Andrew Berchuck, MD, is director of gynecologic oncology at Duke, and a past president of the Society of Gynecologic Oncologists, the leading organization of gynecologic oncologists in the U.S. He treats women with ovarian, endometrial (lining of the uterus), and lower genital tract cancers, and conducts research on ovarian and endometrial tumor formation. We asked Dr. Berchuck what the future holds for the prevention, diagnosis, and treatment of gynecological cancers.
What are gynecological cancers?
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 progress has been made in treating and preventing gynecological cancers?
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 fallopian tubes and ovaries removed before cancer develops.
Also, since the FDA approved the vaccine that prevents human papillomavirus (HPV) infection -- which can cause cervical cancer -- the vaccine has become widely used. 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 gynecological cancer prevention and treatment?
More funding for research is needed because there are no good screening tests to determine if a woman has early-stage ovarian cancer.
Better prevention strategies are also needed to reduce the risk of ovarian cancer. Joellen Schidlkraut, PhD, and I initiated the The North Carolina Ovarian Cancer Study in 1999 to better understand the origins of ovarian cancer in the 90 percent of women who do not have BRCA1 or BRCA2 mutations. About 4,000 subjects were enrolled in the North Carolina study and this research has evolved into an international collaboration that includes over 70,000 subjects. Our consortium has identified several other genetic changes that also predispose women to ovarian cancer. The ultimate goal is to develop risk prediction models based on genetic and reproductive risk factors, such as pregnancy and use of oral contraceptives that are protective against ovarian cancer. Hopefully, in the future each woman will be more aware of their individual risk of ovarian cancer and options for prevention and early detection.
While prevention is very important, we also need more effective treatments. That is also an important focus of our efforts here at Duke.