The Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology at the Medical University of South Carolina has expertise in all aspects of gynecological oncology. This includes premalignant and malignant disorders of the vulva, vagina, cervix, endometrium, fallopian tube, and ovaries. The faculty has positive national and international reputations. The faculty has significant experience in managing all aspects of premalignant and malignant gynecological disorders in women including counseling, surgical management, chemotherapeutic management, and supervision of irradiation management. We are the only group in South Carolina with the availability of clinical trials through the Gynecologic Oncology Group.
Information on Clinical Trials
Our areas of special interest and expertise include:
A. Premalignant lesions of the female genital organs, especially abnormal Pap smears
B. Malignant diseases of the female genital tract
C. Trophoblastic disease (malignancies of the placenta)
D. Chemotherapy for gynecological malignancies including clinical trials
E. Radical pelvic surgery for malignancies as well as benign pelvic surgery
F. Pelvic reconstructive surgery
G. Vesicovaginal and rectovaginal fistulas
H. Management of inherited or genetic malignancies
I. Midlife health care A. PREMALIGNANT LESIONS OF THE FEMALE GENITAL ORGANS, ESPECIALLY ABNORMAL PAP SMEARS:
The most common premalignant disorders that we encounter are those of the vulva, vagina, and cervix. The cervix is obviously the most common due to the fact that it is reflected in abnormal Pap smears. There are also ovarian neoplasms that are premalignant and require expertise in management, especially in the young person who desires reproductive potential. The Division has a conservative approach to abnormal Pap smears, especially in young women who have not fulfilled their reproductive desires. This includes colposcopy for identifying and diagnosing the origin of the abnormal Pap smears as well as outpatient management. Each patient is individualized as to whether their proper management would be close follow-up, cryotherapy or LEEP procedures in the office or cold knife conizations under anesthesia based on location of the lesion, the severity of the pathological abnormalities, and the potential for childbearing. Most abnormal Pap smears can be managed in the office with only a few requiring hospitalization. The Division also has special interest in vulva disorders ranging from vulvadynia to vulvar dystrophy to premalignant vulvar dysplasias. Vulvadynia is a very poorly understood disorder of the vulva, which is usually classified into two types. One is constant burning of the vulva 24 hours a day to a degree that the patient is miserable, yet on vulvar inspection, the vulva essentially looks normal. This treated with medication and can be totally controlled. The second type of vulvadynia is vestibular adenitis, which hurts only when something touches the hymenal ring. Tiny remnants from the prostate gland at the base of the hymenal ring, referred to as vestibular glands in women, get infected. As long as nothing touches this area, it does not hurt but to try to insert a tampon, to try to touch one’s own vaginal introitus or to try to have intercourse, is essentially impossible due to unbearable pain. This is managed by a minor surgical procedure of removing these glands with outstanding results. Vulvar dystrophy is another very poorly understood disorder in which the mucous membrane of the vulva (vaginal introitus) changes its appearance. It can either be thin, pale white, and loses all of its elasticity with atrophy of the labia, especially the labia minora, with fusion of the labia minora over the clitoris. The mucous membrane then tears with any attempted stretching, such as intercourse, and itches incessantly. A second type of hypertrophic is similar except the epithelium is thickened and contains white plaques. Again, it causes itching, tears easily, but does not give the atrophy as the atrophic type does. The hypertrophic kind can have a premalignant tendency. Vulvar dysplasia means a premalignant lesion of the vulva. It can be mild referred to as CIN-I, moderate referred to as CIN-II, severe referred to as CIN-III, or in situ carcinoma. If left alone, the majority will eventually develop into invasive carcinoma. Each can be resected locally by simply removing skin-deep tissue. The cosmetic and therapeutic results are outstanding. The vagina can also have premalignant lesions similar to that described on the vulva, which can be treated in a similar manner. A rare but severe symptom-producing problem is lichen planus of the vagina. Here the vaginal mucosa completely sloughs leaving rare areas with no epithelium and the vagina is severely scarred. This can also be treated with steroid creams. Endometrial hyperplasias with or without atypicalities and borderline ovarian tumors are both disorders that fall within the premalignant scope of the abnormalities. The faculty has major experience and expertise in diagnosis and management of both of these disorders. B. MALIGNANT DISEASES OF THE FEMALE GENITAL TRACT:
All members of the faculty are board certified in gynecologic oncology and have experience and expertise in the diagnosis, evaluation, and management of malignancies arising on the vulva, vagina, cervix, endometrium, fallopian tube, and ovary. Therapy is individualized for each patient, and therapeutic options are discussed. Proper counseling and family support are given to all patients with malignancies. The Division places significant emphasis on maintaining body function and quality of life when possible. Some gynecological premalignant and malignant diseases occur during pregnancy. The Division has experience and expertise in managing these abnormalities during pregnancy. Emphasis is placed whenever possible on maintaining the pregnancy with minimal risk to the mother. C. TROPHOBLASTIC DISEASE:
Trophoblastic disease is a disorder of the placenta in which it functions as a neoplasm rather than support to a pregnancy. The neoplasm can be benign-acting, such as hydatidiform mole or highly malignant, such as a choriocarcinoma. The potential for managing women with trophoblastic disorders requires experience and expertise, which is available within the Division. The true key to management of the benign form of this disorder is very close follow-up with tumor markers to insure that a malignant behavior does not develop. If diagnosed very early, the malignant component of trophoblastic disease can be cured by chemotherapy in a very high percentage of patients. D. CHEMOTHERAPY:
