Every Day
August - December 2005 Issue
Detecting and Treating Gynecologic Cancers
Janet Osborne, MDMedical College of Wisconsin Gynecologic Ocologist
Division Director, Gynecologic Oncology
Each year more than 80,000 women in the United States are diagnosed with a gynecologic cancer. However, if all women had pelvic exams and PAP tests regularly, many of these cancers could be detected at an early stage and successfully treated. Janet Osborne, MD, discusses detection of gynecologic cancers and why women with these cancers should be treated by a gynecologic oncologist.
Q. How are gynecologic cancers detected?Screening is an important tool in detecting gynecologic malignancies. For vulvar, vaginal and cervical cancers, the process is simple: regular gynecologic exams and PAP tests. In most cases, the exam and PAP test provide clinicians with enough information to pinpoint an abnormality. The PAP test is not foolproof, but vulvar, vaginal and cervical malignancies are usually slow growing. An abnormality undetected by the PAP test one year usually appears in a pre-cancerous, treatable stage during the next exam. It is very rare for us to see patients with advanced vulvar, vaginal or cervical cancers who have been getting regular exams, so I can't emphasize enough the importance of these exams.
Unfortunately, endometrial cancer, the most common, and ovarian cancer, the most lethal of gynecologic cancers, present a different challenge, as there are no adequate screening methods for these diseases. Irregular or post-menopausal bleeding are clear-cut symptoms we associate with endometrial cancer. Any woman with irregular bleeding should undergo a thorough evaluation, which will often include a biopsy that can usually be done as part of an office visit.
As for ovarian cancer, it is important that people understand that the blood test known as CA125 is not a screening tool, but a marker for ovarian cancer. This is not a blood test women should have done at a regular exam, because it is not sensitive to early detection. In 50 percent to 70 percent of early ovarian cancer cases, patients will have a normal CA125. The test may be ordered as part of an evaluation if an abnormality is detected or for women who have actually been diagnosed with ovarian cancer. However, the effort to find a successful screening tool for ovarian cancer is an area of intense research. And although women with ovarian cancer may not have symptoms or have symptoms that are vague and non-specific, any woman experiencing gastro-intestinal disturbances or bloating should have a thorough evaluation.
Women should also be aware of all the symptoms for gynecologic cancers. Any unusual vaginal discharge, a persistent irritation or a sore or lump in the genital area, pelvic pain or pressure, or a change in bowel or bladder habits should not be ignored.
Q. How are gynecologic cancers treated? Effective treatment options include surgery, external beam radiation, chemotherapy and brachytherapy, in which radioactive sources are inserted in the uterus and vagina to kill cancer cells over a period of time. The type of treatment used depends on the stage of diagnosis and the type of cancer involved. Early stage cancers are often treated by surgery alone. More advanced cancers that have a higher risk of recurrence may require a combination of treatments.
For treatment of any type of gynecologic cancer, it is extremely important for a woman to see a gynecologic oncologist, physicians who do their general training in obstetrics/gynecology and then complete three extra years of training in gynecologic cancers.
Q. Why is it important that a woman with gynecologic cancer be treated by a gynecologic oncologist? Gynecologic oncologists focus their practice solely on treating gynecologic cancers and have greater knowledge of and experience in treating these types of malignancies. Patients under the care of a gynecologic oncologist will be presented with the latest treatment options, such as minimally invasive surgical techniques, and are more likely to get a complete surgical staging where the regional lymph nodes are removed and tested. The results of staging, in combination with other factors, help us more precisely determine the correct course of treatment. Studies also show that women with ovarian cancer have better, long-term survival rates when they are under the care of a gynecologic oncologist. Overall, having a gynecologic oncologist involved from the beginning leads to better outcomes.
Q. Are treatment methods available for gynecologic cancers that can preserve a woman’s fertility?To a large degree, that is dependent upon the cancer being treated. We carefully consider a woman’s age and other health factors before deciding on the best treatment. In the case of early cervical cancer, surgery and radiation are both curative. But during a woman’s reproductive years, we know surgery is the better option, because the ovaries don’t have to be removed. There also is very new surgical procedure that requires removing only the cervix and surrounding tissue and lymph nodes, but leaves the uterus in place. This is not commonly performed yet, but medical literature indicates that approximately two to three dozen babies have been born around the world to women who had this type of treatment for early cervical cancer. There is also a rare type of ovarian cancer that is more common in very young patients called germ cell tumors. In treating this cancer, we can often spare childbearing capacity. And while very new, some women are taking advantage of tissue banking of ovarian tissue or egg cells.
Author: Janet Osborne, MD Source: Every Day Date: August - December 2005 |