Gynecologic Oncology

Robust resources and gynecological expertise are the foundation of Houston Methodist's internationally recognized gynecologic oncology services. Our diagnostic equipment and treatment procedures are among the best. 

Following a cancer diagnosis, it is common to be overwhelmed by the treatment plan. Our multidisciplinary team closely works and communicates with you and your family. Your team will consist of doctors, including oncologists and other specialists, as well as therapists, social workers and chaplains providing emotional and spiritual support. Your team will devise the best possible plan to treat your cancer and provide an important support system. 

We offer a wide array of cancer treatments to provide the best outcome for your condition. Services include: 


Houston Methodist’s gynecologic oncology team continues to evolve as a leader in screening, diagnosing and treating gynecological cancers, providing traditional and advanced procedures such as:
  • Specialized gynecologic oncology procedures and treatment options
  • Ovarian cancer
  • Vulvar and vaginal dysplasias and cancers
  • Cervical cancer
  • Uterine (endometrial) cancer 

Specialized Gynecologic Procedures and Treatment Options 
Extensive research and a highly specialized staff put Houston Methodist at the forefront of women’s health care with breakthrough procedures and treatments. We offer leading-edge cancer care in a compassionate and personalized environment. 

Surgical and Medical Clinical Trials
As part of our ongoing commitment to groundbreaking research and advances in cancer therapies, we offer our patients the opportunity to participate in surgical and medical clinical trials. Please click here for information on our current studies. If you are interested in being a candidate for one of these trials, please talk to your doctor. We invite you to learn more about our clinical trials, including the types of trials we conduct, the benefits of participation and our commitment to your safety.

Chemosensitivity Assay
A chemosensitivity assay is a test that is particularly useful in the treatment of recurrent cancers. This analysis involves removing cells from a tumor and determining their response to different combinations of chemotherapy medicines. As every patient is different, there is no single chemotherapy treatment that will work well for everyone; therefore, the chemosensitivity assay enables your doctor to determine what your most effective course of treatment will be before administering any chemotherapy to you.

Minimally Invasive Surgery
Houston Methodist experts often offer women the option of minimally invasive surgery  — procedures requiring small (or no) incisions for faster and less painful recoveries for you. Our frequently used methods include:
  • Laparoscopic surgery - Surgery is performed using a laparoscope – a thin, lighted tube with a tiny camera attached. Using a laparoscope, a surgeon views and removes diseased areas making small incisions.
  • Hysteroscopic surgery - Surgery involves a narrow tube-like instrument with a light and camera. A hysteroscope usually requires no incisions. The tool can be inserted into the uterus through the vagina and cervix. Hysteroscopic surgery is useful for retrieving diagnostic samples and performing endometrial ablation —  uterus lining removal — as an alternative to a hysterectomy (removal of the uterus). The procedure can also be used for uterine fibroid treatment.
  • da Vinci® system - This robotic “assistant” increases your surgeon’s movement control and provides a highly magnified 3-D image of the surgical area.
  • Laser surgery - Laser ablation destroys abnormal cells using a beam of intense light and requires no incision. It can be used for vulvar or vaginal dysplasia or early stage cancer.

Neoadjuvant Chemoradiation Therapy 
This chemoradiation therapy is given before a procedure such as surgery. Neoadjuvant chemoradiation shrinks the cancer as much as possible to make tumor removal easier during surgery. This treatment is especially useful in cases involving large cancerous areas. It is sometimes used with surgical debulking, a procedure in which parts of a large or complex mass are initially removed to shrink its size. Neoadjuvant chemoradiation also helps reduce surgical complications.
Gynecologic Oncology Group (GOG) Research
The Gynecologic Oncology Group (GOG) is a nonprofit, multidisciplinary cancer research group the National Cancer Institute funds. Houston Methodist is a GOG member and clinical trial site. More than 300 clinical trials have been conducted at the GOG’s worldwide member institutions, resulting in breakthrough uterine, cervical and ovarian cancer treatment advances. As a GOG member, Houston Methodist benefits from a strong and far-reaching alliance and cooperative information exchange to better understand and treat gynecologic cancers.

