But women who have cancers of the reproductive organs sometimes see only one doctor: a gynecologic oncologist, who performs both surgery and chemo.
There are only about 650 gynecologic oncologists practicing in the United States, most of them at teaching hospitals in major cities. But one of these highly trained specialists is now practicing in Gainesville.
Since August, Dr. Andrew Green has been treating patients at Northeast Georgia Medical Center’s Cancer Center.
He came here right after completing a three-year fellowship at the prestigious Cleveland Clinic in Ohio, and he still can’t believe where he ended up.
"Normally, doing what I do, you have to live in a big city like Atlanta or Dallas," he said. "I grew up in a small town in Louisiana, and I didn’t want that kind of lifestyle."
Green said when he heard of a job opening in Georgia, he didn’t know much about Gainesville except that the city’s population was fairly small.
"I didn’t expect there would be much here in terms of health care, but I decided to come for the interview," he said. "When I first laid eyes on the hospital (Northeast Georgia Medical Center), I was just stunned at how big it was. It is unheard of to have such a high level of medical care in a town this size."
Though Green works exclusively in Gainesville, he is affiliated with Southeastern Gynecologic Oncology, which has an office in Gwinnett County.
Tom Enright, director of oncology services at the medical center, said it was necessary for Green to be part of a physician group. As the only specialist of his kind in Gainesville, Green had to have partners who could fill in for him when he is off duty or on vacation.
"We already had a Southeastern Gynecologic doctor coming up here once a week, and after we identified a need for this service here full time, we started talking with the group about hiring another physician," he said.
Green said he was adamant about seeing patients only in Gainesville. "My whole point of being here is that people don’t have to drive to Atlanta," he said.
Even getting to the medical center in Gainesville can be an hour-long commute for patients who live in counties such as Towns or Union. If those patients have to go to downtown Atlanta, the trip can take as much as three hours.
"Some of the gynecologic cancers are pretty debilitating, and it’s tough to be in a car that long," Enright said.
In 2006, Northeast Georgia Medical Center treated 51 women with cancers of the reproductive organs, including the uterus, ovaries and cervix. But Enright said that number doesn’t reflect the true incidence of those cancers in Northeast Georgia, because in the past, most patients with gynecologic tumors were automatically sent to Atlanta.
"We expect our numbers to increase now," he said. "Already, our patient volume for gynecologic chemo has grown significantly. We’re also seeing more of these patients for radiation therapy."
Radiation is the only treatment method that gynecologic oncologists don’t handle themselves. Green said radiation is often effective for cervical and vaginal cancers, but it can’t be used on ovarian cancer.
"Ovarian is by far the toughest disease that I treat," he said. "There is no good screening test, so 75 to 80 percent of ovarian cancers aren’t diagnosed until they’re at Stage 3 or worse."
He said in the early 1990s, the odds of a Stage 3 ovarian cancer patient surviving longer than five years were about 30 percent. Now, the survival rate is about 50 percent, or as much as 65 percent if the patient receives intraperitoneal chemotherapy.
"IP chemo" was only developed a few years ago, and Green was involved in the technique’s clinical trials while he was working at the Cleveland Clinic. Doctors insert chemo directly into the abdomen via a catheter.
"You can give 30 or 40 times more of the drug that way than you can through intravenous chemo," Green said. "It does have significantly higher side effects, but the trade-off is that you live longer."
But not all ovarian patients meet the criteria for IP. The drugs can only penetrate about 1 centimeter into the tissues, so a surgeon must first be able to remove most of the cancerous mass.
This is where Green’s surgical skills come in. Advanced ovarian cancer is usually not a well-defined tumor but a diffuse growth that spreads all over the abdominal organs. Green said an operation to "de-bulk" the tumors can last as long as seven or eight hours.
That’s why, although all gynecologists are trained in surgery and they often do remove low-grade tumors, complicated cases are referred to gynecologic oncologists.
Green said he loves the challenge of a difficult operation.
"I started out wanting to be a trauma surgeon when I went to medical school at Louisiana State University," he said.
He eventually gravitated toward obstetrics/gynecology and did a standard four-year residency at Case Western Reserve University, but realized he wanted to do something beyond delivering babies.
"Regular ob/gyns don’t usually get to do the big surgeries," he said.
Green also enjoys the long-term relationships that oncologists establish with their patients. Unlike a general surgeon, he doesn’t just see patients for post-operative visits. His cancer patients usually undergo at least 18 weeks of chemo, and then they come in for check-ups several times a year for at least five years.
"I like working with this patient population, especially the ovarian cancer patients, who have to endure so much and yet always seem grateful for whatever you can do for them," he said. "You hope that you can cure them, but if not, I try to give them the best quality of life possible."
Green also tries to make the treatment less grueling for them. Many of the surgeries he performs are done laparoscopically, leaving tiny scars that require far less recovery time than open surgery. He also plans to introduce new techniques to Gainesville.
"I’m trained in robotic surgery, and I hope that at some point the hospital will acquire the equipment so I can do it here," he said.
Enright said Green has been a welcome addition to the Cancer Center.
"We’ve been impressed with his procedures and outcomes," he said. "He’s a good asset to the medical staff, and he’s clearly excited about being here."