A new specialty physician who recently joined Rockwood Clinic PS, the big Spokane-based doctors group owned by Franklin, Tenn.-based Community Health Systems Inc., brings with him an extensive background in caring for women who have a form of cancer that affects their reproductive organs.

Earlier this summer, Rockwood brought on gynecologic oncologist Dr. Joel Webb as a new member of its cancer-fighting team of physicians who work at the clinic's two cancer treatment centers, located in downtown Spokane and in Spokane Valley. Webb is mainly based out of the Valley center and is said to be the first and only doctor with Rockwood who specializes in that area of cancer medicine.

Webb's role with Rockwood is to manage comprehensively any cancer or malignancy of the female reproductive organs, as well to perform complex gynecological surgeries for patients with or without cancer, he says.

"I am the go-to guy for other complex or difficult gynecological surgeries since most of the cancer surgeries are more complex," he says.

Webb also brings to Rockwood's team his experience and knowledge of some more recently implemented oncology treatment methods now being used to fight some forms of cancer that occur only in women.

The most prevalent form of reproductive organ cancer that Webb says that he sees is uterine cancer, followed by ovarian and cervical cancer. Managing precancerous changes in those parts of the body is another common reason he sees female patients; many of those irregular signs can be detected early by an abnormal Pap smear test.

The main difference between Webb's specialization in treating cancers of the female reproductive organs and a general surgical oncologist, he says, is that he focuses on the comprehensive care of a patient from their diagnosis through surgery and the coordination of radiation therapy and chemotherapy.

He adds that most of his patients receive radiation therapy at the Valley center from the same piece of radiotherapy equipment that Rockwood also now is able to use to administer a new method of radiation treatment to breast cancer patients (see story page B13). Chemotherapy treatments also are administered at that location.

Webb asserts that there are some major advantages for women with a cancer of the reproductive organs who are treated by a gynecological oncologist versus a non-specializing oncologist.

He says in some smaller medical communities without a physician who specializes in the specific field of gynecological oncology, women might have a hysterectomy performed to remove their reproductive organ that's affected by cancer. He says that could occur because the doctor might not have the resources to perform a more complex surgery that wouldn't require such an extensive measure as a complete removal of the uterus and cervix.

"The advantage of being treated by a gynecological oncologist is that we know what to do to get the disease out," he says. "We hunt down every piece of cancer; we don't just do a hysterectomy."

Webb says he also works closely with the physicians in Rockwood's Breast Health Center, also located in its Spokane Valley Cancer Treatment Center, in managing the health care of patients who might have a hereditary predisposition to develop breast cancer or a cancer within their reproductive system.

He says two known genetic mutations that have been linked to breast cancer—BRCA1 and BRCA2—also have been noted to increase a patient's risk for developing ovarian cancer.

"We do a pretty good job of identifying at-risk patients," Webb says. "If it is a mutation that increases their risk of ovarian cancer I can counsel them on their options, can do a surgery to remove the ovaries, or just more closely monitor the patient."

Having practiced as a gynecological oncologist with the U.S. Army for 15 years and then for three years at the Huntsman Cancer Institute at the University of Utah, in Salt Lake City, Webb brings with him a history of treating various cancers that can affect the female reproductive organs.

He says that in the last several years, though, he's also seen several cutting-edge innovations come into wider practice that have changed the way some of those cancers are treated.

"One of the biggest advances that have come along is robotic surgery and doing a complex cancer operation in a minimally invasive fashion that decreases time spent in the hospital and the pain after surgery," Webb says. "It's a very useful tool in managing uterine cancer and early stages of cervical cancer."

He says using robotic-assisted surgery instead of laparoscopic surgery has become more accepted in cancer medicine over the last five or six years because of the precision it offers.

"It gives you a better technical ability to do cancer operations," Webb says. "You can do a finer dissection; there's a three-dimensional view, and it gives you a wrist action you (physically) don't have."

Webb says he performs robotic-assisted surgeries on his patients here at both Deaconess Medical Center and Providence Sacred Heart Medical Center & Children's Hospital.

A second major advancement that's specifically being used to treat ovarian cancer is to inject chemotherapy drugs directly into a patient's abdominal cavity via a catheter, called intraperitoneal chemotherapy, along with administering the drug intravenously, Webb says.

Webb says that ovarian cancer can easily spread into parts of the abdomen because the tumors grow on the outside of the organ. Giving the chemotherapy drugs in that form helps it to reach the cancer more directly, he says. This treatment option has caught on in in the field of oncology medicine in the last five years or so, he adds.

Because the injection of the drugs directly into the abdomen cavity can be painful and is a more aggressive form of treatment, Webb says that he'd only recommend it to patients who don't have other significant health problems and who are highly motivated to undergo the procedure for its potential benefit.

"It can be a hard regimen to go through, but there is a significant upside; a study in 2006 showed a 15-month improvement for the right patients," he says.

Additionally, he says that type of treatment would be appropriate only for a patient who'd already had as much as possible of the cancerous tissue surrounding her affected ovary removed through surgery.

Another form of treatment being studied for its effectiveness at treating ovarian cancer involves the use of a drug named Avastin, manufactured by Genentech Inc., of San Francisco, Webb says. Avastin has been used heavily to treat colon cancer by blocking the flow of blood to cancerous tumors that would cause them to stop growing, he says.

"In cancer medicine in general we are increasing our understanding of the biological and genetic mechanisms of cancer and are developing smarter treatments to deal with things on a cellular level," he says. "The old-fashioned concept was a slowly controlled poisoning of the patient slower than the cancer (advanced). Now chemo is targeting specific mechanisms of cancer cells and we're reducing the side effects of chemo and making it a better treatment."

A third emerging trend in gynecologic oncology Webb says has come more into the medical mainstream is genetic risk management, or the close monitoring of patients with a known higher risk to develop a specific form of cancer because of a mutation they carry in their genes.

"It's important to coordinate with other doctors to identify patients who are at a genetic risk for breast, ovarian, and uterine cancers, and to develop a risk-reducing strategy such as doing a hysterectomy or removing the ovaries after childbearing," he says. "Along with that there needs to be a lot more education and appropriate screening for patients who come in with a suspicious family history."

He says another recent advancement in gynecologic oncology was the introduction about five years ago and subsequent encouraged use of the human papillomavirus (HPV) vaccine manufactured under the brand name Gardasil by the Whitehouse Station, N.J.-based pharmaceutical company Merck & Co.

That vaccine was designed to reduce the spread of two strains of HPV that are known to cause 70 percent of cervical cancers in women. It's recommended to be administered both to males, who can be carriers, and females between the ages of nine and 26 to be most effective.

To maintain a healthy reproductive system, Webb says women always should receive a yearly pelvic and breast exam starting at age 20, and should make sure to tell their doctor of any unusual or abnormal symptoms they might notice.

Along with that, he says staying up to date on other screenings, such as mammograms and colonoscopies, at the recommended ages is crucial to catching cancer in its early stages when it's most curable.