The following cancers are among the more common gynecologic malignancies. For information about these and other cancers, read about our cancer services.

Ovarian Cancer
Ovarian cancer is abnormal cell growth in the female hormone and egg-producing organs known as the ovaries. According to the American Cancer Society, ovarian cancer is the fifth leading cause of women’s cancer deaths, with an estimated 21,290 new U.S. cases to be diagnosed in 2015. 

The number of cases diagnosed annually has declined over the past two decades and survival rates have improved because of research and technology advances. Houston Methodist is at the ovarian cancer therapy forefront with experienced doctors, revolutionary treatment options and groundbreaking clinical trials. The high quality care we offer greatly improves your chance of living a long and healthy life after an ovarian cancer diagnosis. 

Our nationally recognized physicians and innovative support services provide complete care for you and your loved ones — physically, emotionally and spiritually. 

Your doctor will work closely with you to determine the best therapy course for you:
  • Chemotherapy
  • Intraperitoneal chemotherapy
  • Maintenance chemotherapy
  • Surgical debulking
  • Radiation therapy

We also offer expertise in managing some more difficult ovarian cancer-related challenges:
  • Recurrent ovarian cancer
  • Malignant ascites
  • Screening for gene mutations in breast cancer 1, early onset (BRCA1), and breast cancer 2, early onset (BRCA2)

Chemotherapy kills cancer cells using intravenous or oral drugs. It most commonly is used after ovarian cancer surgery to destroy remaining cancer cells. You may receive chemotherapy treatments at a clinic, at your doctor’s office or, if taking oral medicine, at home. Side effects depend on the type and amount of medicine given.

Click here to learn about chemotherapy treatment, including how it works in your body and what to expect. 

Intraperitoneal Chemotherapy 
This chemotherapy is administered in the peritoneum, tissue that lines the abdominal cavity, through a thin, flexible tube called a catheter. This method is used with intravenous chemotherapy. Intraperitoneal chemotherapy has proved to be especially effective against advanced ovarian cancer cases, extending survival about one year compared with just intravenous chemotherapy.

Maintenance Chemotherapy
Maintenance chemotherapy is a long-term, lower-dose chemotherapy, usually administered monthly, following initial chemotherapy to prevent rapid cancer recurrence. This treatment is generally better tolerated than high-dose chemotherapy, particularly by those who also have received intraperitoneal chemotherapy. Few studies exist proving maintenance chemotherapy’s effectiveness. It is used less frequently for ovarian cancer compared to other chemotherapy forms.

Surgical Debulking 
During ovarian cancer surgery, surgeons remove as much of the tumor as possible, a process called debulking. Successful debulking surgery will leave tumors smaller than 1 cm. At least one of the following organs could be removed:
  • One or both ovaries
  • Uterus and both fallopian tubes
  • Omentum (fatty tissue in the lower abdominal area that connects, covers, and protects organs)
  • Pelvic and para-aortic lymph nodes
  • Any other tumor bearing area, including portions of small or large intestine, appendix or spleen.

Most patients remain hospitalized three to seven days following surgery and return to their usual activities in four to six weeks. 

Click here to learn more information on surgery, including how different surgical approaches prevent, diagnose and treat cancer.

Radiation Therapy
Radiation therapy kills cancer cells using high-energy rays in targeted areas. It rarely is used in initial ovarian cancer treatment, but may be used to relieve pain and other problems. Each treatment session takes a few minutes.

Click here for information about Houston Methodist’s innovative radiation therapies

Recurrent Ovarian Cancer
Unfortunately, ovarian cancer may recur. Early cancer detection may alleviate this risk. However, most ovarian cancer is not diagnosed until it is in later disease stages.

