Gynecological Oncology

Additional Info

• Audio File:uab/ua038.mp3
• Doctors:Straughn Jr., J. Michael
• Featured Speaker:J. Michael Straughn Jr., MD
• CME Series:Clinical Skill
• Post Test URL:https://cmecourses.som.uab.edu/mod/quiz/view.php?id=4077
• Guest Bio:J. Michael Straughn Jr., MD is a Gynecologic Oncology Fellowship Director with UAB Medicine.
  
  Learn more about J. Michael Straughn Jr., MD 
  
  Release Date: August 1, 2017
  Reissue Date: July 21, 2020
  Expiration Date: July 21, 2023
  
  Disclosure Information:
  
  Planners:
  Ronan O’Beirne, EdD, MBA
  Director, UAB Continuing Medical Education
  
  Katelyn Hiden
  Physician Marketing Manager, UAB Health System
  
  The planners have no commercial affiliations to disclose.
  
  Faculty:
  
  J. Michael Straughn, Jr., MD
  UAB Gynecologic Oncology Fellowship Director
  
  Dr. Straughn has no commercial affiliations to disclose.
  
  There is no commercial support for this activity.
• Transcription:Melanie Cole (Host):  According to the society for Gynecological Oncology, Gynecologic cancers account for about 12% of all new cancer cases in women, and about 15% of all female cancer survivors. Current and continued advances within the field have resulted long-term outcomes with a high rate of survivorship. My guest today, is Dr.  J. Michael Straughn, Jr., he’s a Gynecologic Oncologist at UAB Medicine. Welcome to the show, Dr. Straughn, so explain a little bit about the evolution of Gynecological Oncology and how did this really come about?
  
  Dr. J. Michael Straughn, Jr. (Guest):  Yeah, that’s a great question. In the seventies, when there was really no specialist taking care of women with Gynecologic cancers, a group of OBGYN surgeons got together, and started sort of formalizing the training that would be necessary for someone to get trained in Gynecologic Oncology. And so, since that time, there are now specialized fellowship training programs that OB/GYN’s, who have completed their residency, now spend three or four years of additional training, where they get the training in surgery and chemo therapy, in order to take care of patients with Gynecologic Malignancy.
  
  Melanie:  So, what type of cancers do you treat at UAB?
  
  Dr. Straughn, Jr.:  Yeah, so the number cancer that we take care of is endometrial cancer, also known as uterine cancer. There’s approximately 50,000 new cases of uterine cancer in the United States, and so, that’s the most common cancer that we take care of. The most deadly cancer that we take care of is Ovarian Cancer, which is the second most common cancer, followed by cervical cancer. The initiation of Pap smear, approximately 50 years ago, has really impacted the incidence of cervical cancers. So, now in the United States, there’s less new cases of cervical cancer because of Pap Smear screening, HPV testing, and HPV vaccine. So, those are the three most common cancers that we take care of.
  
  Melanie:  So, while we’re on the subject of screening. How important is early diagnosis for Gynecological cancers, as being crucial to improve outcome prediction, and do you think that HPV testing and Cervical cancer, now, this is going to change the field even more with the addition of those Pap smears from 50 years ago?
  
  Dr. Straughn, Jr.:  Yeah. So, another great question. Obviously, if we can diagnose cancers at an stage, or even in the pre-en base of condition, then outcomes are going to be much better, and so, with the use of the Pap Smear, now we are able to find women who have pre-cancer or what’s known as Cervical dysplasia, and then treat those women and prevent those women from getting Cervical cancer. But today, we still see a number of women who present with advanced cancer because of lack of access to screening or the inability to get proper care, because of insurance issues, or other social issues that haven’t allowed them to get good medical care.
  
  So, early diagnosis in prevention of cervical cancer is a critical piece for women. Women who present with endometrial cancer, also have the early sign of bleeding. So, women who are post-menopausal. If bleeding, then often times their cancer is found early because they go, and are seen by their OBGYN, and then get tested and endometrial cancer can be found. The problem that we still have today is trying to diagnose ovarian cancer at an early stage, and still today, about 75% of women with Ovary cancer present either with Stage three or four cancer. So, there’s a lot of ongoing research to try to find a good diagnostic tool or screening tool for ovarian cancer, but there’s still a lot of work to be done.
  
  Melanie:  So, do you have any other valuable prognostic tools that can help aid in diagnosis early for these types of cancers?
  
  Dr. Straughn, Jr.:  Yeah. So, obviously we’d already mentioned the Pap smear and HPV testing, and so, now there’s a lot of newer tests looking at different types of HPV, and so, those new diagnostic tests can be very helpful, trying to classify women, based off of the type of HPV that they have. So, women who are known to have one of higher risk HPV subtypes, then those women can have more aggressive care, trying to treat their pre-invasive cancer. So, that’s an important tool, and then women who have abnormal bleeding, the transvaginal ultrasound, and endometrial buyouts, so your still very good tools, to help diagnose women and get them diagnosed with their Endometrial cancer.
  
