Preventing and Detecting Gynecologic Cancer
Too often gynecologic cancers (cancers in the female reproductive system) go undetected. Being proactive in your health and learning about gynecologic cancers may reduce your risk and identify ways to prevent cancer and to diagnose cancers in an early stage when more treatment options and higher survival rates are possible.Dr. Joyce Varughese, a board-certified, fellowship-trained gynecologic oncologist at Capital Health Surgical Group, will offer information on what gynecologic cancers are, their symptoms, and how to lower your risk. She will focus on prevention strategies of the three most common gynecologic cancers: uterine, ovarian, and cervical. Learn about different screening options and how your family history may affect your cancer risk.
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Learn more about Joyce Varughese, MD
Joyce Varughese, MD
Dr. Joyce Varughese is a board certified, fellowship trained gynecologic oncology surgeon who specializes in performing traditional and minimally invasive procedures using the da Vinci robotic surgery system. Dr. Varughese completed her fellowship training in gynecologic oncology and residency in obstetrics and gynecology, serving as administrative chief resident, at Yale University.Learn more about Joyce Varughese, MD
Transcription:
Preventing and Detecting Gynecologic Cancer
Prakash Chandran (Host): Too often cancers in the female reproductive system go undetected but being proactive in your health and learning more about diseases like gynecologic cancers may help reduce your risk and prevent getting them. Today, we’re going to learn about what gynecologic cancers are, their symptoms, and how to lower your risk. Let’s talk about it with Dr. Joyce Varughese, a gynecologic oncologist at Capital Health Surgical Group.
This is Capital Health Headlines, a podcast from Capital Health. I’m Prakash Chandran. So, Dr. Varughese, can you tell us about the three most common types of gynecologic cancers?
Joyce Varughese, MD, FACOG (Guest): The most common types of gynecologic cancers are uterine cancer. The common type of that being something called endometrial cancer. So, you sometimes see those used interchangeably in the press or people may hear both of those terms. The other two types that are most common are ovarian cancer and cervical cancer. There are some other types of cancers like vaginal cancers and vulvar cancers that are not as common. We also group together fallopian tube cancers and primary peritoneal cancers along with the ovarian cancers. So, we kind of put those all into a group and sort of label them all ovarian cancers.
Host: I see. Yeah, this topic is kind of closer to me. I have a friend with endometrial cancer—felt like it just came out of nowhere. Can you talk maybe a little bit about why women potentially get this type of cancer and potentially some of the symptoms that they experience?
Dr. Varughese: Sure. It doesn’t surprise me at all that you know somebody with a uterine or an endometrial cancer because actually in the US last year there were over 60,000 new diagnoses of uterine cancer. It is the most common gynecologic cancer that we diagnose and treat in the United States. In terms of the risk factors, one of the primary risk factors that’s actually modifiable is obesity. So, we know that women who are 50 pounds or more over their ideal body weight actually have a 10 times the risk of developing a uterine or endometrial cancer than somebody who’s at their—a normal body weight. Even if somebody’s only 30 pounds over their ideal body weight, they still have a three-fold risk of developing a uterine cancer. One of the other major risk factors for uterine cancer also is something called Lynch syndrome. That’s a familial genetic cancer syndrome where you inherit a genetic mutation from your mother or your father that increases your risk of developing uterine cancer as well as some other cancers such as colon cancer.
Host: I see. So, what kind of symptoms start to exhibit themselves when you might have one of these types of cancers?
