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  1. 1. The Division of Gynecologic Oncology is devoted to providing comprehensive care to women with any cancer of the reproductive tract. Our practice serves as the primary referral institution in the Tri-State area for the treatment of women with pre-malignant gynecologic cases. We work to bring new prevention, detection and treatment discoveries to all of our patients. Our staff combines innovation in research, prevention, control and treatment to provide superior and compassionate patient care. Our healthcare team is available to discuss all treatment options, side effects and the concerns of our patients. We work diligently to make the time that our patients and their families spend with us as pleasant as possible. We treat a full array of complications, including: • Abnormal PAP Smears • Cervical Dysplasia • Abnormal uterine bleeding • Hyperplasia/Endometrial cancer • Adnexal mass/Ovarian Tumor • Ovarian Tumors • Various feminine cancers • Vulvar disorders • Genetic counseling • Familial ovarian cancer GYN ONC NEWSJanuary 2005 Issue 1 January is National Cervical Cancer Awareness Month A woman’s cervix (the opening of the uterus) is lined with cells. Cancer of the cervix occurs when these cells become malignant. In 2004, it is estimated that approximately 10,520 new cases of cervical cancer will be diagnosed. Of those new cases 3,900 women will die from their disease. Cancer of the cervix is one of the most common cancers in women throughout the world, but it has become less common in countries like the U.S. that use the Pap test. When diagnosed and treated in the precancerous stage, which is also called dysplasia or cervical intraepithelial neoplasia (CIN), the cure rate is close to 100%. If the cervical cancer is diagnosed and treated early, as many as 85-90% of women can be cured. The more advanced the disease, the lower the cure rate. In most women, the change in the cells from normal to dysplasia to cancer takes place over many years. In many cases a PAP test can detect dysplastic changes so that they can be treated before they become cancerous. A common infection known as human papillomavirus (HPV) is associated with an increased risk of cervical cancer. There are more than 100 types of HPV, most of which are benign and only a few of which are linked to cervical cancer. Many women will have one type of HPV infection at some point in their lives. The risk factors for cervical cancer depend on a woman’s sexual history, immune system, health, and lifestyle. Those who are at risk for development of cervical cancer are: 1) Women who have had sex with more than one person or have had male sexual partners who have had multiple sexual encounters with more than one person; 2) Those who have had their first sexual experience at a younger age; 3) Those who have a male sexual partner who had a sexual partner with cervical cancer; 4) Those who are smokers; 5) Those who are immunosuppressed, especially those patients who have had a kidney transplant, or those who are chronically taking medication which causes a weak immune system; 6) Those with human immunodeficiency virus (HIV) are at greater risk; 7) Those women who have not been getting routine Pap smears or who are diagnosed with abnormal Pap smear and have failed to get follow-up treatment. Most advanced cancers of the cervix are found in women who did not have a routine Pap test. This is why it is important to have your Pap test done on a regular basis.
  2. 2. Symptoms and Diagnosis of Cervical Cancer Patients with precancerous lesions or early stage cancer of the cervix often do not have any symptoms. By the time symptoms appear, the cancer has already spread to an advanced stage. Most precancerous or dysplastic changes and early cancer are found in women who have had regular Pap tests. The first signs of cervical cancer may be: • Bleeding and spotting or watery foul-smelling discharge from the vagina. • Bleeding usually occurs after intercourse and sometimes patients may experience a heavier period at the time of menses. Cervical cancer in advanced stages can cause: • Pain • Problems with urination • Swelling of the legs • Difficulty in having bowel movements It is worth mentioning that any of these symptoms can be caused by non- cancer related gynecologic problems; therefore, if these symptoms occur, you should see your doctor. Treatments of Abnormal Pap Smears If you have an abnormal Pap smear or symptoms of cervical cancer, you may need further testing to help your doctor decide what type of treatment you need. Colposcopy. A large binocular microscope is used to find abnormal areas in the cervix. Biopsy. A small piece of tissue is removed and sent to the lab for diagnosis. Cryotherapy (Freezing). A probe coated with a freezing agent, which is applied to the cervix for a few minutes, is used to destroy the abnormal cells. Electrosurgical excision (LEEP). The abnormal area is removed, under local anesthesia injected into the cervix, using a thin wire loop and electrical energy. Laser treatment. A high-intensity beam of light is used to burn and destroy the area that contains abnormal cells. Cone biopsy. An outpatient procedure where a cone-shaped wedge of tissue is removed from the cervix and the base of the tissue is cauterized with a cautery. The procedure usually requires general anesthesia. Hysterectomy. Sometimes just a simple hysterectomy can take care of not only dysplasia but other related gynecologic problems the patient may be suffering from such as fibroids, abnormal bleeding, or uterine prolapse, or if the patient no longer wants to have children. Women who wish to remain able to have children should discuss their options with their doctors Treatment of Cervical Cancer If a woman has cervical cancer, a doctor needs to assess the size and extent of the disease, which may require surgery, pelvic exam, chest x-ray, computed tomography scans (CT), or magnetic resonance imaging (MRI). The patient should see a gynecologic oncologist; a physician specialized in the treatment of gynecologic cancer. Staging. After a cancer has been diagnosed, it is assigned to a stage from 1-4. Stage 1 is the earliest stage (confined to cervix only) and is easiest to cure. Stage 4 is the most advanced stage and the cancer has spread to other parts of the body. The cure rate for stage 1disease is around 85-90%; the cure rate for stage 4 disease is 5-10%. Treatment. Cervical cancer is treated with surgery or radiation and/or chemotherapy. Surgery removes the cancerous tumor and any tissue where it may have spread. Radical hysterectomy is the most common surgery for cervical cancer. It is the removal of the uterus and cervix along with the upper part of the vagina and surrounding tissue with the lymph nodes. The ovaries may or may not be removed. This surgery is more complex than a regular hysterectomy. Radiation stops cancer cells from growing by exposing them to high-energy rays. Chemotherapy is sometimes given to enhance the effect of radiation. Some patients with advanced disease may require continuous chemotherapy after radiation is completed. There are several investigational therapies available in the treatment of advanced cervical cancer.
