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WinningtheWaronWomen’sCancerGynecologicCancerTreatment

Edwin Alvarez, MDDivision of Gynecologic OncologyAssociate ProfessorDepartment of Obstetrics, Gynecology & RSUniversity of California San Francisco

Jocelyn S. Chapman, MDDivision of Gynecologic OncologyAssistant ProfessorDepartment of Obstetrics, Gynecology & RSUniversity of California San Francisco

6 Week Course Agenda

I. Introduction to Women’s Cancers

II. Genetics of Gynecologic Cancers

III. Gynecologic Cancer Surgery

IV. Gynecologic Cancer Prevention

V. Gynecologic Cancer Treatment

VI. Sexual Health & Survivorship

Treatment philosophies in Gynecologic Oncology

Why

What

Who

When

Toolkit

Risk vs harm

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Why do we treat?

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Why do we treat?

Extend life

Improve quality of life

Maintain quality of life

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Why do we treat?

To give Hope

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Why do we treat?

To give Hope

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Why do we treat?

Hope has different forms

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Why do we treat?

To find a safe harbor

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Why do we treat?

Hope for dignity and peace

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Guidance philosophy

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What/who do we Treat?

Gynecologic cancer

• Complicated gynecology

Complications from cancer and its treatment

Cancer pain

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Who/what do we treat?

Ranges from

DNA to the community

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What/who do we treat?

DNA

Cell

Microenvironment

Tissue

Organ

Person

Family members

Community

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When do we treat?

Suspected cancer

Diagnosed cancer

Recurrence

Palliation

Survivorship

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Toolkit

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Toolkit

Surgery

Chemotherapy

Radiation

Biologics (including hormones)

• Immune modulation

Doctor/patient relationship

Advocacy and education

Research

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Risk vs Harm

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6 Broad Categories of Treatments

I. Surgery (already discussed)

II. Radiation

III. Cytotoxic chemotherapy

IV. Targeted treatments

I. Agents that inhibit blood vessels

II. Agents that take advantage of damaged genes in cancer

V. Immunotherapy

How does Radiation work? How does Radiation work?

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How does Radiation work? Targeted radiation (brachytherapy)

How does Radiation work -brachytherapy?

Radiation Toxicities (early)

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Radiation Toxicities (early) Radiation Toxicities (late)

Chemotherapy: how does it work? Chemotherapy: how does it work?

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Chemotherapy: toxicities Why does cancer come back after chemotherapy?

Immunotherapy: how does it work? Immunotherapy: how does it work?

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Targeted therapy: how does it work? Targeted therapy: how does it work?

Targeted therapy: how does it work?

“Better is possible. It does not take genius. It takes diligence. … And above all, it takes a willingness to try.”

Atul Gawande, MDBetter: A Surgeon’s Notes on Performance

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