Signs and Symptoms of Gynecologic Cancers
From the Show: Highland Medical P.C.
Summary:
Air Date: 1/8/20
Duration: 10 Minutes
Dr. Ephraim Resnik shares information about the signs and symptoms of various gynecologic cancers.
Transcription:
Scott Webb (Host): There are many keys to surviving gynecological cancers including early detection and proper treatment. Despite all of the information that’s available, many women aren’t aware that gynecologic oncology specialists are here to help them with their goal of survivorship. My guest today is Dr. Ephraim Resnik and he’s a gynecologic oncologist at Highland Medical Gynecology Oncology. This is Sound Advice, a podcast from Highland Medical PC. I'm Scott Webb. Doctor, thanks for joining me today. What types of cancers are considered gynecological cancers?
Ephraim Resnik MD, FACS, FACOG (Guest): The cancers of the female reproductive tract will be considered gynecological cancers. That includes the vulva on the outside, the vagina, the cervix, the uterus, the fallopian tubes, and the ovaries. Interesting enough the breast is not considered a gynecological cancer per se, although it does play role in the female health.
Host: That is interesting. I would have suspected that it would have been included in that. So what are some of the risk factors for these types of cancers? Who’s at risk? Is there a genetic predisposition? What role does inherited trait play in developing ovarian cancer?
Dr. Resnik: So specifically for ovarian cancer, genetics does indeed play a role. Although unfortunately only about 5 to 10% of all patients with ovarian cancer do have an identifiable and testable genetical mutation that they inherited from their parents. The rest—90 to 95% of ovarian cancer patients—have what we call sporadic ovarian cancers. In other words, we don’t have a specific identifiable inheritable mutation. For other cancers, other factors besides the genetic play a much greater role.
Host: What are some of those factors?
Dr. Resnik: Let’s take the most common gynecological malignancy which is endometrial or uterine cancer. That accounts for a majority of the patients besides the breast that do have a gynecological malignancy. This particular cancer happens in women after menopause and it’s directly related to estrogen production. Now after the menopause, one would suspect that the estrogen production drops dramatically because the ovaries are no longer functioning. However, estrogen can come from other sources in the body. For instance, the fatty adipose tissues in the body are an independent producer of female estrogen. Therefore people who tend to be overweight and have higher content of fat in their bodies will be producing larger amounts of estrogen than comparatively thinner women after menopause. That incessant stimulation by estrogen of the endometrial uterine lining will produce the environment that is prone to developing cancer.
Host: So that’s really interesting doctor. What are some of the most common symptoms that a woman might experience? What would send them to the doctor? What should send them to the doctor?
Dr. Resnik: Again, Scott, it depends on the type of cancer. For instance, the most lethal cancer is the ovarian cancer. That, unfortunately, doesn’t have any specific identifiable symptoms. It’s called a silent killer. In fact, there is a phrase amongst the patients that the ovarian cancer whispers, so you have to listen. Basically the woman has to be attuned to the symptoms of her own body. If something is vaguely uncomfortable in her abdominal cavity, she shouldn’t initially attribute it to cancer. It could be just a little bit of gastrointestinal abnormality because she ate something or what have you. If the symptom persists day after day week after week, she should not delay and then present those symptoms to her doctor who will then do an appropriate evaluation. Now, that’s for ovarian cancer.
Now, for endometrial cancer—the most common cancer that effects women—the symptom is very clearly identifiable. That is very, very important. Our listeners should really take a note of this. Any amount of bleeding or spotting after the menopause is considered completely abnormal and must be evaluated immediately because even though the majority of those causes of post-menopausal spotting of bleeding would not be malignant. A full 20%—one out of five women—with post-menopausal spotting or bleeding will be actually showing you early signs of endometrial cancer. Therefore a woman should not think that her youthful periods are coming back after age of 60 or what have you. She should have it as a warning sign that something is abnormal, and she needs to be evaluated.
