Transcription:
Uterine Cancer: Risks, Symptoms and Treatments

Deborah Howell (Host): Hello, and welcome to the show. You are listening to Weekly Dose of Wellness. It's brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Leslie Randall, board certified gynecologic oncologist affiliated with Saddleback Memorial Hospital. Dr. Randall is also assistant professor at the University of California Irvine School of Medicine and Director of Education for Gynecologic Oncology. Welcome, Dr. Randall.

Dr. Leslie Randall (Guest): Thank you, Deborah.

Deborah: Today we're going to be talking a little bit about uterine cancer and its risks, symptoms and treatments. It's a lot to cover, so I'm going to jump right in. Tell me first about which cancers you help treat—what types of surgery do you do at Saddleback Memorial and those types of cancers.

Dr. Randall: We mostly treat uterine cancer. That's the most common cancer that women get out of their reproductive tract. We treat that with surgery. We do minimally invasive surgery with robotic assistance for that in most cases. In some cases, we still do the old-fashioned way with the open surgery. We also treat cervical cancer and also ovarian cancer with surgery. Some rare cancers that we treat are vulvar cancer and vaginal cancer.

Deborah: Okay. Sounds like you do it all. Well, today, let's focus on endometrial cancer, also known as uterine cancer. What are the risk factors, and what are the warning signs for women?

Dr. Randall: The strongest risk factor for endometrial cancer is age. It's much more common as women get older, especially after menopause. The average age is in the sixties. However, obesity is also a risk factor for endometrial cancer, and because of that obesity epidemic, uterine cancer is also [right being] an incident, especially in the younger pre-menopausal age groups, now have to be concerned about endometrial cancer. A third less common factor is the genetic predisposition to uterine cancer. Families who have an extensive history of colon or uterine or ovarian cancer might be an indicator that they may have a genetic pre-disposition to these cancers and should discuss that with their physicians.

Deborah: Okay. That's some of the risk factors. What are some of the warning signs for women?

Dr. Randall: Luckily, uterine cancer usually has symptoms very early on in the [discourse]. Those symptoms are abnormal uterine bleeding. So many women who haven't had a period in many, many years will experience a return of what they think is a period, and they go to their doctor. That's a very strong warning sign for a uterine cancer. In fact, that it is unless proven otherwise in someone who's past their menopause. It can be more difficult in women who are still having normal periods because the bleeding is not unusual to them. But if they are bleeding in between their periods or the periods become unusually heavy, then it's also a warning sign.

Deborah: Is there anything you can do at your annual physical to determine who might be having some areas of concern?

Dr. Randall: Really, pap smears are often done at the annual physical. Those are [not] designed to detect uterine cancer. If you're experiencing any abnormal bleeding, you should discuss that with your physician, bring that to their attention. You should also have a pelvic exam by the physician once a year. That can't always detect cancer in the early stages. It might detect it in the later stages. But these are the things that you can do at your annual visit.

Deborah: Okay. Now, where do you come in as a surgeon? How are you involved in the diagnosis and the treatment?

Dr. Randall: Most patients are referred to me, either it's already a diagnosis of uterine cancer because they've been biopsied by their primary care doctor, their gynecologist; or they come to me with the abnormal bleeding, and then I perform an endometrial biopsy. It's a simple procedure that can be done in the office with no anesthesia, and that sends a sample to a pathologist who can look at that under the microscope, and that's how they diagnose the cancer. For the women who already have the diagnosis, we will examine them to determine if they're surgical candidates. And if so, are they candidates for the minimally invasive surgical approach.

Deborah: Always the more preferred.

Dr. Randall: Always the more preferred, for sure. But with cancer, you have to do the right operation, and so some patients will not be candidates to minimally invasive surgery for cancer-related reasons and they should have a traditional surgery in order to get the best cancer surgery possible.

