.

>> Well hello and welcome to HealthLine.

I'm Jennifer Blomquist.

I have the privilege of hosting the program this evening and I'm so glad you joined us.

We have a rare event here.

We have three guests tonight which is I've never done a show with three guests on HealthLine so it's wonderful.

All three of our our guests are women and they are all gynecologic oncologists.

They work together as a team and they are here ready to answer your questions.

They're going to talk about different types of cancers that they treat what your treatment options are, risk factors, all sorts of things like that maybe even things you can do to prevent getting one of those cancers so they have a wealth of information to share with you and I really hope you will take advantage of the fact that we are live in the studio right here and that's why we keep the phone number up at the bottom of the screen.

So call us at any time we will be discussing these different kinds of cancers, treatment options and so forth.

But please we would love for you to interrupt us with your question.

So the phone number is (969) 27 two zero if you're outside of Fort Wayne, just put the 866- in front of there and it will be a toll free call.

And I would just want to remind you in case you're not one of our regular viewers, you have two options when you call in.

The first one is my favorite because you can interact with the doctors.

One of them may need to ask you more questions to be able to give you a better answer.

So that's a great way to ask your question.

We put you on leave but we don't just throw you on the air to talk to a call screener first and it's really easy and that's a great option if you'd prefer not to do that, I completely understand it.

Maybe you're shy or would prefer to just listen to your answer.

Just call in the call screener.

We'll get your question and then I'll ask for you.

>> So let's go ahead and meet our guest tonight so make sure I get everybody's names correct.

So I'll start all the way at the bottom of the hour.

The end of the table is Dr. Christina Duncan and next to her is Dr. Bognar Brezinski and sitting right next to me is Dr. Onya Menzies.

So welcome to all of you.

>> Thank you.

Thank you so much.

We're excited to be here.

Well, it was you know, when I heard that we were doing a show on this topic, I was expecting cancer to be the but it's it's not it's all it's gynecology, you know, it's all I would say in the lower part of the body that the cancers that you treat we don't hear a lot about those.

I feel like cancer kind of dominates the cancer scene.

But sadly there are a lot of other very important issues that can happen in the reproductive area of a woman's body.

So why don't you guys tell me what kinds of cancers you would would treat and whoever wants to take you I know you were all talking about maybe focusing in on a different one.

So I know I'm sure the three of us and any gynecologist treats like you said the cancers that are of the reproductive tract.

So we treat cervical cancer vulvar cancer, vaginal cancer, ovarian cancer and endometrial cancer.

>> And you were going to talk about endometrial which I think a lot of people have heard of but they probably couldn't tell you what it is.

>> Sure.

I think as we age I think a lot of women get away from getting regular exams because they think oh, I'm done having children or I'm done.

I already had a hysterectomy.

Why do I need to have these important pelvic exams?

And so one thing that we think of for endometrial cancer which is cancer of the uterus is that that is a cancer that is about three percent of the general population can it and about seventy thousand cases per year occur.

And so when we have a post menopausal women who has any type of bleeding, we are concerned about that and I think every gynecologist would say please get attention with your OBGYN immediately and is there what are the other symptoms you talked about obviously bleeding.

So if you're postmenopausal I know we've had gynecologists on in the past and they've all said you're not technically in menopause until you've had a full year of nothing yet no bleeding, not even light or anything.

So if you're that so then you are considered postmenopausal at that point and if you have any kind of bleeding that could be and Dimitrios or endometrial cancer or endometrial cancer sorry.

>> So yes.

So you're right in saying menopause is after you've had a full 12 months of no bleeding and then any bleeding after that is cancer until it's proving that it is not.

>> And again that's why it's so important to get those well women exams every year with their gynecologist because they can be looking and feeling and making sure they don't see anything abnormal and be asking those appropriate questions to screen for those cancers.

>> So are there other symptoms besides the bleeding that you should be bleeding is the number one but sometimes pelvic pain other times it can be if someone's premenopausal it can be irregular cycles even.