Malignant Ascites
A potential complication of breast, abdominal or gynecological cancers is development of malignant ascites, which can cause pain and fatigue and inhibit cancer treatment success. Ascites is fluid buildup in the abdominal area (specifically, the peritoneal cavity) and can be a side effect of many conditions. When cancer growth causes ascites, it is called malignant ascites. A tumor can irritate the peritoneal cavity lining or block lymphatic system function, causing fluid buildup. 

Treatment usually involves palliative care, a form of care for those with serious illnesses to reduce discomfort. Palliative care for malignant ascites usually includes fluid drainage through a catheter called an ascitic tube.

Genetic Screening for BRCA1 and BRCA2
Evidence shows some patients may benefit from genetic testing of two genes known as breast cancer 1, early onset (BRCA1), and breast cancer 2, early onset (BRCA2). Mutations in these genes may cause hereditary forms of breast or ovarian cancer, especially in certain ethnic populations. 

Those with a strong family link — more than one close relative (mother and sister) diagnosed with breast or ovarian cancer before age 50 or many cases of breast, uterine (endometrial) or ovarian cancer among relatives — may choose genetic screening. This screening is only recommended for those in this high-risk group. Results may determine whether preventive surgical or medical intervention could benefit you. 

Click here for information about Houston Methodist Cancer Center’s high risk cancer program at Houston Methodist Cancer Center.

Vulvar and Vaginal Dysplasias and Cancers
Dysplasia refers to abnormal and precancerous cells. Vulvar and vaginal dysplasia are uncommon and cancer rarely occurs in these areas. Dysplasias and vulva and vagina cancers are highly treatable. Houston Methodist’s experienced and caring doctors provide you individualized care from diagnosis through therapeutic and reconstructive surgery, giving you your best chance to survive, thrive and maintain a positive body image.

Vulvar Dysplasia and Cancer
Vulvar dysplasia, or vulvar intraepithelial neoplasia (VIN), is abnormal cell growth. It affects external female genitalia and is generally a precancerous condition. Most VIN cases will not become cancer unless they go untreated. VIN is slow-growing and often produces symptoms such as itching and visible, wart-like lesions on the vulva. Most vulva cancers develop from VIN, although a small number of cases may be caused by another cancer type (such as melanoma, or skin cancer).

Vaginal Dysplasia and Cancer
Vaginal dysplasia, also known as vaginal intraepithelial neoplasia (VAIN), is precancerous cell growth on the lining the vagina, or birth canal. VAIN can become vaginal cancer (other vaginal cancers include melanoma and sarcomas, which grow below the vagina’s lining). Pap tests and pelvic exams detect VAIN and vaginal cancer.

Learn about our vulvar and vaginal dysplasia and cancer services:

  • Surgical and medical treatment
  • Clinical trials for vulvar and vaginal dysplasia and cancers
  • Radical surgery and reconstruction
  • Chemoradiation therapy
  • Neoadjuvant chemoradiation therapy

Surgical and Medical Treatment of Vulvar and Vaginal Cancers 
Surgery is commonly used and may be supplemented with radiation therapy and chemotherapy for vulvar and vaginal cancers. Some therapies for cancer and precancerous conditions are:
  • For dysplasia:
    • Laser ablation to destroy abnormal cells
    • Local excision (surgical removal) of the dysplasia
    • Partial vaginectomy (removal) of the upper vagina
  • For cancer:
    • Chemotherapy (including topical chemotherapy, in which cream is applied to cancerous lesions)
    • Radiation therapy
    • External radiation - administered from outside the body, targeting cancer cells with a beam.
    • Internal radiation (also known as brachytherapy) – radiation-emitting materials are placed in the vagina to maximize the dose to the cancer and minimize damage to surrounding healthy tissue
  • Combination therapy - surgery, chemotherapy and radiation (including chemoradiation)

Houston Methodist’s doctors are radiation therapy leaders, offering the most advanced technologies and a multidisciplinary approach for safe and accurate radiation administration.