The Division has the expertise and availability of providing intensive chemotherapy to women with malignancies. This is especially true for patients with ovarian cancer and trophoblastic disease. The expertise in selection of proper drugs, dosage and preventing complications for a spectrum of drugs is available. One of the main problems in administering chemotherapy is the prevention of side effects from the medications and the ability to manage potential lethal complications of chemotherapy if they should develop. That expertise is available within this division. The Division is a member of the Gynecological Oncology Group, which makes available to us experimental drugs and protocols for use in patients when they are needed. In fact, the Gynecologic Oncology Division at the Medical University of South Carolina is the only group of gynecologic oncologists in the state of South Carolina that is a member of the Gynecologic Oncology Group. This availability of new drugs and outcome research is extremely beneficial to some patients. The faculty has the experience and expertise where most side effects and major complications to chemotherapy can be prevented. E. RADICAL PELVIC SURGERY AND PREDICTED COMPLICATED OR DIFFICULT PELVIC SURGERY:
The gynecologic oncologists at the Medical University of South Carolina are superbly trained pelvic surgeons and capable of managing bowel and urinary tract disorders and complications. Many cancers require extensive radical pelvic surgery and that expertise is present and utilized weekly. In addition, many patients with severe benign pelvic disorders from infection and/or endometriosis or pelvic masses frequently require ultra difficult and radical approaches to manage. Most general gynecologists are not trained to manage these types of patients. The Division of Gynecologic Oncology at the Medical University of South Carolina has surgical expertise that can essentially manage any difficult pelvic surgical procedure. Many times, the surgical approach involves the bowel or urinary tract, which would require expertise to resect. This faculty has that expertise. We take pride in being available to care for these gynecological disorders. F. PELVIC RECONSTRUCTIVE SURGERY:
In general, the gynecologic oncologists are the best trained gynecological surgeons in the specialty of obstetrics and gynecology. Severe pelvic relaxation requires this surgical expertise for management. More specifically, pelvic reconstructive surgery refers to pelvic relaxation in which the support to the pelvic floor has given away and permits the protrusion through the vaginal introitus of the bladder, rectum, vaginal apex, and/or uterus and/or small bowel. This pelvic relaxation can range from mild displacement to total prolapse of the entire genital tract outside the vaginal introitus. The faculty of the Division of Gynecologic Oncology has the surgical expertise of restoring each of these various organs into their original position with maintenance of an adequate and functional vagina. Some procedures require an abdominal approach and some can be done entirely through the vagina. The experience and expertise for managing all degrees of pelvic relaxation exist in this division. G. VESICOVAGINAL AND RECTOVAGINAL FISTULAS:
Some of the most disabling disorders that a woman can obtain are leaking urine or stool into the vagina. Each of these complications can follow a vaginal delivery or after a gynecological surgical procedures. It is an incapacitating complication. The Division has the experience and expertise in the management of both the vesicovaginal fistula and the rectovaginal fistula and restoring the woman to a normal functional life. Some of these fistulas can be repaired even when they are complications of radiation. H. MANAGEMENT OF INHERITED OR GENETIC CANCERS:
It is well known that some gynecological malignancies are genetic or inherited malignancies. The faculty is well aware of these malignancies. The Women’s Center at the Hollings Cancer Center has genetic counselors that can provide expert guidance and recommendations. Such help can be life-saving and/or relieve an enormous amount of potential stress. The Division has the availability of such expertise. I. MIDLIFE HEALTH CARE:
The members of the Division take pride in counseling women with menopausal disorders, menopausal uncertainties, and symptomatology. We are presently living in an era of uncertainties regarding hormone replacement therapy. Lay publications can be extremely frightening to women even when major symptoms are present that are interrupting normal functional life. The faculty has significant expertise in discussing the pros and cons of hormone replacement therapy as well as alternates to this therapy when available. The risk versus benefits varies from patient to patient and most women need to be counseled on the pros and cons of hormone replacement therapy to be able to make their own decision based on facts. Our faculty has that expertise in such counseling with special interest in when or when not to use hormone replacement therapy, what type, what dosage, and for how long or alternating management. We are happy to provide counseling to the individual or to take over management of their menopausal disorders. Unfortunately, confusion, fear, and quality of life enter into the decision-making and guidance is needed for the patient to make an informed decision. We also provide health maintenance for these women, such as bone density studies, lipid and thyroid studies, and breast maintenance. Faculty Involved:
Dr. William Creasman
Patients are seen at the Women’s Center of the Hollings Cancer Center
Dr. Matthew Kohler
Patients are seen at the Women’s Center of the Hollings Cancer Center
Dr. Paul Underwood
Patients are seen at the East Cooper Women’s Center
Dr. Jennifer Young
Patients are seen at the Women’s Center of the Hollings Cancer Center
Treatment Option Tools for Cancer:
Nexcura Treatment Option Tools for Cancer
Other Online Resources:
Hollings Cancer Center at MUSC
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