Now for younger women with surgical cancer, the abnormality that usually brings them to the attention of a gynecologic oncologist like myself is an abnormal pap smear or biopsy that their regular OBGYN did as part of their screening. Or, more ominously, if a woman spots after the sexual intercourse. Any amount of bleeding or spotting after sexual intercourse should be evaluated. It’s not a normal finding.
Host: You are a wealth of information. Related to cervical cancer, I wanted to ask you about the relation between HPV and cervical cancer. What other types of cancer can HPV infections cause?
Dr. Resnik: We have now confirmed beyond any reasonable doubt that overwhelming majority of cancers of the cervix are due to the HPV infection. Now, the human papilloma virus—the HPV—is not a single virus. It’s actually a family of viruses with over 100 different subtypes. Some of those subtypes are not cancerogenic. They cause some warts, or they don’t cause anything at all. Others, unfortunately, are much more high risk in their propensity to cause cancer developing. For instance, some of the more common HPV viral subtypes are 16 and 18, 31, 33, 35. Current pap testing includes the HPV DNA testing. If a woman is tested positive for those high risk HPV viruses, the evaluation should be immediately done on her cervix. In some countries, HPV is now becoming the predominant method of screening women for the risk of cervical cancer rather than just the regular cytological pap smear, which is still pretty much a standard in this country. We do co-testing. We do cytological pap smear and we’ll also do the HPV testing, but HPV is clearly a more accurate, a more sensitive, and more predictive of the risk of developing of the surgical cancer.
Host: So now there is a vaccination for HPV, right? Who should be getting it? What should young men and women do if they didn’t receive the vaccination or if they didn’t finish the series?
Dr. Resnik: It’s a very good point. We now have first time ever a vaccine available for prevention of a cancer. This is cervical cancer. We know an identifiable cause for majority of cervical cancers, which is the HPV. Now we have a vaccine. Either bivalent or quadrivalent vaccine that basically vaccinates people against the most common high risk viruses. Now companies are working in producing vaccines that will cover even more different subtypes than just those two or four subtypes that I mentioned. The best time to vaccinate is before the young person becomes sexually active because everybody who is sexually active at least transiently becomes infected with HPV. For majority of people in whom the immune system is strong, that transient HPV infection can be easily eliminated by their own immune system. For people who carry either a very high viral load because they have multiple sexual partners or because their own immune system is somewhat compromised then the vaccine, I think, is a perfect way to decrease their risk of cervical cancer. Now, we don’t have any data yet to say that it completely eliminates any kind of risk of the cervical cancer, but we certainly know that the vaccination cuts tremendously on the rate of developing precancerous dysplastic lesions in the cervix. So it stands to reason that it will eventually after several more decades after following up that the incidents of cervical cancer will, as well, be reflected in its decrease.
The people who should be vaccinated, as I mentioned, are those who are not sexually active yet to immunize them against the infection with HPV once they become sexually active. Therefore, a gynecologic oncologist like myself doesn’t deal with that group of populations, but pediatricians and regular OBGYNs definitely are addressing the needs of those women. Now because sexual intercourse involves both males and females, there's a strong push to vaccinate young boys before they become sexually active as well, although the HPV carriers in the male population do not develop cancer with the same kind of frequency of the female carriers of HPV infection. Still because the males are the carriers and will be passing it on to their female partners, it is recommended that both boys and girls prior to start of sexual activity be vaccinated.
Host: I think it’s great to get this information out there, especially for men. It’s pretty amazing that we’re talking about cancer, but we’re talking about vaccinations and immunizations to possibly prevent cancer which is really amazing. Give us a brief update on the advances in the treatment of gynecological, ovarian, cervical, and uterine cancers. What’s new? What’s happening? What’s got you excited right now?