Dr. Varughese: The good news is that it’s usually diagnosed at a very early stage, and the reason for that is that 90% of women with an endometrial cancer will experience some type of abnormal bleeding. So, most women who are diagnosed with endometrial cancers are post-menopausal. So, they have not had a period or blood in many years, and all of a sudden, they notice some vaginal bleeding or some spotting or new discharge and then they seek gynecologic care. So, fortunately, they’re usually diagnosed early stage because of this abnormal bleeding, but some women just say that they never actually went into menopause, and they’re like late 50’s, and they’re like well they’re cycling, and so that can sometimes be [an] indication that there may be something going on, or it may be completely normal, but it does lend itself to having some medical evaluation. Other women who are pre-menopausal, and so they are used to getting periods, they may notice like a new onset of heavy menstrual periods or bleeding in between periods—any type of abnormal uterine bleeding really does need further workup—even in women as young as the age of 35. I’ve personally diagnosed 28-year-olds with it—with uterine cancers. Less commonly we see—you know we hear of complaints of pelvic or abdominal pain, and you know, very rarely do we actually feel something on examination that then lends itself to a diagnosis of uterine cancer. It’s really the abnormal bleeding and discharge that’s most common.
Host: Okay. So, if a woman is experiencing this abnormal bleeding—I’m curious about what screening options she might have to detect exactly what type of cancer it is.
Dr. Varughese: So, the only way to really, truly diagnose it would be a tissue sample. So, usually that requires either a biopsy in the office, or something called a D&C which is a dilation and curettage, which is basically a scraping of the lining of the uterus that can be done sometimes in the office, but more commonly done in like—as an outpatient surgical procedure. The other thing that can sometimes be done is an ultrasound looking for a thickening of the lining of the uterus or a thickening of the endometrium, but again, though, endometrium can be thickened for a variety of reasons. It can be thickened If patients have benign things like polyps or fibroids. So, just a thickened endometrium on ultrasound isn’t really going to tell us what they have. It may increase our suspicion for uterine cancer, but it’s not going to diagnose it. That being said, also, there are other types of uterine cancers that are a little bit more aggressive or high-grade uterine cancers that don’t always present with a thickened lining on ultrasound. So, really any woman with some kind of bleeding after menopause really does need some sort of tissue diagnosis to rule out a uterine cancer.
Host: So, yeah. We talked about the Lynch syndrome in the family history, but I’m curious as to if there’s anything else in the family history that should be considered when making a determination for when to get screened.
Dr. Varughese: So, depending on somebody’s family history, a referral to genetic counseling may be appropriate and then genetic testing as they see fit, but in terms of gynecologic cancer specifically, there are other familial cancer syndromes. So, there’s something called Hereditary Breast and Ovarian Cancer Syndrome. Many patients know it more commonly because of the BRCA mutations like BRCA-1 and BRCA-2. It’s the mutation that Angelina Jolie had. So, it’s kind of come out in the lay press a little bit more, but there are actually other mutations other than just BRCA-1 and BRCA-2 that comprise this Hereditary Breast and Ovarian Cancer Syndrome and can increase one’s risk of breast cancers, ovarian cancers as well as actually even some uterine cancers. So, if the patient has a family history that they don’t actually have many women in the family, but they’ve got, you know, a lot of people with colon cancers in the family, for example, that’s still concerning to me for Lynch syndrome potentially, or if they have a family history with pancreatic and prostate cancers, breast cancers, potentially ovarian cancers, that’s concerning to me for Hereditary Breast and Ovarian Cancer Syndrome, and I usually will refer them for genetic counseling and testing.
Host: Let’s move on to treatment. So, I’m curious as to what that actually entails and what life is like afterwards. You know, I’m sure people listening to this might be wondering, you know, am I able to conceive afterwards? What are some of the things that I should be aware of? So, maybe speak to that a little bit.
