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Taking aim at gynecologic cancer

Dr. Krishnansu S. Tewari leads research trials of a drug that could starve cervical cancer cells.
Paul R. Kennedy
Dr. Krishnansu S. Tewari leads the first randomized trial to evaluate the drug AvastinĀ® in blocking the formation of blood vessels that feed cervical cancer cells.

New techniques and therapies give hope to women

Across the broad cancer spectrum, gynecologic malignancies are among the most feared, for good reason.

This group of cancers-including ovarian, uterine, cervical and endometrial-strikes at a woman's very core: her reproductive organs. Complicating matters, each type has unique signs and symptoms, risk factors and prevention strategies. They also are deadly: Of the more than 76,000 U.S. women diagnosed annually with gynecological cancers, statistics show that nearly 28,000 succumb to their disease.

These days, however, UC Irvine's nationally recognized gynecologic oncology program at the Chao Family Comprehensive Cancer Center gives hope to women, offering the most advanced diagnostic and treatment options informed by leading-edge research.

"I believe our program is among the finest anywhere," says Dr. Philip DiSaia, a gynecologic oncologist and architect of UC Irvine's program and a nationally renowned leader in the medical specialty. "We do an excellent job treating patients day to day."

The cancer center is one of 41 in the United States that are designated by the National Cancer Institute (NCI) as a "comprehensive cancer center" based on overall excellence-and the only one in Orange County.

Keys to the center's success are its multidisciplinary approach to diagnosing and treating gynecologic cancers as well as the leading-edge research being conducted by its physicians and scientists. Also, patients at UC Irvine Medical Center, Orange County's only university hospital, often have access to groundbreaking treatments before they are available elsewhere.

The gynecologic oncology program also offers the latest therapies and technologies, including lifesaving chemotherapy, minimally invasive surgery and robot-assisted procedures. For each patient, gynecologic oncologists team with medical and radiation oncologists to determine the best treatment plan.

"Robotic surgery has really revolutionized how we are able to take care of patients," says Dr. Krishnansu S. Tewari, who uses the da Vinci Surgical System® and other technology to perform such advanced procedures as complex laparoscopic surgery, minimally invasive radical hysterectomies and fertility-preserving procedures. It gives surgeons a three-dimensional view, enhances accuracy and allows them to treat heavier patients.

"It enables us to safely treat those who have much more complicated diseases," Tewari says.

Many physicians at the Chao Family Comprehensive Cancer Center conduct high-priority NCI-supported clinical trials. Tewari is the principal investigator for the world's first randomized trial to evaluate use of the drug Avastin® (bevacizumab) to prevent the growth of blood vessels that feed cervical cancer cells.

"Blocking formation of these blood vessels is a new way of treating this form of cancer," he says. "Hopefully, this will result in significant benefits for women with cervical cancer."

UC Irvine gynecologic oncologist Dr. Leslie M. Randall uses the da Vinci robot to perform radical hysterectomies and to remove fallopian tubes and lymph nodes in the pelvis area.

"Radical hysterectomy is a highly specialized, extremely complicated procedure-much more challenging than a typical hysterectomy," she says. "In younger women, we always try to preserve the ovaries so that they can maintain their hormonal function. It's not too common to perform this procedure using laparoscopy or robotics, and we've had good success."

Randall also offers counseling for pregnant women with cancer, fertility-sparing options for women with gynecologic cancers and risk reduction services for women with a genetic predisposition to gynecologic cancers.

She also is working on the development of medical imaging techniques to assess responses to novel therapies. Using MRI and SPECT-a nuclear medicine procedure-she hopes to observe the effect of chemotherapeutic agents as they strike tumors.

Ovarian cancer remains their biggest challenge, DiSaia says. "When I was a fellow, there were one or two drugs and most patients were either cured or they died-there was no in between. Now, we have 25 drugs, and women are living 10 or more years beyond what once was expected. That, combined with new surgical techniques, has made for better survival for our patients."

- UC Irvine Health Affairs Communications

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