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Gynecologic Cancers: Prevention, Symptoms & Treatment
Dr. Peter Morris discusses gynecologic cancers.
Featured Speaker:
Peter Morris, MD
Dr. Morris is a gynecologic oncology surgeon with Cancer Partners of Nebraska. Transcription:
Gynecologic Cancers: Prevention, Symptoms & Treatment
Melanie Cole (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole and today, we're discussing gynecologic cancers, prevention, symptoms, and treatment. Joining me is Dr. Peter Morris. He's a Gynecologic Oncology Surgeon with Cancer Partners of Nebraska. Dr. Morris, it's a pleasure to have you join us today. What exactly is a Gynecologic Oncology Surgeon? What kind of training goes into this specialty? Give us a little background on yourself.
Peter Morris, MD (Guest): Well, after medical school, there is a four year residency in general obstetrics and gynecology. And so we have a base of women's health care and then there's a three-year fellowship, specifically in Gynecologic Oncology. We're trained in the surgical and medical treatment of gynecologic cancers, which include the uterus, cervix, fallopian tubes, ovary, vagina, and vulvar area. So it's a very narrow field of specialty.
Host: Such an important field as we're learning more and more about the impact on women's health and overall health. So what are the most common gynecologic cancers that you treat Dr. Morris and tell us a little bit about them.
Dr. Morris: Well, the most common one we treat is type of uterine cancer, endometrial cancer, cancer of the lining of the uterus. And that's by far the most common. The next would be ovarian and fallopian tube cancers, which unfortunately are by far the most lethal of the cancers we treat as a gynecologic oncologist. Cervical cancer, is next. Cervical cancer is actually the most common gynecologic cancer worldwide. But it's third Nebraska for gynecologic cancers and rare cancers are cancers of the vulvar skin and vaginal cancers.
Host: Dr. Morris, as we're learning more about HPV and its relation to cervical cancer and we get our PAP smears. And that's a little bit controversial anyway. However, tell us a little bit about what would even send us if we're not doing this as part of our well visit, are there early warning signs because ovarian cancer is one of those scary ones because they call it silent. Are there any early warning signs for cancers that we should be aware of?
Dr. Morris: Well, the biggest one for the most common cancer, uterine cancers post-menopausal bleeding. And if a woman experiences any bleeding, even minor spotting or a discharge after the menopause, that has to be evaluated to rule out uterine cancer because uterine cancer does cause a symptoms about three quarters of the cases are diagnosed at an early stage.
You're absolutely correct about ovarian cancer. It grows silently and spreads extensively before it causes much in the way of symptoms. And when it does become symptomatic, the symptoms are very common for people anyway, constipation, bloating, pelvic pressure. So, if those persist, that's reason to see your doctor. Cervical cancer, abnormal bleeding patterns in the pre-menopausal or post-menopausal female can also be a sign of cervical cancer.
PAP smears are a screening test for cervical cancer. And it's important to understand that a screening test really doesn't diagnose anything, but an abnormal PAP smear tells the physician, hey, let's look closer. Let's do some further tests to make sure there's not a cervical cancer. The vast majority of women with abnormal PAP smears do not have nor do they ever get cervical cancer, but it is a very effective screening test.
Host: Well, thank you for that. And if we were experiencing any of these symptoms, and as you said, and I'm so glad you brought up the fact that so many of the symptoms and that's what's confusing and a little bit scary for women, even, you know, someone like me, I'm post-menopausal and those symptoms, Dr. Morris are things that we women have been experiencing since our first period, bloating. And you know, all of those kinds of things that you mentioned. So if we are experiencing those symptoms, what steps should we take? When do we go to see our doctor? I mean, if we went to every time we were bloated, we'd be in there every day.
Dr. Morris: Right. I think symptoms that are progressive or additive, bloating that comes and go, constipation that comes and goes is normal. But things that progress, for example, you're constipated, you're bloating now you're having nausea or vomiting. Other things to take into account would be the patient's age and family history. The majority of ovarian cancers appear in women with no other particular risk factors, but about five to 10% do have a genetic component. And there are certain groups of women who need to be looked at closer if they have a family history. And to consider risk reducing surgery.
Host: And we'll talk a little bit about some of the surgeries that are available, but just for overall health, Dr. Morris, tell us about the exams and tests that we should be having on a regular basis. We did mention PAP smears and the recommendations for those change. And so tell us a little bit about what a well-visit and regular checkup entails.
