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Bob Lewis (Host): Hi! I'm Bob Lewis. We're continuing our series today with the doctors from the Summa Health System. It's estimated that more than 115,000 women in our country will develop one of the five main types of gynecologic cancer. That's according to the American Cancer Society. Although gynecologic cancer is not as common as other types of cancer, every woman is at risk for this disease.

Awareness of your body and of screenings is vital in early protection of the disease, and that's when it's the most treatable. Today, our expert is Dr. Clarissa Polen-De. She's a gynecologic-oncologist at Summa Health, and she'll talk to us today about gynecologic cancers. Dr. Polen-De, can you explain what gynecologic cancers are?

Dr. Clarissa Polen-De: Yes, thank you. So, gynecologic cancers are any cancer that starts in the female reproductive tract. So, that is an umbrella term that really includes cancer of the uterus; the lining of the uterus, which is called the endometrium; the ovaries, the tubes that connect uterus to the ovaries, the cervix, the vagina, and the vulva.

Gynecologic cancers can also form in tissues that surround the ovaries in the tubes, something called the peritoneum, which is the lining of the abdomen in that area. And then, depending on how aggressive a GYN cancer is, and when it's discovered, they can also spread to other parts of the body, such as lymph nodes, the bladder, sometimes the digestive system like the bowel, and sometimes the lungs.

Host: Now, are some types of these cancers more common than others?

Dr. Clarissa Polen-De: Yes, definitely. So, endometrial cancer, which is a type of cancer that forms in the uterus and it forms in the lining of the uterus, is the most common type of cancer that we see in women. And it is the fourth most common cancer in women in the United States. Unfortunately, also, the rate of endometrial cancer is rising because obesity is one of the biggest risk factors for this disease. And as we know, obesity is trending upward in the United States.

After endometrial cancer or uterine cancer, the most common types of GYN cancers are ovarian cancer, which can include ovarian and tubal cancers, and then cervical cancer. And cervical cancer used to be second. But thankfully, we have Pap smears, HPV testing and the HPV vaccine, which has significantly dropped the rate of cervical cancer in the United States, although it still has a large role in other countries.

Host: So, what are the symptoms of these different types of gynecologic cancers?

Dr. Clarissa Polen-De: Yeah, that's one of the hardest things about GYN cancers, is that they can be very subtle and very vague. The symptoms definitely vary by the type of cancer and, you know, with everything, they're not the same for everyone. But some of the signs of things like endometrial cancer would be abnormal bleeding or bleeding when you're not supposed to have any bleeding anymore, like postmenopausal bleeding. Symptoms of cervical cancer could be symptoms of abnormal discharge, sometimes bleeding, sometimes pelvic pain or pressure. And then, unfortunately, one of the most vague symptoms or diagnoses with the most vague symptoms is ovarian cancer, which can cause, again, sometimes pain, but sometimes very non-specific, bloating, nausea, abdominal distension, weight loss, early satiety. And so if those symptoms are ever persistent for a woman, we encourage them to definitely let their doctors know.

Host: Now, of the population at a risk for these cancers, who is the most at risk?

Dr. Clarissa Polen-De: So, anyone with female reproductive organs is at possible risk for these types of cancers. And so, definitely, anyone that has female reproductive organs needs to be screened for things like cervical cancer or go in for, you know, any of the symptoms that we talked about. They can affect anyone with female reproductive organ and the risk actually can increase with age, especially for endometrial and ovarian cancer.

And then, other risk factors that we always think of are things like we mentioned before, potentially obesity; tobacco use can increase the risk of things like vulvar cancer and cervical cancer, high blood pressure, HPV infection, and then family and personal history of cancer, which can put you at an increased risk for certain types of cancer if things run in your family. And those genetic syndromes are called Lynch syndrome and BRCA syndrome.

Host: Now, what about females, again, either post or pre-menopause? Does that have an effect on these cancers?

Dr. Clarissa Polen-De: Yes, definitely. So, we more often see endometrial cancer, that cancer in the lining of the uterus after menopause, that is when women are at higher risk. But because it's also associated with obesity and sometimes also some of those things that we think about for metabolic syndrome like diabetes and high blood pressure, we are starting to see endometrial cancers in younger patients as well. And so, we can see differences in pre and postmenopausal ovarian cancer is almost always as well postmenopausal, but it's not a hundred percent. So, you know, anytime that you're having symptoms that are concerning to you or anything that's persistent, we definitely always say be attuned to your body and let your provider know.

