Gynecologic Oncology Program

The decision of where to be treated for cancer is an important one, for you and your family. Our dedicated cancer specialists provide the expertise, guidance and personalized support you need.

Our staff includes gynecologic oncologists, medical oncologists, radiation oncologists, diagnostic and interventional radiologists, and pathologists. Our multidisciplinary case conference gives every patient the benefit of input from many experts, all helping to design a cancer treatment plan that provides evidence-based therapies to offer the best possible outcome.

Our specialists treats all stage and types of gynecologic cancer including:

  • Cervical cancer
  • Endometrial cancer
  • Fallopian tube cancer
  • Ovarian cancer
  • Uterine sarcoma
  • Vaginal and vulvar cancer
  • Rare gynecologic cancers
  • Gestational trophoblastic disease

Our expert, multidisciplinary care team meets regularly to discuss every patient’s care. The goal is develop an individualized and comprehensive treatment plan offering the latest and most advanced therapies.

We provide an array of innovative treatments and technologies to give you the best odds for an excellent outcome:

  • Minimally invasive surgical techniques, including the da Vinci Surgical System
  • HDR (high dose brachytherapy), which delivers radiation directly into   to the tumor
  • Intraperitoneal (IP) chemotherapy in combination with intravenous chemotherapy, which allows a higher drug concentration to be achieved within the abdominal cavity
  • HIPEC (hyperthermic, or heated, intraperitoneal chemotherapy), a form of  chemotherapy delivered during a surgical procedure, which can be an option for cancers that originated or have spread throughout the abdominal cavity

Our comprehensive clinical research program offers opportunities to participate in groundbreaking trials investigating novel cancer therapies.

Other than a physician exam, the only routine screening test for gynecologic cancer is the PAP test, which screens for cervical cancer. Therefore, it is important to be aware of warning symptoms for gynecologic cancer and, if you experience any, to report them immediately to your healthcare provider.

Symptoms include: 

  • Abdominal bloating
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Changes in bowel and bladder patterns that continue and/or worsen
  • Uterine bleeding
  • Pain during intercourse
  • Sores, lumps, ulcers or other physical changes to the vagina or vulva

Increased Risk Due to Family History

Approximately 10 - 20% of women diagnosed with ovarian cancer have an inherited risk (cancer that runs in the family). Factors that put a woman at higher risk for ovarian cancer include:

  • A family history of breast or ovarian cancer (in first degree relative, including mother, sister, or daughter)
  • A personal history of breast cancer
  • Two or more close relatives with breast cancer prior to age 50 or with ovarian cancer diagnosed at any age
  • Ashkenazi Jewish heritage and a personal history of breast cancer prior to age 50
  • Ashkenazi Jewish heritage and a first- or second-degree relative with breast cancer prior to age 50 or with ovarian cancer at any age

If you fit these criteria, contact genetic counseling and testing through our Hereditary Cancer Program. Our genetic counselors will meet with you to review your history and discuss your risk.

Increased Risk Due to Genetic Mutations

Mutations in either the BRCA1 or BRCA2 genes increase ovarian cancer risk 10  -45%. Women with Lynch Syndrome also have an increased risk (13%) of ovarian cancer and (60%) of uterine cancers. If you have an identified genetic mutation, it is very important to discuss your screening schedule with your doctor.

If you have an abnormal PAP smear or other symptoms that suggest the possibility of a gynecologic cancer, your doctor may order diagnostic tests such as:

Biopsy: A procedure to obtain tissue for diagnosis. Types of biopsies used to test for gynecologic cancers include:

  • Conization, also referred to as a “cone biopsy” of cervical tissue
  • Endometrial biopsy, a tissue sample is taken from the endometrium (inner lining of the uterus) for examination

CA-125: A blood test used to detect an elevated level of the cancer antigen CA-125, which is a protein found at high concentration on the surface of many ovarian cancer cells. (It is also found in other cancers, in noncancerous diseases and in small amounts in normal tissue.)

Colposcopy: A procedure that uses an instrument with a magnifying lens and a light, called a colposcope, to examine the cervix (opening to the uterus) and vagina for abnormalities

Dilation and curettage (D&C): A surgical procedure to remove tissue from inside your uterus

Pap test: A way to examine cells collected from the cervix for the presence of infection, inflammation, abnormal cells and cancer

Pelvic ultrasound: A noninvasive exam to visualize the female pelvic organs and structures including the uterus, cervix, vagina, fallopian tubes and ovaries

Transvaginal ultrasound (TVU): A procedure using sound waves to examine the vagina, uterus, fallopian tubes and bladder

Other imaging studies may be used to evaluate the extent of cancer. These may include:

CT scan: Imaging uses x-rays and a computer to visualize organs in the chest, abdomen or pelvis

PET/CT scan: A form of 3-D imaging that can provide more definitive information about cancerous tumors and other lesions located throughout the body

Magnetic resonance imaging (MRI): Imaging that uses a powerful magnet to provide detailed images

Pathology:

Specialists in the critical evaluation and diagnosis of diseases, our board-certified pathologists and cytopathologists work closely with the medical and surgical team in the diagnosis of cancer. Our accredited laboratory is committed to using the latest and most trusted methods of testing to ensure the accuracy and quality of each analysis for a cancer diagnosis in the shortest time possible.

