Gynecologic oncology: the known, the unknown, and the promise

The treatment of gynecological cancers has advanced dramatically in the last two decades with the introduction of targeted therapies, immunotherapy, and surgical refinements. In a recent Penn Medicine Physician Interviews podcast, Noah Adam Goldman, MD, MBA, discusses these developments as standards of practice at Penn Medicine Princeton Health and reviews the advantages of his program’s assimilation into Penn Medicine.

Dr. Goldman also offers insights on the known and unknown factors of screening for ovarian cancer, and discusses risk reduction and a promising development at Penn Medicine to bring gynecological cancer care closer to home for patients in central New Jersey.

Advantages of the cancer care network at Penn Medicine

Dr. Goldman observes that while Penn Medicine Princeton offers all of the options available in the downtown facilities in Philadelphia, the beauty of integration with the Division of Gynecologic Oncology at Penn Medicine is the Princeton program’s access to information and recommendations elsewhere within the Penn hospital system.

“The wonderful thing about the Division of Gyn Oncology is it’s truly systemic,” Dr. Goldman says. “And so, when I have a patient who has a complex problem, I’m able to ask the other gyn-oncologists what their recommendation might be, and what they think about my plan.”

Ovarian cancer screening: the known and unknown

Although early detection of ovarian cancer can improve overall survival rates, the disease is often undetected until its later stages. A part of this challenge can be attributed to the absence of effective screening for ovarian cancer despite 50 years of clinical studies.

Dr. Goldman notes that for ovarian cancer, multiple international screening trials have been performed since the 1980s. “Unfortunately, we haven’t really gotten anything yet that’s ready for prime time,” he says, adding that this includes AI, though the technology shows promise.

Outside of these efforts, the impediments to a useful screening tool include the presence in 5% to 10% of women of complex benign ovarian cysts and masses, which may lead to a heightened risk for false positive findings, unnecessary surgeries, and their complications, Dr. Goldman says.

Given that the harm of an unnecessary intervention may outweigh the risk of a cancer that is relatively rare, hesitancy to pursue an aggressive course in women at low-to-moderate risk for ovarian cancer reflects modern guidelines for gynecologic care.

Risk reduction

According to the Guttmacher Institute, the Ovarian Cancer Research Alliance, and other sources, younger women may achieve ovarian cancer risk reduction via oral contraceptives, IUDs, tubal ligation, salpingectomy, pregnancy, and breastfeeding. Risk reduction in ovarian cancer is also possible for women known to be BRCA positive, all of whom are considered to be at high risk for disease. Diagnosed BRCA-carriers typically enter proactive management for ovarian cancer, which may include increased surveillance or prophylactic surgery.

When asked what women concerned about risk should bring to the attention of their gynecologists, Dr. Goldman advises that they be attuned to their bodies.

“I’ve always said throughout my career that the most important thing to do is to listen to your body,” he says. “Nobody knows their body better than the person themselves. So, if there’s something that feels wrong, this needs to be brought to the attention of the primary care physician or the gynecologist.”

The promise of care close to home

In keeping with the promise of advanced cancer care closer to home, Penn Medicine is constructing a new 200,000-square foot, four-story center on its Plainsboro campus to house the cancer program. The addition, says Dr. Goldman, will make Penn Medicine Princeton Health a regional leader in cancer care in the central New Jersey area. Scheduled to open in May 2028, the new cancer center will house more than 40 exam rooms, 30 infusion chairs, and two linear accelerators to deliver radiation therapy.

Referring patients to Penn Medicine

The gynecologic oncology program at Penn Medicine stands out for its clinical excellence and compassionate, patient-centered approach to care. Patients with gynecologic cancer often come to Penn Medicine for access to its research portfolio—but they are always cared for as patients, not data points.

Referrals and consultations

To refer a patient for gynecologic cancer care at Penn Medicine Princeton Health, please call 609-853-6590 or refer a patient online.