Female Cancer: Advanced Treatments -- September 28, 2009 -- Dr. Laura Williams and Dr. John Wheelock - NewsChannel5.com | Nashville News, Weather & Sports

Female Cancer: Advanced Treatments -- September 28, 2009 -- Dr. Laura Williams and Dr. John Wheelock

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Female Cancer: Advances Treatments
September 28, 2009
Dr. Laura Williams and Dr. John Wheelock

Endometrial (Uterine) Cancer - Topic Overview

What is endometrial cancer?

Endometrial cancer is the growth of abnormal cells in the lining of the uterus. The lining is called the endometrium. Endometrial cancer is also called cancer of the uterus, or uterine cancer.

Endometrial cancer usually occurs in women older than 50. The good news is that it is usually cured when it is found early. And most of the time, the cancer is found in its earliest stage, before it has spread outside the uterus.

What causes endometrial cancer?

The most common cause of endometrial cancer is having too much of the hormone estrogen compared to the hormone progesterone in the body. This hormone imbalance causes the lining of the uterus to get thicker and thicker. If the lining builds up and stays that way, then cancer cells can start to grow.

Women who have this hormone imbalance over time may be more likely to get endometrial cancer after age 50. This hormone imbalance can happen if a woman:

  • Is obese. Fat cells make extra estrogen, but the body doesn't make extra progesterone to balance it out.
  • Takes estrogen without taking a progestin.
  • Has polycystic ovary syndrome, which causes hormone imbalance.
  • Starts her period before age 12 or starts menopause after age 55.
  • Has never been pregnant or had a full-term pregnancy.
  • Has never breast-fed.

What are the symptoms?

The most common symptom of endometrial cancer is unexpected (abnormal) bleeding from the vagina after menopause. (If you are taking hormone therapy, some vaginal bleeding is expected.) About 20 out of 100 women who have abnormal bleeding after menopause have endometrial cancer.1 That means that 80 out of 100 women with abnormal bleeding don't have this cancer.

A woman with advanced endometrial cancer may have other symptoms, such as losing weight without trying.

How is endometrial cancer diagnosed?

Endometrial cancer is usually diagnosed with a biopsy. In this test, the doctor removes a small sample of the lining of the uterus to look for cancer cells.

How is it treated?

Endometrial cancer in its early stages can be cured. The main treatment is surgery to remove the uterus plus the cervix, ovaries, and fallopian tubes. If the cancer has spread, the doctor may also remove the pelvic lymph nodes.

Endometrial (Uterine) Cancer - Surgery

Surgery to remove the uterus (hysterectomy) is the most common treatment for endometrial cancer. The surgeon will also remove the fallopian tubes, ovaries, and often the pelvic lymph nodes , which are examined to determine the extent of the cancer and to help plan your treatment. If examination of tissue determines that more aggressive cancer still may be in the lymph system, a lymphadenectomy may be done to remove and examine additional lymph nodes. Surgery has the highest cure rate of all treatments for endometrial cancer.

Surgery Choices

Hysterectomy with removal of the fallopian tubes and ovaries (bilateral salpingo-oophorectomy)

Lymphadenectomy (removal of lymph nodes)

What To Think About

Most women have their ovaries removed after a diagnosis of endometrial cancer to make sure the cancer has not spread to the ovaries, to reduce the production of estrogen, and to slow cancer growth. In addition, some women who have had endometrial cancer may be at greater risk of developing ovarian cancer.

You will not be able to become pregnant or continue to menstruate after a hysterectomy. If you have not yet gone through menopause, it will begin as soon as your ovaries are removed. For more information, see the topic Menopause and Perimenopause.

A woman whose cancer has spread may also have:

It's common to feel scared, sad, or angry after finding out that you have endometrial cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

Frequently Asked Questions

Learning about endometrial cancer:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with endometrial cancer:

End-of-life decisions:

Ovarian Cancer: Topic Overview
What is ovarian cancer?

Ovarian cancer happens when cells that are not normal grow in one or both of your ovaries . This topic is about epithelial ovarian cancer, the most common type.

This cancer is often cured when it is caught early. But most of the time, the cancer has already spread by the time it is found.

It is frightening to hear that you or someone you love may have ovarian cancer. It may help to talk with your doctor or join a support group to deal with your feelings.

What causes ovarian cancer?

The cause of ovarian cancer is not known. Genetics are a risk factor for some women. A family history of ovarian cancer is found in 10% to 20% of women with ovarian cancer.

