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What Patients Need to Know About Gynecologic Cancer
Gynecologic cancers including cervical, ovarian, uterine and vulvar cancer are complex conditions that require specialized care. Dr. John Schorge is an expert in treating these conditions, and he's sharing what patients need to know to manage their risk, recognize symptoms, and make treatment decisions to protect and improve their health.
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Learn more about John Schorge, MD
John Schorge, MD
John O. Schorge, MD is Chief of the OB/GYN Service at Regional One Health, overseeing a department that boasts the historied Center of Excellence in high-risk obstetrics. As a recognized leader in gynecologic oncology, he will bring a service line back to Regional One Health that has not been on-campus for more than two decades.Learn more about John Schorge, MD
Transcription:
Cheryl Martin (Host): One-on-One with Regional One Health is your inside look at how we're building healthier tomorrows for our patients and our community. Join us for expert insight that empowers you to achieve a lifetime of better health. Dr. John Schorge is our guest today and he's here to discuss gynecologic cancers, specifically how patients can manage their risk factors, recognize symptoms and make treatment decisions to improve their health and overall quality of life. Dr. Schorge, so glad to have you on.
Dr. John Schorge: Thank you so much. It's a great opportunity to get the word out.
Cheryl Martin (Host): So, doctor, first, what are the different types of gynecologic cancer?
Dr. John Schorge: There's four main types of gynecologic cancers that common misconception to include breast cancer, but that's actually a whole separate portion of surgical oncology and general surgery. The four GYN cancers are, in order of frequency, uterine cancer, ovarian cancer, cervical cancer and vulvar cancer. And for the most part, these are interconnected with the reproductive organs. But uterine cancer is the most common one with about 65,000 diagnoses per year.
Cheryl Martin (Host): What symptoms should patients be aware of that might signal these conditions?
Dr. John Schorge: So for uterine cancer, it's pretty consistent that the main symptom is either bleeding after the menopause, which women generally know that when they go through the change of life, they are not supposed to have any bleeding and that is abnormal. And that's typically the symptom that gets them to come to the healthcare provider. I've actually had some patients that told me they thought they had found the fountain of youth because their periods had started up again, but that turned out not to be the case. The other symptom for a woman before menopause is just irregularity with bleeding and her periods. So either of those symptoms prompt a concern for uterine cancer.
Ovarian cancer is the next most common diagnoses with about 23,000 women in the United States diagnosed each year. That's about a third of the uterine cancers. There's four classic symptoms for ovarian cancer that tend to be kind of vague. One is bloating. Number two is feeling full all the time. Number three is abdominal or pelvic pains. And number four is urinary frequency. So if you think of ovarian cancer, it's often a cannonball size ovarian tumor with four to six liters of extra fluid in there, you can understand a cannonball. Sitting on the bladder would cause urinary changes in pelvic pains and all that fluid would cause a lot of bloating and feeling like they're full all the time, because the stomach is getting squished. So it's a misconception that ovarian cancer is the disease that whispers. It's just that women tend to either neglect those symptoms, because they're fairly common with a lot of conditions where the doctor isn't acting upon symptoms.
Cervical cancer tends to be the classic symptom of bleeding after having sexual intercourse. So if there's a tumor on the cervix, any trauma to that during sexual intercourse could cause some bleeding after the event Vulvar cancer is something on the outside of the body and it's typically visible and you can feel something down there, so that's often what gets women into the hospital for that condition.
Cheryl Martin (Host): So doctor, are there some women at a higher risk for these conditions?
Dr. John Schorge: Yes. Great question. Uterine cancers, for example, I'll tell our students, are going up pretty dramatically across the country. And the reason for that is they're typically caused by excess estrogen hormone. And the way that estrogen is created in the body is when people are overweight or obese. The extra fatty tissues produce a type of estrogen that causes an increased risk of uterine cancer. So they're very directly related with the obesity epidemic in the country and increasing rates of uterine cancer.
Ovarian cancer has a sizable fraction of people that are genetically predisposed. So for example, a woman has multiple family members that has breast or ovarian cancer, and you're now able to get a genetic test that can identify what's called a BRCA gene mutation. And if you have one of those gene mutations, your risk of getting ovarian cancer is about 40% versus the general population, where it's about 1%.
