As we honor Gynecological Cancers Awareness Month, what message do you want to send to our patients, families, and the community?
Gynecological cancers represent a major cancer category affecting women in the United States and worldwide with significant morbidity and mortality. Prevention, early detection, and timely treatment are essential. Yale Gynecologic Pathology is a fundamental component in the management of gynecologic tumors at Smilow Cancer Hospital. In our subspecialized practice, gynecological pathologists have the diagnostic expertise to facilitate delivery of modern precision medicine. In addition to tissue diagnosis, our team members also actively participate in real-time decision-making in patient care, including daily intraoperative consultations, tumor board conferences, and on-going clinical trial programs.
As a pathologist, how do you collaborate with the Gynecologic Cancer team at Smilow Cancer Hospital to care for patients?
The Yale Gynecologic Pathology Section is a dynamic, high-volume subspecialty service working in close collaboration with the gynecologic oncologists at Smilow Cancer Hospital through diagnostic services, translational research, and teaching. The goal of such collaboration is to ensure outstanding clinical service and translational research with emphasis on diagnostic tissue evaluation, oncological biomarker identification and clinical applications, and understanding the pathogenesis of various gynecological cancers.
What advances have made the biggest impact in the treatment of patients with a gynecologic cancers over the last five years?
Recent clinical applications of targeted and immune therapies represent important advances in the management of patients with gynecological cancers. Anti-PD-L1 immunotherapy using immune checkpoint inhibitors has become an important option for patients with advanced vulvar or cervical cancers, and other gynecological cancer types. A randomized, multi-institutional trial led by Yale gynecological oncology in collaboration of the Yale Gynecologic Pathology team has confirmed that combining Trastuzumab (Herceptin) with standard chemotherapy can significantly improve the survival of patients with HER2 positive endometrial serous carcinoma, an aggressive form of uterine malignancy. Now the National Comprehensive Cancer Network (NCCN) guidelines recommend Trastuzumab as a targeted immune therapy for patients with HER2-positive endometrial serous carcinoma.
How important are regular visits to your gynecologist for early detection of a gynecologic cancer?
Cancer prevention and early detection is the fundamental aspect of cancer care for women. Regular visits to your gynecologist are essential for timely diagnosis and intervention of cancer precursor lesions and early cancers of vulvar, vaginal, cervical, uterine, fallopian tube, or ovarian cancers. Squamous intraepithelial lesions of the vulva, vagina, and cervix and endometrial hyperplasia of the uterus are common precancerous lesions that can be biopsied by gynecologists and precisely diagnosed by gynecological pathologists. Such early detection offers crucial opportunities for gynecologic oncologists to effectively intervene by applying various strategies including surgery, radiotherapy, and targeted chemotherapies.
Are there any risk factors that can be controlled to prevent gynecologic cancers and why is it important to be aware of these factors?
Yes, absolutely. Some major gynecological cancers can be prevented and/or detected at their early stage so that effective clinical therapeutic measures can be applied, leading to a significant reduction of morbidity and mortality. HPV vaccination in early childhood represents the most recently medical advance in preventing adulthood cervical cancers. Routine cervical cytology screening and HPV testing are highly effective in the detection of early cervical cancers and their precursor lesions. Timely uterine biopsy or curettage sampling of patients with uterine bleeding may identify early endometrial cancerous lesions, and therefore timely surgical procedures can be taken to prevent further growth or metastasis of the cancer. Genetic testings of BRCA1 and BRCA2 germline mutations or close clinical surveillance of members of a confirmed germline mutation family may prevent the development of highly aggressive fallopian and ovarian cancers. Moreover, through genetic testing of patients with endometrial cancers, families with germline mutation of DNA mismatch repair genes (Lynch syndrome) may be identified so that the patient and her family members may benefit from prevention and early detection of various Lynch syndrome related malignancies, particularly uterine and colon cancers.