Cancer Care Connections
Cancer Care Connections
Empowering Women’s Health: A Glimpse into the World of Gynecologic Oncology
During this episode, we sat down with Dr. Devin Miller, a gynecologic oncologist with Virginia Oncology Associates. Our conversation was not only informative but also a call to action for women to become advocates for their health. Dr. Miller's dedication to her field is obvious as she discusses the complexities of fighting cancers unique to the female reproductive system and shares breakthroughs in treatment that are changing lives.
Learn why something as simple as quitting smoking or maintaining a healthy lifestyle can drastically reduce your cancer risks, and why your family history could be the key to unlocking your best defensive strategy. Dr. Miller's compassionate approach emphasizes the importance of listening to one's body and the necessity of having a robust support system when facing a cancer diagnosis.
Join us for this enlightening discussion that not only sheds light on the advancements in gynecological oncology but also equips you with the knowledge to take control of your health journey.
Dr. Devin Miller is a native of Virginia Beach. She attended the College of William and Mary, earning a Bachelor of Science in Kinesiology and Health Sciences. She received her medical degree at Virginia Commonwealth University School of Medicine. She proceeded to clinical training at Yale New Haven Hospital for obstetrics and gynecology residency, where she served as chief resident. Dr. Miller completed her fellowship in Gynecologic Oncology at Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, NY, where she was recognized as an outstanding educator for resident physicians and medical students. While in fellowship, she received grant funding for her research from the Foundation for Women’s Cancer.
Dr. Miller treats patients with all forms of female cancers, including those of the uterus, ovaries, fallopian tubes, vulva, vagina, and cervix, as well as complex benign gynecologic conditions. As part of a multidisciplinary team, she works closely with pathologists, radiologists, radiation oncologists, and other physician specialists. This collaboration gives each patient a treatment plan tailored to their unique diagnosis and goals. As a gynecologic oncologist, Dr. Miller is trained in advanced surgical techniques, specializing in minimally invasive and robotic procedures that promote faster recovery and less hospitalization.
Resources mentioned in this podcast
Foundation for Women’s Cancer: https://foundationforwomenscancer.org/
Thank you for listening! If you're interested in hearing more from Virginia Oncology Associates, make sure to subscribe to Cancer Care Connections on Apple Podcasts, Spotify, or anywhere podcasts are available, or listen online at cancercareconnections.buzzsprout.com.
Cancer Care Connections is the official podcast of Virginia Oncology Associates. For more information, visit us at VirginiaCancer.com. or find us on Facebook or Instagram at Virginia Oncology Associates.
Intro
00:06
On this episode of Cancer Care Connections, Cheryl spoke with Dr. Devin Miller, a gynecologic oncologist with Virginia Oncology Associates. Dr. Miller discusses the types of cancers treated by a gynecologic oncologist, the intricacies of gynecologic treatment, and what simple changes you can make to reduce your risk. Dr Miller passionately advocates for women's health, empowering women to navigate their healthcare with confidence.
Cheryl
00:35
Dr. Devin Miller is thrilled to return to the Tidewater area and provide gynecologic cancer care to the women in her home region. She is a native of Virginia Beach and has been with Virginia Oncology Associates since 2024. Dr. Miller treats patients with all forms of female cancers, including those of the uterus, ovaries, fallopian tubes, vulva, vagina, and cervix, as well as complex benign gynecologic conditions. As a gynecologic oncologist, Dr. Miller is trained in advanced surgical techniques, specializing in minimally invasive and robotic procedures that promote faster recovery and less hospitalization. Outside of medicine, Dr. Miller enjoys being active, traveling, and spending time with her husband, daughter, and dogs. Dr. Miller, thanks so much for joining us today.
Dr. Miller
01:26
Thank you for having me.
Cheryl
It's good to be home, isn't it?
Dr. Miller
It's great to be home, especially at this time of year, as it's getting warmer and beautiful outside.
Cheryl
01:34
What brought you to medicine, and GYN oncology in particular?