Dr. Varughese: So, with the uterine cancers, the standard of care treatment is a surgical staging, which includes removing the uterus, the cervix, usually both tubes and both ovaries as well as some lymph nodes down in the pelvis and potentially some a little bit higher up in what we call the periaortic region. Like I said, most of women diagnosed with uterine cancer are post-menopausal, so having a hysterectomy isn’t life altering for them in the sense that they’re done childbearing. There are times though where, as I mentioned, I had a patient who was 28, and it’s not uncommon now to diagnose uterine cancer in pre-menopausal women. If they’re done childbearing, we still recommend a hysterectomy because many times that can be curative. That might be all the treatment that they need, but because of the way that obesity leads to uterine cancer, which is, basically, there’s extra estrogen on board. So, the lining of the uterus is really sensitive to two hormones, estrogen and progesterone, and men and women both have something called testosterone, and testosterone gets converted to estrogen in the fatty tissue. So, it’s kind of like when you see really overweight or obese men, it looks like they have breast development. That’s because their testosterone is getting converted to estrogen in their fatty tissue and stimulating their breasts to actually develop. That’s not just fatty tissue like depositing at the breast. So, in women, being overweight and/or obese, you also get that conversion of testosterone to estrogen in the fatty tissue, and so it’s what puts overweight and obese women at increased risk for breast cancer, but also for this uterine cancer because of this unopposed estrogen now acting on the lining of the uterus. So, one of the more conservative ways that we can treat uterine cancer is giving progesterone back to kind of help restore that balance, and so we really limit that though for patients who are really interested in having children in the future and have what appears at least on imaging studies to be a really early stage uterine cancer. Some women after they’ve had a hysterectomy, may require radiation treatment, and other women may even require some chemotherapy as well, but most women can be cured with just a hysterectomy.
Host: You know, you talked a little bit about estrogen and testosterone converting into it. I’m curious about diet and lifestyle, you know, for those people that are vegetarian or vegan that eat a lot of soy-based products or a lot of tofu, is there any concern there around estrogen leading to these types of cancers?
Dr. Varughese: The data’s sort of mixed at this point. We do know that certain soy-based products do have estrogenic effect, but I have to say there hasn’t really been any data—at least none that I’m aware of—showing that vegetarians who eat more tofu and such are at increased risk for uterine cancer, per se. In fact, many of them are probably at decreased risk of uterine cancer because they tend to be of a healthier body weight. Yeah, overall, again, these are sort of overarching generalizations, but for the most part, that tends to be the case. The other piece of it, though, is in terms of ovarian and fallopian tube and primary peritoneal cancers, there’s also, you know, concerns similar to in the breast cancer literature about extra soy or additional soy in tofu-based products kind of increasing estrogenic effect, but again, that hasn’t really been born out at least from an ovarian, fallopian tube, and primary peritoneal cancer standpoint.
I know that you asked about treatment. I spoke a little bit about uterine cancer. For ovarian, fallopian tube, and primary peritoneal cancer, we also, typically, do surgery first, and that’s also a total hysterectomy and removing the fallopian tubes and ovaries as well as lymph nodes and something called the omentum, which is like a fatty apron that kind of covers the intestines on the inside and then based off of that, we often times recommend chemotherapy because unlike uterine cancer, most ovarian, fallopian tube, and primary peritoneal cancers are actually caught later stage—at stage 3 or 4, and so those do require further treatment.
Host: There’s two things that I’ve really taken away from this. One is to obviously try to maintain that healthy weight, and then the second thing is, you know, be on the lookout for a family history, especially that Lynch syndrome. Is there any other advice that you might give to women who are concerned about getting gynecologic cancer?
Dr. Varughese: So, many uterine cancers can be prevented because they are obesity related. So, like you said, maintain a healthy weight and know your family history. In terms of ovarian cancers, we really can’t prevent most of them because only about 10 to 15% of them are related to a hereditary mutation, but knowing your family history is very important because if you do carry one of those mutations, then we can do sort of risk reducing maneuvers such as surgeries or medications that can help reduce your risk of developing one of these deadly ovarian cancers. One cancer that we didn’t talk all that much about is cervical cancer, but one way to really prevent that is we know that most cervical cancers are caused by something called Human Papilloma Virus or HPV. There is a vaccine out for HPV now, and so getting vaccinated if you’re within the age group to be vaccinated, and also having routine gyn care and getting pap smears at whatever interval is appropriate for you, and you and your gynecologist can sort of discuss that based off of guidelines. Those are really the things to sort of know about and variant (11:25) ways to help prevent some of the gyn cancers.