Women who inherit changes (genetic mutations) in the BRCA1 and BRCA2 genes have a higher chance of developing ovarian cancer and breast cancer. Most women with BRCA gene changes have a first-degree female relative, such as a sister or mother, or several second-degree female relatives, such as an aunt or grandmother, who have had breast or ovarian cancer, especially at an early age (before 50).1

You have a higher chance of developing ovarian cancer if you:

  • Are unable to become pregnant (infertility).
  • Have never had a baby.
  • Do not use hormonal birth control methods. Hormonal methods change the normal cycle of the female hormones, estrogen and progesterone, so ovulation does not occur each month.

If you have a strong family history of ovarian cancer, you may want to talk with your doctor or a genetic counselor about having a blood test to look for BRCA1 and BRCA2 gene changes. Women who inherit these changes in one or both of these genes have a higher chance of developing ovarian cancer.

Symptoms
Ovarian cancer does not cause many symptoms in its early stages. This is why 75% to 80% of cases are not found until the cancer has spread. Most women do have symptoms in the 6 to 12 months before ovarian cancer is found. Symptoms that occur in later stages are most likely caused by the pressure of the growing cancer. These symptoms include:

  • Ongoing cramps or pain in your belly.
  • Ongoing pain in your pelvis or lower back.
  • Abnormal bleeding from your vagina, especially after menopause if you are not using any hormonal medicines.
  • Abnormal discharge from your vagina that contains mucus that may be tinged with blood.
  • Pain or bleeding during sex.
  • Nausea or loss of appetite or you cannot eat normally.
  • Ongoing bloating or intestinal gas that is not relieved by home treatment measures.
  • Bigger belly size or a lump that can be felt in your belly.
  • Decreased energy level.
  • A change in your bowel habits, such as constipation or diarrhea.
  • A change in your bladder habits, such as urinary frequency or urgency.
  • Weight loss.

What Happens
Ovarian cancer spreads when cancerous (malignant) cells enter the abdominal cavity. The cancer cells then grow on the peritoneal lining of the abdomen and other abdominal organs. In its advanced stage, ovarian cancer usually spreads to the lymph nodes and to other organs in the pelvis. This may cause kidney and bowel problems. Cancer may also spread to other organs in the body, such as the liver and lungs.

Cancer from other areas of the body can also spread to the ovaries. This most commonly occurs in cancers that involve the breast, stomach, colon, and the lining of the uterus (endometrium).3

Ovarian cancer usually is not found in its early stages because it causes few, if any, symptoms. Laparotomy surgery is done to confirm that cancer is present, to provide initial treatment, and to stage the cancer with biopsies of abdominal tissue, peritoneal fluid, and lymph nodes. The long-term outcome (prognosis) depends on the stage of your ovarian cancer.

What Increases Your Risk
Risk factors for ovarian cancer include:

  • A family history. Between 10% and 20% of women with ovarian cancer have a close female relative who had ovarian or breast cancer.1 Women with a family history may develop ovarian cancer at an earlier age, such as in their 40s, rather than at the more typical age of postmenopausal women in their 50s. Women who have BRCA1 or BRCA2 gene mutations have between a 16% and 60% chance of developing ovarian cancer during their lifetime.4
  • Increasing age. Ovarian cancer most often affects postmenopausal women.
  • Never having a baby.
  • Starting menstrual cycles before age 12 and going through menopause at an older age. The more menstrual cycles you have, the more risk you have for ovarian cancer.
  • Being unable to become pregnant (infertility). Women who do not use birth control and are sexually active but who are unable to become pregnant may have a higher chance for ovarian cancer. Studies are also being done to determine if taking infertility medicines, such as clomiphene citrate, makes you more likely to get ovarian cancer.
  • Use of estrogen or hormone replacement therapy. Studies have shown that some women who use these hormones have a slightly increased risk of developing ovarian cancer.5, 6
  • Women who are of Ashkenazi Jewish ancestry or Icelandic ethnicity may have an increased risk because of changes to the BRCA1 gene. Women from high-risk families with BRCA1 gene changes have a lifetime risk as high as 28% to 44% of developing ovarian cancer.3
  • Use of talcum powder in the genital area. Experts have seen an increase in ovarian cancer in women who routinely use talc (magnesium silicate).3
  • Polycystic ovary syndrome (PCOS). Elevated levels of male hormones (androgens) commonly found in PCOS may increase your risk for ovarian cancer.5
  • A history of breast cancer. Women with a personal history of breast cancer or a family history of breast cancer have a higher risk for ovarian cancer.