Dr. Miller
01:41
That's a great question. It's so interesting for every doctor to kind of see how we got to the place that we are. In particular, when I was in medical school, I really enjoyed working with female patients. I think at the time and to this day, there's a lot that has happened in medicine that has been frankly harmful to women and they haven't always had the advocacy they needed. Things are changing. GYN cancers, in particular endometrial cancer, are becoming more prominent. Originally, you start in OBGYN when you become a GYN oncologist. And so I saw this incredible group of women, kind of the matriarchs of their families, these really strong people that were dealing with things that I just thought were, you know, obviously horrible to deal with in oncology. I wanted to be the person who was with them and provide as much comfort and excellent care as I could. So luckily I was able to secure a position in fellowship for GYN oncology and through kind of a winding road, it's brought me back to my hometown.
Cheryl
02:49
That's wonderful that you have such a passion, and I can hear it. To your point, you only know what you know. So in years past a woman would just know what she knew, what people told her. And when you have someone like you who's doing the research, who's involved in so much of the care, you're bringing to the forefront the things that they should know.
Dr. Miller
03:13
Exactly, and I think things are changing quickly. Particularly with the advent of social media, women are becoming more conscious of what's going on with their bodies. I mean, there was a time when women weren't even told what was going on with their bodies, their husbands were. Or they weren't allowed to make decisions about their own medical care. So I think we really try, particularly as the younger generations come up through medicine, to promote women knowing their bodies, advocating for themselves with us beside them, and also promoting excellent care on par with any other part of medicine.
Cheryl
03:46
All right. Let's get to helping people understand what you do and why they would see you. So I think people know what a GYN is. Maybe they go to an OBGYN and they maybe know what an oncologist is. What is a gynecologic oncologist?
Dr. Miller
04:04
That's a great question because it is one of the smaller and more specific fields in medicine. So really right now there are only about 1,000 to 1,200 of us in the entire country. We are a tiny field that focuses completely on the care of women with GYN cancers. So essentially we go to medical school and then we do an OBGYN residency. So we take care of women across all aspects of their lives and then when we have an interest we can subspecialize in just oncology. That's another three-year fellowship on top of our residencies and in that fellowship we do research and learn to treat all kinds of GYN cancers.
But what's very unique about our field is that we are the people who are both doing surgery for GYN cancer and also chemotherapy, targeted therapies, and immunotherapies. We don't physically administer radiation but we work closely with the doctors that do that. It's one of the last fields in medicine where we are kind of doing everything having to do with one patient and one disease. We're guiding the ship the whole time. So most GYN oncologists to this day are in charge of the patient's care and their journey from the second we meet them with a diagnosis through multiple lines of treatment, if they need them, including surgery and sometimes multiple surgeries. It can be a very long-term relationship. I always say when I meet someone for the first time, "I hope it's a short time and I get to discharge you from oncology and, I hope to only run into you socially," but you know, if we need to be with someone for an extended period of time, we are.
Cheryl
05:54
That brings up such a good question, who gets the pleasure of seeing you? A woman sees their OBGYN, they see their GYN primary care once a year, whenever they need to. They don't know if they would necessarily think to pick up the phone and call to make an appointment with you. When do they get to see you?
Dr. Miller
06:18
That's a great question. So most of our patients come to us from their OBGYN or primary care doctor if they have anything that they either have diagnosed as a GYN cancer or a precancer. Or if there's something complex about the patient that they want us to weigh in on. As I alluded to before, we get additional training beyond our residency in specific surgeries and complex GYN surgeries. So oftentimes too, we'll see a patient who just has a complex surgical issue that maybe her OBGYN thinks would be better served with us for one reason or another. If you're referred to see us by somebody, it doesn't mean necessarily that there's a cancer. There may be something that is a little bit higher risk, or it's just that you know, either surgically or medically, your doctors, think it would be best that we weigh in, if not take care of whatever it is. So kind of all across the spectrum; it could be something completely benign, not cancer to pre-cancer, all the way through any type of GYN cancer.