Clinical Trials for Vulvar and Vaginal Dysplasia and Cancers 
Houston Methodist offers our patients surgical and medical clinical trial participation opportunities as part of our commitments to groundbreaking research and women’s health advancements, Click here for information on our current cancer trials.

Radical Surgery and Reconstruction 
Radical surgery is an advanced cancer treatment option. All or part of the vulva, including the clitoris and surrounding tissue, may be removed to tackle vulvar cancer. Surgeons may remove the vagina, uterus, cervix and parts of nearby organs in advanced vaginal cancer cases. The most extreme cases may require pelvic exenteration, the removal of all pelvic organs. 

The team performs vulvar reconstruction and vaginal reconstruction using the patient’s skin and tissues. Reconstructive surgery could aid your physical recovery, as well as preserve your sexual health and positive self-image. 

Cervical Cancer 
Cancer of the cervix — the tissue forming the uterus’ lower opening — can be detected earlier than other cancers if you have an annual gynecological exam. A vaccine can provide immunity against HPV (human papillomavirus, the major cause of cervical cancer), and reduce the risk of cervical cancer caused by certain HPV strains. 

The American Cancer Society estimates 12,900 women will be diagnosed with cervical cancer in 2015. Others will be diagnosed with dysplasia (a precancerous condition). Read more about Houston Methodist’s cervical cancer screening, prevention and treatment resources:
  • Surgery
    • Radical surgery/pelvic exenteration
    • Fertility-preserving surgery
  • Chemotherapy
  • Radiation Therapy
  • Chemoradiation
  • Cervical dysplasia screening and treatment
  • HPV testing and vaccination

Surgeries can diagnose and treat cervical cancer.
  • Conization is a cone-shaped piece of tissue removed from the cervix to facilitate diagnosis or remove abnormal cells.
  • Hysterectomy is performed to remove the uterus and cervix.
  • Radical hysterectomy is performed to remove the uterus, cervix, upper vagina and adjacent tissues
  • for treatment of certain cervical cancers.
  • Trachelectomy is performed to remove the cervix and upper part of the vagina but not the body of the uterus to preserve fertility.
  • Pelvic exenteration is performed to address recurrent cervical cancer. The same organs and tissues are removed as would be during a radical hysterectomy. Additional organs also could be removed, including the bladder, vagina, rectum and part of the colon.
  • Pelvic lymph node dissection is performed with a radical hysterectomy to remove pelvic lymph nodes adjacent to the cervix to evaluate for disease spread and treatment planning. Houston Methodist surgeons perform radical hysterectomies or trachelectomies with pelvic lymph node dissection robotically, which results in shorter hospitalizations.

Click here to learn more information on surgery, including how different surgical approaches prevent, diagnose and treat cancer. 

Radical Surgery/Pelvic Exenteration 
Radical surgery, an advanced cervical cancer treatment option, is removal of the uterus, cervix, vagina and parts of nearby organs. The most extreme radical surgery is pelvic exenteration, during which all pelvic organs, including reproductive organs, the bladder and rectum, are removed. 

Radical surgery is used in recurrent or extremely advanced cervical cancer. There has been great innovation in pelvic reconstruction. Houston Methodist offers the most advanced forms of restoration after radical surgery. 

Fertility-Preserving Surgery 
It may be possible to treat dysplasia or early-stage the cancer and preserve fertility. Early cancer diagnosis may allow for a remedy as simple as conization (removal of a cone-shaped portion of the cervix, including abnormal cells and small amount of surrounding normal tissue). Most cases will require a vaginal radical trachelectomy, during which the upper vagina, cervix and some surrounding tissues are removed. The uterus and ovaries are left, making pregnancy possible.

Chemotherapy kills cancer cells using intravenous or oral drugs. It most commonly is used after ovarian cancer surgery to destroy remaining cancer cells. You may receive chemotherapy treatments at a clinic, at your doctor’s office or, if taking oral medicine, at home. Side effects depend on the type and amount of medicine given.

