Gynecologic Cancer

Overview

Our gynecological cancer team includes gynecologic oncologists, radiation oncologists and research collaborators. We offer patients the latest approaches in surgery (including laparoscopic and robotic), chemotherapy, biological therapies, radiation, and brachytherapy for the treatment of ovarian, cervical, uterine, vaginal, and vulvar cancers. We are also leaders in the diagnosis and treatment of hereditary gynecologic cancers.  Learn more about some of the major research programs ongoing in the Gynecological Cancer Program by clicking on the Research tab.

We have had leadership roles in a wide range of cooperative group therapeutic clinical trials that have defined the standard of care for surgery, radiation, and systemic therapies in gynecologic malignancies.  Recent discoveries in cancer biology have led to the development of new biomarker-directed therapeutic approaches for gynecologic cancers.  This most notably includes the use of PARP inhibitors in ovarian cancer and immune checkpoint inhibitors in uterine cancer, but other targetable alterations also exist. 

In 2019, Dr. Angeles Secord founded a consortium of peer academic institutions to better define the use of targeted biological agents in metastatic endometrial cancer.  The centralized database for the consortium, which is housed at Duke, now includes over 2,000 patients.   

Ovarian Cancer

Ovarian cancer is the most lethal gynecologic malignancy due late stage presentation as a result of a lack of effective screening and prevention approaches.  The International Ovarian Cancer Association Consortium (OCAC) was formed in 2005 to better understand the genetic and behavioral factors that affect ovarian cancer risk.  OCAC now includes over 100,000 research subjects from many case-control studies.  Dr. Andrew Berchuck has served as the head of the OCAC steering committee since the inception of the group.  About 40 common low penetrance genetic risk variants have been identified through genome-wide association studies, as have epidemiological risk factors.  This provides the basis for improved risk stratification that could aid the implementation of personalized risk-reducing strategies including prophylactic surgery, screening, and chemoprevention. 

Our group was awarded an NCI cancer, intervention, and surveillance modeling network (CISNET) grant in 2022 to work on mathematical models of uterine cancer to help inform strategies for prevention and improved outcomes for uterine cancer.  We are working on tools to help address the growing uterine cancer incidence and mortality in the US.  There are striking disparities in both incidence and mortality between black and white women, both nationally, and in North Carolina.  Dr. Laura Havrilesky is the principal investigator for CISNET and this work also involves Evan Myers MD, MPH.  Dr. Havrilesky is also involved in a wide range of quality improvement and health services research projects. This includes studies that assess the impact of patient preferences on clinical decision-making in ovarian cancer.

Drs. Laura Havrilesky and Brittany Davidson have collaborated to address issues surrounding the end-of-life decisions of women with ovarian cancer.  This has focused on communication skills that facilitate difficult conversations.  Earlier goals of care conversations with patients who have limited life expectancy facilitate earlier hospice enrollment and better quality of life while reducing hospitalizations and futile treatment.  Dr. Davidson also conducts research related to patient adherence with oral anticancer medicines and optimization of oral pain medication use after surgery. 

Cervical Cancer

Cervical cancer is a highly preventable disease in the developed world due to the wide availability of cervical screening and HPV vaccination.  In developing countries lack of access to these preventive approaches remains an unfortunate reality. Dr. Megan Huchko and Dr. Nimmi Ramanujam have led efforts, including in Peru and Kenya, to address barriers to early detection and screening with education, cultural awareness, and clinical tools - such as HPV self-sampling, pocket colposcopy, thermal ablation, and decision-making algorithms to community-based clinics.  This focus on technology and implementation strategies has the potential to allow more accurate and lower-cost cervical cancer screening to reach millions of women living in low- and middle-income settings. Dr. Davidson serves on the steering committee for the American Cancer Society Round Table on Cervical Cancer, a group that aims to eliminate cervical cancer diagnoses by increasing access to guideline-based prevention, screening, and treatment techniques.

Tomi Akinyemiju, Ph.D. is an epidemiologist in the Duke Population Health group whose work focuses on racial disparities in women’s cancer care.  She is performing a prospective cohort study of 1,600 Black, Hispanic, and White ovarian cancer patients in the US characterizing multiple healthcare access domains and how they individually and synergistically influence receipt of guideline-adherent primary treatment, supportive care, and survival.  These studies are intended to provide novel, empirical, and generalizable insights that can help identify and prioritize specific modifiable factors that can be targeted to reduce cancer disparities and improve care for all patients.

Finally, Drs. Emma Rossi and Leah McNally are involved in a wide range of research and educational programs related to the surgical management of gynecologic cancers.  This work focuses mainly on the use of minimally invasive laparoscopic and robotic approaches that lead to better patient outcomes.