  Melanie:  And Dr. Straughn, how do you see robotic-assisted surgery as impacting Gynecologic Oncology?
  
  Dr. Straughn, Jr.:  Yeah, so robotic surgery has really changed the entire landscape of how we treat women with endometrial cancer. So, over 10 years ago most women were still having an open procedure, when they were diagnosed with Endometrial cancer or women who had a pelvic mass, or ovarian mass. Most of those women had to have an open procedure, which led to three or four days in the hospital, and four to six weeks of recovery, but now with robotic surgery, most women are going home the next day after surgery. We’re able to perform that surgery through five small incisions, and the amount of pain and complication is very low now with robotic surgery. So, it’s been the biggest game changer that we’ve had, as far as the way we surgically manage our patient.
  
  Melanie:  So, as survivorship continues to grow, where do you see the coordination of care between the Gynecologic Oncologists and other healthcare providers, such as Radiation Oncologists and other healthcare providers that women might meet with?
  
  Dr. Straughn, Jr.:  Yeah. So, there’s been a lot of focus on survivorship. Most large cancer programs now have survivorship clinics, where women who have achieved remission from their cancer can still have close follow-up with specialists who deal with some of the long-term side-effects that patients who’ve had therapy either surgically or radiation. So, those clinics are very important, both to deal with the physical needs of the patients, and some of the emotional needs that they have, related to being a cancer survivor.
  
  Another important aspect is the palliative and supportive care clinics, that now help us manage our patients, many patients who have issues with long-term chronic pain, depression, anxiety, and there’s many specialists who’ve now been trained and work in these supportive care clinics, which is a critical, critical aspect of their sort of long-term care.
  
  Melanie:  And, do you have any newer adjuvant therapies you’d like to discuss, Dr. Straughn? What’s going on in the field?
  
  Dr. Straughn, Jr.:  Yeah. So, probably one of the most exciting things that we’re now working with is a drug called a PARP inhibitor. So, this is a new cancer fighting drug, that is an oral medication, and there’s been three new PARP inhibitors, that are FDA approved, to treat women who have ovarian cancer. So, these drugs really target some of the genetic mutations that someone women have. So, women who either have a BRCA one or two mutation, have now been found to respond well to these oral medications PARP inhibitor. So, we’re now testing women, both doing blood testing and tumor testing, to see if they will be eligible to take one of these drugs called a PARP inhibitor.
  
  Melanie:  What an exciting field that you’re in, Dr. Straughn, an exciting time to be in this field. What are some current research indicate for future developments and treatments? Give us a little blueprint for future research that you might see.
  
  Dr. Straughn, Jr.:  Yeah. So, I still think that probably the biggest sort of field is going to be genomics. Today, we’re now testing patients’ tumors for genetic mutations that then will alter their treatment plans. The sole sort of falls under the topic of, what we call personalized medicine. So, now we’re trying to look at the individual patient, and the individual characteristics, and really the genetic makeup of that patient's’ tumor, so that we can make decisions about what drugs to treat with, sort of what their prognosis is, and then obviously these genomic alterations are very helpful for future research, as we try to develop new drugs.
  
  Melanie:  And in summary, Dr. Straughn, tell other physicians what you’d like them to know about gynecological cancers and when to refer to a specialist.
  
  Dr. Straughn, Jr.:  Yeah, I think that’s probably one of the most important messages we would like to get out is that, women who have a suspected gynecologic malignancy need referral to specialist, and so, there’s been a lot of research that’s been published over the last five years, showing that outcomes are improved in women who seek care with a specialist. So, any women who has the suspected Endometrial cancer, Ovarian cancer, Cervical cancer, really needs referral from their OBGYN to a Gynecologic Oncologist, so that they can get the proper diagnostic workup, surgical intervention, and then adjuvant therapy for their cancer.
  
  Melanie:  And tell us about your team. Why is UAB so great to work with?
  
  Dr. Straughn, Jr.:  Well, we have one of the longest fellowship programs. We’ve had a fellowship program here at UAB for about 40 years, and so, we’re one of the earliest programs who’ve been training young positions in Gynecologic Oncology, and so, that along with working with the UAB Comprehensive Cancer Center, the amount of resources that we’ve had have allowed us to do cutting edge research, be sort of the leaders in robotic surgery, and then really develop this team approach to taking care of our patient.
  
  Melanie:  Thank you so much, Dr. Straughn, for being with us today, and a community physician can refer a patient to UAB Medicine by calling the MIST Line at, 1800, UAB MIST, that’s 1800 822 6478. You’re listening to UAB Med Cast. For more information on resources available at UAB Medicine, you can go to UABMedicine.org/physician, that’s UABMedicine.org/physician. This Melanie Cole, thanks so much for listening.
  
  
  
  
• Hosts:Melanie Cole, MS