Dr. Morris: A well visit includes a history. We concentrate on the menstrual and reproductive history to seek out any symptoms that the patient may have and may not be aware of. So, that's the history. A general physical examination. I don't treat breast cancer, but a breast examination is a part of that and a general thorough pelvic examination with a pAP smear or a liquid based PAP smear, which also tests for HPV. The recommendations for a PAP smears, you're right, they vary. PAP smears are really not a part of my practice because I don't screen for that. But the general gynecologists do. Women who are low risk and have had normal PAP smears, the recommendation is they can stop having PAP smears around 65 or 70 years of age.
The caveat there is that a lot of women think, well, if I don't need PAP smears anymore, then I don't really need the gynecologic examination. And that's not a true statement. So, even though they're don't require a PAP smear at a well woman visit, they still require to have those yearly examinations for sure.
Host: Well, I'm so glad that you clarified that because what an important thing as we want to be our own best health advocate and we're taking care of ourselves. We must, or we can't take care of the ones that we love. Tell us about prevention. You mentioned HPV. There's a vaccine for that. Both my kids have it. Tell us a little bit about prevention of any gynecologic cancers that we can.
Dr. Morris: Well, as far as cervical cancer, you're absolutely right. We have a vaccine, that is effective against the most common types of HPV that are related and cause cervical cancer. This is an amazing step forward. It could be one of the first cancers that we could be on the verge of eliminating, hopefully with vaccination.
A recent report says that the incidence of cervical cancer is declining. Most likely due to the Gardasil vaccination. As far as preventing ovarian cancer, there are certain subgroups of patients, especially those who carry the BRCA one and two or BRCA genes, who do need to seriously consider risk reducing surgery.
It is clear that removing the ovaries and fallopian tubes, reduces the risk of ovarian cancer significantly. As far as uterine cancer, there really is no specific prevention. It is often seen in women who are obese, associated with diabetes and some other medical problems that go along with the obesity.
And that's due to just prolonged estrogen stimulation from the patient's adipose or fatty tissue. So abnormal bleeding, as I said earlier, I think abnormal bleeding in a post-menopausal woman is uterine cancer until you rule it out.
Host: What great information you're giving us here today, but back to treatment and the surgery you provide Dr. Morris, you're now part of the new April Samson Cancer Center, which has a goal of not only providing the best care, but making it convenient for patients. What are the advantages of women to have a gynecologic oncologist and a surgeon in their community or close by? Tell us a little bit more about the April Sampson Cancer Center.
Dr. Morris: Well, it is gonna be a multidisciplinary cancer center that offers women the opportunity, really to get state-of-the-art care, without having to to Omaha. Now we live in a rural to semi rural state. And up until now, all of the gynecologic cancer specialists were here in Omaha. There are only eight of them, and I will be the sort of first one to be in a town the size of Lincoln. And, it gives women from Lincoln and Western Nebraska, the option of having state-of-the-art cancer care, without having to travel to Omaha.
Host: What a great thing for women in that community to have close by. As we get ready to wrap up Dr. Morris and as survivorship continues to grow for these gynecologic cancers, and you mentioned the multidisciplinary approach at the April Samson Cancer Center, I'd like you to just expand a little bit on that multidisciplinary approach to allow for this follow-up care and routine health maintenance; where do you see that coordination of care between gynecologic oncologists and all these other health care providers and what else you'd like women to know about gynecologic cancers?
Dr. Morris: Well, it's just great for the patients because multimodality cancer care that can be given in one setting with the patient able to see the gynecologic surgeon, such as myself. We work closely with the radiation oncologist. Cervical cancer, vulvar cancers, endometrial cancers generally have a component of radiation treatment to them. We're there with the medical oncologist, who we work closely with to decide on chemotherapy options, chemotherapy administration. And in this day and age, all of the biologics and immunologic therapies that are pushing cancer care forward at an amazing rate right now.It is what I think is breaking down one of the biggest barriers that I've seen since being in Nebraska since 1992, is that it is difficult for women in the more rural areas to get to a center with these services. And sometimes they're just not available in some of the small local communities.
And I know patients who drive hundreds of miles, not only for their surgery, but for the radiation treatment and chemotherapy. So we're putting together a group of highly specialized and well-trained expert individuals, in my field of gynecologic cancer that allows women to undergo the diagnosis, treatment, management, both of cancer related symptoms, treatment complications, physical therapy, genetic evaluation, all without having to have their care fractionated between many, many different providers, hospitals, and institutions. So, it's a great leap forward for Lincoln community. And I think the whole state.
Host: Absolutely it is. What a wonderful addition to the community. And thank you, Dr. Morris for joining us and sharing your incredible expertise for us today. And if you'd like to learn more about the April Samson Cancer Center, you can visit Bryanhealth.org/cancer. And I'd like to thank our Bryan Foundation partner Mapes Industries. That concludes this episode of Bryan Health Podcast.
