Shana Wingo, MD, gynecologic oncologist, Arizona Oncology, discusses the evolution of surgery in endometrial cancer.

Gynecologic oncology is extremely complex—it is a melding of multiple concentrations into 1 specialty, says Wingo. Advanced surgical training for gynecologic oncology includes more complex surgeries in the upper abdomen. One thing that has persisted over time and remains true to this day, Wingo says, is that the amount of residual disease affects survival. Surgical knowledge and skills need to be improved and modified as time goes on so that the field is continuing to provide the best outcomes. 

Surgery for patients with endometrial cancer has changed drastically in the past 20 years, Wingo explains. Surgeons often performed open surgeries in the past, whereas now, 80% to 90% of cases are minimally invasive. Through proper development, Wingo believes that there is a chance that the technique of minimally invasive surgery can be perfected. If that proves to be true, patients will experience quicker recoveries, which will allow clinicians to administer the next line of therapy sooner.

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Dr. Wingo on the Evolution of Surgery in Endometrial Cancer

Shana Wingo, MD, gynecologic oncologist, Arizona Oncology, discusses the use of neoadjuvant chemotherapy in the treatment of patients with ovarian cancer.

Although there has not been many new surgical advancements in the treatment of ovarian cancer in the last year, there has been an uptake of neoadjuvant chemotherapy. Wingo says that many patients do not see a gynecologic oncologist before they start their therapy, so many surgeons administer chemotherapy, perfom the surgery, and then follow-up themselves.

The adoption of neoadjuvant chemotherapy has caused a paradigm shift, Wingo says. Previously, upfront debulking was often used in lieu of neoadjuvant therapy. Wingo says that she feels less apprehensive about bypassing upfront debulking as more data come out in support of neoadjuvant chemotherapy. This paradigm shift may be a very positive one for patients with ovarian cancer, she concludes.

Shana Wingo, MD, gynecologic oncologist, Arizona Oncology, discusses the use of neoadjuvant chemotherapy in the treatment of patients with ovarian cancer.
 

Dr. Wingo Discusses Neoadjuvant Chemotherapy in Ovarian Cancer

Shana Wingo, MD, gynecologic oncologist, Arizona Oncology, discusses surgical options for the treatment of patients with newly diagnosed ovarian cancer.

The role of neoadjuvant therapy has shifted the paradigm for physicians, says Wingo. Physicians are used to debulking upfront; however, as data come out in support of neoadjuvant therapy, they feel less apprehensive about bypassing upfront debulking. 

Carboplatin and paclitaxel are typically used in the neoadjuvant setting. Physicians determine who is appropriate for upfront surgery versus upfront chemotherapy by evaluating their disease burden and the location of their cancer. There are certain areas where physicians cannot safely operate, or know that a complete resection of the cancer is unlikely. Physicians will also look at a patient's comorbidities. The goal is to get every patient to surgery, Wingo says, but some patients are too ill to have upfront surgery.

Shana Wingo, MD, gynecologic oncologist, Arizona Oncology, discusses surgical options for the treatment of patients with newly-diagnosed ovarian cancer.

Dr. Wingo on the Evolution of Surgery in Patients With Ovarian Cancer

Shana Wingo, MD, gynecologic oncologist, Arizona Oncology, discusses gynecologic oncology guidelines.

published guidelines at the end of 2016 recommending that all patients with gynecologic malignancies should be referred to a gynecologic oncologist.

Though a medical oncologist has the ability to administer the chemotherapy, an upfront consultation with a gynecologic oncologist is needed, says Wingo.

The guidelines also recommend that if a patient is suitable for upfront surgery, they should receive it.

Dr. Wingo on Gynecologic Oncology Guidelines

Shana Wingo, MD, gynecologic oncology, Arizona Oncology, discusses the advances of surgical technology in gynecologic cancers.

Technology is quickly advancing, Wingo says, such as the invention of sentinel lymph node detection—where dye is injected into the cervix during robotic surgery and laparoscopic surgery.

Another technology is infrared detection technology, which determines where the lymph nodes are.

Shana Wingo, MD, gynecologic oncology, Arizona Oncology, discusses the advances of surgical technology in gynecologic cancers.
 

Dr. Wingo on Advances of Surgical Technology in Gynecologic Cancers

Shana Wingo, MD, gynecologic oncology, Arizona Oncology, discusses the various surgical approaches being explored and conducted across patients with gynecologic malignancies.

More surgical oncologists are doing minimally invasive surgery for patients with gynecologic malignancies, Wingo explains. However, this is more difficult for patients with ovarian cancer, she adds, as this is known to be a bulkier malignancy. The use of robotic surgery and minimally invasive surgery has been typically adopted and conducted for patients with uterine, cervical, and some early-stage ovarian cancers.

Additionally, in some centers with more experience with robotic surgeries, there are more aggressive procedures being done, she adds. Typically, a multi-port surgery is done in a laparotomy, but some centers are exploring single-site laparotomies. Time will tell if this single-site approach will be uniformly adopted across the United States, Wingo says.

Shana Wingo, MD

Articles

Dr. Wingo on the Evolution of Surgery in Endometrial Cancer

Dr. Wingo Discusses Neoadjuvant Chemotherapy in Ovarian Cancer

Dr. Wingo on the Evolution of Surgery in Patients With Ovarian Cancer

Dr. Wingo on Gynecologic Oncology Guidelines

Dr. Wingo on Advances of Surgical Technology in Gynecologic Cancers

Dr. Wingo on Surgical Approaches Across Gynecologic Malignancies