What Increases Your Risk

More research is needed to confirm if certain other factors can increase a woman's chances of getting ovarian cancer, such as:

  • Exposure to asbestos.
  • A history of endometriosis or ovarian cysts.
  • Smoking.6
  • Diets high in lactose (a milk sugar), which is found in foods such as milk and ice cream.8

When To Call a Doctor
Ovarian cancer does not cause many symptoms in its early stages. Having symptoms not always mean you have cancer. These symptoms may be caused by other problems. It is important to talk to your doctor if you have any new symptoms, such as:

  • Ongoing cramps or pain in your belly.
  • Ongoing pain in your pelvis or lower back.
  • Abnormal bleeding from your vagina, especially after menopause if you are not using any hormonal medicines.
  • Abnormal discharge from your vagina that contains mucus that may be tinged with blood.
  • Pain or bleeding during sex.
  • Nausea or loss of appetite or you cannot eat normally.
  • Ongoing bloating or intestinal gas that is not relieved by home treatment measures.
  • Bigger belly size or a lump that can be felt in your belly.
  • Decreased energy level.
  • A change in your bowel habits, such as constipation or diarrhea.
  • A change in your bladder habits, such as urinary frequency or urgency.
  • Weight loss.

Exams and Tests

There are no reliable screening tests for ovarian cancer. Ovarian cancer is confirmed and staged by biopsies that are taken during laparotomy surgery.

Some initial exams and tests are done before surgery if ovarian cancer is suspected. These tests include:

Treatment Overview
The choice of treatment and the long-term outcome (prognosis) for women who have ovarian cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to have children (preserve fertility) must also be considered.

  • Surgery is done to confirm and treat cancer. Removal of all cancerous tissue and taking biopsies to check for the spread of cancer (surgical staging) is important for diagnosis and treatment because the amount of cancer remaining (residual cancer) after the initial surgery may affect your outcome.
  • Chemotherapy, which uses medicines to kill cancer cells, is recommended after surgery for most stages of ovarian cancer. Recent studies show that the addition of chemotherapy after surgery improves the outcome for some early-stage ovarian cancer.11 Chemotherapy is also recommended for all other stages of ovarian cancer.

Initial treatment

The goal of the initial surgery is to remove all visible cancer. The type of surgery you will need depends on the stage of your cancer and if you want to be able to have children after having the surgery.

If you have early-stage (stage I and low-grade [grade 1]) cancer and you wish to have children, your surgery may include:

  • Removal of your cancerous ovary and fallopian tube.
  • A biopsy of your other ovary.
  • Removal of fatty tissue (omentum) that is attached to some of the abdominal organs.
  • Removal of lymph nodes in the pelvis and near the large blood vessel (aorta) in the belly.
  • Biopsies of other tissues and peritoneal fluids (peritoneal washings) from the belly to find cancer cells.

Your uterus and the healthy ovary will remain, so it may be possible for you to become pregnant.

If you have a more advanced stage (stage II, III, or IV) of cancer or you have stage I and do not want to have children, your surgery may include:

  • A hysterectomy, which removes your uterus, and a salpingo-oophorectomy, which removes your ovaries and fallopian tubes.
  • Collection of peritoneal fluid.
  • Removal of pelvic and aortic lymph nodes (lymph node dissection).
  • Removal of fatty tissue (omentum).
  • Removal of as much cancerous tissue as possible.
  • Biopsies of any tissue that may be cancerous.

Because this surgery removes all the reproductive organs, you will not be able to become pregnant after having it.

Chemotherapy is recommended after surgery for most women. The current standard of treatment is 6 cycles of paclitaxel (Taxol) and carboplatin or cisplatin. Each chemotherapy cycle is scheduled every 3 to 4 weeks, so chemotherapy may last 4 to 6 months. Studies are looking at delivering chemotherapy directly into the belly (intraperitoneal chemotherapy). One study compared women with stage III ovarian cancer who had already had surgery. In that study, one group had treatment with paclitaxel delivered into a vein (intravenous) followed by intravenous cisplatin; the other group had treatment with intravenous paclitaxel followed by intraperitoneal cisplatin and paclitaxel. Although the intraperitoneal group had more side effects, overall survival was better than for the intravenous group.12

Home treatment measures may help relieve some of the common side effects of cancer treatment, such as nausea, vomiting, fatigue, hair loss, stress, or sleep problems.

If both of your ovaries are removed, you are likely to experience menopausal symptoms after surgery. Home treatment measures may relieve some of these symptoms. If home treatment does not help your menopausal symptoms, talk to your doctor about other ways to manage your symptoms.

If you have recently been diagnosed with ovarian cancer, you may experience a wide variety of emotions in reaction to having cancer. Most women feel some denial, anger, and grief. There is no "normal" or "right" way to react to having cancer. You can take steps, though, to manage your emotional reactions to learning that you have ovarian cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their cancer.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after having cancer such as yours can help you accept and deal with your cancer.