Host: Well, Dr. Varughese, I really appreciate your time today. That’s Dr. Joyce Varughese, a gynecologic oncologist at Capital Health Surgical Group. Thanks for checking out this episode of Capital Health Headlines. Call 609-537-6000 or visit capitalhealth.org/gynonc to schedule an appointment with Dr. Varughese. 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 next time.
Preventing and Detecting Gynecologic Cancer
Prakash Chandran (Host): Too often cancers in the female reproductive system go undetected but being proactive in your health and learning more about diseases like gynecologic cancers may help reduce your risk and prevent getting them. Today, we’re going to learn about what gynecologic cancers are, their symptoms, and how to lower your risk. Let’s talk about it with Dr. Joyce Varughese, a gynecologic oncologist at Capital Health Surgical Group.
This is Capital Health Headlines, a podcast from Capital Health. I’m Prakash Chandran. So, Dr. Varughese, can you tell us about the three most common types of gynecologic cancers?
Joyce Varughese, MD, FACOG (Guest): The most common types of gynecologic cancers are uterine cancer. The common type of that being something called endometrial cancer. So, you sometimes see those used interchangeably in the press or people may hear both of those terms. The other two types that are most common are ovarian cancer and cervical cancer. There are some other types of cancers like vaginal cancers and vulvar cancers that are not as common. We also group together fallopian tube cancers and primary peritoneal cancers along with the ovarian cancers. So, we kind of put those all into a group and sort of label them all ovarian cancers.
Host: I see. Yeah, this topic is kind of closer to me. I have a friend with endometrial cancer—felt like it just came out of nowhere. Can you talk maybe a little bit about why women potentially get this type of cancer and potentially some of the symptoms that they experience?
Dr. Varughese: Sure. It doesn’t surprise me at all that you know somebody with a uterine or an endometrial cancer because actually in the US last year there were over 60,000 new diagnoses of uterine cancer. It is the most common gynecologic cancer that we diagnose and treat in the United States. In terms of the risk factors, one of the primary risk factors that’s actually modifiable is obesity. So, we know that women who are 50 pounds or more over their ideal body weight actually have a 10 times the risk of developing a uterine or endometrial cancer than somebody who’s at their—a normal body weight. Even if somebody’s only 30 pounds over their ideal body weight, they still have a three-fold risk of developing a uterine cancer. One of the other major risk factors for uterine cancer also is something called Lynch syndrome. That’s a familial genetic cancer syndrome where you inherit a genetic mutation from your mother or your father that increases your risk of developing uterine cancer as well as some other cancers such as colon cancer.
Host: I see. So, what kind of symptoms start to exhibit themselves when you might have one of these types of cancers?
Dr. Varughese: The good news is that it’s usually diagnosed at a very early stage, and the reason for that is that 90% of women with an endometrial cancer will experience some type of abnormal bleeding. So, most women who are diagnosed with endometrial cancers are post-menopausal. So, they have not had a period or blood in many years, and all of a sudden, they notice some vaginal bleeding or some spotting or new discharge and then they seek gynecologic care. So, fortunately, they’re usually diagnosed early stage because of this abnormal bleeding, but some women just say that they never actually went into menopause, and they’re like late 50’s, and they’re like well they’re cycling, and so that can sometimes be [an] indication that there may be something going on, or it may be completely normal, but it does lend itself to having some medical evaluation. Other women who are pre-menopausal, and so they are used to getting periods, they may notice like a new onset of heavy menstrual periods or bleeding in between periods—any type of abnormal uterine bleeding really does need further workup—even in women as young as the age of 35. I’ve personally diagnosed 28-year-olds with it—with uterine cancers. Less commonly we see—you know we hear of complaints of pelvic or abdominal pain, and you know, very rarely do we actually feel something on examination that then lends itself to a diagnosis of uterine cancer. It’s really the abnormal bleeding and discharge that’s most common.