Cervical cancers and vulvar cancers really have no other genetic predispositions. But uterine cancer and ovary cancer, certainly there, you can explain why women are at risk.
Cheryl Martin (Host): So how can a woman manage her risk through screening, lifestyle and other factors? What can be done?
Dr. John Schorge: Well, the first thing that is helpful is not smoking. That's kind of a general health, you know, concern that puts people at more risk for cervical cancer, vulvar cancer because it changes the cells that are exposed. And they're more at risk for HPV infection and/or dysplasia or precancer. Ovary and uterine cancer, ovary cancer, there's not much of a way to decrease your risk. It's a pretty insignificant risk, 1%. There's no screening for ovarian cancer. It's mainly just identifying if you've got family members that need to have genetic testing and uterine cancer is weight loss or weight reduction strategies. So people that have very significant obesity are at a sizeable risk. But if they undergo gastric bypass or lose a whole bunch of weight, their risk goes away.
Cheryl Martin (Host): Dr. Schorge, walk us through what a patient can expect in terms of getting that initial diagnosis and then talking to a specialist like you, for example, about their condition and treatment options.
Dr. John Schorge: So the one thing that is for sure is that if a woman with one of these types of cancer sees a specialist like me, a GYN oncologist, they have a much better prognosis, must better chance of cure, much better outcome. And the reason for that is these are fairly uncommon and the specialists like myself tend to put them on the right treatment sequence. And so that's important to seek out a GYN oncologist when you've got one of these cancer diagnoses. But essentially, what happens is a patient comes in and, let's say, she had some irregular bleeding, she had a biopsy that can be done in the office that shows an endometrial cancer. There's a couple of different types of them, but the most common, 90 plus percent, is a low-grade cancer. Patients are often very nervous and worried. And anytime you are introduced to the C word, you know, there's a very real worry about how the outcome is going to be.
But fortunately, for uterine cancer, most of these are highly curable just with a hysterectomy operation itself and the way that hysterectomy operations are done these days is with tiny little abdominal incisions, minimally invasive technique and often they go home the same day. So once you explain to the patients that they're going to need an operation, but they're probably going to go home that same day, need very little as far as pain pills go, they probably won't need any further treatment and they won't have any hot flashes or other side effects, that tends to really be reassuring to them and they feel like you've got a plan to proceed. And part of the reason that people go into my field is that you have a real opportunity, especially in the Memphis area, to impact health disparities within our region. And that's a big deal.
Cheryl Martin (Host): You've touched on this a little bit in your answer, but what are other ways that you work with the patient to decide on the best treatment for that person?
Dr. John Schorge: The lingo that's used now is shared decision-making. And what that means is when you've got a diagnosis of a GYN cancer, typically, I will draw out a picture of the reproductive organs point to where the cancer is located, and we will talk about some options. There's always a few options as far as treatment goes. Some patients are younger and want to maintain their fertility and we go down that road. Others, just, you know, want to proceed with the safest, best treatment option, we'll go down that road. So it really depends on the patient's age, circumstances, family circumstances and desires and goals as far as where we end up in terms of getting the treatment plan going.
Cheryl Martin (Host): Now, you specialize in minimally invasive surgery to treat cancer. What does that mean for a patient in terms of the procedure itself, the recovery and potential outcomes.
Dr. John Schorge: That is an excellent question. Minimally invasive surgery is thought to be the best way of performing a hysterectomy or the GYN surgery. When a patient has a GYN cancer, typically the operation is the first treatment step. And ideally, that is performed either what's called robotically or with regular laparoscopy. They're very similar types of procedures that include tiny little incisions of the abdominal wall. And you're able to remove lymph nodes, perform staging, perform a hysterectomy on the inside of the body, very technically, you know, expert dissection and so on. But all the benefits come afterwards when the patient typically goes home the same day has a very low risk of infection, really has a much faster return to work. And so when I'm seeing patients as a second or third opinion, you know, it may or may not be the case that they were advised to have minimally invasive or an open procedure, but everybody would acknowledge that an open incision, what's called a laparotomy, which is a bigger incision, is inferior in every which way including risk of infection and complications.
Cheryl Martin (Host): So why is it so important for patients with these conditions to be under the care of a doctor who specializes in gynecologic cancer?