>> And so when somebody has that pain, that cramping, bloating, those are kind of the main signs of individual cancer.

>> So you can have it before you could get this type of cancer even before menopause.

>> Absolutely.

One of the risk factors is anything has unopposed estrogen.

So if somebody is on a lot of estrogen supple are medication or if they are obese we saw a lot of estrogen within our adipose tissue and that can lead to that unopposed estrogen causing that endometrial tissue to get hypoplastic and have abnormal cells within it that can be precancerous and then lead to cancer.

>> OK, all right.

Go ahead.

>> Dr. Brzezinski, you were going to tackle yes, I was going to I was going to tackle ovarian cancer.

I just wanted to add one thing is just a reminder that you know, the average age of menopause for most women is around age fifty two .

So I know all of us have frequently had patients that come in and are 50 60 years old and tell us well I've never gone through menopause, I'm still having periods and that's not normal.

>> Is it really even beyond 50 to so well once you get upwards of that OK it's worth at least talking to your gynecologist about an OK and further delving into that essentially OK that's that's a good point.

>> But one of the other cancers that we treat is ovarian cancer .

So this is cancer that starts in the ovaries or the fallopian tubes or sometimes the lining of the abdomen.

They're all kind of grouped together.

It's probably the one then when people hear about it as the scariest because to yeah, it used to really be considered almost a death sentence but probably in the last five to 10 years we've come very, very far with new treatment options, new medications and how we treat it.

And so that's no longer really the case.

It's estimated that about one in 70 women will get ovarian cancer and unfortunately it's a cancer that oftentimes isn't diagnosed until later stages because the symptoms of it are very nonspecific, you know, bloating, abdominal discomfort kind of feeling full early.

So very vague symptoms that a lot of people may write off and even sometimes health care providers may write off if you're persistent about saying hey, you know, this is not normal for me like I you know, let's let's look at look into this more and does it tend to affect older women or can it yeah.

Age wise usually it's probably women mostly in their 60s to 70s.

The exception would be that there are genetic syndromes that are associated with an increased risk for ovarian cancer.

So you know, everybody has heard about Angelina Jolie and she has Broca mutation which is this which most people know is causes cancer but it's also associated with ovarian cancers and there's other genetic syndromes as well that can increase that risk and that will usually happen in younger women potentially and I know we were going to talk about risk factors as well.

So we'll get to that and then I'm sorry, Doctor Menzies, you were going to do vaginal and bovver in cervical cancer cervical.

Yeah.

Yeah.

So of those kind of the most common is going to cervical cancer that affects about fourteen thousand women and the United States annually in terms of new cases it's probably the fourth most common cancer affecting women worldwide and in contrast to ovarian cancer, we actually have some good screening tests for it the pap smears that would test for exactly and that helps us diagnose a lot of early cervical cancers or pre cancers that we can treat and kind of get better outcomes because it's something that we can find early and treat early .

And then what about yeah, I don't really ever hear about vaginal cancer is it I mean is that would you would you have cervical cancer if you had vaginal cancer and they have just one or not the other there can be some associations so vaginal vulvar and cervical cancers they're often associated with the which they with the HPV virus which affects that track and so you don't necessarily have to have one for the other and the vulvar vaginal cancers are much more rare but all of those things are evaluated by an OBGYN or your family doctor that can do a pelvic exam and with those the most common symptoms, you know for vulvar and BATCHELLER going to be if a patient has a mass or potential itching or abdominal discharge, those are things that should absolutely be evaluated with a physical exam.

I glad you guys pointed out that people know women know their own body, you know.

And so yeah.

Like you I think Dr. Brzezinski, you would say that if something doesn't seem right for your own body it may not match what your you know because people I think go online and try and self diagnose.

I'm guilty of that as well.

But yeah, everybody's probably a little different.

So you know what's normal for you and it's not absolutely.

I did want to talk about treatment options and risk factors and things like that but we have somebody in the meantime call in and whoever would like to address this feel free.

