Below the Belt: Preventing and Detecting Gynecologic Cancer Program Recap

Thank you to Dr. Joyce Varughese from Capital Health Surgical Group for presenting on gynecologic cancers in honor of National Women’s Health Month.  As of 2016, cancer was the second leading cause of death among women, just behind heart disease, yet many gynecologic cancers have no testing and can be difficult to diagnose.  Therefore, knowledge is often the best weapon against these cancers and as always, the earlier cancer is diagnosed, the better the potential outcome.  While there are a few different types of gynecologic cancers, Dr. Varughese focused on three: Uterine, Ovarian, and Cervical.  Let’s take a closer look at each one!

Uterine Cancer

Uterine cancer is the 4th most commonly diagnosed cancer in women and the 6th most deadly.  2.8% of women will develop uterine cancer in their life and most of these women, roughly 75%, will be post menopausal.  While the average age of diagnosis is 62, certain risk factors may boost your chances of getting uterine cancer at an earlier age.

Risk and Protective Factors

There are number of risk factors that can increase your risk of developing uterine cancer.  These include:

• Lynch Syndrome, genetic defect in specific genes that help repair DNA – increase risk 6-10 fold
• Obesity between 30 and 50 pounds over Ideal Body Weight – increase risk 3 fold
• Obesity over 50 pounds over Ideal Body Weight – increase risk 10 fold
• Diabetes – increase risk 2.8 fold
• Older age – increase risk 2-3 fold
• History of infertility – increase risk 2-3 fold
• Hypertension – increase risk 1.5 fold

As indicated above, obesity is a serious risk factor when it comes to uterine cancer.  In fact, overweight or obesity account for 20% of cancer deaths in women.  Additionally, 40% of endometrial cancers can be attributed to obesity.  This can result in more co-morbid medical conditions, more difficult surgery, increased complications, and questions regarding optimal chemotherapy dosing.

In addition to these risk factors, there are some things that can decrease your risk of ovarian cancer, including pregnancy, age of first period over 15, and oral contraceptive and progesterone use.

Diagnosis

Unlike other cancers, there is no diagnostic test or screening for uterine cancer.  Many of the symptoms of uterine cancer can seem minor or indicative of other conditions.  90% of women diagnosed with uterine cancer experienced abnormal bleeding, including:

• vaginal bleeding/spotting after menopause
• experiencing late menopause
• new onset of heavy menstrual periods
• bleeding between periods
• abnormal uterine bleeding in women as young as 35

Outside of abnormal bleeding, other symptoms of uterine cancer can include pelvic or abdominal pain, vaginal discharge, pelvic masses, or thickened endometrial stripe on an ultrasound.  If you experience any of these symptoms, you should see your OBGYN immediately.

Prevention

It is believed that 40% of uterine (endometrial) cancers are potentially preventable just by reporting and following up with postmenopausal bleeding.  Maintaining a healthy lifestyle, including exercise and proper diet, can be a great way to lower your risk of uterine cancer, especially if you have a family history of uterine cancer.  If you have Lynch Syndrome, it is recommended to get a hysterectomy when done bearing children or by your mid-40s.

Ovarian Cancer

Ovarian cancer, including cancers of the fallopian tubes, is the 5th most deadly cancer for women.  Shockingly, 75-80% of women diagnosed with ovarian cancer are diagnosed at an advanced stage, either Stage 3 or 4.  Like uterine cancer, there are no screening tests for ovarian cancer, which contributes to the late diagnosis and is all the more reason to know your risk factors and report any symptoms right away to your doctor.

Risk and Protective Factors

Unlike uterine cancer where obesity can have a significant impact on your risk, risk factors with ovarian cancer are not preventable.  If you have a family history of ovarian cancer, your risk is 3-4 fold, but if you have BRCA 1 or 2 genetic mutations (similar to Lynch Syndrome), your risk skyrockets to between 14 and 35 fold.  Other risk factors include:

• Older age – increase risk 3 fold
• Infertility – increase risk 2-5 fold
• Endometriosis – increase risk 2 fold
• Late menopause – increase risk 1.5-2 fold

Similar to uterine cancer, the use of oral contraceptives can lower your risk by 30-50%.

Diagnosis

Unfortunately, early stages of ovarian cancer present generic or non-descript symptoms.  Additionally, there is generally a delay of 6-12 months in diagnosis after the onset of symptoms, so it is critical to report any of the following conditions to your doctor:

• Abdominal pain
• Urinary changes
• Increasing abdominal distension or girth
• Change it appetite, including early satiety and decreased appetite
• Bowel changes, including persistent nausea, vomiting, diarrhea, or constipation

Additionally, ovarian cancer can be diagnosed if a pelvic mass is felt or a fluid wave is observed during a pelvic exam.  If ovarian cancer is suspected, it is recommend to meet with a gynecologic oncologist for confirmation and treatment options.

Cervical Cancer

Cervical cancer is becoming more rare thanks to increased PAP smear and HPV testing as well as the HVP vaccine.  Only about 13,000 women were diagnosed with cervical cancer in the United States in 2019.  Yet, the incidence and mortality rates are still 50% higher in African-American women.  Cervical cancer is caused by certain strains of HPV, the human papillomavirus, that can infect the cells of the cervix and eventually turn into cancerous cells.  It takes on average 15 years for someone with HPV to develop cervical cancer.   Because of this, cervical cancer is 99% preventable with modern medicine.

Risk Factors

The risk factors for contracting HPV or stimulating the progression of an HPV infection into cancer include:

• Early age of first sexual encounter
• Multiple sexual partners
• High-risk sexual partner
• History of STI
• History of vaginal or vulvar pre-cancers/cancers
• Immunosuppression
• Cigarette smoking

Diagnosis

Most women will have no symptoms as it relates to cervical cancer.  In some cases, women may experience bleeding after intercourse, excessive discharge, or abnormal bleeding between periods.

Prevention

As mentioned above, cervical cancer is 99% preventable through proper testing and the HPV vaccine.  Women should undergo age appropriate PAP smears and girls and boys should undergo HPV testing and receive the HPV vaccine.  The vaccine is non-infectious, meaning that it does not contain live or dead strands of the virus, and is non-oncogenic, meaning that you cannot develop cervical cancer from the vaccine.  Studies have shown that HPV vaccine recipients actually produce higher levels of the neutralizing antibody than someone who is naturally infected.

Gardasil 9 is the most prevalent HPV vaccine in the United States.  The vaccine is approved for ages 9-45, but it is recommended to get the vaccine starting at age 11.  If the vaccine is administered before age 15, there is only 1 follow-up dose 6-12 months after the initial dose.  If the first dose is administered between the ages of 15 and 26, there are 2 follow-up doses; the first 1-2 months after the initial and then 6 months after the initial.  For anyone between the ages of 27 and 45, it is recommended to discuss with your doctor.

More Information

If you would like more information on gynecologic cancers, including types, diagnosis, prevention, or treatments, please visit the Society of Gynecologic Oncologists at www.sgo.org/patient-resources.  If you have any questions, please contact Dr. Joyce Varughese at 609-573-6000 or check her out on Facebook as “Lady Doctor MD” where she posts all sorts of information related to women’s health.  You can view a recording of the webinar on our YouTube channel at https://youtu.be/q7bWVeTiCw0.