  3. 3. Nader Husseinzadeh, M.D. Professor, Dept of OB/GYN Director, Division of Gyn Oncology Medical Arts Building Clifton, Ohio (513) 475-8588 Barrett Cancer Center Clifton, Ohio (513) 584-8227 St. Elizabeth Cancer Care Ctr Edgewood, KY (859) 344-2237 C. Blair Harkness, M.D. Asst Professor, Dept of OB/GYN, Division of Gyn Oncology Medical Arts Building Clifton, Ohio (513) 475-8588 University Pointe West Chester, OH (513) 475-8266 Barrett Cancer Center Clifton, Ohio (513) 584-8227 St. Luke Cancer Treatment Ctr Ft. Thomas, KY (859) 572-3298 . Our Physicians and Locations The Breast and Cervical Cancer Screening Project Beth O’Connor, RN, Program Coordinator, University of Cincinnati Breast and Cervical Cancer Project In 1990 Congress passed the Breast and Cervical Cancer Mortality Prevention Act with a mission to decrease morbidity and mortality from these two diseases. The Centers for Disease Control and Prevention signed on as the governing agency at the Federal level and began partnering with each individual state to develop and implement the National Breast and Cervical Cancer Early Detection Program. Through this program women would receive free mammograms and Pap tests along with education on the importance of early detection of these diseases. By 1994, the Ohio Department of Health applied for and received grant money to start the Breast and Cervical Cancer Screening Project (BCCP) in Ohio. Dr. Nader Husseinzadeh of the University of Cincinnati Department of Obstetrics and Gynecology applied for and received the funds to administer the grant in Southwestern Ohio, Region 1. The target population for the BCCP is uninsured and underinsured, minority women with limited income, but any woman living in the state of Ohio meeting the grant’s eligibility criteria may apply. Women must be 40 years of age or older, have an income within 200% of the poverty level and have no other insurance that will cover the cost of these screenings. Once women are determined eligible for the BCCP they may choose to receive their screenings from over 50 contracted healthcare providers in Region 1. Eligibility can be determined over the phone by calling the BCCP office at 584-4342 or toll free at 1-888-727-6266. To date, 5,622 women have been screened through the BCCP in Region 1. Approximately 46% of these women are returning annually to receive their Pap tests and mammograms through the program. As of 06/30/04, 9 cervical cancers and 136 breast cancers were diagnosed through the BCCP in this region. In 2001 Governor Taft signed legislation to enact the BCCP Medicaid Treatment Act. Starting July 1, 2002 any woman diagnosed with breast or cervical cancer or a precancerous condition, through the BCCP, was immediately eligible for Ohio Medicaid to pay for her treatment. Every woman screened through the BCCP is sent a survey asking for her evaluation of the program and the services she received. After reviewing hundreds of positive comments, this comment sums up the purpose of BCCP in just a few words. One participant wrote, “I’m thankful to you for the program because I wouldn’t have had the test done otherwise, since I don’t have insurance. Also I would have been a nervous wreck wondering if I had breast or cervical cancer. Thank you.” The key in the fight against cancer is prevention and early diagnosis that yields a high cure rate. Therefore, we recommend that every woman, who is sexually active, get a Pap smear, and those who are in a high-risk category may require more frequent Pap smears and pelvic examinations.
