Amanda (Host): This is BayCare HealthChat, the podcast from BayCare Health System. I'm your host, Amanda Wilde. We're talking about gynecological cancers from risk to recovery with gynecologic oncologist, Dr. Logan Corey from BayCare Health System. Dr. Corey, welcome to the podcast.

Logan Corey, MD: Thank you very much for having me today.

Amanda (Host): Well, this is a big subject, and I know treatment has evolved, and I want to get into all that. What are the most common types of gynecological cancers affecting women today?

Logan Corey, MD: I just want to say before I start that I do have a speech impediment and so as we talk it'll, there'll be ebbs and flows, but I think it's important for the podcast listener to also understand that so they can understand how the flow of my voice is, it doesn’t always track how a normal speaker’s does.

But I will get all the info out there.

Amanda (Host): , what are the most common types of gynecological cancers that you see?

Logan Corey, MD: The top three that I see the most are in order probably endometrial, cervical, and ovarian cancer.

Amanda (Host): Let's take a closer look into each one of these, starting with cervical cancer. First of all, there's cervical dysplasia and cervical cancer. Can you describe the difference?

Logan Corey, MD: Yes, I can at least try to. So, this is one of the more

confusing subjects out there, I think because cervical dysplasia are abnormal cells of the outside of the cervix, and so it doesn't tell you anything about your ovaries or anything about your endometrial cavity at all, but a pap smear is the most common way to test how those surgical cells look.

And so most, female patients after the age of 21 should be getting pap smears. The point of the pap smear is to take a look at those cells and see how abnormal or normal they appear on a cell level. Nowadays there are high grade changes and there are low grade changes.

Most patients who are young, if they have low grade changes, they potentially resolve on their own. High grade changes are the ones that can actually go on to become cancer, and that's a real problem. The single most common cause of this is infection with HPV. And so that's why I always encourage patients under the age of 46 or anytime really to get the HPV vaccine.

Amanda (Host): And do the majority of patients get that?

Logan Corey, MD: I would say, nowadays teenage girls tend to get it. It is recommended to be given age nine to 13. At that age, it's only two injections and has a very good job of preventing infection of the higher risk HPV subtypes.

Amanda (Host):

Logan Corey, MD: A pap smear is one of the few screening tests in cancers that has been shown to actually reduce overall cancer mortality.

Amanda (Host): Now when we talk about endometrial cancer, what are the risk factors there and are there the same kinds of screenings available? There's no vaccine. Are there early warning signs we might watch out for?

Logan Corey, MD: Even though it's all under a single name of endometrial cancer, which comes to be known as uterine cancer, the most common type we see are actually low-grade cancers. The low-grade changes are mostly caused by excess estrogen. And that is typically from if you're taking excess hormone therapy, but the most common cause is either obesity or PCOS.

With the high-grade cancers, these are actually just oftentimes totally, what we call, sporadic cancers, where it is just an abnormal cell found a mutation and, in their DNA, and it progressed into cancer. Sometimes these can actually be inherited as well.

Amanda (Host): And how is endometrial cancer diagnosed?

Logan Corey, MD: Most often it is actually an initial presenting symptom of abnormal vaginal bleeding, especially in the patients who have already gone through menopause. Any vaginal bleeding after that age, the average age of that is around 51, but it can, it can span years. Any vaginal bleeding after that age is abnormal and should be further investigated.

Amanda (Host): So vaginal bleeding is the main signal.

Logan Corey, MD: Number one signal. Yep. I think well over 80% of  patients present with that symptom first.

Amanda (Host): What are the usual treatments for endometrial cancer?

Logan Corey, MD: Typically for a low-grade cancer surgery is all a patient will actually need. And surgery being a hysterectomy with pelvic node sampling. Four out of five of those patients actually don't have to have anything other than a surgery. For the high-grade cancers oftentimes, we will do surgery and then after that, they may need chemotherapy, radiation, or even both sometimes.

In the last five years, there's a certain subtype of this cancer that can also be treated with, what's called, immunotherapy, and that's a little different from the traditional chemotherapy patients actually think of, and it's a way for your own body to identify abnormal cancer cells and have your body kill those.

Amanda (Host): Yeah, we should point out that the treatment options are evolving all the time with new developments in the field and in technology.

