A diagnosis of a gynecologic cancer is life-altering.
Gynecologic cancer is any cancer that begins in a woman's reproductive organs.
Most cases of gynecological cancer are found in women who are middle-aged or older.
The Gynecologic Oncology Program at City of Hope offers a unique approach for women diagnosed with all types of gynecologic cancer (cervical, ovarian, endometrial/uterine).
At City of Hope, we focus on the patient as a whole, treating both the physical and emotional changes that a gynecologic cancer diagnosis can bring, while also addressing the needs of partners and families.
Listen in as Michael Lin, MD discusses gynecologic cancer and just what it means to you and your family.
Selected Podcast
What You Need To Know About Gynecological Cancer
Featured Speaker:
Michael Lin, MD
Wei-Chien Michael Lin, MD is an associate clinical professor and staff surgeon at City of Hope. Transcription:
What You Need To Know About Gynecological Cancer
Melanie Cole (Host): A diagnosis of gynecological cancer is life-altering. The gynecological oncology program at City of Hope offers a unique approach for women diagnosed with all types of these cancers. My guest today is Dr. Michael Lin. He is an associate clinical professor and staff surgeon in the gynecological oncology department at City of Hope. Welcome to the show, Dr. Lin. Tell us about gynecological cancers. What types are they and who is most at risk for them?
Dr. Michael Lin (Guest): The three most common cancers in this area are: The first most common one is uterine cancer. The second most common will be ovarian cancer. The third one will be cervical cancer. The other minor cancers are vulvar cancer, vaginal cancer, or gestational trophoblastic tumor. But majority is ovarian, uterine, and cervical cancer.
Melanie: What are some risk factors for these?
Dr. Lin: Well, obviously, the ovarian cancer, the most important risk factor is family history. For uterine cancer, the majority is obesity-related and also diabetes and hypertension-related. Cervical cancers are obviously HPV-related. In terms of the age risk, cervical cancer tends to be around late 40s, early 50s. Ovarian cancer tends to be around age 60, 70. Uterine cancer is anywhere between 50 and 70 years old.
Melanie: Then let’s talk about the most common first, the uterine cancer as you said. Tell us a little bit about symptoms. You know, Dr. Lin, patients always want to know symptoms first. Is there something that we would notice as women that would send up a red flag that would send us to see you.
Dr. Lin: Obviously, the post-menopausal bleeding is cancer until proven otherwise. If you’re bleeding post-menopausally, then it should be looked into and we need to figure where the source is coming from. Patient will only require a [Pap smear] of uterine lining to make sure it’s not cancer or pre-cancerous.
Melanie: Okay, so what are some treatments? You know, people hear uterine cancer and, wow, they think it’s a really, really tough one to beat. Tell us a little bit about uterine cancer treatments.
Dr. Lin: Uterine cancer is actually the exact opposite of ovarian cancer. Uterine cancer is actually very treatable and curable. Majority of uterine cancer is early stage because the presenting symptoms are vaginal bleeding. Women tend to show up early in their presentation and they are treated. Majority of treatments is surgically, by removing the source, which is the uterus, ovaries, and cervix, and majority of women will do well.
Melanie: So, you have a hysterectomy. Is this generally followed by chemotherapy and/or radiation? Does the hysterectomy generally take care of most of it?
Dr. Lin: About 75 percent of uterine cancer is stage I and majority of stage I disease are treated surgically and cured surgically. If patient has risk factors, either in stage I or stage II and above, the patient will require adjuvant therapy, but majority of uterine cancer will be treated surgically.
Melanie: Let’s move on to ovarian cancers—and this is an overview of all of these, Dr. Lin, we understand that—speak about symptoms of ovarian cancer because it’s been called the silent cancer. Why is that?