A woman named Grace called and she said that her flow has become extremely heavily heavy and is lasting for seven plus days and wants to know if this is a sign of something serious.

>> Now we don't know her age so yeah.

So thanks for your question, Grace.

I think that it really is age dependent but really any cycle that's lasting more than seven days is considered as sort of abnormal uterine bleeding.

So probably really important just to talk to your OBGYN and see exactly so she can kind of see exactly how long those cycles are, how often they're coming and just something important to get checked out.

And I do think there is a lot of there are a lot of benign things that cause abnormal bleeding or heavy bleeding or changes in periods.

But you know, we see kind of the worst of the worst and when people get to us it's usually to rule out a cancer.

And so that's kind of always at the top of our list.

But just because there was a change, you know, we don't want to incite panic either but just promote awareness and making sure people are getting their exams and still no matter what age you are, is it still recommended yearly or does it I guess we could talk about risk factors that would maybe change it a little bit.

But in general everybody should try and go.

Yes, absolutely.

Even for younger patients, you know, maybe getting started with their pap smears and getting those evaluations talking about birth control, those are things that you know, they should see their began for and then kind of as time goes on having their gynecological visits for pregnancies and if they have abnormal bleeding and as time goes on further, you know, whether they've had a hysterectomy or not, some people think well after I've had that I don't need care.

But you know, you still do you still do if you have any other complaints that come up, you know, vulvar vaginal cancers are often not missed because people aren't seeing they don't get the exams and so it's important to continue to get that care.

Yeah.

And think about that.

So I just want to remind you that we only have these three lovely ladies with us till eight o'clock and so the time goes by quickly and we love to answer any questions that you may have for them.

We're going to continue talking about different kinds of gynecologic cancers but like I said earlier in the show, please feel free to call.

We'd love for you to interrupt us at any time and ask your question again.

The phone number stays up at the bottom of the screen.

It's (969) 27 two zero outside of Fort Wayne.

Still a free call for you as long as you put an 866- in front of there.

>> Why don't we go ahead go in order again starting with endometrial and just what you're like out there certain people who are certain women who are more at risk for that.

I know you talked about post menopausal tends to be and the other question I wanted to ask you was she always heard about endometriosis says I want to ask you the difference between endometrial cancer and endometriosis.

So this kind of goes back to the question about what other causes of different types of abnormal bleeding.

And so sometimes we will have women who have fibroids or endometriosis or adenomyosis and a lot of times the enemy process can present as painful periods and that is basically there's a lot of different ideas about exactly where endometriosis comes from.

But it's the thought is that there's some sort of gland from the uterus that gets out somewhere that it shouldn't be and it causes a little bit more cramping in that and some pain.

And so that's the difference.

The actual endometrial cancer, our glands of that lining of the uterus that become abnormal and so there can be abnormal glands that are complex.

A typical and that is considered endometrial into epithelial neoplasia which is a pre cancerous condition.

And so those conditions again have the same risk factors so those can be your unopposed estrogen, obesity and early menarche.

So if you started periods early or you had menopause late and so and those patients that treatment for that for those precancerous lesions of the uterus is usually hysterectomy or an IUD placement and then for individual cancer I think I'm jumping ahead a little bit and getting into the treatment but that is very tailored to the stage of the cancer and a lot of times there's different modalities we will use to figure out this age depending on the patient's physical exam, their medical comorbidities and once we have that information we can make the best decision about how to move forward to determine that stage.

The best way to get a stage of the uterine cancer is a surgery and then that surgery is typically taking out the uterus, taking out the cervix, taking out the fallopian tubes and both ovaries as well as doing a lymph node sampling OK and by a biopsy and everything and all of that gets taken out of that pathology and then they kind of take that over.

>> All right.

Well, I know you were talking, Dr. Brzezinski, about ovarian cancer.

We actually had somebody call in about a question regarding ovarian cancer.

So I don't know if we could address that first a woman named Janet wanted to know if ovarian cancers like cancer in that is there a genetic component to it?