I know I got a hysterectomy several years ago, and it was not at all what my mom was so worried about because she'd had one 40 years earlier, and it was a completely different experience, and you don't even have to look at that broader span. But even in the last 10 or 15 years, there've been advancements.

So, it's important to remember when we're considering these treatment options. They're not as scary as they might've been once.

Logan Corey, MD: Exactly. And I also find that, anytime I speak with a patient about this, they always have a friend or a partner or a

relative who has had some form of a different cancer. And I would say that every cancer type and every treatment type is actually vastly different. And so, it's hard to generalize if a person had a breast cancer and now, they have ovarian cancer; it'll be entirely different treatment options and also personal experience.

Amanda (Host): Well, looking at ovarian cancer, this is one I know a little more about, and what I know is that often not caught early, and that's the key to treating ovarian cancer. So, what are some of the preventive measures we can take, and also risk factors, first of all.

Logan Corey, MD: Yes. I'll start with the risk factors first, so half the time it is actually caused by an inherited gene mutation from a mom or a dad or aunt or that kind of thing. And the most common ones of that are the, which I'm sure people have heard of, but the BRC1 and 2 genes. We're also finding more like BRIP1, RAD51C and a lot of other, causes of ovarian cancer there. But half the time it's actually a totally sporadic thing. And we have done many, many prospective studies on how to catch it early, and it's almost impossible to find a lab test or a reliable imaging study that can actually catch it early. Most of the time it's found at an advanced stage.

And so now there's a big push to actually try to reduce the risk of ovarian cancer and the primary way now is that if a patient has one of these inherited high-risk genes, that they actually undergo surgery in their late thirties, early forties, and have the ovaries and tubes taken out. Nowadays we're just looking at if just taking out the fallopian tubes alone is enough to actually reduce that risk. And at the first glance of the studies, it seems that is the main culprit actually.

Amanda (Host): So the biggest risk factor that we know of is genetics and the preventive measure you can take there is prophylactic surgery to remove the ovaries or maybe just the fallopian tubes, which would benefit you because you would still have some of the benefits of your female body parts as you go through menopause, right?

Logan Corey, MD: Yes. But it is always a very personal choice, and it always depends on the patient’s age and also the type of gene mutation they have.

Amanda (Host): Is there a way to be monitored if you do find you have one of these genetic mutations?

Logan Corey, MD: There is, but we're not sure how well it actually works. At this time, we do recommend ultrasounds of the pelvis probably every six months or so, as well as a lab draw with a lab that's called CA-125. They can be seen to be elevated in some advanced ovarian cancers. And I'm not sure how well that actually works, but it does make us feel better when we do those tests, and they come back normal.

Amanda (Host): Now you're a gynecologic oncologist. What is the role that you take, and is there a role for non-oncology, OB GYN for people who have gone through these cancers and have had treatment? So, post hysterectomy, for example?

Logan Corey, MD: Yes, I always tell patients that you should always keep your OB GYN. Studies show that patients who have an OB GYN and a primary care doctor actually live longer. And the fact that when I see these patients, like one-year, two-year follow-up, five-year, 10 years. I'm very focused on the status of their cancer, and I get kind of pigeonholed into that. Whereas their trusted OB GYN, which is over all of their OB and or GYN problems, and I kind of focus on just the cancer.

Amanda (Host): Right, right. And you should always have someone in your life looking after your gynecological health.

Logan Corey, MD: Exactly. Beyond just cancer.

Amanda (Host): Well, Dr. Corey, thank you so much for this really important information and for all you do to help women navigate through these common gynecological cancers.

Logan Corey, MD: I would want to say one more thing is that GYN oncologists are the only field that do offer surgery as well as chemotherapy treatments for their patients. And it's very nice to be able to have the tools to offer all of that because in certain cases it's not always straightforward if a surgery's better or if chemotherapy first is actually better.

And we are trained in both and so that allows us to be able to weigh those options fairly, I think.

Amanda (Host): So, you kind of have a broader scope of options really to choose from that will suit each patient.

Logan Corey, MD: Right.

Amanda (Host): Well, thank you again, Dr. Corey. This has been very informative, and I know it affects a lot of us.

Logan Corey, MD: Definitely. Thank you for having me and make me sound smart, okay.

Amanda (Host): That was gynecologic oncologist, Dr. Logan Corey. That wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts. For more health tips and updates, follow us on your social channels.

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 [PG2]can the host add a softer transition from the doctors disclaimer?