Expanding Care in the Valley for Gynecologic Cancers

posted on July 30, 2019

« The Connection, Summer 2019

University Gynecologic Oncology Specialists »

While driving to the San Joaquin Valley this spring to assume the directorship of the UCSF Fresno gynecological oncology services, Trung “Tim” Nguyen, DO, MBA, thought about the patients in need of care.

Dr. Nguyen was coming to UCSF Fresno from four years as a faculty member at Stanford University School of Medicine, but he had an understanding of the challenges facing San Joaquin Valley women with endometrial, cervical, uterine and ovarian cancer.

UCSF Fresno is fortunate to have Dr. Nguyen, said Carlos Sueldo, MD, Chief of the UCSF Fresno Department of Obstetrics/Gynecology. “Dr. Nguyen is the only fellowship-trained obstetrician/gynecologist in the area who is fully dedicated to the diagnosis and treatment of cancer in females’ reproductive organs,” he said.

An assistant professor at UCSF and a University Centers of Excellence provider, Dr. Nguyen brings an expertise in new techniques, including sentinel lymph node mapping. The procedure involves injecting a special dye into the origin of the cancer to see what group of lymph nodes the dye reaches first and where the cancer could spread. “It can be helpful in minimizing the number of lymph nodes we remove and in some cases increase the detection rate,” Dr. Nguyen said.

Dr. Nguyen also specializes in fertilitysparing treatment for young women with cancer who may want to have children. “As a physician and as a member of the community, I have a sense of responsibility to make sure we do a good job and that we provide up-to-date and cutting-edge care,” he said.

He emphasizes the importance of regular doctor visits for prevention and early detection of gynecological cancers. This is particularly true of cervical cancer, he said.

Cervical screening is an effective way to detect the cancer early so it can be cured. Cervical cancer can be prevented. The (human papillomavirus) HPV vaccine prevents HPV infection — the route-course of most cervical cancers, he said. Girls and boys who are 11 or 12 years old should get two shots of HPV vaccine and three shots are recommended for teens and young adults who start the series at ages 15 through 26 years.

Prevention has to be a priority, Dr. Nguyen said. Statewide, the rate of cervical cancer is 7.2 per 100,000, but the rate in Kings County is 11.4 per 100,000 – the highest in the state, according to the most recent data from the federal Centers for Disease Control and Prevention. Madera and Tulare counties each has an incidence rate of 10.4 per 100,000, ranking third- and fourth-highest. Fresno County has a rate of 8.7, ranking it tenth-highest in California. “Any woman who dies of cervical cancer is one too many,” Dr. Nguyen said.

And women are dying of uterine cancer because of delayed treatment, he said. There is no screening test for the cancer but a common sign is abnormal bleeding, especially in post-menopausal women. “When identified early, the rate of effective management is high. The rate of cure is high. And so it’s so important to recognize symptoms early and go seek care early,” Dr. Nguyen said.

Ovarian cancer does not have a screening test but doctors can identify women in certain high-risk groups and provide intervention. “And recently there are oral drugs that can be prescribed as maintenance therapy for certain women with BRCA gene mutations or certain tumors,” Dr. Nguyen said. Immunotherapy also could be promising and he is interested in bringing clinical trials to UCSF Fresno.

Dr. Nguyen, in partnership with UCSF Fresno’s Amir Fathi, MD, a liver/pancreas surgeon, hope to provide hyperthermic intraperitoneal chemotherapy (HIPEC) for women with certain types of ovarian cancer. HIPEC is a concentrated, heated chemotherapy treatment delivered directly to the abdomen during surgery. HIPEC is available in only a few major academic centers in California, Dr. Nguyen said.

Access to care is an obstacle to prevention and treatment of gynecological cancers. Dr. Sueldo said Dr. Nguyen’s goal is to build the gynecology/oncology program so a team can efficiently cover the huge number of cases requiring their expertise.

“Plenty of data demonstrates that the patient who is treated by a gynecologist/ oncologist has much better outcomes,” Dr. Nguyen said.