Gynecologic oncologist: Why cancer patients should come to MD Anderson first

I didn’t always want to be a doctor. When I first started college, I was a double major in literature and biology. I thought I’d be a literature professor.

But during my second year of college, my 47-year-old mother was diagnosed with breast cancer. I often took her to her appointments and treatments. Over time, I realized that I was interested in medicine, and oncology in particular. So, I decided to go to medical school. It was there that I discovered how much I enjoyed performing surgery.

During my obstetrics and gynecology residency, I developed a strong interest in gynecologic cancers, especially cervical, ovarian and uterine cancers. I decided then to become a gynecologic oncologist. My dream was to work at MD Anderson. I achieved that dream in 1998.

Today, I find great satisfaction in helping women return to their normal lives after a cancer diagnosis. And though I care for women with all types of gynecologic cancers, it’s extremely gratifying to help younger women — particularly those with cervical cancer — hold onto their dreams, so that one day, they might be able to have children.

The MD Anderson advantage: more options and a multidisciplinary approach

Over the years, I’ve learned that it’s exceedingly important for women to seek cancer treatment at a place like MD Anderson first, not just to come here for a second opinion. Because MD Anderson may have options that are not available elsewhere. And survival rates are much higher in patients with gynecologic cancers who visit specialized cancer centers like MD Anderson. So, coming to MD Anderson first could completely change a person’s path.

Our multidisciplinary approach means patients don’t just receive input from one doctor. Instead, multiple gynecologic oncologists reach a consensus and then make a recommendation. Our patients also benefit from the expertise of the best pathologists and radiation oncologists in their respective fields. And our researchers conduct hundreds of cancer clinical trials to test new treatments for both common and rare cancers.

Right now, we’re using immunotherapy that’s not available at other hospitals to treat some patients with recurrent cervical cancers. We’re also treating some uterine cancers effectively without surgery. And we have a list of ovarian cancer protocols that are only available here at MD Anderson, including integrated targeted molecular therapy.

We recently completed a landmark clinical trial, too, that compared open hysterectomies to minimally invasive hysterectomies in treating early stage cervical cancer. That study showed women who minimally invasive hysterectomies had much higher rates of recurrence and much lower rates of survival than those who had open surgery. This study has changed the standard of care not only in the United States, but around the world. That is the value of being treated at MD Anderson

Preserving fertility before and during gynecologic cancer treatment

About 15% of our patients with uterine or ovarian cancers are diagnosed while still of child-bearing age. And about half of our cervical cancer patients are diagnosed before age 45. Fertility preservation is still very important to many of these women, so they feel devastated not only by their cancer diagnoses, but also by the chance that they won’t be able to have children.

Sometimes, our patients have been told by other doctors that they’ll have to choose between their fertility and their lives, and give up on their dreams of having a family. But as we tell them, that’s not always the case.

Between 50 and 60% of all women who undergo fertility-preserving surgery are able to get pregnant after finishing their cancer treatment. This could happen either naturally or through in vitro fertilization or other assistive technologies.

Surgical conization reduces need for hysterectomies in select women wanting to preserve fertility

At MD Anderson, we always aim to treat the cancer first, but we definitely consider options for maintaining fertility in women of child-bearing age. For instance, the standard of care for many cervical cancers is a radical hysterectomy, but that eliminates a woman’s chances of carrying biological children to term.

We recently completed another landmark study which showed that a procedure called a surgical conization offers women the same results as a radical hysterectomy, and with far fewer complications. So, that’s great news. It only takes about 15 minutes and is used to treat cervical cancer by removing a cone-shaped wedge around the cervix, instead of the entire uterus (radical hysterectomy). Patients can generally go home just a few hours after having this procedure. 

And it’s amazing to see patients return years after their diagnosis, not only cancer-free, but also with their beautiful children.

A highlight of my career: preserving a pregnancy while treating cervical cancer

Looking back, I think one of my most memorable patients was Tricia Jordan. When she came to me 16 years ago, she was in her first trimester of pregnancy and had just been diagnosed with cervical cancer. She’d already been to several other doctors, and they’d all told her the same thing: to save her life, she would have to terminate the pregnancy and have a hysterectomy. Tricia was devastated.

Then Tricia came to see me, and we had a very long discussion about a procedure called a simple trachelectomy. It was not completely accepted and considered a very risky option at the time, but she was willing to take the chance. I performed the surgery on her in early 2004. She went on to deliver her baby at full term. Today, that baby is a vibrant and healthy young man. And Tricia is still cancer-free. Helping Tricia was one of the highlights of my career. And the opportunity to give patients like her hope is what drives me and my colleagues every single day.

Pedro T. Ramirez, M.D., is a gynecologic oncologist at MD Anderson.

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