Dr. Lin: Yeah, it’s just because the symptoms are common among women, a lot of symptom mimicking menstrual irregularity, like bloating, abdominal distention, subtle early satiety, and some of these symptoms the woman go through in a monthly basis. These are like very subtle symptoms and unfortunately majority of these patients will present at advanced stage when the symptoms really blossom, when the abdomen is distended and they’re losing weight and clearly this is not right. Unfortunately, majority of ovarian cancers are presented in advanced stage, which is exact opposite of uterine cancer.
Melanie: We get a Pap smear every year, Dr. Lin, and the Pap smear will show us cervical issues, but how is ovarian cancer diagnosed if we only have symptoms such as bloating and bleeding, things that happen to us all the time? When do we ask our gynecologist to check for ovarian cancer?
Dr. Lin: Right. There is no perfect screening test for ovarian cancer unfortunately. Our current screening tools are tumor markers such as CA-125 and pelvic ultrasound, but even those two tests are not recommended on the general population because they are not specific and they can lead to unnecessary surgeries if this nonspecific finding shows up. I would say patient got to pay attention to subtle symptoms and discuss with their physician, and if it’s appropriate, the test can be ordered. In the general population without family history or personal history of breast cancer, screening is not recommended. That is a frustration among patients, that “how do I know?” If you don’t screen for this test, by the time it shows up, it’s too late. So far, there is no standard recommended screening test for ovarian cancer, unfortunately.
Melanie: Now, what about treatments? Hopefully, if you found this and you’ve discussed this with your doctor, what do you do for these patients?
Dr. Lin: Yeah, majority of ovarian cancers are advanced stage and the best treatment modality is aggressive cytoreductive surgery and removing all the visible tumor. That category of patient will give the best outcome when you follow aggressive chemotherapy after cytoreductive surgery. That’s been shown that it can improve overall survival if they’re cytoreduced to no visible disease and followed by chemotherapy.
Melanie: What about preventative surgery, Dr. Lin? If someone is at risk for ovarian cancer, genetic risk, family history, that sort of thing, is there preventive surgery and do you generally recommend that if somebody has that genetic risk for this?
Dr. Lin: Yeah, if the patient, either a personal history of ovarian cancer, breast cancer, or strong family history of breast cancer, ovarian cancer, and they are tested positive for the BRCA gene 1 and 2, the common recommendation is prophylactic oophorectomy after complete child bearing and probably this is recommended after age 40 to age 45 and that’s been shown to decrease the risk of ovarian cancer. Also, our current knowledge is that about 80 to 90 percent of BRCA-related ovarian cancer came from the distal tip of the fallopian tube. There had been a push for taking the fallopian tube out when patient is younger or when the patient is undergoing hysterectomy or preserving the ovaries for women who are BRCA-positive but not ready to take the ovaries out yet because of their age and to take the tube out. These are preventative measures that have been proven to decrease the risk of ovarian cancer.
Melanie: The BRCA gene that we’ve heard so much about for breast cancer is also the gene for ovarian cancer?
Dr. Lin: Yes, they are linked together.
Melanie: Do you recommend women get tested for this gene?
Dr. Lin: You have to refer to the clinical guideline for BRCA testing for any personal history of ovarian cancer, also the strong family history of ovarian cancer or breast cancer, or even a family history of male breast cancer. If you fit all those criteria, then the recommendation is go through testing.
Melanie: Now let’s just finish up with cervical cancer as it’s been related to the HPV, human papilloma virus, and now we’re giving girls this vaccine and boys in their early teens. Those of us who are past that age that we can get that vaccine are still at risk for cervical cancer. Are there symptoms we would notice?
Dr. Lin: For cervical cancer, the best strategy is prevention and screening for cervical cancer with a Pap smear and an HPV testing. The screening guideline has evolved and has changed. Now, the screening guideline is including both HPV testing and Pap smear; that can give the best predictive values. The best prevention other than vaccine in young girls and boys up to age 26, Pap smear, HPV testing is still the best tool we have in terms of detecting pre-cancer to cervix and prevent cervical cancer.
Melanie: In just the last minute, please, Dr. Lin, give your best advice for women that are worried about these gynecological cancers and why they should come to City of Hope for their care.