Dr. John Schorge: I would say, because we see this all the time, we've got a lot of experience with each of these four diagnoses. The field, like a lot of medicine, moves rapidly, so you're needing to keep up with new treatments across the country. We're fortunate here at Regional One to be the main site for our University of Tennessee Health Science Center. We're engaged nationally with new practice updates. We are the people that wrote the textbook. And so we're fairly plugged in with new advances and better and new ways of doing things. And you want to see a doctor that is in this specialty, if you have a GYN cancer and you want them to be as updated as possible with the best and the newest treatments.
Cheryl Martin (Host): That's great. Dr. Schorge, anything else you wanted to add on this topic that we didn't cover?
Dr. John Schorge: Just really awareness that many times a woman with a GYN cancer brewing, so to speak, is not urgently getting herself to the doctor to get this checked out. She's usually the medical decision-maker for the entire family. And she's worried about either kids or spouse or other people and tends to neglect her own healthcare needs, but to pay attention to her body. Most times that I see somebody with ovarian cancer or one of these other types of cancer, the majority of them will say, "You know, I knew something was wrong," and yet the facts are with ovarian cancer, for example, that the woman generally knew something was up, she had seen multiple different doctors, maybe her primary care and some other doctors and no one thought of ovarian cancer and her diagnosis was delayed. So if she's having any of these symptoms that we talked about and no one of her medical team has done a pelvic exam, which is visualizing the outside of the perineum or vulvar area, doing a speculum Pap smear-type exam and feeling on their abdominal wall, if nobody's done that, they haven't been appropriately assessed for one of these cancers and they need to be.
Cheryl Martin (Host): Dr. John Schorge, this has been so informative. Thanks so much for going into detail about gynecologic cancers, the symptoms and what patients need to know to manage their risks. Thank you.
Dr. John Schorge: I appreciate the opportunity and I can't thank you enough for getting this out there to help improve the care of women in our community. It is a high risk center of health disparities. And I'm proud to say that with the cancer program now at Regional One, patients in town do not have to go 20, 30 miles away to receive this type of care. We're proud to have them stay right here at Regional One and receive world class care.
Cheryl Martin (Host): Dr. Schorge sees patients at regional one Health's main campus and east campus for an appointment with Dr.
Serge. Either location, call 9 0 1 5 1 5 3 8 0 9. That's 9 0 1 5 1 5 3 8 0 9. Thanks for making One-on-One with Regional One Health part of your journey to better health. Join us next time as we cover another topic to keep you on the path to a healthier tomorrow.
Cheryl Martin (Host): One-on-One with Regional One Health is your inside look at how we're building healthier tomorrows for our patients and our community. Join us for expert insight that empowers you to achieve a lifetime of better health. Dr. John Schorge is our guest today and he's here to discuss gynecologic cancers, specifically how patients can manage their risk factors, recognize symptoms and make treatment decisions to improve their health and overall quality of life. Dr. Schorge, so glad to have you on.
Dr. John Schorge: Thank you so much. It's a great opportunity to get the word out.
Cheryl Martin (Host): So, doctor, first, what are the different types of gynecologic cancer?
Dr. John Schorge: There's four main types of gynecologic cancers that common misconception to include breast cancer, but that's actually a whole separate portion of surgical oncology and general surgery. The four GYN cancers are, in order of frequency, uterine cancer, ovarian cancer, cervical cancer and vulvar cancer. And for the most part, these are interconnected with the reproductive organs. But uterine cancer is the most common one with about 65,000 diagnoses per year.
Cheryl Martin (Host): What symptoms should patients be aware of that might signal these conditions?
Dr. John Schorge: So for uterine cancer, it's pretty consistent that the main symptom is either bleeding after the menopause, which women generally know that when they go through the change of life, they are not supposed to have any bleeding and that is abnormal. And that's typically the symptom that gets them to come to the healthcare provider. I've actually had some patients that told me they thought they had found the fountain of youth because their periods had started up again, but that turned out not to be the case. The other symptom for a woman before menopause is just irregularity with bleeding and her periods. So either of those symptoms prompt a concern for uterine cancer.