Dr. Resnik: In the ovarian cancer which is the most lethal cancer of the gynecological tract, the most exciting thing right now are immunotherapy. Those are the group of medications that are specifically targeting specific molecules in the cancer cells and therefore can target specific cancers with more precision than the general chemotherapy, which indiscriminately kills any dividing cells and therefore is much more toxic than the immunotherapy. The ovarian cancers have showed real improvement in the median survival of patients that are newly diagnosed with the current combination of surgery, the chemotherapy, the immunotherapy. We can put most of the patients into the remission and then keep them in that remission for longer than before. The sad thing, however, overall survival at five and ten years has not really showed that much improvement. So the early testing and discovery of newer medications will definitely be needed to really show a major difference in the ovarian cancer survival. The other cancers that led themselves much more to screening and early detection such as cervical and uterine cancer definitely can be easily eliminated if the patient’s are educated on how to detect the abnormality and present early enough to their physicians so the process of evaluation and treatment can be started earlier.
Host: As survivorship continues to grow, where do you see the coordination of care between gynecologic oncologists, other healthcare providers. We start talking about compliance with cancer follow up and routine health maintenance. Can you discuss that coordination between doctors and healthcare providers?
Dr. Resnik: I am so glad that you're asking this question because I think the quality of care in cancer in 2020, let’s say, requires the complete team approach to the patient’s care. It’s not longer sufficient enough for the surgeon to work in the silo of isolated surgical intervention and the medical oncologist working in the silo of administering chemotherapy or other medications. It’s no longer sufficient for the social worker’s work with whatever issues the patient’s might be presenting to them. The best cancer care that the patient can receive is from the team approach. That combines not only the medical professionals within the surgery, chemotherapy, radiation therapy, but also psychology and also the social work. There are multiple different aspects of survivorship that effects the person who is essentially cured from her cancer and now is facing other issues that might be related to the treatment that she received or might be related to the diagnosis that she received. The data in the medical literature is now showing clearly that once we identified the patients who have those issues, if the team approach is instituted those issues can be addressed in a very expeditious and efficient manner.
Host: Thanks so much for your time today Dr. Resnik. Call 1-866-550-HMPC to make an appointment with Dr. Resnik. Thanks for checking out this episode of Sound Advice. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk again soon.
Scott Webb (Host): There are many keys to surviving gynecological cancers including early detection and proper treatment. Despite all of the information that’s available, many women aren’t aware that gynecologic oncology specialists are here to help them with their goal of survivorship. My guest today is Dr. Ephraim Resnik and he’s a gynecologic oncologist at Highland Medical Gynecology Oncology. This is Sound Advice, a podcast from Highland Medical PC. I'm Scott Webb. Doctor, thanks for joining me today. What types of cancers are considered gynecological cancers?
Ephraim Resnik MD, FACS, FACOG (Guest): The cancers of the female reproductive tract will be considered gynecological cancers. That includes the vulva on the outside, the vagina, the cervix, the uterus, the fallopian tubes, and the ovaries. Interesting enough the breast is not considered a gynecological cancer per se, although it does play role in the female health.
Host: That is interesting. I would have suspected that it would have been included in that. So what are some of the risk factors for these types of cancers? Who’s at risk? Is there a genetic predisposition? What role does inherited trait play in developing ovarian cancer?
Dr. Resnik: So specifically for ovarian cancer, genetics does indeed play a role. Although unfortunately only about 5 to 10% of all patients with ovarian cancer do have an identifiable and testable genetical mutation that they inherited from their parents. The rest—90 to 95% of ovarian cancer patients—have what we call sporadic ovarian cancers. In other words, we don’t have a specific identifiable inheritable mutation. For other cancers, other factors besides the genetic play a much greater role.
Host: What are some of those factors?
