Each October our attention turns to breast cancer awareness as the nation spotlights Breast Cancer Awareness Month. But for most women, the only time to think about gynecologic cancer is when it’s time to make that often-dreaded phone call for their yearly pelvic exam. Luckily, many of these potential life threats can be prevented with early diagnosis, the kind that can be made during those tedious appointments.
Whatever the reason, the most important thing is to make that appointment, said Dr. David L. Hoogerland, a gynecologic oncologist at Columbia-St. Mary’s Hospitals. Why? Approximately 82,000 women are diagnosed with cancer of the reproductive organs nationwide, each year.
More than likely, you would be referred to someone like Dr. Hoogerland by your obstetrician/gynecologist (OB/GYN) after cancer had been detected in one of the GYN Cancer areas; ovarian, uterine, cervical, vulvar, vaginal or tubal. These types of cancer are usually treated by surgery, radiation therapy or chemotherapy. A gynecologic oncologist is a board certified OB/GYN with additional training as a cancer specialist.
Of the six types of GYN cancer, the “big three,” are ovarian, uterine and cervical, with the others being a bit more rare and treatable. When abnormal cells in one of those areas show uncontrolled growth, and are diagnosed as cancer, Hoogerland steps in to establish a path of treatment and management. But, he emphasizes, prevention, health and early detection are the most important aspects of his field.
“When you experience unusual symptoms, be sure to have them checked out,” he said. “A pelvic exam should be part of every evaluation. If your doctor won’t do it, find another doctor.”
Hoogerland also said, however unpleasant, a rectal exam is the most important part of a pelvic exam, and one of the only ways to detect ovarian cancer. “I always tell my patients, ‘if your doctor isn’t doing one, you’re not getting your money’s worth!’”
According to Hoogerland, there are some very simple ways to contribute to your gynecological health and life:
Symptoms To Watch
“The foremost symptom of many GYN cancers is abnormal bleeding associated with intercourse, between periods or after menopause,” said Hoogerland. “Unfortunately, with ovarian cancer the symptoms are far more vague and can present as a different problem.”
In terms of the “big three,” uterine cancer is the most common of the female reproductive malignancies and ovarian is the most serious. Cervical cancer, frequently referred to as a sexually transmitted disease, is often caused by (HPV). If diagnosed early, it can usually be taken care of by a simple procedure in the doctor’s office. Smoking increases the chances of getting cervical cancer because it decreases the effectiveness of the immune system.
“The beauty of cervical cancer is that with early detection and surveillance, we can drastically reduce the chances of cancer actually occurring in the cervix,” said Hoogerland. “On the other hand, ovarian cancer is an insidious threat, a lethal disease. It doesn’t lend to early diagnosis and we don’t yet have good diagnostic techniques.”
Ovarian cancer presents additional challenges because the cells start to grow inside the abdominal cavity, which, in women, is accessible to cancer-causing materials (carcinogens) from outside the body. “Men don’t have anything similar to ovarian cancer,” said Hoogerland. “It’s a completely different cell type.”
Today, there are blood tests that can determine whether a woman has the gene that causes ovarian and breast cancer. Ninety percent of the women with that gene are vulnerable to this cancer. Hoogerland suggests you talk with your OB/GYN to see if you are at risk and what tests are appropriate for you. “If you are 30 to 35 years old and your family has a history, the test may be advisable,” he said. “You are at risk.” Uterine, or endometrial cancer can be caused by too much estrogen in the system. Women who have never been pregnant, are overweight and 60 to 65 year old are its primary target. “In the 1950s and 1960s, women were being given estrogen alone for menopause,” said Hoogerland. “In the 1970s, as doctors began to prescribe progesterone along with it, we saw a significant decrease in the incidence of this cancer.”
“As far as early detection is concerned,” said Hoogerland, “I encourage patients to be assertive with their gynecologic health management and push physicians to perform complete pelvic exams, all the time.”