Please remember to subscribe, rate and review this podcast and all the other fascinating Bryan Health podcasts. Until next time, I'm Melanie Cole.
Gynecologic Cancers: Prevention, Symptoms & Treatment
Melanie Cole (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole and today, we're discussing gynecologic cancers, prevention, symptoms, and treatment. Joining me is Dr. Peter Morris. He's a Gynecologic Oncology Surgeon with Cancer Partners of Nebraska. Dr. Morris, it's a pleasure to have you join us today. What exactly is a Gynecologic Oncology Surgeon? What kind of training goes into this specialty? Give us a little background on yourself.
Peter Morris, MD (Guest): Well, after medical school, there is a four year residency in general obstetrics and gynecology. And so we have a base of women's health care and then there's a three-year fellowship, specifically in Gynecologic Oncology. We're trained in the surgical and medical treatment of gynecologic cancers, which include the uterus, cervix, fallopian tubes, ovary, vagina, and vulvar area. So it's a very narrow field of specialty.
Host: Such an important field as we're learning more and more about the impact on women's health and overall health. So what are the most common gynecologic cancers that you treat Dr. Morris and tell us a little bit about them.
Dr. Morris: Well, the most common one we treat is type of uterine cancer, endometrial cancer, cancer of the lining of the uterus. And that's by far the most common. The next would be ovarian and fallopian tube cancers, which unfortunately are by far the most lethal of the cancers we treat as a gynecologic oncologist. Cervical cancer, is next. Cervical cancer is actually the most common gynecologic cancer worldwide. But it's third Nebraska for gynecologic cancers and rare cancers are cancers of the vulvar skin and vaginal cancers.
Host: Dr. Morris, as we're learning more about HPV and its relation to cervical cancer and we get our PAP smears. And that's a little bit controversial anyway. However, tell us a little bit about what would even send us if we're not doing this as part of our well visit, are there early warning signs because ovarian cancer is one of those scary ones because they call it silent. Are there any early warning signs for cancers that we should be aware of?
Dr. Morris: Well, the biggest one for the most common cancer, uterine cancers post-menopausal bleeding. And if a woman experiences any bleeding, even minor spotting or a discharge after the menopause, that has to be evaluated to rule out uterine cancer because uterine cancer does cause a symptoms about three quarters of the cases are diagnosed at an early stage.
You're absolutely correct about ovarian cancer. It grows silently and spreads extensively before it causes much in the way of symptoms. And when it does become symptomatic, the symptoms are very common for people anyway, constipation, bloating, pelvic pressure. So, if those persist, that's reason to see your doctor. Cervical cancer, abnormal bleeding patterns in the pre-menopausal or post-menopausal female can also be a sign of cervical cancer.
PAP smears are a screening test for cervical cancer. And it's important to understand that a screening test really doesn't diagnose anything, but an abnormal PAP smear tells the physician, hey, let's look closer. Let's do some further tests to make sure there's not a cervical cancer. The vast majority of women with abnormal PAP smears do not have nor do they ever get cervical cancer, but it is a very effective screening test.
Host: Well, thank you for that. And if we were experiencing any of these symptoms, and as you said, and I'm so glad you brought up the fact that so many of the symptoms and that's what's confusing and a little bit scary for women, even, you know, someone like me, I'm post-menopausal and those symptoms, Dr. Morris are things that we women have been experiencing since our first period, bloating. And you know, all of those kinds of things that you mentioned. So if we are experiencing those symptoms, what steps should we take? When do we go to see our doctor? I mean, if we went to every time we were bloated, we'd be in there every day.
Dr. Morris: Right. I think symptoms that are progressive or additive, bloating that comes and go, constipation that comes and goes is normal. But things that progress, for example, you're constipated, you're bloating now you're having nausea or vomiting. Other things to take into account would be the patient's age and family history. The majority of ovarian cancers appear in women with no other particular risk factors, but about five to 10% do have a genetic component. And there are certain groups of women who need to be looked at closer if they have a family history. And to consider risk reducing surgery.
Host: And we'll talk a little bit about some of the surgeries that are available, but just for overall health, Dr. Morris, tell us about the exams and tests that we should be having on a regular basis. We did mention PAP smears and the recommendations for those change. And so tell us a little bit about what a well-visit and regular checkup entails.
Dr. Morris: A well visit includes a history. We concentrate on the menstrual and reproductive history to seek out any symptoms that the patient may have and may not be aware of. So, that's the history. A general physical examination. I don't treat breast cancer, but a breast examination is a part of that and a general thorough pelvic examination with a pAP smear or a liquid based PAP smear, which also tests for HPV. The recommendations for a PAP smears, you're right, they vary. PAP smears are really not a part of my practice because I don't screen for that. But the general gynecologists do. Women who are low risk and have had normal PAP smears, the recommendation is they can stop having PAP smears around 65 or 70 years of age.