Dr. Resnik: Let’s take the most common gynecological malignancy which is endometrial or uterine cancer. That accounts for a majority of the patients besides the breast that do have a gynecological malignancy. This particular cancer happens in women after menopause and it’s directly related to estrogen production. Now after the menopause, one would suspect that the estrogen production drops dramatically because the ovaries are no longer functioning. However, estrogen can come from other sources in the body. For instance, the fatty adipose tissues in the body are an independent producer of female estrogen. Therefore people who tend to be overweight and have higher content of fat in their bodies will be producing larger amounts of estrogen than comparatively thinner women after menopause. That incessant stimulation by estrogen of the endometrial uterine lining will produce the environment that is prone to developing cancer.
Host: So that’s really interesting doctor. What are some of the most common symptoms that a woman might experience? What would send them to the doctor? What should send them to the doctor?
Dr. Resnik: Again, Scott, it depends on the type of cancer. For instance, the most lethal cancer is the ovarian cancer. That, unfortunately, doesn’t have any specific identifiable symptoms. It’s called a silent killer. In fact, there is a phrase amongst the patients that the ovarian cancer whispers, so you have to listen. Basically the woman has to be attuned to the symptoms of her own body. If something is vaguely uncomfortable in her abdominal cavity, she shouldn’t initially attribute it to cancer. It could be just a little bit of gastrointestinal abnormality because she ate something or what have you. If the symptom persists day after day week after week, she should not delay and then present those symptoms to her doctor who will then do an appropriate evaluation. Now, that’s for ovarian cancer.
Now, for endometrial cancer—the most common cancer that effects women—the symptom is very clearly identifiable. That is very, very important. Our listeners should really take a note of this. Any amount of bleeding or spotting after the menopause is considered completely abnormal and must be evaluated immediately because even though the majority of those causes of post-menopausal spotting of bleeding would not be malignant. A full 20%—one out of five women—with post-menopausal spotting or bleeding will be actually showing you early signs of endometrial cancer. Therefore a woman should not think that her youthful periods are coming back after age of 60 or what have you. She should have it as a warning sign that something is abnormal, and she needs to be evaluated.
Now for younger women with surgical cancer, the abnormality that usually brings them to the attention of a gynecologic oncologist like myself is an abnormal pap smear or biopsy that their regular OBGYN did as part of their screening. Or, more ominously, if a woman spots after the sexual intercourse. Any amount of bleeding or spotting after sexual intercourse should be evaluated. It’s not a normal finding.
Host: You are a wealth of information. Related to cervical cancer, I wanted to ask you about the relation between HPV and cervical cancer. What other types of cancer can HPV infections cause?
Dr. Resnik: We have now confirmed beyond any reasonable doubt that overwhelming majority of cancers of the cervix are due to the HPV infection. Now, the human papilloma virus—the HPV—is not a single virus. It’s actually a family of viruses with over 100 different subtypes. Some of those subtypes are not cancerogenic. They cause some warts, or they don’t cause anything at all. Others, unfortunately, are much more high risk in their propensity to cause cancer developing. For instance, some of the more common HPV viral subtypes are 16 and 18, 31, 33, 35. Current pap testing includes the HPV DNA testing. If a woman is tested positive for those high risk HPV viruses, the evaluation should be immediately done on her cervix. In some countries, HPV is now becoming the predominant method of screening women for the risk of cervical cancer rather than just the regular cytological pap smear, which is still pretty much a standard in this country. We do co-testing. We do cytological pap smear and we’ll also do the HPV testing, but HPV is clearly a more accurate, a more sensitive, and more predictive of the risk of developing of the surgical cancer.
Host: So now there is a vaccination for HPV, right? Who should be getting it? What should young men and women do if they didn’t receive the vaccination or if they didn’t finish the series?