Host: So, what are some of the screening methods they use to determine which type of a cancer one might have?

Dr. Clarissa Polen-De: That's a really good question. One of the most important screening tests that we have, especially for cervical cancer, is the Pap smear. So, having a yearly exam, having an exam where you see an OB-GYN provider, they go through your history, meaning any abnormal symptoms that you've been having, if you've been having any abnormal bleeding, if you have a significant family history of any cancers that they should do additional testing for, and then getting that pelvic exam to be able to look at the vulva and the vagina. And then, getting that Pap smear is one of the best ways that we know of to help prevent cervical cancer, help catch vulvar cancer at an early stage.

And then, unfortunately, with ovarian cancer, we don't have excellent screening for it. And like we mentioned, because the symptoms are so vague, it can be hard to catch early. You know, just like we said, if you have those symptoms, we encourage you to get in sooner and to just, you know, very openly communicate any concerns or suspicions you have with your doctor so that we can get additional testing if needed. Sometimes we'll do things like a transvaginal ultrasound that gives us a really clear picture of the uterus, the lining of the uterus, the ovaries and the tube. Sometimes we'll order some additional blood work to see if anything looks abnormal so that we can further investigate that.

Host: Can some of these symptoms that one might have, could they actually be for something else that's much less benign than a cancer?

Dr. Clarissa Polen-De: Yes. Yeah, definitely. And so, when women come in with potentially abnormal bleeding or postmenopausal bleeding. Having a benign condition is actually much more likely than having a cancer, something like a polyp or an overgrowth of the lining of the uterus, or just having a thinning of the lining of the uterus. Something that is very, very common and causes both abnormal bleeding and postmenopausal bleeding is uterine fibroids, which is an overgrowth of the muscle of the uterus. And so, having a benign condition is much more likely. But because those are really the only signs and symptoms that we get that something abnormal might be going on, we always want you to come in, you know, and let us know what's been going on so we can look into it and make sure it's one of those benign conditions, not one of those cancerous conditions.

Host: Once again, we're talking to Dr. Polen-De. She is a gynecologic-oncologist at Summa Health. We're talking about gynecologic cancers in women. Now, if a woman has had a hysterectomy, is she still at risk for some of these cancers?

Dr. Clarissa Polen-De: Whenever a woman has had a hysterectomy, we still encourage them to have an annual exam or a pelvic exam with either their gynecologist or if their family provider is the one who performs those exams. And it may get to the point where they only have an exam every two years or every couple years. But the biggest thing that I always tell women after we do a hysterectomy is that there are still other areas that could potentially develop a cancer. And so, we always want to make sure that you have a relationship with someone so that, if we saw something on exam, we could treat it very early. Not all hysterectomies take out the cervix. And so, women are still potentially at risk for cervical cancer.

So, it's really important to know whether or not your cervix was removed during your hysterectomy. And many women who are premenopausal or haven't gone through menopause yet will keep their ovaries. And so, in that situation, it's definitely important to still have an exam and make sure that no masses or anything abnormal form in the ovaries. And then even without those two things, women still have their vagina and their vulva, which are still at risk even though it's less likely for some cancerous conditions, but other benign conditions that are just bothersome that we can, you know, help with medications or other different treatment options if women are having any symptoms.

Host: Now, is it possible for a pregnant woman to have these kinds of cancers develop?

Dr. Clarissa Polen-De: Unfortunately, it is not endometrial cancer, but women who are pregnant can develop a cervical cancer or have a cervical cancer, and it is possible to develop an ovarian cancer while you are pregnant, which is thankfully incredibly rare, but it is possible.

Host: Now, what can a woman do to reduce their own risk of these kinds of gynecologic cancers?

Dr. Clarissa Polen-De: So some of the things that we advise to help ,reduce the risk of gynecologic cancers are things like quitting smoking. That's one of the best things you could do for your overall health, your overall lifespan, your overall quality of life, achieving and maintaining a healthy weight with diet, exercise, trying to reduce, you know, processed food intake and increasing things like fruits, vegetables, lean meat, things like that. Making sure that you're getting your annual exams and your preventative visits. You can talk to your healthcare professional about the HPV vaccine if you're not part of the age group that received that when you were younger. If you're under 45 years of age, it should be approved. It's approved to be able to get it. And then, sometimes after 45 years of age, we can ask the insurance to still cover it. Make sure, like we talked about, that you stay up to date with your Pap screens and then, you know, talk to your healthcare professional about your lifestyle to see if there's anything specific about you and your lifestyle that, you know, we can help advise you to help to reduce any risks.