Cheryl
7:32
So a call to your office doesn't necessarily mean the worst?
Dr. Miller
07:36
Correct.
Cheryl
07:36
But also, just because of the specialty that you have, you're very well versed in one part of the body, I guess you might say. So let's talk about some of the cancers that you treat and some of the surgeries that you carry out, just kind of on a generic level.
Dr. Miller
07:56
Yes, so we treat all types of pelvic cancers and it's important to remember that pelvic cancers don't necessarily always start right in the pelvis, nor do they end there. So, again, that's another reason why our field is important. Specifically, we deal with, cervical cancer, uterine cancer, ovary cancer, and also the more external cancers like vulvar and vaginal cancers. Those involve all kinds of different surgeries and treatments. Some of our surgeries have to do with, minimally invasive surgery, sometimes just a minimally invasive hysterectomy, which is now a same-day surgery. Sometimes we take samples of lymph nodes when we do that or use a special dye to help us take targeted biopsies. And sometimes we, just do minor things to get diagnoses, like biopsies or things like that, under anesthesia all the way through big ovarian cancer surgeries which are known as debulking surgeries, where we actually remove all the cancer we can see with our eyes at the time of that surgery. And sometimes we even give chemotherapy during that surgery to the inside of the abdomen. So you can imagine it's a huge surgery and sometimes when I talk to a patient when I meet them, I say we may be doing a small surgery today and you may go home, but if we find something different, I am prepared as a GYN oncologist, to do what I need to do so that most of the time you end up with one surgery and recover with us in the hospital if you need to, and then we have the plan after surgery as well.
Cheryl
09:32
I'm hearing this, and I'm just thinking about the level of skill you must have.
Dr. Miller
09:36
You know, I think all of us are quite humbled by our training, by the patients that we meet, and how amazing they are. But it is a large amount of training that we go through and a huge amount of time in the operating room and time with our patients managing these plans. It's also about collaboration. None of us is an island. I still reach out to mentors I have from training or mentors that I have who are experts on a national level or my partners here, and we discuss cases together. This happens multiple times a day. I'm not saying it happens once a week. Everyone is constantly trying to do the best thing for their patient across our field and always trying to stay current. So I think we do truly, because of what we cover and what we take care of, we are very amenable to constantly getting advice from others. That collaboration, I think, is what allows us to stay where we are and stay on our toes in the field.
Cheryl
10:39
I think, for anyone hearing this, whether it's a patient, a loved one of a patient, a friend...hearing that is so comforting; to hear that collaboration and that constant desire to learn and know more, to support the patients.
Dr. Miller
10:53
Exactly, and I think we all together have that drive. As a field, we are constantly absorbing more information and constantly talking, and the field is constantly advancing. And I think you know if you choose to do GYN oncology and choose to take all of this on in your day-to-day, you're a certain type of person. I think there's no question about that, but at the same time, you're also probably a very warm person because you take care of these amazing women through all aspects of their lives. So it's a great group to be a part of. We have five of us here and I would say the same for all five of us, that everyone cares very much and brings excellence to their day-to-day.
Cheryl
11:38
That is apparent. So I want to ask you about risks and what a patient can do to decrease their risk of having to see you. Not that you're not a lovely person, but truly to decrease the necessity, maybe, of coming to see you. Is there anything that they can do there?
Dr. Miller
11:56
There are actually a lot of things that people can do to avoid oncologists. I think it comes across different aspects of your life. The first thing every oncologist would say to avoid seeing me, don't smoke. Number one, try to avoid smoking, particularly for cervical cancer risk. You know cervical cancer is mostly caused by a virus that's very common. About 90% of people have been exposed. It's called HPV. But smoking is the driver of the advancement of that in the disease process; of getting either pre-cancer of the cervix or cervical cancer. So, number one don't smoke or please, we'll help you stop, anything we can do. Number two is all the things that everyone tells you every day, active lifestyle and try to maintain a healthy weight. For instance, endometrial cancer; some types are driven by obesity and the overabundance of some hormones, so if we can control weight and get to a healthy weight, that's very helpful. Or even some weight loss and being active, like I said, obviously having a healthy diet.