  4. 4. Future Direction Scientists are investigating the use of vaccine to prevent progression of precancerous lesions to cancer. The Division of Gynecologic Oncology at the University of Cincinnati is a full member of the Gynecologic Oncology Group (GOG), a national clinical research group sponsored by the National Cancer Institute (NCI). We also participate in pharmaceutical and industry clinical trials. This gives us access to the latest investigational products available for treatment of all types of gynecologic cancer. Active protocols at the University of Cincinnati, Division of Gynecologic Oncology GOG 0171 Expression of the MN Protein in Atypical Glandular Cells of Undetermined Significance (AGUS or AGCUS) as a Potential Diagnostic Biomarker of Cervical Dysplasia/Neoplasia GOG 0128-G A Phase II Evaluation of Capecitabine in the Treatment of Persistent or Recurrent Non-Squamous Cell Carcinoma of the Cervix GOG 0204 A Randomized Phase III Trial of Paclitaxel plus Cisplatin versus Vinorelbine plus Cisplatin versus Gemcitabine plus Cisplatin versus Topotecan plus Cisplatin in Stage IVB, Recurrent or Persistent Carcinoma of the Cervix GOG 0227-C A Phase II Evaluation of Bevacizumab (rhuMAB VEGF) in the Treatment of Persistent or Recurrent Squamous Cell Carcinoma of the Cervix GOG 8003 Vaginal Length, Elasticity, Lubrication and Sexual Function in Women with Stage IB2 Cervix Carcinoma GOG 0174 A Randomized Phase III Trial of Weekly Parenteral Methotrexate versus "Pulsed" Dactinomycin as Primary Management for Low Risk Gestational Trophoblastic Neoplasia HPV-01 Expression Levels of the Human DEK Proto-oncogenes in HPV Positive Anogenital Lesions GOG 0126-P A Phase II Evaluation of Weekly Paclitaxel and Celecoxib (Celebrex) in the Treatment of Recurrent or Persistent Platinum- Resistant Ovarian or Primary Peritoneal Cancer GOG 0146-N A Phase II Evaluation of Bortezomib (Velcade, PS-341) in the Treatment of Persistent or Recurrent Platinum-Sensitive Epithelial Ovarian or Primary Peritoneal Cancer GOG 0146-O A Phase II Evaluation of Irofulven in the Treatment of Recurrent or Persistent Platinum-Sensitive Ovarian or Primary Peritoneal Cancer GOG 0146-P A Phase II Evaluation of Cetuximab (C225) and Carboplatin in the Treatment of Recurrent, Platinum-Sensitive Epithelial Ovarian or Primary Peritoneal Cancer GOG 0186-C A Phase II Evaluation of CT-2103 in the Third-Line Treatment of Recurrent or Persistent Epithelial Ovarian or Primary Peritoneal Cancer GOG 0190 An Exploratory Evaluation of Fenretinide (4-HPR) as a Chemopreventive Agent for Ovarian Carcinoma GOG 0198 A Randomized Study of Tamoxifen versus Thalidomide in Patients with Biochemical Recurrence Only Epithelial Ovarian Cancer, Cancer of the Fallopian Tube, and Primary Peritoneal Carcinoma after First Line Therapy GOG 0199 Prospective Study of Risk-Reducing Salpingo-Oophorectomy and Longitudinal CA-125 Screening among Women at Increased Genetic Risk of Ovarian Cancer TLK286.3017 Phase III Randomized Study of TLK286 versus Doxil/Caelyx or Hycamtin as Third-Line Therapy in Platinum Refractory or Resistant Ovarian Cancer BRN 2001 A Phase II Trial of Paclitaxel administered as a Weekly 1hr Infusion as Second-Line Therapy for Patients with Cervical CA or Endometrial CA GOG 0209 Randomized Phase III Trial of Doxorubicin/Cisplatin/Paclitaxel and G-CSF versus Carboplatin/Paclitaxel in Patients with Stage III & IV or Recurrent Endometrial Cancer GOG 0210 A Molecular Staging Study of Endometrial Carcinoma GOG 0150 A Phase III Randomized Study of Accelerated Hyperfractionated Whole Abdominal Radiotherapy versus Combination Ifosfamide and Mesna with Cisplatin in Optimally Debulked Stage I, II, III or IV Carcinosarcoma of the Uterus GOG 0230-C A Phase II Evaluation of in the Treatment of Recurrent or Persistent Carcinosarcoma of the Uterus GOG 0173 Intraoperative Lymphatic Mapping and Sentinel Node Identification in Patients with Squamous Cell Carcinoma of the Vulva GOG 0195 A Phase III Clinical Trial of Tisseel VH Fibrin Sealant to Reduce Lymphedema Incidence After Inguinal Lymph Node Dissection Performed in the Management of Vulvar Malignancies For further information, please call our Research Office at (513) 584-3454 or (513) 584-0578.