Chemotherapy can make radiation more effective in a combined therapy called concurrent chemoradiation. Chemotherapy can be given without radiation as well. It also is an option if cervical cancer returns or spreads. 

Click here to learn about chemotherapy treatment, including how it works in your body and what to expect. 

Radiation Therapy
Radiation therapy kills cancer cells using high-energy rays in targeted areas. Many radiation types can be used, depending on tumor size and location. Click here to learn about Houston Methodist’s variety of innovative radiation therapies

Chemoradiation Therapy
Chemoradiation therapy combines chemotherapy (intravenous or oral medicines) and radiation therapy. Chemoradiation may be neoadjuvant therapy — the first treatment tried before surgery — or adjuvant therapy, given after surgery or a procedure to destroy remaining cancer cells. Your chemotherapy and radiation treatments may be given simultaneously or in alternating sessions. Chemoradiation most often is used in advanced or complicated cancer cases.

Cervical Dysplasia Screening and Treatment
Cervical dysplasia is an area of abnormal cells, also known as a lesion, growing on the cervix. Dysplasia must be promptly diagnosed and treated because it is a cervical cancer precursor. Diagnosis begins with your annual pelvic exam and Pap test, which detects cervix inflammation or abnormalities. Annual Pap tests typically are recommended after age 18. An HPV test is also important for women over 30.

If tests show you have abnormal cells, additional tests determine cell type and treatment. Precancerous lesions can be treated using several methods, most of which are simple outpatient procedures. These treatments include:
  • Cryosurgery - a cooled probe freezes and kills precancerous cells.
  • Laser surgery - a laser destroys abnormal cells. Dead cells slough off after the procedure.
  • Conization (cone biopsy) - removal of a cone-shaped portion of the cervix, including abnormal cells and small amount of surrounding normal cells. Cone biopsy also is used to diagnose dysplasia after Pap and other tests indicate abnormalities.
  • LEEP (loop electrosurgical excision procedure) - an electrified wire loop scrapes precancerous cells.
  • Hysterectomy - removal of all or part of the uterus, including the cervix. Hysterectomy usually is performed in most extreme cases.

HPV Prevention and Testing
HPV, or human papillomavirus, infects the cervix. Up to 80 percent of women will contract HPV at some point, even while practicing safe sex. HPV is not a sexually transmitted disease. It is a virus.

HPV forms generally are classified as high-risk and low-risk, depending on their likelihood of causing dysplasia, cancer or genital warts. Most people fight the virus on their own (particularly with low-risk HPV forms), but in some cases infection remains, causing cervical cell abnormalities that may lead to cancer. 

If you are over age 30, the combination of a Pap test and an HPV test is recommended. Women younger than 30 years old are less likely to have cervical cancer and more likely to have HPV (which tends to go away on its own). If you are younger than 30 and have an abnormal Pap test, your doctor may perform an HPV test. An HPV test is performed like a Pap test. 

Uterine (Endometrial) Cancer 

Uterine cancer, or cancer of the uterine lining (endometrium), is the most common cancer of the female reproductive system, affecting roughly 40,000 women annually. It is one of the most survivable gynecological cancers when diagnosed early and properly treated.

Houston Methodist is a uterine cancer treatment leader. We provide you with the most complete therapy course and fastest recovery time because of our revolutionary surgical and medical techniques, groundbreaking clinical trials and highly trained, caring staff.

We offer the latest treatment options in a respectful and compassionate atmosphere. We treat you – not just your disease – to improve your prognosis and quality of life.