Then you bridge into the world of what is your risk based on what you've inherited.
13:13
So I think there've been several celebrities recently that have come forward and said that they were found to be at higher risk for cancers and did something, either prophylactically, or got screened early. If you have a family history of cancer that's concerning to you, absolutely bring that up to your doctor. You may be able to have genetic testing. Genetic testing is where you meet with a genetic counselor and they review your history and decide whether or not you should have testing. And then if you have it and anything comes up in that testing that increases your risk, you may have the opportunity to either have better screening or even potentially up to the point of having surgery to reduce your risk of cancer dramatically, so there are all kinds of things you can do. It can be a little overwhelming, so it's something to definitely talk to your primary doctor or GYN about. We do that surgery a lot too or we see those patients and talk to them. That's another reason you would even come see me, before having to deal with something like cancer.
Cheryl
14:18
Are there some symptoms that people can look out for?
Dr. Miller
14:22
I love this question because I feel like it should be on a billboard. You know I'm biased, but I think everything about GYN cancer should be on a billboard. I would say there are a few things that really stand out. Number one, any abnormal bleeding that women have, particularly after menopause. The definition of menopause these days is if you haven't had a period for a year or any bleeding for a year, then you're officially menopausal. There are a lot of caveats to that, but in general bleeding at that point is not normal and should be evaluated by your doctor. That kind of makes you think more of things like uterine cancers, cervical cancers, or precancers.
15:05
The thing about ovarian cancer is that it's very difficult to detect, so most women come to us with ovarian cancer, with at least what we call stage three or stage four cancer. That's because it's inside the belly and it has these vague symptoms. Those symptoms are things like bloating, not feeling like you can eat much, your pants get a little tight, abdominal pain, and changes in your bowel habits or bladder habits. And you know what everyone says to me when I say that, "Well, everyone has that, Dr. Miller, at some point," and that's true. But I'd say if you feel that something like that is persistent, especially in your 50s and 60s, (in that time period) it's time to get checked out. Again, another time when you can advocate for yourself and say this doesn't feel right and it's not getting better. That's what I tell women to think about. So those kinds of things are most important.
Cheryl
16:06
It's kind of listening to your intuition a little bit. I mean as a woman, sometimes we're busy taking care of everyone else in our family.
Dr. Miller
16:13
Exactly.
Cheryl
16:14
It's like, that's nothing, everybody's dealing with that.
Dr. Miller
16:18
Yes, we hear that every day and I've seen a fair amount of patients that were taking care of another family member and said they just didn't have time to get evaluated. What I always say is that every time that happens, the patient's family member says, oh, I wanted her to get checked out, or something like that. So rest assured that if you're having symptoms, your family wants you to be seen, and they will help you get to that point.
Cheryl
16:48
I hope somebody hears that...I hope somebody hears that. So, if somebody were to maybe go to a doctor or primary care and they say you should see Dr. Miller, what can a patient expect at this first visit?
Dr. Miller
16:58
Typically when we see patients for the first time, usually we do a lot of talking in the office first. We usually do end up doing a full physical exam sometime during the visit, depending on what they are there for, but we're going to talk a lot. We're going to get a nice history of your medical history, your family history, genetic history, all those kinds of things, and then, based on that, we may do a physical exam, including a pelvic exam. We may not, it depends. Then we may be talking about things like surgery at that visit, talking to surgical schedulers, talking to people that get you ready for chemotherapy, so it depends on what you're coming for, but we can get a lot done in one day, and that can be a bit overwhelming. I say what's really important for patients is bringing somebody with them who's a second set of ears because whatever we say and whatever everyone else who you're going to meet says, you're going to remember 20% of it. And that's completely normal. So I say bring a friend, bring a trusted relative, someone like that, with you, if you can.
