Medical Specialties & Services

Gynecologic Oncology

Gynecologic Oncology

The Gynecologic Oncology department specializes in the diagnosis and treatment of cancers pertaining to the reproductive organs of women. We work very closely with radiation oncologists, medical oncologists, social workers and other health care providers to bring you the most comprehensive medical care. 

The types of cancer we treat include:

Ovarian Cancer

Ovarian cancer is a cancer that starts within the cells of the ovary. Each female has two ovaries, one on each side of the uterus. Within the ovaries, eggs are produced, along with the hormones, estrogen and progesterone. Ovarian Cancer is most commonly diagnosed in women aged 50-65. 

Risk factors for Ovarian Cancer

  • Obesity
  • Infertility
  • Genetics: a strong family history that includes breast and/or ovarian cancer may increase your risk of ovarian cancer. If you have a known BRCA mutation, that also increases your risk of ovarian cancer. 

Symptoms of Ovarian Cancer

  • Abdominal pain or bloating
  • Abdominal weight gain
  • Frequent urination
  • Feeling full or difficulty eating
  • Nausea
  • Diarrhea or constipation
  • Vaginal bleeding

Early on, ovarian cancer may not produce many symptoms. As the cancer continues to grow, generally the above symptoms are most common. 

Diagnosis

Springfield Clinic physicians who suspect ovarian cancer in a patient will order some of the following tests depending on case:

  • Imaging: ultrasound or CT scan
  • Blood Tests: CA-125 is a tumor marker that can sometimes be helpful in the diagnosis of ovarian cancer
  • Biopsy: a procedure in which tissue may be sampled from the ovaries. The only way to definitively diagnose ovarian cancer is through a biopsy or surgery. 

Treatment of Ovarian Cancer

  • Surgery:
    • Staging: The first goal is to stage the cancer, which means to see how far the cancer has spread from the ovaries. This typically involves removing the uterus, fallopian tubes and ovaries. Also, the omentum will be removed (omentectomy). The omentum is a layer of fatty tissue that covers the contents of the abdominal cavity and there is a chance the cancer could have spread to this tissue. Some patients accumulate ascites (fluid in the abdomen) prior to surgery. If so, this fluid will be drained during surgery.
    • Debulking: The other important goal for surgery is to remove as much of the cancer as possible, this is called debulking. In some situations, the surgeon may need to remove a portion of the colon that is involved with tumor. If this occurs, there is a possibility that the end result may be a colostomy. A portion of the colon is attached to an opening (stoma) in the skin of the abdomen that allows body wastes to get out. This may be temporary (reversed by a surgery at a later date) or permanent. It may also be necessary to remove your appendix, as it can contain distant metastasis from your ovarian cancer. Debulking may also require removing a portion of the bladder, stomach, pancreas and/or liver if it appears any of these organs have been affected by your cancer.
  • Chemotherapy: Another treatment of ovarian cancer is to use chemotherapy. Chemotherapy is a group of medications that is used to kill cancer cells. This can be administered through a vein or through an intraperitoneal (IP) port placed in the abdomen. 

Additional Information

Endometrial (Uterine) Cancer

Cancer that originates within the lining of the uterus (the endometrium) is the most common cancer of female reproductive organs. The uterus also has a muscular layer (the myometrium) and cancer can also originate within this layer, however it is rarer. This type of cancer is called a uterine sarcoma. 

Risk factors for Endometrial (Uterine) Cancer

  • Early menarche: starting periods before the age of 12
  • Late menopause
  • Infertility
  • Obesity
  • History of Tamoxifen use
  • Never having a child
  • Obesity
  • Genetics: family history of endometrial or colon cancers (Lynch Syndrome)
  • History of polycystic ovarian syndrome 

Symptoms of Endometrial (Uterine) Cancer

  • Post-menopausal bleeding
  • Vaginal bleeding after intercourse
  • Vaginal bleeding not associated with menstruation
  • Pain during intercourse 

Diagnosis of Endometrial (Uterine) Cancer

Springfield Clinic physicians who suspect Uterine cancer in a patient will perform or order some of the below exams or tests.

  • Pelvic exam: helps to determine if the uterus is enlarged or any abnormal masses palpated
  • Endometrial biopsy: a biopsy to sample tissue from the lining of the uterus; the tissue can be examined under the microscope to look for cancerous cells; this is a procedure typically done in the office
  • Dilation and curettage: this is a minor procedure in which the cervix is dilated to obtain samples of the tissue that lines the cervical canal and uterine lining; this tissue is also examined for cancerous cells
  • Transvaginal ultrasound: this helps to understand the size of the uterus and the thickness of the lining of the uterus 

Treatment of Endometrial (Uterine) Cancer

  • Surgery: The mainstay of surgery for endometrial cancer is to remove the uterus and cervix as well as the bilateral fallopian tubes and ovaries. It may also be necessary to remove some of the lymph nodes in the pelvis.
  • Chemotherapy: It will depend on the stage of your cancer, chemotherapy may be indicated.
  • Chemotherapy is a group of medications that is used to kill cancer cells. This can be administered through a vein or through an intraperitoneal (IP) port placed in the abdomen.
  • Radiation therapy: It will depend on the stage of your cancer, radiation therapy may be indicated.
    • External radiation (external beam therapy): radiation therapy is used to kill cancer cells and help to shrink the size of the tumor. This type of radiation is used externally to target specific areas within the abdomen and pelvis 
    • Internal radiation (brachytherapy)

Cervical Cancer

This is a cancer that originates in the cervix, which is the lower, narrower portion of the uterus. The cervix opens into the vagina and sits in between the bladder and the rectum. 

