Wataru Yamagami: Beyond "Curing"—Cancer Care with a Focus on Women's QOL

2025/05/19

Cancer is currently the leading cause of death in Japan, and cancers such as cervical, endometrial, and ovarian cancer occur in the uterus and ovaries, which are organs unique to women. Among these, advanced cancer has a poor prognosis, but in recent years, the development and clinical application of new drugs such as immune checkpoint inhibitors and PARP inhibitors have progressed, and improvements in treatment outcomes are expected. On the other hand, the five-year survival rate for early-stage gynecologic cancer is very high, with Stage I showing favorable results of over 90 percent in all cases, and a complete cure is sometimes possible through surgery alone.

Much of cancer research has accumulated evidence for standard treatments by developing diagnostic and therapeutic methods and verifying them in clinical trials, with the primary goal of "improving survival rates." In cancers of organs essential for life support, preserving their function has been emphasized because it contributes to improving survival rates. However, the uterus and ovaries are not essential organs for life support, and because the peak age of onset was often higher than childbearing age, there was a tendency to neglect functional preservation. However, with the recent trend toward later marriage and childbirth, as well as progress in reproductive medicine such as egg freezing, the idea that it is "unavoidable to lose" the functions of the uterus and ovaries is no longer suited to the times.

For example, if the uterus is removed, the possibility of pregnancy is lost, and the removal of ovaries, radiation therapy, or certain drug therapies will stop the secretion of female hormones. Lymphedema caused by lymph node dissection and hair loss due to chemotherapy are also side effects that cannot be overlooked; these are issues deeply related to quality of life (QOL) that cannot be expressed simply by survival rate figures. That is why we are now seeking a new approach to cancer care that emphasizes maintaining women's QOL, rather than just aiming for "improvement of survival rates."

In our department, we are conducting various studies with QOL as the endpoint and verifying their effectiveness, including fertility-sparing treatment for cervical and endometrial cancer, sentinel lymph node navigation surgery, the establishment of an ovarian support outpatient clinic to support the ovarian function of cancer survivors, and scalp cooling therapy to prevent hair loss due to chemotherapy.

"Cancer" does not end when it is cured. How can one live their life after being cured in a way that is true to themselves? We are working on research while looking toward a future of "living with cancer" together with our patients.