Contents
Treatment of female tumors should be performed by oncological gynecologists. According to studies conducted in the USA, patients who were immediately treated by a team that included a gynecologist-oncologist had longer survival periods, compared to those treated by a gynecologist without an oncology specialization and general surgeon. In Poland, new combination methods of treatment in oncological gynecology are already available.
Success in oncology is achieved when a doctor meets his patient 10 or 15 years after the primary treatment. In order to best treat women with genital cancers, a new specialization was recently distinguished – oncological gynecology. According to prof. Jerzy Stelmachow, National Consultant in the field of Oncological Gynecology, if the therapy is carried out by a gynecologist-oncologist, and not only by a surgeon, the operating team prepares the patient for further combined treatment, i.e. for chemotherapy or radiotherapy, which then gives better results.
New methods of treatment in oncological gynecology
Hyperthermia, i.e. exposing cancerous tissues to high temperature, primarily damages them. In addition, the elevated temperature is detrimental to the tiny blood vessels that nourish the cancerous tissue. In addition, hyperthermia treatment also has an analgesic effect. Hyperthermia can be used in combination with chemotherapy for any treatment course. It is also used with brachytherapy or teletherapy, thanks to which a better response to treatment is obtained. It is also used independently in most oncological indications. Contraindication to the use of this method are metal pacemakers, metal elements, prostheses in those parts of the body that we want to heat. There are few centers in Poland that have the appropriate devices for the use of hyperthermia. These devices are very expensive. These are special beds and electrodes that use the electromagnetic field. The heating process takes place in those layers of the body where neoplastic lesions are located. Everything is computed by computer. The maximum temperature is 42 degrees C, but most treatments are performed at 40 degrees C. Hyperthermia combined with radiotherapy is reimbursed (in some centers also combined with chemotherapy). At the moment, hyperthermia is used by the Oncology Center – Institute in Warsaw, the Oncology Center in Krakow, the Oncology Center in Gliwice, the Greater Poland Cancer Center in Poznań, the Świętokrzyskie Cancer Center in Kielce and the NZOZ Medical Oncology and Hyperthermia Center in Warsaw at ul. Belgradzka 5.
Cytoreductive surgery combined with intraperitoneal chemotherapy under hyperthermia (HIPEC) is a very advanced procedure that has been used in Poland for a year. It has been known in the world for years. But since it is an aggressive treatment method that combines top-level surgery with a highly specialized team, it is not needed by a large number of patients. It is an operation lasting many hours to remove even small neoplastic lesions, followed by intraperitoneal chemotherapy for hyperthermia (HIPEC) performed by another team. In Poland, 4 centers with the capacity to perform this procedure are sufficient to cover the demand for it. A new procedure called the Cyber Knife is also being introduced. One device is already in operation in Gliwice, the other is in operation at the hospital in Wieliszew. These are very precise beams of ionizing rays, located on a lymph node or a tumor deeper located in order to destroy it. It often eliminates the need for surgical treatment.
Increase availability
There are currently 180 gynecologists-oncologists in Poland. – It’s definitely not enough. I estimate the needs at around 500. This is one of the youngest specializations in Polish medicine, hence the problems with obtaining such a large number of specialists. The time of specialization is 10 years, of which 6 years in obstetrics and gynecology and 3,5–4 years in oncological gynecology. Therefore, the number of gynecologists-oncologists in Poland is slowly increasing – explains the national consultant. In his opinion, the availability of surgical treatment in Poland is sufficient. It is only when a highly specialized team is needed to perform an operation that it may be a week or two that you wait. There are also no problems with the availability of treatment with cytostatics, i.e. chemotherapy. The problem is with ionizing radiation treatment, i.e. teletherapy and brachytherapy. It is a highly specialized treatment. However, the availability of radiotherapy is constantly increasing. Until recently, there were centers offering this method of treatment only in some provincial cities. Currently, in connection with the admission of private capital to the market, new centers have been established, including in Otwock, at the European Health Center, in Wieliszew, Poznań, Koszalin, Wałbrzych and many other cities. Soon, a center is to be established in Płock or Radom. According to the national consultant, oncological vynecology does not need to send patients abroad, the same procedures are performed in Poland. – If we see shortcomings, the specialist supervision reacts immediately to fill this gap – he assures.
Where to find information
The program I am with you and the website www.jestemprzytobie.pl helps women suffering from genital cancer and their relatives. It includes the necessary information on the prevention, diagnosis and treatment of cancers of the reproductive organs (cervical cancer, vulvar cancer, ovarian cancer, endometrial cancer), as well as advice on where to seek psychological support.
Via www.jestemprzytobie.pl, you can ask questions to experts, read real women’s stories and exchange experiences with other readers in a similar situation. The program is co-created by 4 non-governmental organizations: Fundacja “Różowa Konwalia” prof. Jana Zieliński, the MSD Foundation for Women’s Health, the Polish Association of Oncological Nurses and the National Organization for Fighting Cervical Cancer “Flower of Femininity”.
Tekst: Halina of Pilon