Dr. Magtibay explains why a woman with a gynecologic cancer should see a gynecologic oncologist and why choosing a Mayo Clinic specialty physician is a good option.
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Choosing a Doctor for Gynecologic Cancer Treatment I think it’s very important for women to know that if they receive the diagnosis of a gynecologic malignancy meaning ovarian cancer, uterine cancer, cervix cancer, vulvar cancer, fallopian tube cancer, primary peritoneal carcinoma, that they specifically request that they be referred to a gynecologic oncologist. Gynecologic oncologists are physicians who have done OB/GYNE training, four years of OB/GYNE training, and at least three additional years in training specifically addressing gynecologic cancers. So they are the experts in this disease process, in these disease processes, and it’s very important that patients have the opportunity to visit with and be managed by a gynecologic oncologist because we have several studies, for example in ovarian cancer, that show that patients have improved survival when managed by a specialist. So it’s critical, I think, that patients be their own advocate and specifically request that they’re seen by a gynecologic oncologist. Gynecologic oncologists are specialists and they are relatively few in number. For example, the Phoenix metro area we’re underserved in gynecologic oncology. We have five million patient lives in the Phoenix metro area and only six gynecologic oncologists. Now at Mayo Clinic, we’re different than many other gynecologic oncologists and gynecologic oncology practices and we think for the better. One aspect of Mayo Clinic is that as a gynecologic oncologist I only do surgery. Many other gynecologic oncologists will do surgery and chemotherapy, meaning their practice is divided fairly evenly between the two. They will operate and they will give chemotherapy. We personally at Mayo Clinic believe that our system and our practice, our multi-specialty practice has advantages in that, since I only do surgery, I hope to be very good at what I do. I think that the more you do of anything the better you are. We know from an ovarian cancer standpoint that treatment involves surgery, usually first, followed by chemotherapy. The one aspect about surgery is that it’s very important that the surgeon consider being a very aggressive in removing all the disease that’s present in a woman’s abdomen. We know that one of the most important factors influencing a patient’s survivability is how much tumor is left in the abdomen at the completion of the operation. So that means that that surgeon needs to be potentially quite radical and adept in doing multiple different types of surgical procedures. We need to do things such as splenectomy if there’s tumor involved in the spleen. We need to take out lymph nodes if the lymph nodes are involved. We may need to take out a piece of liver or piece of the colon and put that back together. We need to do whatever it really takes within reason to remove all the tumor burden in the abdomen at that time because, again, that is one single most important prognostic factor on a patient’s survival, and that’s the only thing that I can influence as a physician because I can’t influence whether or not your tumor is going to respond to chemotherapy. I can’t influence what kind of mutation you have that causes that tumor to occur. But I can influence how much tumor I leave behind. Meaning, I want to remove, if possible, all visible disease that I can actually see. If I can get it down to fine pieces of sand, maybe a millimeter or two, that’s acceptable, but it’s best if I can get it down to nothing. If I leave bigger pieces, a centimeter or larger, we know that those patients do much poorly from a statistical standpoint and from a survival standpoint. So it’s important that the surgeon be aggressive in looking in every nook and cranny in the abdomen in removing all the tumor that he or she can because, again, that will influence the patient’s long-term survivability. I can influence how much tumor is left behind, as a surgeon I can influence that. I can’t influence whether or not a patient’s tumor is going to re