Host: Okay. So, if a woman is experiencing this abnormal bleeding—I’m curious about what screening options she might have to detect exactly what type of cancer it is.
Dr. Varughese: So, the only way to really, truly diagnose it would be a tissue sample. So, usually that requires either a biopsy in the office, or something called a D&C which is a dilation and curettage, which is basically a scraping of the lining of the uterus that can be done sometimes in the office, but more commonly done in like—as an outpatient surgical procedure. The other thing that can sometimes be done is an ultrasound looking for a thickening of the lining of the uterus or a thickening of the endometrium, but again, though, endometrium can be thickened for a variety of reasons. It can be thickened If patients have benign things like polyps or fibroids. So, just a thickened endometrium on ultrasound isn’t really going to tell us what they have. It may increase our suspicion for uterine cancer, but it’s not going to diagnose it. That being said, also, there are other types of uterine cancers that are a little bit more aggressive or high-grade uterine cancers that don’t always present with a thickened lining on ultrasound. So, really any woman with some kind of bleeding after menopause really does need some sort of tissue diagnosis to rule out a uterine cancer.
Host: So, yeah. We talked about the Lynch syndrome in the family history, but I’m curious as to if there’s anything else in the family history that should be considered when making a determination for when to get screened.
Dr. Varughese: So, depending on somebody’s family history, a referral to genetic counseling may be appropriate and then genetic testing as they see fit, but in terms of gynecologic cancer specifically, there are other familial cancer syndromes. So, there’s something called Hereditary Breast and Ovarian Cancer Syndrome. Many patients know it more commonly because of the BRCA mutations like BRCA-1 and BRCA-2. It’s the mutation that Angelina Jolie had. So, it’s kind of come out in the lay press a little bit more, but there are actually other mutations other than just BRCA-1 and BRCA-2 that comprise this Hereditary Breast and Ovarian Cancer Syndrome and can increase one’s risk of breast cancers, ovarian cancers as well as actually even some uterine cancers. So, if the patient has a family history that they don’t actually have many women in the family, but they’ve got, you know, a lot of people with colon cancers in the family, for example, that’s still concerning to me for Lynch syndrome potentially, or if they have a family history with pancreatic and prostate cancers, breast cancers, potentially ovarian cancers, that’s concerning to me for Hereditary Breast and Ovarian Cancer Syndrome, and I usually will refer them for genetic counseling and testing.
Host: Let’s move on to treatment. So, I’m curious as to what that actually entails and what life is like afterwards. You know, I’m sure people listening to this might be wondering, you know, am I able to conceive afterwards? What are some of the things that I should be aware of? So, maybe speak to that a little bit.
Dr. Varughese: So, with the uterine cancers, the standard of care treatment is a surgical staging, which includes removing the uterus, the cervix, usually both tubes and both ovaries as well as some lymph nodes down in the pelvis and potentially some a little bit higher up in what we call the periaortic region. Like I said, most of women diagnosed with uterine cancer are post-menopausal, so having a hysterectomy isn’t life altering for them in the sense that they’re done childbearing. There are times though where, as I mentioned, I had a patient who was 28, and it’s not uncommon now to diagnose uterine cancer in pre-menopausal women. If they’re done childbearing, we still recommend a hysterectomy because many times that can be curative. That might be all the treatment that they need, but because of the way that obesity leads to uterine cancer, which is, basically, there’s extra estrogen on board. So, the lining of the uterus is really sensitive to two hormones, estrogen and progesterone, and men and women both have something called testosterone, and testosterone gets converted to estrogen in the fatty tissue. So, it’s kind of like when you see really overweight or obese men, it looks like they have breast development. That’s because their testosterone is getting converted to estrogen in their fatty tissue and stimulating their breasts to actually develop. That’s not just fatty tissue like depositing at the breast. So, in women, being overweight and/or obese, you also get that conversion of testosterone to estrogen in the fatty tissue, and so it’s what puts overweight and obese women at increased risk for breast cancer, but also for this uterine cancer because of this unopposed estrogen now acting on the lining of the uterus. So, one of the more conservative ways that we can treat uterine cancer is giving progesterone back to kind of help restore that balance, and so we really limit that though for patients who are really interested in having children in the future and have what appears at least on imaging studies to be a really early stage uterine cancer. Some women after they’ve had a hysterectomy, may require radiation treatment, and other women may even require some chemotherapy as well, but most women can be cured with just a hysterectomy.
