Sage Chapman had been feeling off for weeks. Her abdomen hurt, and even the smallest of snacks would leave her uncomfortably full.
One day at work, the 39-year-old sign language interpreter experienced bouts of nausea so severe that she feared she had appendicitis. Twelve hours of tests and imaging at a nearby emergency department revealed the culprit: two large tumors that were consuming her ovaries.
Chapman, who lived in Washington, D.C., at the time, didn’t know yet if the masses were malignant. But she left the hospital knowing she needed a gynecologic oncologist — a doctor who specializes in diagnosing and treating cancers and pre-cancers of female reproductive organs.
She chose Mildred Chernofsky, M.D., a Johns Hopkins surgeon at the Sibley Center for Gynecologic Oncology and Advanced Pelvic Surgery and an assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine.
Chernofsky has treated gynecologic cancers since 2002, first at Walter Reed Army Medical Center and, starting in 2009, with the Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital. She is part of a multidisciplinary team that treats reproductive cancers in women.
Chapman and Chernofsky quickly developed a rapport. “I like information, I like to ask a lot of things,” says Chapman, now 46. “Dr. Chernofsky is very matter of fact. We are a perfect match.”
Chernofsky removed the tumors (a process known as debulking), along with Chapman’s uterus, fallopian tubes, ovaries, appendix and some lymph nodes.
Biopsies of the removed tissue delivered grim news. Chapman had stage IIIC ovarian cancer.
Sitting in the oncologist’s office with her mother and aunt by her side, Chapman struggled to digest the diagnosis. She had a simple question for Chernofsky: “Am I going to die?”
She still remembers the doctor’s confident answer. “She said, ‘You’re going to be stuck with me for a few more years.’ I stopped crying and I started laughing,” says Chapman. “I could tell she wasn’t just placating me.”
That was in April 2013, and Chernofsky’s prediction, based on decades of experience, proved accurate.
After the surgery, Chapman saw Bruce Kressel, M.D., medical oncologist at the Kimmel Cancer Center at Sibley Memorial, for chemotherapy.
“She has been disease free for more than seven years, since completion of her last chemotherapy on Nov. 1, 2013,” says Chernofsky. “This bodes very well that she could remain cancer free, which is spectacular considering the stage of her cancer.”
Chapman, who now lives in Northern Virginia, says Chernofsky saved her life, and she is “forever grateful.”
About 100,000 women in the U.S. are diagnosed with gynecologic cancers each year. Of those, about 65,000 have endometrial cancer — cancer of the uterine lining. The rest are cancers of the ovaries, cervix and fallopian tubes; sarcomas of the uterus, vagina and vulva; and trophoblastic cancers (which grow in the uterus of pregnant women after conception).
Symptoms of gynecologic cancer include pelvic-area pain, post-menopausal or other abnormal vaginal bleeding, and discomfort during intercourse, says Chernofsky.
Many gynecologic cancers can be “very curable,” she says, particularly if diagnosed early.
Other Johns Hopkins doctors at the Sibley Center for Gynecologic Oncology and Advanced Pelvic Surgery are Jeffrey Lin, M.D., the center’s director and an assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine; Daniel Gruber, M.D., M.S., medical director of urogynecology (incontinence and pelvic organ prolapse) at Sibley Memorial Hospital and an assistant professor at the school of medicine; and Jeanine Staples, M.D., M.P.H., an assistant professor of gynecology and obstetrics. Gruber and Staples joined Johns Hopkins in September 2020.
The center performs about 600 gynecologic surgeries per year. That will likely rise to about 850 with the addition of the new surgeons, says Chernofsky.
The doctors work with medical and radiation oncologists at the Kimmel Cancer Center to add radiation therapy or chemotherapy to treatment when needed. Those decisions depend on the kind of cancer, cell type and how far the malignancy has progressed, says Chernofsky.
For example, treatment of the most common cell type in endometrial cancers often starts and ends with removal of the uterus, fallopian tubes and ovaries with a robot-assisted minimally invasive procedure that typically requires a single night in a hospital.
Some endometrial cancers need treatment in addition to surgery, such as chemotherapy or radiation. Cancers of the cervix and vulva can require surgery or chemoradiation (chemotherapy at the same time as radiation). Ovarian cancers generally need more extensive surgery and chemotherapy.
Chernofsky’s years of experience help her speak knowledgably with patients about their treatment options. Loss of reproductive organs can be deeply personal, even for women who are past their pregnancy years.
Chapman says she feels comfortable talking to Chernofsky about symptoms of her surgery-induced menopause, including vaginal dryness, which is a common side effect. “She was very helpful and got it rectified for me,” says Chapman.
Many of Chernofsky’s patients came to the Sibley Center for Gynecologic Oncology and Advanced Pelvic Surgery after their primary care doctor or gynecologist detected tumors in their reproductive organs that may have been malignant.
“I’ve looked at hundreds of masses over the years, so I have an archive in my head of what might be benign and what might be cancer,” says Chernofsky. “I can say to a patient, ‘I think this is benign, but it depends on the pathology.’ Sometimes you have to just wait and see.”