The caveat there is that a lot of women think, well, if I don't need PAP smears anymore, then I don't really need the gynecologic examination. And that's not a true statement. So, even though they're don't require a PAP smear at a well woman visit, they still require to have those yearly examinations for sure.
Host: Well, I'm so glad that you clarified that because what an important thing as we want to be our own best health advocate and we're taking care of ourselves. We must, or we can't take care of the ones that we love. Tell us about prevention. You mentioned HPV. There's a vaccine for that. Both my kids have it. Tell us a little bit about prevention of any gynecologic cancers that we can.
Dr. Morris: Well, as far as cervical cancer, you're absolutely right. We have a vaccine, that is effective against the most common types of HPV that are related and cause cervical cancer. This is an amazing step forward. It could be one of the first cancers that we could be on the verge of eliminating, hopefully with vaccination.
A recent report says that the incidence of cervical cancer is declining. Most likely due to the Gardasil vaccination. As far as preventing ovarian cancer, there are certain subgroups of patients, especially those who carry the BRCA one and two or BRCA genes, who do need to seriously consider risk reducing surgery.
It is clear that removing the ovaries and fallopian tubes, reduces the risk of ovarian cancer significantly. As far as uterine cancer, there really is no specific prevention. It is often seen in women who are obese, associated with diabetes and some other medical problems that go along with the obesity.
And that's due to just prolonged estrogen stimulation from the patient's adipose or fatty tissue. So abnormal bleeding, as I said earlier, I think abnormal bleeding in a post-menopausal woman is uterine cancer until you rule it out.
Host: What great information you're giving us here today, but back to treatment and the surgery you provide Dr. Morris, you're now part of the new April Samson Cancer Center, which has a goal of not only providing the best care, but making it convenient for patients. What are the advantages of women to have a gynecologic oncologist and a surgeon in their community or close by? Tell us a little bit more about the April Sampson Cancer Center.
Dr. Morris: Well, it is gonna be a multidisciplinary cancer center that offers women the opportunity, really to get state-of-the-art care, without having to to Omaha. Now we live in a rural to semi rural state. And up until now, all of the gynecologic cancer specialists were here in Omaha. There are only eight of them, and I will be the sort of first one to be in a town the size of Lincoln. And, it gives women from Lincoln and Western Nebraska, the option of having state-of-the-art cancer care, without having to travel to Omaha.
Host: What a great thing for women in that community to have close by. As we get ready to wrap up Dr. Morris and as survivorship continues to grow for these gynecologic cancers, and you mentioned the multidisciplinary approach at the April Samson Cancer Center, I'd like you to just expand a little bit on that multidisciplinary approach to allow for this follow-up care and routine health maintenance; where do you see that coordination of care between gynecologic oncologists and all these other health care providers and what else you'd like women to know about gynecologic cancers?
Dr. Morris: Well, it's just great for the patients because multimodality cancer care that can be given in one setting with the patient able to see the gynecologic surgeon, such as myself. We work closely with the radiation oncologist. Cervical cancer, vulvar cancers, endometrial cancers generally have a component of radiation treatment to them. We're there with the medical oncologist, who we work closely with to decide on chemotherapy options, chemotherapy administration. And in this day and age, all of the biologics and immunologic therapies that are pushing cancer care forward at an amazing rate right now.It is what I think is breaking down one of the biggest barriers that I've seen since being in Nebraska since 1992, is that it is difficult for women in the more rural areas to get to a center with these services. And sometimes they're just not available in some of the small local communities.
And I know patients who drive hundreds of miles, not only for their surgery, but for the radiation treatment and chemotherapy. So we're putting together a group of highly specialized and well-trained expert individuals, in my field of gynecologic cancer that allows women to undergo the diagnosis, treatment, management, both of cancer related symptoms, treatment complications, physical therapy, genetic evaluation, all without having to have their care fractionated between many, many different providers, hospitals, and institutions. So, it's a great leap forward for Lincoln community. And I think the whole state.
Host: Absolutely it is. What a wonderful addition to the community. And thank you, Dr. Morris for joining us and sharing your incredible expertise for us today. And if you'd like to learn more about the April Samson Cancer Center, you can visit Bryanhealth.org/cancer. And I'd like to thank our Bryan Foundation partner Mapes Industries. That concludes this episode of Bryan Health Podcast.
Please remember to subscribe, rate and review this podcast and all the other fascinating Bryan Health podcasts. Until next time, I'm Melanie Cole.