Prevention
Ovarian cancer cannot be prevented, but you may be able to reduce some of your chances for developing it.

Studies have found that the use of a combined estrogen and progestin birth control pill for more than 5 years reduces a woman's risk by 40%.2 Women who have a family history of ovarian cancer may also lower their risk by using birth control pills. The results are not clear from studies on the use of birth control pills in women who have BRCA gene changes.

Having surgery to close or tie off your fallopian tubes (bilateral tubal ligation) will lower your chances of developing ovarian cancer. However, you will not be able to become pregnant after having this surgery. Talk to your doctor about whether this choice is right for you.9

Having a baby lowers your chances for ovarian cancer. Having more than one baby lowers your chances even more. Breast-feeding also lowers your chances.

A small number of women with ovarian cancer have a first-degree female relative, such as a sister or mother, or a second-degree female relative, such as an aunt or grandmother, who has had ovarian cancer. Changes (mutations) in two major genes, BRCA1 and BRCA2, are most closely related to a higher lifetime chance of 15% to 40% for ovarian cancer in these families. You may consider a BRCA gene test if you have a family history of ovarian cancer. Most experts recommend that women with known BRCA mutations have their uterus, ovaries, and fallopian tubes removed while these organs are still healthy to reduce their lifetime chance of developing ovarian cancer. You will not be able to become pregnant but studies have shown that this surgery lowers your chance of getting ovarian cancer by more than 95%.

What causes cervical cancer?

The cervix is made up of two kinds of cells: columnar cells and squamous cells. Columnar cells constantly change into squamous cells in an area of the cervix called the transformation zone. As a result of this natural process of change, some cervical cells can become abnormal. Infection can also cause abnormal cervical cell changes. When abnormal cell changes persist over time (years) and become severe, these cells may develop into cervical cancer.

What are the symptoms?

Since abnormal cervical cell changes rarely cause symptoms, it is important for you to have regular Pap test screening. If untreated cervical cell changes progress to cervical cancer, symptoms may develop. Symptoms of cervical cancer may include:

  • Abnormal vaginal bleeding or a significant unexplained change in your menstrual cycle.
  • Bleeding when something comes in contact with your cervix, such as during sexual intercourse or the insertion of a diaphragm.
  • Pain during sexual intercourse.
  • Abnormal vaginal discharge containing mucus that may be tinged with blood.

What increases my risk for cervical cancer?

Abnormal cervical cell changes are often the result of high-risk sexual behaviors years earlier. These behaviors include having unprotected sex (not using condoms), having multiple sex partners, or having a partner who has had multiple partners. These behaviors increase your risk of infections and sexually transmitted diseases (STDs). The most common cause of cervical cancer is infection with a high-risk type of the human papillomavirus (HPV). A past HPV infection in you or your partner can cause abnormal cervical cell changes later since the virus may remain in the body for life. Low-risk types of HPV cause genital warts, but other types may not cause any symptoms so you may not know you have had it.

Smoking (or a history of smoking) or having an impaired immune system may also increase your risk for cervical cell changes. The use of birth control pills for more than 5 years may be a risk factor related to infection with HPV.2

How is cervical cancer diagnosed?

As part of your routine gynecological exam, you should have a Pap test. If a Pap test indicates abnormal cell changes, further tests, such as a colposcopy or cervical biopsy, will be done to diagnose whether there are precancerous or cancerous changes present on your cervix.

You may also be diagnosed because of your specific symptoms, such as abnormal bleeding after sexual intercourse, but a biopsy will still be needed.

If cervical cancer is present, your doctor will determine the stage of your cancer by gathering information from a variety of tests, including blood tests, bone scans, and X-rays. The stage of your cancer, which identifies its size and how much it has spread, is one of the most important factors in selecting the treatment option that is right for you.

How is it treated?

Cervical cancer in its early stages can be cured with treatment and close follow-up. Your treatment choices depend on:

  • The stage of your cancer.
  • Your age and your desire to be able to have children. If the cancer is discovered very early, a cone biopsy may be a treatment choice that may not affect your ability to have children.

Treatment for later stages of cervical cancer is more extensive to remove the cancer and will likely take away your ability to have children. More extensive treatment may include:

A combination of these treatments or a specific sequence, such as surgery before radiation or chemotherapy along with radiation, may be recommended as the most effective treatment for the best possible outcome.

Women with human immunodeficiency virus (HIV) will usually have cervical cell changes that have progressed to a more advanced stage of cervical cancer.

Notes from WebMD.

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