Ovarian cancer is the next most common diagnoses with about 23,000 women in the United States diagnosed each year. That's about a third of the uterine cancers. There's four classic symptoms for ovarian cancer that tend to be kind of vague. One is bloating. Number two is feeling full all the time. Number three is abdominal or pelvic pains. And number four is urinary frequency. So if you think of ovarian cancer, it's often a cannonball size ovarian tumor with four to six liters of extra fluid in there, you can understand a cannonball. Sitting on the bladder would cause urinary changes in pelvic pains and all that fluid would cause a lot of bloating and feeling like they're full all the time, because the stomach is getting squished. So it's a misconception that ovarian cancer is the disease that whispers. It's just that women tend to either neglect those symptoms, because they're fairly common with a lot of conditions where the doctor isn't acting upon symptoms.
Cervical cancer tends to be the classic symptom of bleeding after having sexual intercourse. So if there's a tumor on the cervix, any trauma to that during sexual intercourse could cause some bleeding after the event Vulvar cancer is something on the outside of the body and it's typically visible and you can feel something down there, so that's often what gets women into the hospital for that condition.
Cheryl Martin (Host): So doctor, are there some women at a higher risk for these conditions?
Dr. John Schorge: Yes. Great question. Uterine cancers, for example, I'll tell our students, are going up pretty dramatically across the country. And the reason for that is they're typically caused by excess estrogen hormone. And the way that estrogen is created in the body is when people are overweight or obese. The extra fatty tissues produce a type of estrogen that causes an increased risk of uterine cancer. So they're very directly related with the obesity epidemic in the country and increasing rates of uterine cancer.
Ovarian cancer has a sizable fraction of people that are genetically predisposed. So for example, a woman has multiple family members that has breast or ovarian cancer, and you're now able to get a genetic test that can identify what's called a BRCA gene mutation. And if you have one of those gene mutations, your risk of getting ovarian cancer is about 40% versus the general population, where it's about 1%.
Cervical cancers and vulvar cancers really have no other genetic predispositions. But uterine cancer and ovary cancer, certainly there, you can explain why women are at risk.
Cheryl Martin (Host): So how can a woman manage her risk through screening, lifestyle and other factors? What can be done?
Dr. John Schorge: Well, the first thing that is helpful is not smoking. That's kind of a general health, you know, concern that puts people at more risk for cervical cancer, vulvar cancer because it changes the cells that are exposed. And they're more at risk for HPV infection and/or dysplasia or precancer. Ovary and uterine cancer, ovary cancer, there's not much of a way to decrease your risk. It's a pretty insignificant risk, 1%. There's no screening for ovarian cancer. It's mainly just identifying if you've got family members that need to have genetic testing and uterine cancer is weight loss or weight reduction strategies. So people that have very significant obesity are at a sizeable risk. But if they undergo gastric bypass or lose a whole bunch of weight, their risk goes away.
Cheryl Martin (Host): Dr. Schorge, walk us through what a patient can expect in terms of getting that initial diagnosis and then talking to a specialist like you, for example, about their condition and treatment options.
Dr. John Schorge: So the one thing that is for sure is that if a woman with one of these types of cancer sees a specialist like me, a GYN oncologist, they have a much better prognosis, must better chance of cure, much better outcome. And the reason for that is these are fairly uncommon and the specialists like myself tend to put them on the right treatment sequence. And so that's important to seek out a GYN oncologist when you've got one of these cancer diagnoses. But essentially, what happens is a patient comes in and, let's say, she had some irregular bleeding, she had a biopsy that can be done in the office that shows an endometrial cancer. There's a couple of different types of them, but the most common, 90 plus percent, is a low-grade cancer. Patients are often very nervous and worried. And anytime you are introduced to the C word, you know, there's a very real worry about how the outcome is going to be.
But fortunately, for uterine cancer, most of these are highly curable just with a hysterectomy operation itself and the way that hysterectomy operations are done these days is with tiny little abdominal incisions, minimally invasive technique and often they go home the same day. So once you explain to the patients that they're going to need an operation, but they're probably going to go home that same day, need very little as far as pain pills go, they probably won't need any further treatment and they won't have any hot flashes or other side effects, that tends to really be reassuring to them and they feel like you've got a plan to proceed. And part of the reason that people go into my field is that you have a real opportunity, especially in the Memphis area, to impact health disparities within our region. And that's a big deal.
