Andrew Berchuck, MD, is director of gynecologic oncology at Duke and holds the F. Bayard Carter Distinguished Professorship. In addition to treating patients with ovarian, endometrial (lining of the uterus), and lower genital tract cancers, he conducts research on the molecular-genetic alterations involved in ovarian and endometrial tumor formation.

Dr. Berchuck just completed a term as president of the Society of Gynecologic Oncologists, the leading organization of gynecologic oncologists in the United States. We asked Dr. Berchuck to discuss what progress has been made in the prevention, diagnosis, and treatment of gynecological cancers and what the future holds.

Can you briefly describe gynecological cancers?

Andrew Berchuck: Gynecological cancer refers to several types of cancers that impact the female reproductive systems. Uterine cancer is the most common while ovarian is the most deadly. Each cancer has different symptoms. These cancers can be difficult to diagnose because many of these symptoms, such as bloating for ovarian cancer or bleeding for endometrial cancer, can also be symptoms for other conditions. Treatment options for gynecologic cancers are based on the individual patient’s tumor characteristics and may include a combination of surgery, chemotherapy, and radiation.

What kind of progress has been made in treating and preventing gynecological cancers?

Andrew Berchuck: We are in the golden age of medical progress -- we’ve made great strides in the last few decades. One example is the use of minimally invasive laparoscopic or robotic surgery for endometrial cancer, which uses tiny incisions and enables the patient leave the hospital the next day. I routinely perform this procedure as do other oncologists at Duke.

Another advance is the discovery that women who carry mutated BRCA1 or BRCA2 genes have an increased risk of developing ovarian cancer. Our team at Duke was part of the international consortium that was involved in the discovery of these genes. Patients with these mutated genes make up 10 percent of ovarian cancer cases, so we can save the lives of many women each year if every woman who has a family history of ovarian cancer receives a genetic risk assessment. Women who find they have an elevated risk can decide whether or not to have their ovaries removed before cancer develops.

I’m very excited about the FDA approval last year of the vaccine that prevents human papillomavirus (HPV) infection, which can cause cervical cancer. Between the vaccine, the use of Pap smear, and HPV screening, hopefully cervical cancer can largely be eradicated in the coming decades.

What are the next steps in preventing and treating gynecological cancers?

Andrew Berchuck: More funding for research is needed because there are no good diagnostic tests to determine if a woman has early stage ovarian cancer. I am happy to say that Senators Elizabeth Dole and Barbara Boxer have introduced The Ovarian Cancer Biomarker Research Act of 2008 that would authorize the National Cancer Institute to make grants to public or nonprofit entities to establish research centers focused on ovarian cancer biomarkers. (The House has introduced similar legislation.) Biomarkers would indicate the probability of a woman developing ovarian cancer and may indicate which treatments would be most effective, much like the PSA test for prostate cancer. At Duke, we are conducting research to find these biomarkers.

Better prevention strategies are needed to reduce the risk of ovarian cancer. The North Carolina Ovarian Cancer Study was initiated in 1999 by Joellen Schildkraut, PhD, and me in an effort to better understand the origins of ovarian cancer in the 90 percent of women who do not have BRCA1 or BRCA2 mutations. There is strong evidence to suggest that reducing numbers of lifetime ovulations and use of analgesics are protective against ovarian cancer.

While prevention is very important, we also need more effective treatments. We are initiating clinical trials at Duke that seek to determine which therapies will work best for a particular patient based on a genomic analysis of her cancer -- personalized medicine. The hope is that this will not only cure more patients, but also spare patients from the side effects of ineffective treatments.