Cancer pathology review includes:

  • Histopathologic evaluation of all diagnostic and surgical specimens, including intraoperative consultation (frozen section) when appropriate.
  • Immunohistochemical (IHC) testing of cancer tissue
  • Availability of comprehensive molecular testing of cancer tissue
  • Second pathologist review for every diagnosis

Our Western Connecticut Health Network physicians provide personalized cancer treatment based on your specific diagnosis. Factors weighed in identifying the optimal treatment for each patient include the type and stage of your cancer, along with your own treatment goals and lifestyle.

Factors evaluated include:

  • Stage of your cancer (localized vs. advanced)
  • Pathological and molecular profiling
  • Your general health and treatment goals

Your doctor will discuss the recommended treatment plan with you and, together, you and your doctor will decide on the approach that is right for you.  It may include one or a combination of several of the following types of treatment:

  • Surgery
  • Systemic therapy (a type of chemotherapy that includes targeted therapy)
  • Radiation therapy
  • Palliative care
  • Clinical trials

Surgery

The goal of gynecologic surgery is to eliminate all traces of disease. The type of surgery that may be used to remove your cancer depends on the size and spread of the tumor and whether or not you plan to have children in the future. Surgery may include the following:

  • Laparoscopic and minimally invasive surgical techniques including da Vinci robotic surgery: The robotic surgical platform offers important advantages, including superior visualization, greater precision and a lower rate of complications.
  • Hysterectomy: The surgical removal of the uterus. Different portions of the uterus, as well as other organs, may also be removed in the same procedure.
  • Oophorectomy:  The surgical removal of one or both ovaries and the fallopian tubes
  • Total hysterectomy and oophorectomy:  Surgery to remove the uterus, cervix and both ovaries and fallopian tubes
  • Open laparotomy and debulking:  If it is not possible to completely remove a tumor, your surgeon may recommend taking out as much as possible.

Systemic Therapy

The latest approach to treating gynecologic cancers involves tailoring treatment to each patient’s cancer and health status and goals. Called systemic therapy, this involves different types of drug treatments as listed below.

The decision to use systemic therapy is based on many factors, including the stage of your cancer, the results from surgery, information on pathology (the tissue evaluation) and your overall condition. Systemic therapies are drugs that travel throughout the body to control, slow or cure your cancer. They include chemotherapy, targeted therapies and endocrine therapy. Systemic therapy may be used alone or in combination with surgery or radiation.

Chemotherapy

Chemotherapy drugs are used to fight and kill cancer cells. Chemotherapy is associated with side effects, but there are many medications today to help reduce these. Chemotherapy is sometimes given intravenously (by infusion through a vein in your arm or port), via intraperitoneal delivery (into the abdominal cavity) or orally, taken as a pill. Most patients have a series of treatments over several weeks or months.

Chemotherapy can be used in several ways:

  • To decrease the risk of spread of cancer
  • Prior to surgery, to shrink a tumor so it is easier to remove
  • After surgery, to ensure that no cancer cells remain after the tumor has been removed
  • As a palliative therapy, to reduce pain and other symptoms of advanced cancer
  • As maintenance therapy

Targeted Therapy

Targeted therapies work differently from standard chemotherapy. They are typically oral medications that work by “targeting” specific DNA abnormalities within the cancer cells. The target is chosen after a thorough analysis of a patient’s tumor specimen.  Herceptin, which targets HER2, was one of the first targeted therapies.  These are truly personalized cancer medicines.

For more information on targeted therapies click here.

Endocrine Therapy

Oral or injectable medications used to block hormones that may be fueling or adding to the growth of cancer cells.

Hyperthermic Intraperitoneal Chemotherapy

This advanced treatment combines the surgical removal of most visible abdominal tumors with heated, cancer-fighting drugs that are delivered directly into the abdominal cavity.

Used primarily to treat advanced-stage abdominal cancers, HIPEC is an especially powerful treatment for several reasons.  First, cancer cells are more vulnerable to heat than healthy cells. Second, because the chemotherapy is largely isolated to the abdomen, a more potent dose can be delivered. This maximizes the power of the drug while minimizing the toxicity and side effects typically associated with intravenous chemotherapy.