Host: You know, you talked a little bit about estrogen and testosterone converting into it. I’m curious about diet and lifestyle, you know, for those people that are vegetarian or vegan that eat a lot of soy-based products or a lot of tofu, is there any concern there around estrogen leading to these types of cancers?
Dr. Varughese: The data’s sort of mixed at this point. We do know that certain soy-based products do have estrogenic effect, but I have to say there hasn’t really been any data—at least none that I’m aware of—showing that vegetarians who eat more tofu and such are at increased risk for uterine cancer, per se. In fact, many of them are probably at decreased risk of uterine cancer because they tend to be of a healthier body weight. Yeah, overall, again, these are sort of overarching generalizations, but for the most part, that tends to be the case. The other piece of it, though, is in terms of ovarian and fallopian tube and primary peritoneal cancers, there’s also, you know, concerns similar to in the breast cancer literature about extra soy or additional soy in tofu-based products kind of increasing estrogenic effect, but again, that hasn’t really been born out at least from an ovarian, fallopian tube, and primary peritoneal cancer standpoint.
I know that you asked about treatment. I spoke a little bit about uterine cancer. For ovarian, fallopian tube, and primary peritoneal cancer, we also, typically, do surgery first, and that’s also a total hysterectomy and removing the fallopian tubes and ovaries as well as lymph nodes and something called the omentum, which is like a fatty apron that kind of covers the intestines on the inside and then based off of that, we often times recommend chemotherapy because unlike uterine cancer, most ovarian, fallopian tube, and primary peritoneal cancers are actually caught later stage—at stage 3 or 4, and so those do require further treatment.
Host: There’s two things that I’ve really taken away from this. One is to obviously try to maintain that healthy weight, and then the second thing is, you know, be on the lookout for a family history, especially that Lynch syndrome. Is there any other advice that you might give to women who are concerned about getting gynecologic cancer?
Dr. Varughese: So, many uterine cancers can be prevented because they are obesity related. So, like you said, maintain a healthy weight and know your family history. In terms of ovarian cancers, we really can’t prevent most of them because only about 10 to 15% of them are related to a hereditary mutation, but knowing your family history is very important because if you do carry one of those mutations, then we can do sort of risk reducing maneuvers such as surgeries or medications that can help reduce your risk of developing one of these deadly ovarian cancers. One cancer that we didn’t talk all that much about is cervical cancer, but one way to really prevent that is we know that most cervical cancers are caused by something called Human Papilloma Virus or HPV. There is a vaccine out for HPV now, and so getting vaccinated if you’re within the age group to be vaccinated, and also having routine gyn care and getting pap smears at whatever interval is appropriate for you, and you and your gynecologist can sort of discuss that based off of guidelines. Those are really the things to sort of know about and variant (11:25) ways to help prevent some of the gyn cancers.
Host: Well, Dr. Varughese, I really appreciate your time today. That’s Dr. Joyce Varughese, a gynecologic oncologist at Capital Health Surgical Group. Thanks for checking out this episode of Capital Health Headlines. Call 609-537-6000 or visit capitalhealth.org/gynonc to schedule an appointment with Dr. Varughese. 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 next time.