Cheryl Martin (Host): You've touched on this a little bit in your answer, but what are other ways that you work with the patient to decide on the best treatment for that person?
Dr. John Schorge: The lingo that's used now is shared decision-making. And what that means is when you've got a diagnosis of a GYN cancer, typically, I will draw out a picture of the reproductive organs point to where the cancer is located, and we will talk about some options. There's always a few options as far as treatment goes. Some patients are younger and want to maintain their fertility and we go down that road. Others, just, you know, want to proceed with the safest, best treatment option, we'll go down that road. So it really depends on the patient's age, circumstances, family circumstances and desires and goals as far as where we end up in terms of getting the treatment plan going.
Cheryl Martin (Host): Now, you specialize in minimally invasive surgery to treat cancer. What does that mean for a patient in terms of the procedure itself, the recovery and potential outcomes.
Dr. John Schorge: That is an excellent question. Minimally invasive surgery is thought to be the best way of performing a hysterectomy or the GYN surgery. When a patient has a GYN cancer, typically the operation is the first treatment step. And ideally, that is performed either what's called robotically or with regular laparoscopy. They're very similar types of procedures that include tiny little incisions of the abdominal wall. And you're able to remove lymph nodes, perform staging, perform a hysterectomy on the inside of the body, very technically, you know, expert dissection and so on. But all the benefits come afterwards when the patient typically goes home the same day has a very low risk of infection, really has a much faster return to work. And so when I'm seeing patients as a second or third opinion, you know, it may or may not be the case that they were advised to have minimally invasive or an open procedure, but everybody would acknowledge that an open incision, what's called a laparotomy, which is a bigger incision, is inferior in every which way including risk of infection and complications.
Cheryl Martin (Host): So why is it so important for patients with these conditions to be under the care of a doctor who specializes in gynecologic cancer?
Dr. John Schorge: I would say, because we see this all the time, we've got a lot of experience with each of these four diagnoses. The field, like a lot of medicine, moves rapidly, so you're needing to keep up with new treatments across the country. We're fortunate here at Regional One to be the main site for our University of Tennessee Health Science Center. We're engaged nationally with new practice updates. We are the people that wrote the textbook. And so we're fairly plugged in with new advances and better and new ways of doing things. And you want to see a doctor that is in this specialty, if you have a GYN cancer and you want them to be as updated as possible with the best and the newest treatments.
Cheryl Martin (Host): That's great. Dr. Schorge, anything else you wanted to add on this topic that we didn't cover?
Dr. John Schorge: Just really awareness that many times a woman with a GYN cancer brewing, so to speak, is not urgently getting herself to the doctor to get this checked out. She's usually the medical decision-maker for the entire family. And she's worried about either kids or spouse or other people and tends to neglect her own healthcare needs, but to pay attention to her body. Most times that I see somebody with ovarian cancer or one of these other types of cancer, the majority of them will say, "You know, I knew something was wrong," and yet the facts are with ovarian cancer, for example, that the woman generally knew something was up, she had seen multiple different doctors, maybe her primary care and some other doctors and no one thought of ovarian cancer and her diagnosis was delayed. So if she's having any of these symptoms that we talked about and no one of her medical team has done a pelvic exam, which is visualizing the outside of the perineum or vulvar area, doing a speculum Pap smear-type exam and feeling on their abdominal wall, if nobody's done that, they haven't been appropriately assessed for one of these cancers and they need to be.
Cheryl Martin (Host): Dr. John Schorge, this has been so informative. Thanks so much for going into detail about gynecologic cancers, the symptoms and what patients need to know to manage their risks. Thank you.
Dr. John Schorge: I appreciate the opportunity and I can't thank you enough for getting this out there to help improve the care of women in our community. It is a high risk center of health disparities. And I'm proud to say that with the cancer program now at Regional One, patients in town do not have to go 20, 30 miles away to receive this type of care. We're proud to have them stay right here at Regional One and receive world class care.
Cheryl Martin (Host): Dr. Schorge sees patients at regional one Health's main campus and east campus for an appointment with Dr.
Serge. Either location, call 9 0 1 5 1 5 3 8 0 9. That's 9 0 1 5 1 5 3 8 0 9. Thanks for making One-on-One with Regional One Health part of your journey to better health. Join us next time as we cover another topic to keep you on the path to a healthier tomorrow.