Advancing Gynecologic Cancer Treatment Through Research

At the Podium – January 2008

By David Mutch, MD

At the risk of stating the obvious, medicine is a rapidly changing field. Generalists and specialists alike routinely adjust the care they offer to patients based on evidence produced through basic, clinical and epidemiological research and disseminated through journals, individual medical societies, continuing education and even informal dialogue among providers.

As part of an academic medical center, the gynecologic oncology program at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is privileged to be involved in the process of advancing medicine. Through their research and teaching, the faculty members in our program help ensure patients across the country receive the best care available at any given time.

For example, professor L. Stewart Massad, MD, who joined our program this fall, served as co-author of consensus guidelines for the treatment of women with abnormal Pap results and cervical cancer precursors that were recently released by the American Society of Colposcopy and Cervical Pathology. The guidelines were revised in response to data showing a higher risk for preterm delivery in women previously treated for cervical precancers.

At Siteman, Dr. Massad and I are joined by three other gynecologic oncologists who treat about 650 new patients with invasive cancer annually, many of them in new space on our main campus that consolidates outpatient services in one location. This volume results in about 1,300 chemotherapy admissions, 1,500 surgical procedures and 10,000 outpatient visits each year. Our team includes 30 nursing and support staff members who deal exclusively with gynecologic cancer patients, and we work closely with Siteman specialists in such areas as radiation oncology, medical oncology and pathology to provide a multidisciplinary approach to treatment.

Given the size of our program and the broad expertise of our team, we participate in a large number of clinical trials. Many of these trials are available through Siteman’s membership in the Gynecologic Oncology Group and Radiation Therapy Oncology Group, cooperative research groups sponsored by the National Cancer Institute (NCI). Adding in studies of new cancer therapies developed by our own faculty, we currently offer approximately 40 clinical trials, more than any other gynecologic oncology group in the Midwest. These trials provide important opportunities for women interested in receiving potentially lifesaving new treatments for their disease – or who hope the knowledge gained by their participation will help others in the future.

On the basic research front, we are looking into the genetic roots of endometrial and cervical cancer with the goal of preventing their occurrence and developing more effective treatments. My colleague Paul Goodfellow, PhD, a geneticist, and I have uncovered genetic abnormalities that play a critical role in tumor development in endometrial cancer. We’ve successfully identified a subgroup of women who are susceptible to this cancer because of inherited mutations in important DNA repair genes. These insights have led to changes in clinical care for these patients and their close relatives. Now we are searching for the molecular changes that lead to the development of nonhereditary, sporadic endometrial cancers. We hope to expand our research in this area through funding from the NCI.

Professor Janet Rader, MD, has a similar goal as she explores the genetics of cervical cancer to better understand who is at risk and target screening or tailor treatment accordingly. In a current NCI-funded study, she is looking at the specific characteristics of human papillomavirus (HPV) – an underlying factor in cervical cancer. To date, she has found some interesting genes involved in the immune response that may be important in clearing the body of HPV. Further work is being done to study variations in the DNA code of these genes in women with cervical cancer or cervical intraepithelial neoplasia. Inheritance factors also are under investigation.

Ultimately, we hope the research we undertake at Siteman bears fruit for our own patients and other women affected by gynecologic cancers. The advances we’ve seen in our field in the last 20 years give us reason for optimism. In the 1980s, the median survival for ovarian cancer was 24 to 36 months or less. Now, some subsets of patients treated aggressively with surgery and such therapies as intraperitoneal chemotherapy – chemotherapy delivered directly into the peritoneum – have a median survival of 10 years or more. Treatment modalities like intensity-modulated radiation therapy allow us to fight cancers in a much less toxic way. And laparoscopic surgery techniques, such as the robotic surgeries performed by our team’s Matthew Powell, MD, offer patients increased precision and shorter recovery times.

Perhaps in another 20 years, we will be able to tell more women affected by gynecologic cancers that their disease is not a death sentence. That’s the goal that guides our team at Siteman to embrace and drive the process of change.

David Mutch, MD

David Mutch, MD, is the Ira C. and Judith Gall Professor of Obstetrics and Gynecology and chief of the Division of Gynecologic Oncology at Washington University School of Medicine.

You can hear Dr. Mutch as a guest on Cancer Connection, Siteman Cancer Center's podcast series.

Womens Cancers at Siteman.