Dr. Resnik: It’s a very good point. We now have first time ever a vaccine available for prevention of a cancer. This is cervical cancer. We know an identifiable cause for majority of cervical cancers, which is the HPV. Now we have a vaccine. Either bivalent or quadrivalent vaccine that basically vaccinates people against the most common high risk viruses. Now companies are working in producing vaccines that will cover even more different subtypes than just those two or four subtypes that I mentioned. The best time to vaccinate is before the young person becomes sexually active because everybody who is sexually active at least transiently becomes infected with HPV. For majority of people in whom the immune system is strong, that transient HPV infection can be easily eliminated by their own immune system. For people who carry either a very high viral load because they have multiple sexual partners or because their own immune system is somewhat compromised then the vaccine, I think, is a perfect way to decrease their risk of cervical cancer. Now, we don’t have any data yet to say that it completely eliminates any kind of risk of the cervical cancer, but we certainly know that the vaccination cuts tremendously on the rate of developing precancerous dysplastic lesions in the cervix. So it stands to reason that it will eventually after several more decades after following up that the incidents of cervical cancer will, as well, be reflected in its decrease.
The people who should be vaccinated, as I mentioned, are those who are not sexually active yet to immunize them against the infection with HPV once they become sexually active. Therefore, a gynecologic oncologist like myself doesn’t deal with that group of populations, but pediatricians and regular OBGYNs definitely are addressing the needs of those women. Now because sexual intercourse involves both males and females, there's a strong push to vaccinate young boys before they become sexually active as well, although the HPV carriers in the male population do not develop cancer with the same kind of frequency of the female carriers of HPV infection. Still because the males are the carriers and will be passing it on to their female partners, it is recommended that both boys and girls prior to start of sexual activity be vaccinated.
Host: I think it’s great to get this information out there, especially for men. It’s pretty amazing that we’re talking about cancer, but we’re talking about vaccinations and immunizations to possibly prevent cancer which is really amazing. Give us a brief update on the advances in the treatment of gynecological, ovarian, cervical, and uterine cancers. What’s new? What’s happening? What’s got you excited right now?
Dr. Resnik: In the ovarian cancer which is the most lethal cancer of the gynecological tract, the most exciting thing right now are immunotherapy. Those are the group of medications that are specifically targeting specific molecules in the cancer cells and therefore can target specific cancers with more precision than the general chemotherapy, which indiscriminately kills any dividing cells and therefore is much more toxic than the immunotherapy. The ovarian cancers have showed real improvement in the median survival of patients that are newly diagnosed with the current combination of surgery, the chemotherapy, the immunotherapy. We can put most of the patients into the remission and then keep them in that remission for longer than before. The sad thing, however, overall survival at five and ten years has not really showed that much improvement. So the early testing and discovery of newer medications will definitely be needed to really show a major difference in the ovarian cancer survival. The other cancers that led themselves much more to screening and early detection such as cervical and uterine cancer definitely can be easily eliminated if the patient’s are educated on how to detect the abnormality and present early enough to their physicians so the process of evaluation and treatment can be started earlier.
Host: As survivorship continues to grow, where do you see the coordination of care between gynecologic oncologists, other healthcare providers. We start talking about compliance with cancer follow up and routine health maintenance. Can you discuss that coordination between doctors and healthcare providers?
Dr. Resnik: I am so glad that you're asking this question because I think the quality of care in cancer in 2020, let’s say, requires the complete team approach to the patient’s care. It’s not longer sufficient enough for the surgeon to work in the silo of isolated surgical intervention and the medical oncologist working in the silo of administering chemotherapy or other medications. It’s no longer sufficient for the social worker’s work with whatever issues the patient’s might be presenting to them. The best cancer care that the patient can receive is from the team approach. That combines not only the medical professionals within the surgery, chemotherapy, radiation therapy, but also psychology and also the social work. There are multiple different aspects of survivorship that effects the person who is essentially cured from her cancer and now is facing other issues that might be related to the treatment that she received or might be related to the diagnosis that she received. The data in the medical literature is now showing clearly that once we identified the patients who have those issues, if the team approach is instituted those issues can be addressed in a very expeditious and efficient manner.
Host: Thanks so much for your time today Dr. Resnik. Call 1-866-550-HMPC to make an appointment with Dr. Resnik. Thanks for checking out this episode of Sound Advice. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk again soon.
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