Once uterine cancer has been diagnosed and staged, your doctor may recommend at least one of the following:
  • Surgery
  • Radiation Therapy
  • Chemotherapy

Surgerical removal of the uterus and any affected tissue is the most common uterine cancer treatment. Your physician may recommend several surgery types, depending on cancer stage. Most procedures can be performed at Houston Methodist Cancer Center using minimally invasive techniques, including laparoscopy and robotic surgery.
  • Simple hysterectomy (also called total hysterectomy) removes the whole uterus, including the cervix, but leaves the loose connective tissue around the uterus (parametrium), the tissue connecting the uterus and sacrum (uterosacral ligaments), and the vagina. The uterus can be removed through the vagina or a small abdominal incision.
  • Bilateral salpingo-oophorectomy removes both fallopian tubes and ovaries. This is often done with a hysterectomy.
  • Lymph-node dissection removes lymph nodes in the pelvis and around the aorta (the main artery from the heart to the abdomen). This is often done with a hysterectomy.
  • Radical hysterectomy removes the entire uterus, parametrium and uterosacral ligaments and upper part of the vagina. This procedure is rarely performed to treat uterine cancer and is usually done if cancerous cells have been found in the cervix.

Hospitalization for an abdominal hysterectomy is usually three to five days. Complete recovery takes four to six weeks. Laparoscopic and vaginal hysterectomies usually require one to two days of hospitalization and two to three weeks for recovery.

Click here to learn more information on surgery, including the roles that different surgical approaches have in preventing, diagnosing and treating cancer.

Radiation Therapy
Radiation therapy kills cancer cells using targeted high-energy rays. It may be used before or after surgery or as an alternative treatment if surgery can’t be performed to treat uterine cancer.

Two main radiation therapy types treat uterine cancer:
  • External radiation therapy directs radiation at your pelvis or other areas where cancerous cells have appeared. Each session takes a few minutes and usually occurs five days a week for several weeks.
  • Internal radiation therapy (also called brachytherapy) involves insertion of a narrow cylinder loaded with a radioactive substance into the vagina. Treatments last a few minutes and may be repeated two or three times over several weeks.

Click here to learn more about the variety of innovative radiation therapies

Chemotherapy kills cancer cells using intravenous or oral drugs. It most commonly is used after ovarian cancer surgery to destroy remaining cancer cells. You may receive chemotherapy treatments at a clinic, at your doctor’s office or, if taking oral medicine, at home. Side effects depend on the type and amount of medicine given.

Click here to learn about chemotherapy treatment, including how it works in your body and what to expect.

Find information on some of our state-of-the-art methods for uterine cancer treatment in the following:
  • Laparoscopic treatment
  • Robotic-assisted surgery
  • Genetic testing

Laparoscopic Treatment 
Laparoscopic surgery is a great uterine cancer treatment improvement. It is minimally invasive, often involving one-inch incisions, rather than large abdominal incisions, which can increase recovery and pain. Through these incisions, your surgeon views and removes diseased areas with a narrow tool called a laparoscope. The laparoscope is equipped with a small camera to guide it. Although most often used for minor procedures, laparoscopic treatments can be used for hysterectomies, cutting recovery time in half of that of traditional abdominal surgery.

Robotic-Assisted Surgery
Robotic-assisted surgery is one of the most innovative technologies used in medicine today. The da Vinci® surgical system offers unprecedented precision through the smallest incisions, making it a tremendous surgical breakthrough. Using this system, your surgeon will have greater movement control while working with a highly magnified 3-D image of the surgical area. This level of accuracy leads to fewer complications and reduces recovery time. The da Vinci system is a highly advanced tool your skilled surgeon operates like any other equipment.

Genetic Testing
Studies indicate a link between a condition known as hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch Syndrome, and uterine cancer. A genetic mutation causes HNPCC and greatly increases many cancers risks, especially colorectal and uterine cancers. 

Houston Methodist’s range of services and treatments include genetic testing.Individuals with a family history of uterine or colorectal cancer, particularly early onset cancer, could benefit from this test. Your doctor may recommend testing to give you information for appropriate prevention plan development if you have a high uterine cancer risk.


Our physicians at Houston Methodist specialize in gynecologic oncology at the following convenient locations: