Robot-assisted surgery at NYU Lutheran offers hope to women with endometrial cancer

Nandi Kumar Carpen, a 51-year-old wife, mother of two young girls, and a nurse at a major city hospital, noticed some "spotty" bleeding outside of her regular menstrual cycle. It was not the first time this had happened. Her gynecologist noted a low blood count, and a sonogram showed thickening of her endometrium, the inner lining of the uterus that is shed during a menstrual period. Further testing revealed she had endometrial cancer.

"All I could think about was my husband and two young girls -- how I wanted to spend more time with them," Carpen said.

Carpen and her husband met with her gynecologist and, much to their relief, she told them about a certain specialist at NYU Lutheran whom she described as an expert at treating her condition.

Gloria Soto, 54, a paraprofessional who works with kids with special needs, had a slightly different experience. She was already in menopause when she noticed "spotting," along with cramps on her left side. When a D&C showed cancer cells, she sought a second opinion from another gynecologist who told her firmly that she should be seen by a gynecologic oncologist.

Both Carpen and Soto were referred to Ghadir Salame, MD, a member of NYU's Perlmutter Cancer Center who has earned a well-regarded reputation among ob/gyn colleagues in the New York metro region for his expertise in treating endometrial cancer using robot-assisted surgery.

"Endometrial cancer in women is often caused by unopposed estrogen, a hormone produced by the ovaries in pre-menopausal women and by conversion from adipose cells (fat tissue) in post-menopausal women," Salame explains. According to the American Cancer Society, women who are overweight are twice as likely to develop endometrial cancer compared to women who maintain a healthy weight.

Salame also adds: "Estrogen-dependent endometrial cancer generally has a better prognosis than non-estrogen dependent."

Signs of endometrial cancer can include post-menopausal bleeding or irregular menstruation. "Approximately 10 percent of post-menopausal bleeding is cancer related but as with most cancers, early diagnosis is critical to a good outcome," Dr. Salame emphasizes.

It hardly mattered to both women that they had to travel quite a distance -- Carpen from Jamaica, Queens, and Soto from Coney Island -- to get to NYU Lutheran in the Sunset Park neighborhood of Brooklyn. Within a week of their diagnoses, both made appointments to see Dr. Salame. He recommended that each undergo surgical staging which includes a removal of the uterus, cervix, ovaries, fallopian tubes and lymph node sampling.

Robot-assisted surgery is Salame's preferred approach for treating clinically early endometrial cancer. "The procedure is safe, requires only a few small incisions, and provides excellent visualization of the tissues that need to be removed," he says. "Also, patients experience little pain that requires medication, often without even an overnight hospital stay, a faster recovery and return to normal activities."

Soto had her hysterectomy at the end of July - and was sitting up shortly after surgery. She opted for an overnight stay but was back to work at a summer day camp five days later. Carpen, who had her surgery in mid-August, also opted to stay overnight, and experienced very little post-surgical pain. She went home early the next day. She is up and about, and only refrains from heavy lifting for the time being.

A week following their surgery, Carpen and Soto both received good news from Dr. Salame: Their pathology reports confirmed that the endometrial cancer had been removed. In addition, they did not require further treatment such as chemo or radiation therapy.

Even with the good news, a much-relieved Carpen still could not bear to say the "C" cancer) word without her voice breaking. "I am so grateful to Dr. Salame," she says. "I have been around all kinds of medical and health professionals, but he is one of the special ones!"