Deborah: Absolutely. So if you are lucky enough to be a candidate for robotic surgery, tell me a little bit about that surgery. What's the process like for a patient?

Dr. Randall: The patient will typically have a pre-op visit. They'll need usually a pelvic ultrasound. They'll need some blood work and a chest x-ray. If all of that checks out well, then we take them to the operating room. They'll be put to sleep with a general anesthesia, and then we make five small incisions on the abdomen, through which we put our tools that we use to detach the uterus from above, so to speak, and then we actually deliver the uterus to the vagina like a baby, to take it out. It has to be removed in one piece. It can't be cut into pieces in order to get it out through a small incision. It must come out the vagina in one piece.

Deborah: Okay.

Dr. Randall: Sometimes we can make a small skin incision to deliver the uterus to the abdomen the traditional way. But typically, we can remove it just through the vagina.

Deborah: Much more comfortable for the patient with follow-up, I would imagine.

Dr. Randall: Yes. These patients recover much faster than patients having the traditional incision, to the tune of usually about a month faster. The hospital stays are much shorter; it's an overnight stay as opposed to three to five days in the hospital for the traditional procedure. Plus, the patients who have the minimally invasive robotic surgery are at much lower risk of serious surgical complications, which is wound infection, separation, and other infection. They're also at lower risk for blood transfusion.

Deborah: Really? Okay, of course. You've listed a number of advantages for robotic surgery. Are there any others that we might have missed?

Dr. Randall: Those are the most direct benefits to the patient. Anytime you put a patient through less surgery, they have indirect benefits, and those indirect benefits include if they need radiation chemotherapy after surgery, they can often start that treatment sooner than they could have had they had the traditional surgery. Also, patients tend to have less minor complications of surgery, and they also tend to get back to work faster.

Deborah: Right. Now, are some patients better candidates for this type of surgery than others?

Dr. Randall: The main factor in whether someone's a candidate or not has to do with how advanced the cancer is at the time the patient presents for treatment. We can pretty much figure that out before the surgery occurs. However, the surgery itself gives us a lot of information about that. So sometimes we plan to do the minimally invasive procedure, and then, when we get in, look in with the scope, looking through the camera, we realize the cancer's much worse than we thought, and then we have to do the open surgery.

Deborah: Yeah, I'm sure that's a disappointment for the patients.

Dr. Randall: Big disappointment, for sure.

Deborah: At that point, you become a little bit of a counselor, I would
imagine.

Dr. Randall: I think a lot of my job is very much counseling. These are frightening, life-threatening diseases. Most patients come into my office with having heard the C-word and think that that's a death sentence, they're very terrified, whereas most endometrial cancers will be cured with surgery. And so it's not a death sentence to get a endometrial cancer diagnosis. It just really depends on what the stage is at the time we find it and how we're best able to treat it.

Deborah: Right. I have one final question for you, doctor. Can you provide me an example of how today's research may impact patients by either preventing or advancing the treatment of uterine cancer in the future?

Dr. Randall: I absolutely can. I do lots of research, and this is my first blow. Yeah, the robotics, minimally invasive surgery and robotic surgeries are probably the biggest advance we have in endometrial cancer care in the last decade. Right now, we're trying to focus on women who have high-risk cancers and what we can do in addition to surgery to help them survive their cancer long-term. We're working in the areas of radiation and chemotherapy, trying to develop, trying to optimize our current treatment protocols and trying to develop novel treatment protocols that have much fewer side effects than the treatment that we currently provide.

Deborah: Well, thank you so much, Dr. Randall, for all that you do and for all the research. It's very exciting. It's been wonderful having you on the program today to talk to us about uterine cancer and the exciting research surrounding it.

Dr. Randall: Great. Thank you so much for the opportunity to talk about this cancer that is very common and yet not many people seem to know much about it when they come to see me with the diagnosis.

Deborah: The pleasure is ours to get the information out there. To listen to the podcast or for more information, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have yourself a fantastic day.