Cervical Cancer Risk Assessment

Cervical Biopsy

Risk Factors for Cervical Cancer

  • Infection with human papillomavirus (HPV)
  • Not having regular Pap tests
  • Smoking
  • Having many sexual partners
  • Diethylstilbestrol (DES): this was a medication used to prevent miscarriage b/t the years 1940 and 1971. Women, whose mothers took this medication while pregnant with them, have a higher susceptibility of developing cervical cancer.  

Symptoms

  • Post-menopausal bleeding
  • Abnormal bleeding or discharge in between menstrual cycles
  • Bleeding after intercourse
  • Pain during intercourse 

Diagnosis

There are several different types of cervical biopsies that can be used to help diagnose cervical cancer.

  • Colposcopy: using a magnifying lens to examine the cervix for abnormalities; a biopsy may also be performed if abnormal areas are identified on the cervix
  • Loop electrosurgical excision procedure (LEEP): obtaining a piece of tissue using an electric wire loop
  • Endocervical curettage (ECC): scraping the canal of the cervix to obtain a sample of tissue to examine under the microscope
  • Cone biopsy: A biopsy that takes a larger cone shape of tissue for evaluation 

Treatment

  • Surgery: a radical hysterectomy may be performed; this is removal of the cervix, uterus and the upper portion of the vagina; the fallopian tubes and ovaries may or may not be removed
  • Radiation therapy: this may be internal or external chemotherapy 

Vulvar Cancer

Vulvar cancer forms on the vulva, the area around the external genitalia, of a woman. This type of cancer may form very slowly over many years. View the anatomy of the vulva.

Risk Factors:

  • Age: most common in women over 50
  • Infection with HPV
  • History of vulvar intraepithelial neoplasia (VIN)
  • Smoking

Symptoms:

  • Itching in the vaginal area
  • Vulvar bleeding or discharge
  • Changes in the appearance of the skin
  • Pain or burning
  • Open sores or cuts in the vulvar area that won’t heal
  • A lump or mass in the vulva

Diagnosis:

Most cases are diagnosed by taking a biopsy of the tissue and having it evaluated under the microscope. 

Treatment:

  • Surgery: the type of surgery depends on the size, depth and spread of the cancer
  • Wide local excision: surgical procedure in which the cancer and some of the healthy surrounding tissue is removed
  • Radical excision: surgical procedure in which the cancer is removed, along with a wider portion of the healthy tissue surrounding the lesion
  • Groin lymph node dissection: it may also be necessary to remove the lymph nodes in either one or both sides of the groin
  • Radiation therapy: radiation may be used alone, before, or after surgery 

Genetic Counseling

Springfield Clinic offers genetic counseling and testing for Hereditary Breast and Ovarian Cancer Syndrome (HBOC) and Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome).

Hereditary Breast and Ovarian Cancer Syndrome

This is an inherited condition that causes an increased risk for ovarian, breast, pancreatic and prostate cancer. A large majority of hereditary breast and ovarian cancer is due to a gene mutation in either the BRCA1 or BRCA2 genes. This can be inherited from your mother of father. 

Risk Factors

  • Breast cancer diagnosed before the age of 50
  • Ovarian cancer at any age
  • History of two breast cancers
  • Male breast cancer at any age
  • Triple negative breast cancer at any age
  • A previously identified HBOC syndrome mutation in your family
  • Ashkenazi Jewish ancestry and a personal or family history of an HBOC associated cancer at any age
  • Three or more HBOC associated cancers at any age (in same individual or same side of family)

Managing Hereditary Breast and Ovarian Cancer

  • Increased surveillance
  • Monthly self-breast exams starting at age 18 and clinical breast exams twice/year starting at age 25
  • Yearly screening with a mammogram and breast MRI beginning at age 25
  • Pelvic exams two times/year beginning at age 35
  • Transvaginal ultrasound and a CA-125 blood test two times/year
  • Preventive Surgery
  • Preventive mastectomy: removal of both breasts
  • Preventive bilateral salpingo-oophorectomy: removal of both fallopian tubes and ovaries

Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome)

This is an inherited condition that causes an increased risk for colorectal cancer, gynecologic cancers (endometrial and ovarian) and other cancers. 

Risk Factors:

  • Colon or rectal cancer before the age of 50
  • Endometrial cancer before the age of 50
  • One family member with colon or endometrial cancer before the age of 50
  • Two or more Lynch syndrome cancers at any age in the same person
  • A previously identified Hereditary Colon Cancer mutation in the family
  • Personal or family history of 10 or more cumulative colorectal polyps
  • Two or more family members with a Lynch syndrome cancer on the same side of the family (one before age 50)
  • Three or more family members with a Lynch syndrome cancer on the same side of the family

Managing Lynch Syndrome Risk

  • Increased Surveillance
  • Colonoscopy: depending on your specific mutation, colonoscopies will be recommended between the ages of 20 and 35. The frequency will also depend on the mutation.
  • Transvaginal ultrasound: every 1-2 years
  • Preventive Surgery
    • Hysterectomy: removal of the uterus and/or fallopian tubes and ovaries