Cheryl
18:13
You mentioned earlier that sometimes when you see patients, someone who has ovarian cancer, they may be in an advanced stage. So what you're saying, it sounds like to me, is that time is of the essence and if someone were to be recommended to come see you, they need to be ready to move because time is of the essence.
Dr. Miller
18:32
Certainly, there are situations where we have a lot of time, but really the gold standard in our field is that uterine cancer patients, for instance, from the time they meet us in the office until they're either having surgery or treatment, need to be within four to six weeks, and even shorter sometimes with the ovarian cancer patients. I'm not saying that if that's not what's happening to you or what you've been told, it's wrong, because every situation is very specific. But in general, yes, you may need to be prepared to take some time off work and get help at home with taking care of children or with family members, because if you're seeing us, it's probably a time when you need to put your health at the top of the list.
Cheryl
19:20
Can we talk a little bit about the most common types of gynecologic cancers that you treat and maybe some of the treatments that a person hearing this might expect to hear in an office if they were to meet you?
Dr. Miller
19:34
Yes, the most common type of GYN cancer at this time is uterine cancer. It's still not in the top five cancers that are most common, say, in the United States, but that's because only women can get uterine cancer. It's more common, frankly, because of lifestyle changes and people tend to be a little bit on the more obese side now. And, as I referred to earlier, it is sometimes related to that. That said, there is also a subset of uterine cancer that is becoming a lot more common that is not related to lifestyle and obesity, or so we think. It tends to be a more aggressive type of cancer. So, again, things are changing a little bit and that's why I say right now it's the most common type of cancer because things may change over time.
20:24
Now ovarian cancer and vulvar vaginal cancer are lower on the list. I bring up cervix cancer as well because we have been trying to eliminate cervical cancer as a country now for a while. There is one country in the world that's probably on track to do it in the next 20 years, and that's Australia.
20:45
That's because of something I didn't mention before, which is the vaccine against that virus I brought up. So there's an HPV vaccine that actually prevents you from really contracting the virus and having the changes that it does over time in your body. So back to prevention a little bit, the more that we can do to prevent and get that vaccine done. I would love to never see a patient with cervical cancer again for the rest of my life. So it's not as common as, say, uterine cancer, but it is a cancer that we can prevent kind of across the board. so again, just bringing that up. But we hope that over time, and we're starting to see its downturn, but it's not gone yet.
Cheryl
21:35
As far as treatment options for these different types of cancers...
Dr. Miller
21:39
Yes. So, depending on the type of cancer, most of our cancers end up with surgery at some point during their treatment process. It may be when you first meet us, it may be after some other treatments have happened. For instance, for ovarian cancer, the decision is made by the GYN oncologist whether you would have surgery first or you would get something like chemotherapy first.
22:11
When all that's going on, there's been so much advancement in ovarian cancer recently, you would also, for instance, be seen by a geneticist to talk about reasons you may have been at risk for this and also those kinds of things now, with the advent of targeted therapy, have allowed us to make changes early on in the process with cancer treatment targeted directly to the patient. Most people with uterine cancer will have a hysterectomy. Now some women are young, unfortunately, that present with uterine cancer to us, and so we do have fertility-sparing ways to treat it, but again it's something that has to typically happen quickly, so be prepared for quick treatment decisions to be made. Then there are some patients that we see and we recommend things like radiation therapy and we work closely with a radiation therapist to discuss that, and everything is intertwined in a way, in terms of these treatments. It sounds very confusing, but they're well-established and the treatments we're going to use are very well-established in the way that they work and are tailored to each patient.
Cheryl
23:28
I'd love to talk more about the therapies. Before we had the opportunity to sit down and hit record on this podcast episode, you were talking about some exciting new developments, things that are rapidly happening that could really impact future patients who walk into your office.