>> Yes.

So there is a subset of ovarian cancers that's related to the same genes that can sometimes be associated with cancer risk and those are those BRCA one and two or BRAK I think a lot of people call them so those also have a much increased risk of ovarian cancer about 20 to 40 percent.

And so a lot of times when we look at family histories we see cancers and ovarian cancer is kind of running together in the same families.

So if you have a concern say you know, you have a mother and an aunt and grandmother that had cancer but they've never been tested for , you know, genetics.

That's a good reason for you to talk to your doctor about getting genetic testing to look at, you know, hey, do I have this risk factor?

There's other syndromes as well called Lynch Syndrome is probably the other most common one that we see and it has associations with endometrial cancers, colon cancers, and ovarian as well.

What was the name that again the Lynch Lynch Lynch syndrome.

>> OK, yeah.

So while again majority of ovarian cancers are not genetic or not associated with genetic syndromes, there is a subset that are most are still random though unfortunately and you were saying a lot and I had heard this too even a long time ago that it's you know, a lot of times that's how I would hear about so many women dying from ovarian cancer because by the time they were detected it was it was just too far advanced.

Yes.

So I know you would you want to mention the symptoms again and what you would what how would you start looking into it?

So with ovarian cancer, I think the the issue is that we don't have a good screening test.

Unfortunately there's no good screening that we can do like we do pap tests for cervix cancers but for ovarian we don't have that so the main symptoms that people may develop are usually bloating abdominal discomfort or pain changes and bowel or bladder habits potentially early satiety meaning you only eat a little bit and you already feel really full OK because ovarian cancer tends to kind of I talk about I had a mentor once describe it as a glaze on a donut but it kind of covers your bowels and covers the surfaces in your belly and it kind of makes your bowels work slower and so things don't move through and that's why you get the bloating, the discomfort, the nausea.

So all those kind of really vague symptoms, you know, a lot of us can attribute to say oh well, you know, I've been eating poorly for the last few days or whatever, but those are so that's why it's really kind of hard to pinpoint.

>> Yeah.

Do you just do it if you suspect it that's a list you do a surgery or could you do even like an ultrasound?

>> Yeah.

So usually I find that most patients get diagnosed because you know they either go into their doctor or go into the E.R.

with these vague symptoms ,end up getting some sort of imaging done so whether they get a CT scan or an ultrasound and we find a pelvic mass or an ovarian mass or something else that's concerning and then that usually kind of based on symptoms and other lab tests, they kind of they end up coming to see us for surgery.

And again, management usually is a combination of surgery and chemotherapy for ovarian cancers.

That's good to know.

You said like in the last five years it's treatment.

I mean because I didn't you know, yeah.

I always thought of it as a death sentence like you said.

Yeah, yeah.

We have chemotherapy is still the kind of gold standard front line treatment.

Yeah.

But for patients that have recurrent disease or other advanced diseases we have more disease.

We now have a lot of new drugs that are more targeted so people hear about the buzzwords of immunotherapy and targeted therapies or like a chemo pill.

Those are all things that we use in our arsenal as far as treating ovarian cancers as well.

OK, great.

And under Menzies cervical cancer so the PAP test usually would detect any abnormalities.

Absolutely.

So that it can show precancerous as well or things that can kind of trigger us to want to do some additional testing, additional biopsies potentially find something early other signs of cervical cancer in advance or that would trigger work up would be maybe having abnormal bleeding, having a thermal discharge.

Patients who have pelvic pain or maybe pain with intercourse those are kind of red flags that something is wrong.

I don't want to deflect from your answer but that kind of ties in with something that a caller wanted to ask.

So if you don't mind to divert the question really quickly and then we'll finish up I'm sorry I didn't mean to throw that at you.

Shirley was saying she called in and said she had a hysterectomy and she was told she couldn't have anything inserted into the vaginal region like a tampon couldn't do.