HIPEC is delivered as the second phase of a surgical procedure. During the first phase, your surgical oncologist explores the abdominal cavity to find and remove as much of the cancer as possible. Next your surgeon administers a heated chemotherapy solution that is circulated throughout the abdomen to kill off any remaining cancer cells.

For more detailed information on chemotherapy click here.

Radiation Therapy

Radiation therapy, the precise and controlled use of radiation to kill cancer cells, can provide effective treatment for cancer. Here at WCHN, our highly skilled radiation oncologists use advanced technology that adapts to your breathing cycle. This ensures accuracy and protects nearby tissue as high doses of radiation therapy are delivered to your cancer. Our techniques include:

High Dose Rate (HDR) brachytherapy:

High Dose Rate (HDR) brachytherapy is a leading-edge treatment that allows radiation oncologists to deliver precise radiation treatment directly to cancerous tumors. This is done by using catheters or applicators inserted into a body cavity or directly into the tissue. It is frequently used in the treatment of cervical and uterine cancers.

External beam radiation

External beam radiation delivers a beam of high-energy x-rays destroy cancer cells. External beam radiation gets its name from the fact that the beams come from an external source (a machine called a linear accelerator) that aims them to the site of the tumor.

We offer several types of external beam radiation:

  • Image-guided radiotherapy (IGRT)
  • Intensity-modulated radiation therapy (IMRT)
  • 3D conformal radiation therapy
  • Volumetric modulated arc therapy (VMAT)

Clinical Trials

Clinical trials are research studies that evaluate the safety and effectiveness of new methods or drugs to treat cancer or procedures to diagnosis or screen for cancer. Participation is always voluntary. WCHN’s research program is part of a premier regional cancer network that includes Danbury, New Milford and Norwalk Hospitals. Clinical trials at WCHN come from a wide variety of sources, including the National Cancer Institute (NCI), pharmaceutical companies, nearby university cancer centers, as well as well as those developed at the WCHN.  Our goal is to offer you the most promising emerging treatments available.

We offer many supportive services to help with the questions and concerns that may arise during treatment, and beyond, in your life as a survivor of cancer.

Navigation - Cancer treatment can be complex, but we’re here to help. To ensure that your needs are met, we’ll connect you to a special team of navigators focused on helping you through your treatment experience. Though our entire staff is available for questions and guidance, we also have dedicated navigators with specific areas of specialization.

Oncology Nurse Navigator - Our nurse navigators will meet with you to provide information and emotional support, help you understand treatment options or assist with scheduling and coordination of your medical tests or appointments.

Oncology Financial Navigators - We offer financial counseling for all patients (insured and uninsured). Their role is to provide information on treatment costs and insurance benefits and help connect you to resources that may help cover or subsidize costs for treatment and cancer medications.

Integrative Medicine - We offer a wide array of complementary programs to promote healing and relaxation, help reduce unpleasant side effects and contribute to overall well-being. We believe in holistic cancer treatment, using complementary therapies such as aromatherapy, acupuncture, massage, and reflexology.

Nutritional Counseling - Our dietitian can provide support and guidance on nutrition during treatment and in managing sensory changes in taste along other side effects that alter nutritional intake.

Support Groups - We offer an ongoing calendar of community support groups and educational programs for you and family members, with programs for people who are newly diagnosed, in treatment and living as survivors of cancer. Danbury Hospital works collaboratively with Ann’s Place (link here to events), a cancer community support center that offers support groups, classes, and social support services to those who need additional assistance.

Spiritual Care - With sensitivity to every patient’s beliefs, needs and desires, our specially trained oncology chaplains are available for supportive listening, patient advocacy and counseling for you and your family members.

Palliative Care - The Western Connecticut Health Network is the first in the state to have offered a JCAHO-accredited palliative care program at Danbury Hospital. Pain and other symptoms are not only uncomfortable, but also can present a barrier to treatment. That’s why symptom management is a key part of our palliative care program. Please make sure to communicate with us about what pain you or your loved one may be feeling; we have many therapies and treatments to offer.

Physical Therapy/Rehabilitation - Our occupational therapists have expertise in treating lymphedema and other complications from axillary surgery. With the goal of helping every patient achieve as close to normal function as possible, we offer the full array of rehabilitation.

To find more information on the team or to speak with a cancer specialist, call:

  • 860-210-5300: WCHN The Diebold Family Cancer Center at New Milford Hospital
  • 203-852-2148: WCHN Whittingham Cancer Center at Norwalk Hospital

For additional resources, please visit:

Our expert cancer treatment professionals – physician specialists, nurses, care coordinators and the many other caregivers you’ll meet during the course of treatment – are highly trained and fully dedicated to providing excellent treatment in a warm and personalized manner.