A Healthy Lifestyle and Early Diagnosis are the Best Cure for Gynecologic Cancer
By Marisa Keller
A visit to the gynecologist for a yearly pelvic exam is probably not high on a woman's list of favorite things to do. Even worse, when that exam reveals something abnormal, the ensuing questions, tests and fears can be even more daunting.
That's why the most important thing is to make that appointment, according to Dr. David L. Hoogerland, a gynecologic oncologist at Columbia-St. Mary's Hospital. Each year, approximately 82,000 women are diagnosed with cancer of the reproductive organs nationwide. Luckily, many of these potential life threats can be prevented with early diagnosis, the kind that can be made during those tedious appointments.
More than likely, you would be referred to someone like Dr. Hoogerland by your obstetrician/gynecologist (OB/GYN) after cancer had been detected in one of the GYN Cancer areas; ovarian, uterine, cervical, vulvar, vaginal or tubal.
These types of cancer are usually treated by surgery, radiation therapy or chemotherapy. A gynecologic oncologist is a board certified OB/GYN with additional training as a cancer specialist.
Of the six types of GYN cancer, the "big three," are ovarian, uterine and cervical, with the others being a bit more rare and treatable. When abnormal cells in one of those areas show uncontrolled growth, and are diagnosed as cancer, Hoogerland steps in to establish a path of treatment and management. But, he emphasizes, prevention, health and early detection are the most important aspects of his field.
"When you experience unusual symptoms, be sure to have them checked out," he said. "A pelvic exam should be part of every evaluation. If your doctor won't do it, find another doctor."
Hoogerland also said, however unpleasant, a rectal exam is the most important part of a pelvic exam, and one of the only ways to detect ovarian cancer. "I always tell my patients, 'if your doctor isn't doing one, you're not getting your money's worth!'"
Doctor's Orders
According to Hoogerland, there are some very simple ways to contribute to your gynecological health and life:
• Don't smoke - linked with cervical cancer, smoking can increase your chances of abnormal cells becoming cancerous.
• Avoid multiple partners - statistics show that the risk of getting Human Papilloma Virus (HPV), the most common cause of cervical cancer, is distinctly higher with multiple sexual partners.
• Take the birth control pill - studies show that it can reduce the risk of ovarian and uterine cancer as much as 50 percent.
• Watch your weight - obesity has been directly linked to uterine cancer.
• Have children - women who have been pregnant lower their chances of uterine and ovarian cancers.
Symptoms To Watch
"The foremost symptom of many GYN cancers is abnormal bleeding associated with intercourse, between periods or after menopause," said Hoogerland. "Unfortunately, with ovarian cancer the symptoms are far more vague and can present as a different problem."
In terms of the "big three," uterine cancer is the most common of the female reproductive malignancies and ovarian is the most serious. Cervical cancer, frequently referred to as a sexually transmitted disease, is often caused by (HPV). If diagnosed early, it can usually be taken care of by a simple procedure in the doctor's office. Smoking increases the chances of getting cervical cancer because it decreases the effectiveness of the immune system.
"The beauty of cervical cancer is that with early detection and surveillance, we can drastically reduce the chances of cancer actually occurring in the cervix," said Hoogerland. "On the other hand, ovarian cancer is an insidious threat, a lethal disease. It doesn't lend to early diagnosis and we don't yet have good diagnostic techniques."
Ovarian cancer presents additional challenges because the cells start to grow inside the abdominal cavity, which, in women, is accessible to cancer-causing materials (carcinogens) from outside the body. "Men don't have anything similar to ovarian cancer," said Hoogerland. "It's a completely different cell type."
Today, there are blood tests that can determine whether a woman has the gene that causes ovarian and breast cancer. Ninety percent of the women with that gene are vulnerable to this cancer. Hoogerland suggests you talk with your OB/GYN to see if you are at risk and what tests are appropriate for you.
"If you are 30 to 35 years old and your family has a history, you are at risk," he said. "There are new screening techniques that are being evaluated and may become important tools in the detection of ovarian cancer in the future. They might work, we just don't know."
Uterine, or endometrial cancer can be caused by too much estrogen in the system. Women who have never been pregnant, are overweight and 60 to 65 year old are its primary target.
"In the 1950s and 1960s, women were being given estrogen alone for menopause," said Hoogerland. "In the 1970s, as doctors began to prescribe progesterone along with it, we saw a significant decrease in the incidence of this cancer."
"As far as early detection is concerned," said Hoogerland, "I encourage patients to be assertive with their gynecologic health management and push physicians to perform complete pelvic exams, all the time."
The Six GYN Cancers
Ovarian Cancer appears on the surface of the ovaries
Most Common symptoms: pressure or fullness in the pelvis, abdominal bloating, changes in bowel and bladder patterns that are constant and progressive, vague but persistent gastrointestinal complaints, frequency or urgency of urination, constipation, abnormal bleeding, fatigue, pain during intercourse.
Uterine Cancer begins on the lining of the uterus and can grow and spread out of control into the muscle of the uterus
Most common symptoms: abnormal bleeding after menopause or other irregular vaginal bleeding before menopause
Cervical Cancer reveals itself as abnormal cell changes in the cervix
Most common symptoms: bleeding after intercourse, excessive discharge, abnormal bleeding between periods
Vulvar Cancer appear as lesions on the surface of the vulva or labia
Most common symptoms: itching in the vulvar area
Vaginal Cancer is very rare
Most common symptoms: abnormal bleeding, usually in elderly women
Tubal Cancer is cancer of the fallopian tubes
Most common symptoms: similar to ovarian cancer
