10 questions about gynecologic cancers

Each year, approximately 100,000 women are diagnosed with some form
of gynecologic cancer: cervical, ovarian, fallopian tube, uterine (also called endometrial cancer), vulvar or vaginal.

We spoke with Shannon Westin, M.D., associate professor in Gynecologic Oncology and Reproductive Medicine
and co-leader of MD Anderson’s Ovarian Cancer Moonshot™, to learn more about
these diseases. Here’s what she wants every woman to know.

What are the most common types of gynecologic cancers?

The most prevalent is uterine cancer. Since 2007, there have been
about 60,000 new diagnoses each year. The second is ovarian cancer, with about 20,000 diagnoses per
year. The third is cervical cancer, with about 10,000 diagnoses per
year. Vulvar and vaginal cancers are the rarest, with about
10,000 diagnoses a year between them. The vast majority of cervical,
vulvar and vaginal cancers are HPV-related.

What are some symptoms women should watch for?

Ovarian cancer has been called the silent killer because its symptoms are so vague. But there are four main
ones to look for: bloating, pelvic/abdominal pain, frequent urination
and difficulty eating/feeling full. All of those are very easy to blow
off as being something else, so if you experience them daily and they
persist for more than a few weeks, see a doctor.

For uterine cancer and cervical cancers, post-menopausal bleeding or
irregular bleeding are the most common symptoms among women who are still menstruating.

For vaginal and vulvar cancers, patients may experience abnormal
bleeding or note an abnormal lump or bump. Non-healing ulcers or pain
during intercourse can be seen with these tumors as well.

Are there any diagnostic tests available?

For cervical cancer, there’s the Pap test. But for ovarian and uterine cancers,
the diagnosis is really just based on symptoms, even in high-risk patients.

The only exception is for patients with Lynch Syndrome, a hereditary condition that
increases the risk for cancer. Lynch Syndrome patients get screened
for other cancers.

Why should I seek treatment from a gynecologic oncologist
rather than my regular ob/gyn?

The data is clear on this. The outcomes are simply better for cancer
patients who see a gynecologic oncologist. This is true both in terms
of surgical success and in long-term survival rates. Gynecologic
cancers are complex, and gynecologic oncologists undergo specialized
training, so you can get the right treatment from the very beginning.
If there’s not a gynecologic oncologist near your home, it’s worth the
trip to see one.

At what point should I seek a second opinion?

If ever you don’t feel comfortable with the diagnosis you’ve
received or the treatment your doctor recommends, get a second
opinion. Most doctors don’t mind. And you know your body better than
anyone else. So, if your concerns get pooh-poohed by your regular
doctor, get a second opinion. You have to be an advocate for yourself.

Who should consider getting genetic testing?

Since uterine cancer is often an indicator of Lynch Syndrome, we automatically test
endometrial tissue after we remove it at MD Anderson.

Women with a family history of breast cancer, pancreatic cancer or melanoma should consider BRCA genetic testing. Any woman diagnosed with
high-grade ovarian cancer should undergo testing. So should anyone
younger than 50 when she’s diagnosed with cancer. If you fall into any
of these categories, talk to your doctor about whether you should see a genetic counselor.

What types of clinical trials are available now for
gynecologic cancers, and why should women consider them?

A lot of non-chemotherapy options, such as PARP inhibitors, are
hitting prime-time right now. But the real hot ticket items are immunotherapy and vaccines, particularly in
regards to our HPV-Related
Cancers Moon Shot
™. Checkpoint inhibitors allow us to train the
immune system to fight the cancer, rather than targeting the cancer
directly. And the combination of those with vaccines is very exciting.

Has there been any progress in treating low-grade serous
ovarian cancer that doesn’t respond to chemo?

Yes. Low-grade serous ovarian cancer has so many molecular
abnormalities, it really lends itself to targeted therapies. MEK inhibitors, for example,
started out with small studies of fewer than 50 people, and now
they’re in large clinical trials involving hundreds of patients.

We’re also looking at whether we might be able to treat low-grade
serous ovarian cancer using hormones — like letrozole and tamoxifen —
that have been used for ages to treat breast cancer. They’re in pill form, so they’re
easy to take, and they have pretty limited side effects, too.

What’s the outlook for women with recurring uterine cancer?

It used to be fairly grim, but now there’s hope. Even just a few
years ago, the average survival time after re-diagnosis was about 12
months. We’ve pushed that back to two and three years now with
standard chemotherapy and clinical trials. Uterine cancer also has a lot
of molecular abnormalities, so there’s a lot of opportunity to try targeted therapy, which stops or slows the
growth of cancer instead of killing it outright. This is a group that
really benefits from clinical trials.

Any new developments in fallopian tube cancer treatment?

Fallopian tube cancer usually gets lumped in
with ovarian and peritoneal cancers, so most clinical trials include all three of those
diseases. The most common type of fallopian tube cancer is high-grade
serous. PARP inhibitors and bevacizumab are some of the most exciting
treatments being looked at.

What should patients know about cancer and fertility?

All cancers can affect fertility. The best thing to
do is talk to your care team before you start treatment. Tell them
your wishes and expectations for the future so you can discuss
non-surgical and fertility-sparing options.

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appointment at MD Anderson
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