Dr. Lin: City of Hope is an NCCN-designated institution. It provides a state-of-the-art cancer cure in a multidisciplinary approach. We work closely with medical oncology colleague, a surgical oncology colleague, and radiation oncology colleague, and the approach is the comprehensive way on cancer cure. This is a team approach. The best team approach, comprehensive approach, gives the best outcome in cancer treatment.
Melanie: Thank you so much. You’re listening to City of Hope radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
What You Need To Know About Gynecological Cancer
Melanie Cole (Host): A diagnosis of gynecological cancer is life-altering. The gynecological oncology program at City of Hope offers a unique approach for women diagnosed with all types of these cancers. My guest today is Dr. Michael Lin. He is an associate clinical professor and staff surgeon in the gynecological oncology department at City of Hope. Welcome to the show, Dr. Lin. Tell us about gynecological cancers. What types are they and who is most at risk for them?
Dr. Michael Lin (Guest): The three most common cancers in this area are: The first most common one is uterine cancer. The second most common will be ovarian cancer. The third one will be cervical cancer. The other minor cancers are vulvar cancer, vaginal cancer, or gestational trophoblastic tumor. But majority is ovarian, uterine, and cervical cancer.
Melanie: What are some risk factors for these?
Dr. Lin: Well, obviously, the ovarian cancer, the most important risk factor is family history. For uterine cancer, the majority is obesity-related and also diabetes and hypertension-related. Cervical cancers are obviously HPV-related. In terms of the age risk, cervical cancer tends to be around late 40s, early 50s. Ovarian cancer tends to be around age 60, 70. Uterine cancer is anywhere between 50 and 70 years old.
Melanie: Then let’s talk about the most common first, the uterine cancer as you said. Tell us a little bit about symptoms. You know, Dr. Lin, patients always want to know symptoms first. Is there something that we would notice as women that would send up a red flag that would send us to see you.
Dr. Lin: Obviously, the post-menopausal bleeding is cancer until proven otherwise. If you’re bleeding post-menopausally, then it should be looked into and we need to figure where the source is coming from. Patient will only require a [Pap smear] of uterine lining to make sure it’s not cancer or pre-cancerous.
Melanie: Okay, so what are some treatments? You know, people hear uterine cancer and, wow, they think it’s a really, really tough one to beat. Tell us a little bit about uterine cancer treatments.
Dr. Lin: Uterine cancer is actually the exact opposite of ovarian cancer. Uterine cancer is actually very treatable and curable. Majority of uterine cancer is early stage because the presenting symptoms are vaginal bleeding. Women tend to show up early in their presentation and they are treated. Majority of treatments is surgically, by removing the source, which is the uterus, ovaries, and cervix, and majority of women will do well.
Melanie: So, you have a hysterectomy. Is this generally followed by chemotherapy and/or radiation? Does the hysterectomy generally take care of most of it?
Dr. Lin: About 75 percent of uterine cancer is stage I and majority of stage I disease are treated surgically and cured surgically. If patient has risk factors, either in stage I or stage II and above, the patient will require adjuvant therapy, but majority of uterine cancer will be treated surgically.
Melanie: Let’s move on to ovarian cancers—and this is an overview of all of these, Dr. Lin, we understand that—speak about symptoms of ovarian cancer because it’s been called the silent cancer. Why is that?
Dr. Lin: Yeah, it’s just because the symptoms are common among women, a lot of symptom mimicking menstrual irregularity, like bloating, abdominal distention, subtle early satiety, and some of these symptoms the woman go through in a monthly basis. These are like very subtle symptoms and unfortunately majority of these patients will present at advanced stage when the symptoms really blossom, when the abdomen is distended and they’re losing weight and clearly this is not right. Unfortunately, majority of ovarian cancers are presented in advanced stage, which is exact opposite of uterine cancer.
Melanie: We get a Pap smear every year, Dr. Lin, and the Pap smear will show us cervical issues, but how is ovarian cancer diagnosed if we only have symptoms such as bloating and bleeding, things that happen to us all the time? When do we ask our gynecologist to check for ovarian cancer?