Host: Is there any connection between STDs and developing these kinds of cancers?

Dr. Clarissa Polen-De: So, interestingly, cervical cancer, for the most part, is caused by HPV, which is a sexually transmitted virus. But it's difficult to say, you know, it's just that because pretty much any woman or any person who has intercourse is exposed to HPV, and so pretty much all people are exposed to HPV during their life.

And the biggest thing is whether or not your body is able to clear the virus and make sure that it doesn't like linger around in the cells. When we really start to see damage and an increased risk for cancer is when the virus is more damaging strains. So, there's a couple of strains of HPV that are much more likely to cause a cancer, and when it sticks around in the cells for a long time. And so, things like smoking actually make it harder for your body to get rid of the virus, and that's why smoking increases the risk of cervical cancer so significantly.

But then, other things that we can't necessarily control, like your immune system, people that have to be on immune suppression medications for one reason or another, but all of those things can put you at higher risk of having persistent HPV and potentially a cervical cancer.

Host: Now, yeast infections are rather common. Are they in any way linked with a risk for cancer?

Dr. Clarissa Polen-De: They are not. No. Bacterial vaginosis, BV, which is something that we commonly hear about as well as yeast infections, those are not associated with cancer and those don't put women at higher risk.

Host: Let's talk about treatment of these types of cancer. And again, it depends a great deal on in what stage those cancers are first detected, I would assume. What are the treatment modalities that we are using today?

Dr. Clarissa Polen-De: Yes, definitely. So, it very much depends on the type of cancer, the person themselves, how fit and if they were needing a more advanced surgery, things like that. But in general, many of our cancers are treated with surgery. And if it is something that we can completely remove with surgery and there's no evidence of disease, either they will go onto something called surveillance, which is where we watch them closely for the next like two to five years. We have them come in, do exams, ask them about symptoms, and then we would get imaging or blood work if needed. And then, for other patients, either after surgery or without surgery, we would use potentially chemotherapy, which is usually a medication through the IV that women will receive over the course of several months, or radiation therapy, which is a therapy that generally occurs locally, kind of a local treatment over the course of about five to seven weeks.

Host: And how effective are these therapies?

Dr. Clarissa Polen-De: They're very effective, yes. Our treatments, you know, we've gotten more specific, more targeted treatments and though, you know, we don't have as much growth as say some of the more common cancers like breast cancer, we have been making strides in developing new cancer treatments and therapies for cervical cancer, endometrial cancer, ovarian cancer. The way that we do some of these surgeries has definitely changed in the last five, 10 years. Now, everything primarily is done through small incisions, if possible. And we have many more targeted therapies, meaning that most often after you have a diagnosis of a cancer and/or a surgery, we'll be sending your tumor tissue off to be analyzed and see is there something in your tumor that makes it more likely to respond to a certain treatment? And that's called targeted therapy. So, we have a lot of different targeted therapies that you see, you know, on the news or on the TV that we can thankfully now apply to our cancers as well.

Host: Now also, is any of these cancers more prone to metastasizing than others?

Dr. Clarissa Polen-De: Some of the more aggressive cancers, ovarian cancer in general is a cancer that, you know, I talk to my patients when we find this diagnosis that in, for the most part, this is a cancer that we will almost always diagnosed at a stage III or a stage IV. And so, you know, because no one can help it, right? Looking something up, looking at Google about the staging system. It's a stage, you know, I through IV system. And so, they automatically think that because I'm a stage IV, I'm going to have the worst possible outcome. But in ovarian cancer, it's a little unique because almost all patients are identified at a stage III and a stage IV. And so, what we really need to know is how well that patient is going to respond to treatment and how well their tumor is going to respond to the treatment, and is there anything else about their tumor, about their genetics that we can use to help them be able to completely get rid of this cancer?

Host: Now if a woman has a family history of a cancer, especially cervical cancer or these other types of cancer, ovarian cancer, you know, is it something that they would be wise to do, if they don't want to bear any more children, to have these organs removed, you know, prematurely or, again, before anything developments. So like they're talking today, some women having breasts removed so they wouldn't get breast cancer if they have a family history of breast cancer. Is that kind of prevention considered logical in this situation?

