How the Experts Treat Cancer Module 2 (Gynecologic Cancers)

Cancer Risk Associated with Menopausal Hormone Therapy: Practical Advice for Doctors Who Take Care of Patients

James Lacey, Jr, PhD
Associate Professor
Division of Cancer Etiology
Department of Population Science
City of Hope
Duarte, CA

Evaluation and Treatment of Cervical Intraepithelial Neoplasia

Mark Wakabayashi, MD
Clinical Associate Professor of Surgery
Department of Surgery
Chief, Gynecologic Oncology Surgery
City of Hope
Duarte, CA

New Agents in Gynecologic Cancers

Robert Morgan, Jr, MD, FACP

Director, Continuing Medical Education

Gynecologic Oncology/Peritoneal Malignancy Program

City of Hope
Duarte, CA

Release date: October 29, 2010

Expiration date: October 28, 2011

Estimated time to complete activity: 1.5 hours

Target Audience

This program has been designed for medical oncologists, gynecologic oncologists, and other medical professionals who treat patients with gynecologic cancers.

Statement of Need

Ovarian cancer is the most deadly of gynecologic cancers, accounting for more than 55% of all gynecologic cancer deaths. Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States and the country’s fifth most common cause of cancer mortality in women. In 2009, there were more than 21,000 new diagnoses and nearly 15,000 deaths from this neoplasm in the United States.. Ovarian cancer is the eighth most common cancer among women, excluding non-melanoma skin cancers, and it accounts for about 3% of all cancers in women and ranks fifth in cancer deaths. A woman's risk of having invasive ovarian cancer during her lifetime is about 1 in 71, and her chance of dying from it is about 1 in 95.

The incidence rate of ovarian cancer has been slowly declining over the past 20 years, even though it is difficult to detect early. Approximately 3 in 4 women with ovarian cancer will survive at least one year after diagnosis, with almost half (46%) of women with ovarian cancer still living at least 5 years after diagnosis. If ovarian cancer is found and treated before it has spread outside the ovary, the 5-year survival rate is 93%. However, less than 20% of all ovarian cancer is found at this early stage. In general, the ovarian cancer survival rate will depend on the type (ovarian epithelial, ovarian germ cell, low malignant germ cell) and stage (I, II, III, IV) of ovarian cancer, a woman's age and general health, and whether the cancer has recently been diagnosed or has recurred.

Despite encouraging recent data on both diagnostics and therapeutics, treatment of ovarian cancer remains a challenge, with many clinical debates remaining. The resolution of these debates will greatly impact the interdisciplinary approach to ovarian cancer treatment. The National Comprehensive Cancer Network (NCCN) recently updated the NCCN Clinical Practice Guidelines for Oncology™ for Ovarian Cancer to reflect the addition of two preferred combination regimens for a specific cohort of patients based on data from recent clinical research studies. However, although improvements in therapy have occurred, first-line chemotherapy fails to provide response rates in more than 20 percent of patients and approximately 40 percent to 50 percent of women who do experience a response to initial treatment relapse within two years. Also, current treatment for late-stage ovarian cancer has a very poor response rate and the toxic side effect profiles of cytotoxic agents limit their usage. Because ovarian cancer has few early symptoms, one of the major gaps is most patients are not diagnosed until the disease has progressed to an advanced stage, which contributes to the high mortality rate. This is because early stage ovarian cancer symptoms may not appear or be noticed or symptoms (ie, bloating, indigestion, diarrhea, constipation and others) may be vague and associated with many common and less serious conditions.  Most importantly, there has been no effective test for early detection.

It is critical for medical oncologists, gynecologic oncologists, and other caregivers to be more aware of the issues and understand the newly available data to support optimal clinical decision-making. This activity has been designed to meet the identified learning gaps in treatment of gynecologic cancers.

Learning Objectives

At the conclusion of this educational activity, participants should be able to:

  • Identify the cancer risk associated with menopausal hormone therapy
  • Apply the methods of evaluation and treatment of cervical intraepithelial neoplasia
  • Discuss the clinical trial data of new therapeutic agents for gynecologic cancers
Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of City of Hope and Carden Jennings Publishing Co., Ltd. City of Hope is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

City of Hope designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


The City of Hope adheres to ACCME Essential Areas, Standards for Commercial Support, and Policies regarding industry support of continuing medical education. Disclosure of the commercial relationships of everyone in a position to control content of an educational activity will be made at the activity. Speakers are also required to openly disclose discussion of any off-label, experimental, or investigational use of drugs or devices in their presentations.

The following City of Hope National Medical Center CME Committee members/planners have indicted they have nothing to disclose: Lucille Leong, MD, Crystal Saavedra, Anna Pawlowska, MD, Karl Gaal, MD, Mary Mendelsohn, Jo Hanson, Christina Eckhart, Khanh Nguyen, MD, Paul Lin, MD, and Teresa Ball.

The following CME Committee Members/planners have indicated a conflict with the following corporate organizations:

  • Jean Kagan discloses that she is a stock shareholder with Amgen/Zimmer
  • Robert Morgan, MD, discloses that he is a stock shareholder with Abbott
  • Fouad Kandeel discloses that he is a consultant for MicoCHIPS, Inc. and he has other financial or
    material interest with Medtronic Minimed
  • Ravi Bhatia, MD, discloses that he is a consultant with Novartis
  • J. Martin Hogan, MD, discloses that he has other financial or material interest with Johnson & Johnson
  • Matthew Loscalzo discloses that he is a member of the speakers bureau with Lilly Pharma

Any potential conflicts relative to the previous disclosure have been resolved.

CJP Medical Communications Disclosure

The employees of CJP Medical Communications have no financial relationships to disclose.

Faculty Disclosures

In accordance with the ACCME’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below:

  • James Lacey, Jr, PhD, does not have any relevant financial disclosures
  • Mark Wakabayashi, MD, discloses that he has received honoraria as a speaker for GlaxoSmithKline
  • Robert Morgan, Jr, MD, FACP
, discloses that he owned common stock in Abbott Corp within the past 12 months; this issue has been resolved
Commercial Support

This activity has been developed through independent educational grants received from Pfizer, Ethicon Endosurgery, and Centocor Ortho Biotech.

Method of Participation

There are no fees for participating in this CME activity. To receive credit during the period October 29, 2010 to October 28, 2011, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, (3) complete the posttest, and (4) complete the activity evaluation form, including the certificate information section.

The posttest can be accessed at the end of the activity. Please e-mail any questions to


The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.


Carden Jennings Publishing and the City of Hope present this resource for educational purposes only. Participants are expected to use their own expertise and judgment while engaged in the practice of medicine. Please consult full prescribing information for any drugs or procedures discussed within this activity. The views and opinions expressed in these presentations are those of the authors and do not necessarily reflect the views of the co-sponsors, supporter, or publisher. Although great care has been taken in compiling and checking the information given in this publication to ensure accuracy, the authors, City of Hope and Carden Jennings Publishing and their servants or agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions, or inaccuracies in this publication, whether arising from negligence or otherwise howsoever or for any consequences arising therefrom.

Disclosure of Unlabeled Uses

This reference may contain discussion of published and/or investigational uses of agents that are not approved by the US Food and Drug Administration. For additional information about approved uses, including approved indications, contraindications, and warnings, please refer to the prescribing information for each product, or consult the Physician’s Desk Reference.


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