A New Era of Care for MUSC Gynecologic Cancer Patients

Advances in minimally invasive surgery and chemotherapy have ushered in a new era of care and treatment for gynecologic cancer patients at MUSC Health.

Dr. Brian Orr, a gynecologic oncologist at MUSC Hollings Cancer Center, says the use of robotic surgery, along with groundbreaking advances in immunotherapy and targeted therapy, are rapidly expanding the treatment options for patients.

“It really is a new era for gynecologic cancer treatment, one that is exciting and encouraging for patients, researchers and clinicians,” Orr says. “For years, oncologists had few options that would change outcomes, but robotic surgery and new therapies are improving outcomes for women diagnosed with a gynecologic cancer.”

Orr says robotic surgery is a major cancer care breakthrough that offers advantages to patients and to surgeons.

“Patients who have robotic surgery have smaller incisions, shorter hospital stays, quicker recovery and less pain medication,” he says. “It’s a real breakthrough for our patient population, most of whom are in their 50s to upper 80s and may have other medical conditions that can lead to complications in open surgery.”

Robotic technology, the latest minimally invasive technique, is more precise. A tiny 3-D camera is inserted through one of the incisions and transmits pictures of the surgical site to a computer console where the surgeon sits and control all aspects of the case. At the console, the hand controls attach to the surgeon’s hands and mimic the surgeon’s natural movements to control the advanced surgical instruments.

A special lens on the robot allows Orr to detect if a patient’s cervical/uterine cancer has spread using a sentinel lymph node technology in which only the first node is removed. This limits the patient’s risk for painful lymphedema and other complications.

“The robot is a powerful tool that increases precision, but the surgeon – not the robot – is in control at all times,” Orr says.

Orr and his team also have partnered with anesthesiologists on an improved approach to pre- and post-operative care, called ERAS, or enhanced recovery after surgery.

“ERAS is an overhaul approach to perioperative care.” Orr says. “Newer pain strategies such as anti-inflammatory medications and fewer opiates help patients get back to their baseline more quickly. When a patient leaves the hospital that same day or the day after surgery, they go home using little to no pain meds. They also can eat and drink almost up to the time of surgery instead of going without nutrition for hours before surgery.”

Gynecologic Oncology is the only surgery specialty in which doctors also provide chemotherapy.

“We’re with our patients through every aspect of their care, regardless of outcome,” Orr says. “Our involvement provides a level of continuity and support that matter to our patients and their families, as well as our care team.”

Orr says recent advances in chemotherapy, specifically immunotherapy and targeted therapy, offer promising treatments that are true viable options for patients. Moreover, many are available to patients through clinical trials.

Immunotherapy, which uses the patient’s immune system to recognize and kill cancer cells, offers curative potential or dramatically extends a patient’s life compared with traditional chemotherapy. 

“Immunotherapy is extremely exciting and can have long-lasting, impressive results,” Orr says. “It is a major breakthrough in cancer care. As a result, we’re conducting clinical trials to increase the number of patients who respond to immunotherapy.

The newer class of targeted therapies that directs treatment effect to a specific site in the tumor instead of attacking cells throughout the entire body dramatically lowers side effects of chemotherapy. Based on the patient’s genetic profile and tumor-specific characteristics, this targeted chemotherapy can isolate cancer cells and avoid attacking healthy cells through the body, Orr says.

Orr is also using heated intraperitoneal chemotherapy (HIPEC) on patients with abdominal tumors. Once the patient’s tumor has been removed surgically, he uses a catheter to circulate the liquid, which is heated to 104 degrees F, through the abdomen for about 90 minutes to kill microscopic residual cancer particles. Reserved for academic medical centers, the complex procedure has been shown to lead to better outcomes, he says.

When treating a patient, Orr says one of his first decisions is whether that patient is a candidate for a clinical trial.

“One of the benefits of being at an academic institution is having access to therapies that may not be available as standard of care options for several years from now,” he says.

Regardless, Orr says delivering safe, high-quality care to his patients is his overarching goal, and he’s optimistic about the future of cancer treatment at MUSC Health.

“We’re in a fast-paced progression for gynecologic cancer treatments, an era of new and promising therapies that offers a multitude of excellent options for our patients. It’s definitely an exciting time that should instill hope and confidence in patients and clinicians.”

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To make an appointment with Dr. Orr, call 843-792-9300.