cancer Experts
Studies done at Johns Hopkins and elsewhere show that patients treated by gynecologic oncologists (experts who specialize in the treatment of these cancers) have better outcomes than patients not treated by cancer specialists. Our gynecologic cancer experts develop comprehensive care plans, use the latest technology and offer innovative clinical trials to patients with gynecologic cancers.
About Gynecologic Cancers
Gynecologic malignancies include ovarian, uterine, and cervical cancers. Combined, they are the fourth most common cancers among American women.
Ovarian cancer generally ranks fifth in cancer deaths among women. It is often referred to as the silent killer as it causes very few symptoms. The risk of ovarian cancer increases with age, and family history of the disease is one of the most significant risk factors.
Cervical cancer is considered one of the most preventable gynecologic cancers with the development of a new vaccine to prevent HPV infection in young women. HPV infection causes the majority of cervical cancers.
Endometrial cancer is the most common cancer of the female reproductive organs and risk factors include obesity, hypertension, diabetes, inappropriate estrogen use, tamoxifen use, and late menopause.
Although aggressive new therapies are being evaluated by gynecologic cancer specialists at Johns Hopkins, early detection and diagnosis remain a woman's best opportunity to treat gynecologic cancers. Routine annual gynecologic examinations are the first line of defense.
Cervical cancer is the only gynecologic cancer that, in most instances, can be avoided by regular Pap test screening. The Pap test, a simple procedure that can be performed during routine gynecologic visits, detects pre-cancerous changes in the cervix. Following the development of this test, mortality rates from cervical cancer have dropped by more than 70 percent. Still, thousands of U.S. women will die annually from cervical cancer.
Our physicians offer valuable advantages in the diagnosis of gynecologic cancers. Because it is difficult to distinguish between some types of cancerous and benign cells on biopsies, our gynecologists created a special division headed by a gynecologist who is board certified in both obstetrics/gynecology and pathology (the study of tissue and cells). The field of gynecologic pathology was pioneered at Johns Hopkins, where specialized pathologists examine all gynecologic cancer tissue samples.
Unfortunately, few advances have occurred in the early detection of ovarian cancer, the most virulent gynecologic malignancy. Physicians still rely on physical examination, a blood test measuring levels of CA 125 and radiologic studies. Johns Hopkins gynecologic pathologists were some of the first to discover that some ovarian tumors are not cancerous or precursors of cancer. These tumors, known as "low malignancy potential," can often be removed by skilled gynecologic cancer surgeons without destroying a patient's fertility. This finding has been particularly significant for women who have not completed their childbearing.
Gynecologic Cancer Symptoms
Women should consult their physician if they experience:
- pressure, fullness or pain in the pelvis,
- abdominal bloating,
- abnormal bleeding
- painful urination
- pain during intercourse
- or changes in bowel and bladder patterns that continue and/or worsen.
Generally, ovarian cancer does not cause many early signs until the cancer grows. Early cervical cancer also does not cause many symptoms, but when the cancer spreads, women may experience abnormal bleeding and increased vaginal discharge. Abnormal bleeding is the most common symptom of endometrial cancer. Other symptoms may include difficult or painful urination, pain during intercourse, or pain in the pelvic area.
Gynecologic Cancer Treatments
Surgery, radiation, hormone therapy or chemotherapy may be used to treat gynecologic cancers. The treatment plan depends on a number of factors, including the type and stage of disease, the woman's age and her general health. Grants and shared research projects with the National Cancer Institute give Johns Hopkins unique added access to new treatments being evaluated for gynecologic cancers.
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins was one of the institutions that pioneered the clinical study of two FDA-approved drugs that are effective in treating ovarian cancer. One is Taxol, the drug made from the bark of the yew tree; the other is topotecan. Our patients who are eligible and choose to participate in clinical trials frequently have access to promising new drugs.
A team of researchers at the Kimmel Cancer Center has developed a possible new weapon in the fight against cervical cancer. Clinical studies of vaccine that tagets an antigen of the human papillomavirus (HPV) most commonly associated with cervical cancer are underway. The vaccine works by activating the immune system against all cells expressing the antigen. Investigators expect this new therapy will stop the progression of precancerous lesions to actual cancers. More information about new treatments for abnormal pap smears is available through the Johns Hopkins Center for Cervical Dysplasia. In women diagnosed and treated for cervical cancer, the researchers are hopeful that the vaccine will clear residual tumor remainig following surgery or other treamtents. Our researchers believe this vaccine will be a model not just for cervical cancer but also for other virus-associated cancers.
Gynecologic Cancer Risk
The Johns Hopkins Breast and Ovarian Surveillance Service (BOSS) uses research dicoveries about the inherited predispositions and the genetic causes of gynecologic and breast cancers to provide individualized risk assessment for women. BOSS experts discuss cancer susceptibility and risk factors, genetic testing, and screening and prevention with patients.