Dr. Lin: Right. There is no perfect screening test for ovarian cancer unfortunately. Our current screening tools are tumor markers such as CA-125 and pelvic ultrasound, but even those two tests are not recommended on the general population because they are not specific and they can lead to unnecessary surgeries if this nonspecific finding shows up. I would say patient got to pay attention to subtle symptoms and discuss with their physician, and if it’s appropriate, the test can be ordered. In the general population without family history or personal history of breast cancer, screening is not recommended. That is a frustration among patients, that “how do I know?” If you don’t screen for this test, by the time it shows up, it’s too late. So far, there is no standard recommended screening test for ovarian cancer, unfortunately.
Melanie: Now, what about treatments? Hopefully, if you found this and you’ve discussed this with your doctor, what do you do for these patients?
Dr. Lin: Yeah, majority of ovarian cancers are advanced stage and the best treatment modality is aggressive cytoreductive surgery and removing all the visible tumor. That category of patient will give the best outcome when you follow aggressive chemotherapy after cytoreductive surgery. That’s been shown that it can improve overall survival if they’re cytoreduced to no visible disease and followed by chemotherapy.
Melanie: What about preventative surgery, Dr. Lin? If someone is at risk for ovarian cancer, genetic risk, family history, that sort of thing, is there preventive surgery and do you generally recommend that if somebody has that genetic risk for this?
Dr. Lin: Yeah, if the patient, either a personal history of ovarian cancer, breast cancer, or strong family history of breast cancer, ovarian cancer, and they are tested positive for the BRCA gene 1 and 2, the common recommendation is prophylactic oophorectomy after complete child bearing and probably this is recommended after age 40 to age 45 and that’s been shown to decrease the risk of ovarian cancer. Also, our current knowledge is that about 80 to 90 percent of BRCA-related ovarian cancer came from the distal tip of the fallopian tube. There had been a push for taking the fallopian tube out when patient is younger or when the patient is undergoing hysterectomy or preserving the ovaries for women who are BRCA-positive but not ready to take the ovaries out yet because of their age and to take the tube out. These are preventative measures that have been proven to decrease the risk of ovarian cancer.
Melanie: The BRCA gene that we’ve heard so much about for breast cancer is also the gene for ovarian cancer?
Dr. Lin: Yes, they are linked together.
Melanie: Do you recommend women get tested for this gene?
Dr. Lin: You have to refer to the clinical guideline for BRCA testing for any personal history of ovarian cancer, also the strong family history of ovarian cancer or breast cancer, or even a family history of male breast cancer. If you fit all those criteria, then the recommendation is go through testing.
Melanie: Now let’s just finish up with cervical cancer as it’s been related to the HPV, human papilloma virus, and now we’re giving girls this vaccine and boys in their early teens. Those of us who are past that age that we can get that vaccine are still at risk for cervical cancer. Are there symptoms we would notice?
Dr. Lin: For cervical cancer, the best strategy is prevention and screening for cervical cancer with a Pap smear and an HPV testing. The screening guideline has evolved and has changed. Now, the screening guideline is including both HPV testing and Pap smear; that can give the best predictive values. The best prevention other than vaccine in young girls and boys up to age 26, Pap smear, HPV testing is still the best tool we have in terms of detecting pre-cancer to cervix and prevent cervical cancer.
Melanie: In just the last minute, please, Dr. Lin, give your best advice for women that are worried about these gynecological cancers and why they should come to City of Hope for their care.
Dr. Lin: City of Hope is an NCCN-designated institution. It provides a state-of-the-art cancer cure in a multidisciplinary approach. We work closely with medical oncology colleague, a surgical oncology colleague, and radiation oncology colleague, and the approach is the comprehensive way on cancer cure. This is a team approach. The best team approach, comprehensive approach, gives the best outcome in cancer treatment.
Melanie: Thank you so much. You’re listening to City of Hope radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.