Dr. Miller
23:47
It's hard to say the word exciting and cancer in the same sentence, but it is actually an exciting time in oncology. I know we've had other people talk about things like immunotherapy and targeted therapy in the past. So GYN oncology has had a really profound amount of growth in the last 5 to 10 years and people have been working to advance the field obviously day in and day out, since the invention of GYN oncology in the 1970s. But because of everything else that's been going on in oncology, we have been able to harness some of that power. Now we've done a lot of clinical trials looking at, say, immunotherapy and targeted therapies recently that have shown that we actually are just as much using them as the other field. For instance, certain advanced cancers, when we saw them for the first time, uterine cancer or cervical cancer, we would just give something like chemotherapy or maybe radiation. But now we actually have the ability, based on some trials that have just resulted recently, to use immunotherapy along with chemotherapy or sometimes radiation in these diseases.
25:02
And I really can't emphasize enough how exciting that is, because it's really taken out the amount of time that people get with these cancers.
25:16
Also, there's something special about immunotherapy in that we think that we are able to cure more women by harnessing their immune system to fight the cancer itself. And then the other exciting thing has been in ovarian cancer, where we were basically using the same chemotherapy for almost 15, 20 years while we were trying to advance it. We were finally able to harness one of the mutations that's very common in ovarian cancer and actually target a treatment and a maintenance therapy to that. Some people may have heard of them, they're called PARP inhibitors. It's a pill that a lot of patients are eligible to take who have ovarian cancer and it's extending their time between the end of their treatment or recurrence by amazing amounts of time. And even probably curing a fair amount of women, which was frankly unheard of in ovarian cancer before the last few years. Again, that's just kind of a glimpse at what's going on, but my point being, it is actually a very exciting time in GYN oncology.
Cheryl
26:23
That is exciting. And for people who are listening. Maybe they have a loved one, maybe it's themselves, and so we talk a lot on the show about how patients can be advocates for themselves. What is the best way for them to do that? If they are the recipient of news, that's not so good, how can they be an advocate for themselves?
Dr. Miller
26:44
There are a lot of ways to be your own advocate.
I think number one is, if you feel like someone's not listening to you about a symptom you're having or something that doesn't feel right..in the world that we live in, I always say, "Don't take no for an answer." Make sure that you feel like something's been evaluated to the extent that it needs to be evaluated. Number two, this is a time to rally your support system. Women have largely, you know we've talked about this a lot, been the support system for everybody else their whole life. I always say if you're with me, you're not expecting to say this is your time, but this is your time. You'd be surprised how often the family is really saying, yes, this is your time, and they want to support that person in their life who's meeting with an oncologist.
27:38
And there are just so many great resources out there. I say, don't go crazy Googling and give yourself so much homework that you don't have time to focus on your own health. But there is something to be said and ask your doctor for what resources are the best. We have plenty of things out there. Foundation for Women's Cancer has now put out an incredible amount of patient-centered literature, which has really changed resources for them. And if you don't like that, ask for more. You know that's what we're here for because it's not just about us doing the reading and the listening and the talking. It's important for you because, as a patient, you also don't have to do what we say. You can tailor your treatment to what works for your life and what's important to you. You know, what's important to you, should be important to us too.
Cheryl
28:33
Dr. Miller, thank you so much for sharing your wisdom and your passion for supporting women in what can be a very dark time.
Dr. Miller
28:41
Yes, thank you so much for having me. I look forward to being here for a long time and taking care of a lot of people, so I appreciate you having me.
Exit
28:55
That's all for this episode of Cancer Care Connections. Stay tuned for our next episode, where Cheryl will sit down with Dr. Nino Balanchivadze, a medical oncologist and hematologist with Virginia Oncology Associates. Dr Balanchivadze's area of specialty is breast cancer. She will discuss how breast cancer treatment affects fertility and what options a patient has in preserving fertility before starting breast cancer treatment.
Don't forget to subscribe to our podcast via Apple Podcast, Spotify, or anywhere podcasts are available, or listen online at cancercareconnections.buzzsprout.com. Cancer Care Connections is the official podcast of Virginia Oncology Associates. For more information, visit us at virginiacancer.com or find us on Facebook or Instagram at Virginia Oncology Associates.