Dr. Clarissa Polen-De: Yeah. So, that's a really good question. And, you know, obviously, it's a very, very personal choice, but we will frequently have women that come in that have say a history of multiple cancer types or a close family history of ovarian cancer. And even if their genetic testing is negative, because that's going to be the first thing that we jump to, is to look to see, do they have some sort of condition that runs within the family that makes them at higher risk to have cancers. Because that's really important for us to identify because that's potentially benefiting this patient, their kids, their family members.

You know, it may help to protect or make sure that we're screening for other cancers earlier. But even without those genetic tests that we can know where the risk is coming from, if someone has a close family member, like a first-degree family member that has a diagnosis of ovarian cancer, we will talk to them about doing a risk-reducing surgery because we think that they do likely still have an increased risk. Things like cervical cancer and vulvar cancer are less associated genetically and within families. But for each patient, you know, it's always just a conversation about their risks, their concerns, you know, any other symptoms that they're having to make sure that we're doing the best thing for them.

Host: Once again, we're talking to Dr. Clarissa Polen-De, a gynecologic-oncologist at Summa Health. So, let's talk about Summa Health and treatment that you provide there for your patients.

Dr. Clarissa Polen-De: Yeah. So at Summa, we pride ourselves on offering high quality compassionate care. We have multiple sites to try to be able to provide that care in, you know, convenient areas for everyone across the greater Akron area. We have comprehensive services like, you know, kind of what we just talked about, spanning the entire cancer care continuum. We see patients in our office to discuss diagnosis. Oftentimes when patients come in for their initial consultation, we'll be talking about the diagnosis, the disease process, likely, you know, surgery or the next steps, and then scheduling surgery and/or those next steps at that visit.

So, patients oftentimes will leave the office after the first consultation, having a good plan in place, which to us is really meaningful because often the unknown is one of the hardest parts I should say about that initial diagnosis, right? Like where are we going from here? And so then, we also have, as we talked about, chemotherapy facilities at multiple sites. We have radiation-oncology located at multiple sites. We have research, clinical trials. We do potentially the largest number of robotic minimally invasive surgeries in the area, do other minimally invasive surgeries and then have advanced surgical techniques for patients with cervical cancer, endometrial cancer, ovarian, vulvar, and vaginal cancers.

And then, just a couple of the other services that we have. We have, like I mentioned, a couple sites with infusion services, digital mammography. And then, we have a cancer care coordinator who is really key in, you know, touching base with our patients as they go through the cancer process and making sure they have everything that they need.

Host: So, how would somebody get in touch with your department there? Would they be referred through their GP or their family doctor or their specialist?

Dr. Clarissa Polen-De: Yeah. So, most often we are seeing patients that are referred, like you said, either from their family provider or from their OB-GYN, sometimes other subspecialists that are seeing things that they think, you know, we need to take a look at, like urologists, things like that. And sometimes patients that come in through the emergency room. You know, the first eyes is sometimes imaging in the emergency room, and then we get in, contact them, and then they see us.

Host: And where can somebody find out more information about the Women's Health Services at Summa Health?

Dr. Clarissa Polen-De: So, we have a wonderful website. If you put Summa Health, GYN Oncology or Gynecologic Oncology into the search bar, you'll find our website, all three of the GYN-Oncologists, so myself and then my partners, Robin Laskey and Stephen Andrews. And then, we have two wonderful nurse practitioners, and then a whole wonderful team of nurses and staff that really helped support us and make everything run.

Host: Excellent. And of course, if you want to go on the web directly, you can always go to summahealth.org/women. I'm sure that will be a gateway to these other sites and more information that people can get. So again, I want to thank you very much, Dr. Clarissa Polen-De, a gynecologic-oncologist at Summa Health, telling us today about these gynecologic cancers and how they can be prevented.

Again, early detection is always the best. So, if you have any questions on your own, be sure to contact your provider, whether it's your family doctor or your gynecologist or your whatever that you want to look at. Don't let some of these symptoms go unchecked. As the doctor said, the earliest we can detect these things, the better off you have of making sure what they are and getting cured with the fine things they have and the technology we have today at Summa Health.

Again, Dr. Polen-De, I want to thank you for taking time out of your Sunday to be with us here on the program, and I wish you a continued good luck in the work that you're doing for the community and for your patience at Summa Health.

Dr. Clarissa Polen-De: Thank you so much. I really appreciate your time and you having us on your radio show.

Host: Thank you very much again, Dr. Clarissa Polen-De, at Summa Health. Go to summahealth.org/women for more information. I'm Bob Lewis.