About the effective treatment of cervical and ovarian cancer: interview with oncogynecologist Yurii Ostapenko

About the effective treatment of cervical and ovarian cancer: interview with oncogynecologist Yurii Ostapenko.

My name is Yuri Ostapenko. I am oncosurgeon, gynecological oncologist. I work at the National Cancer Institute, head of the department of minimally invasive surgery, endoscopy and interventional radiology.

What is your education, internships, refresher courses?

I graduated from the Donetsk National Institute, took an internship in surgery at the same institution. Then completed a specialization in oncosurgery in the thoracic department. There we mainly dealt with esophageal surgery. Since 2000, I have worked in the department of precancerous diseases, where I treated patients with breast cancer, thyroid cancer and patients with gynecological cancer. In 2006 I completed an internship in Serbia in the city Novi Sad, and since that time I have devoted myself to laparoscopy. In 2009 I passed specialization in gynecological oncology, trained in Germany, France, and America.Today I am mainly engaged in laparoscopic abdominal and gynecological oncosurgery.

Tell us about your experience and current opportunities in gynecological oncology?

The concept of modern oncosurgery is to strive for balance. First of all, radicalism of operations is important – it is necessary to remove the tumor within healthy tissues and all tumor foci. On the other hand, it is important to preserve the nerves and blood vessels so as not to invalidate the patient.Laparoscopy meets these requirements. Now about 80% of operations on the body of the uterus are performed laparoscopically. Diagnostic laparoscopic operations are mainly performed on the ovaries. Laparoscopic oncological operations on the cervix are not performed. According to modern research, they cannot provide radicalism. Although laparoscopic technologies are improving, and now there are several international trials, after which, most likely, laparoscopy will find its place in the treatment of cervical cancer.

How can patients in your profile deal with prevention and screening tests correctly?

For screening for oncological diseases in the field of gynecology, a woman only needs to visit a gynecologist once a year. In this case, a gynecological examination, an abdominal ultrasound scan, a gynecological ultrasound scan with a vaginal sensor, and cervical swabs are taken.They should also take oncomarkers CA 125 and HE4, which by 98% exclude the presence of an oncological process in the body.If, after these analyzes, any doubts or suspicions arise, gynecological oncologists are involved.

What tests will help determine the risk group for cancer of the cervix, uterine body or ovaries?

Patients with oncogenic types of human papillomavirus are at risk for cervical cancer. This analysis is taken during a gynecological examination. In the presence of a virus, antiviral therapy is carried out, and in the presence of inflammation, anti-inflammatory therapy.

What operations are performed on the basis of your department?

On the basis of our department, we perform the whole range of oncogynecological operations. We, as I said, perform laparoscopically most of the operations on the body of the uterus and open operations on the cervix.In case of ovarian cancer, we perform diagnostic operations, but if the clinical situation allows, we perform organ-preserving operations for ovarian cancer in patients of childbearing age laparoscopically.

What organ-preserving surgeries and in what cases can be performed on patients in gynecological oncology?

In ovarian cancer, if the patient is young, nulliparous, and she wants to have a baby, as well as early stage ovarian cancer and only one ovary is affected, we can perform organ-preserving surgery by removing one ovary and the fallopian tube. But, for this doctors need to know for sure that there is no oncological process in other organs, therefore, it is necessary to take a biopsy and washings from the abdominal cavity.

Also, in order to carry out an organ-preserving operation in this case, a meeting of a multidisciplinary council with the participation of a oncogynecologist, a radiologist and, of course, an obstetrician-gynecologist is necessary. After treatment, the patient should be closely monitored as the risk of recurrence is very high.

Do you use immuno- and targeted therapy in routine practice?

Yes, targeted and immunotherapy have entered modern oncogynecology practice. At the moment, in the first line of therapy, standard chemotherapy is now prescribed, and patients with progression of the disease have to resort to targeted and immunotherapy. In some cases, and in patients who have successfully completed treatment with standard therapy, supportive therapy with immunotherapy is prescribed.

What complex clinical cases can you highlight in recent years?

Unfortunately, in our country (apparently, this is due to inadequate screening), such patients are encountered almost every day. Patients are regularly treated with advanced stage of ovarian cancer, uterine bleeding, so it is very difficult to single out a specific clinical case.

I want to say that improving the quality of screening solves a large number of such problems. For example, vaccination of girls aged 9-14 years in Europe against human papillomavirus virtually eliminates cervical cancer.

What’s new in your department in recent years, how did you improve the survival rate?

Since most of the operations in our department are performed laparoscopically, we started using the ACG technology. What is it? We inject the dye before the operation. Then, during the operation, with a special camera mode in the green spectrum, we see immunofluorescence, that is, some lymph nodes may be stained differently. In such cases, we don’t immediately expand the scope of the operation, but perform an urgent biopsy. After 20 minutes, we already know if there is a lesion of the altered lymph nodes by an oncological process, and if so, we change the plan of operations and treatment.

What options do patients have, for example, with stage 4 of cervical cancer?

Unfortunately, stage IV of cervical cancer is a rather formidable disease. Radical treatment is possible in patients with stages I-II of the disease, then chemotherapy and radiation therapy are used. In stage IV of cervical cancer, we can now use not one line of chemotherapy, but two. We also have a resource of immunotherapy, which I mentioned above. A very rewarding work in clinical trials, when we see drugs work in front of our eyes, provide improvements in survival that have not been seen before, and receive FDA approval.

What is the average survival rate for your patients with advanced cancer with the right treatment?

Let’s take ovarian cancer as an example. Most often, patients are treated with stage III. This happens because at this time the patients’ abdomen is enlarged, until this moment, as a rule, nothing bothers them. Ten years ago, such patients were considered hopeless. With the advent of platinum preparations, the survival rate of such patients has increased to a year. With the introduction of modern surgical technologies, they began to perform volumetric operations that take 5, 6 or 8 hours, associated with the removal of tumor masses in the abdominal cavity.Thus, it was possible to increase the survival rate up to 5 years. And if supportive therapy is applied correctly, taking into account genetic mutations, better results can be achieved.

Is there a big difference in what medicine can offer in Ukraine and in European countries for gynecological oncology?

I think that today we have all the same resources at the National Cancer Institute as doctors in Europe. All our doctors have been trained in Germany, South Korea and the USA. Also, due to the fact that our department is the base of the pharmaceutical center of Ukraine, clinical trials are carried out on the basis of our department.Thus, we see the clinical effects of new drugs before they appear in practice, and we know their light and dark sides before entering the market.

What opportunities do you see in the development of gynecological oncology in the next 5 years?

Today there are two ways of development.

The first is the development of surgical technology. Surgery is now becoming more gentle, more technological and minimally invasive. Because of this, more and more equipment is required, but better results are achieved.

The second way of development is the improvement of drug therapy. Systemic chemotherapy has not changed significantly over the past 10 years, but new avenues of therapy have made a big leap forward. Targeted therapy is now developing to a lesser extent, but immunotherapy is developing very actively. In the treatment of melanoma and lung cancer, it has been possible to achieve results that could not have been dreamed of before.

What are your scientific and clinical plans for the next 5 years?

I see the main development prospects in conducting clinical trials, so I participate in them with great enthusiasm. Now we are negotiating about participation not only in research, where drugs are studied, but also on the operation. If we join such work, it will be a great achievement.

To make an appointment with the oncosurgeon, leave a request on the MedTour website. The coordinating doctor will arrange a consultation and help with paperwork for a trip to the clinic.