I suppose they can't do intercourse wanted to know why that is and if you can explain I wonder do you think that that's I right is that the short term maybe shortly after surgery that that was the instruction typically after a hysterectomy we want to make sure, you know, folks are not resuming in intercourse or placing a tampon just because at that time, you know, when we do a hysterectomy there's an incision that's between the cervix and the and so that incision has to heal too.

So we don't want to make sure that that has time to heal without any kind of disruption.

So that is for that reason and that's only for short term usually six to eight weeks after a hysterectomy.

OK, but after that she after that she would be OK. OK, I'm so sorry to do that but I kind of tied in right with her question one of ago people though so what are the treatments and specifically you mentioned just obviously a surgery.

So do you actually try and remove actually the I don't know does it come up as a mass or are you just grouping cells or it depends it depends on kind of the stage we're at present.

So if it's just a small lesion sometimes that can be removed with kind of like a large biopsy.

If it's a larger lesion then sometimes people need to undergo a hysterectomy.

If it's present when it's very advanced then hysterectomy is not necessarily the best route then radiation chemotherapy is the way to go.

And so it all depends on kind of what the stages one it's identified and do you find it affects one age over a certain age range over others or probably the most common age is going to be 30s, 40s, 50s is when I was younger.

OK, all right.

And you're very and you were say more like 60s, 60s, 70s and endometrial obviously that's postmenopausal women probably hugely and the like six decade I would say a seventh decade and then other times it can be and younger women as well.

>> All right.

I did have gosh we have a lot of I mean what is going on there?

There's the nicest people they would love to talk to you.

So we had somebody Holland Sue well says that she has three she has three brothers.

Wow.

They had cancer and so she says she gets a checkup every year.

>> Should she be worried about getting cancer because we've talked about that on the show a little bit before we've had you know, physicians come out and say that men can't get cancer and I guess I'll say this with the caveat that I am not a surgeon, I'm not a medical oncologist but again, because cancer is again sometimes can be related to what we treat as well.

Yeah, cancer in males and men is actually almost always associated with genetic syndromes.

That's kind of the biggest risk risk factor there.

So I would say for for Sue if her brothers never had genetic testing I would recommend that they do usually we always want to get genetic testing first in the person that's affected by the cancer if they're unable to or unwilling to, then I would have I would recommend for Sue to discuss with her doctor about getting referred for genetic testing because in families that do have the BRCA mutations or other genetic predispositions to cancers that may change and affect what kind of screening is actually recommended.

So for BRCA that usually involves screening several times a year and not just once a year like the annual mammogram.

>> OK, yeah I'm assuming with cancer you're you're screening and you're in even just your visits.

Would we be altered?

Yes.

Then would you have I wanted to quickly just go to one more question and then we only have a couple of minutes left so we'll see if we can get this in really quickly.

So Ken is saying that his wife had a hysterectomy and ovarian cancer and wants to know what signs should other people be aware of in terms of maybe trying to prevent that from happening or like I don't know if there are a lot of things you can do to prevent these cancers.

>> Yeah, with with ovarian cancer there probably isn't honestly much that you can preventative wise I would say you know and we talked a little bit about the symptoms, signs and symptoms again bloating you know, increase in weight feeling like you can't eat because you're full of nausea, vomiting, those types of things.

I will say that the one preventative thing you can do for ovarian cancer actually is take hormonal birth control so we actually know now that most ovarian cancers start in the fallopian tubes and we think that some of the pathogenesis that were the process that leads to cancer development begins with, you know, every time you ovulate.

So every time your ovary releases an egg there's a little bit of information that happens there near the end of the tube and that inflammation over years and years and years of having periods having menstrual cycles may sometimes cause abnormal changes that can then lead to a cancer and so taking a birth control pill.

So if you're not planning on getting pregnant or not trying to get pregnant a birth control pill will shut down the normal ovulation of your ovary and so you don't have that same exposure and so that actually is very protective and it's up it's it's estimated that there's about a 50 percent risk reduction in your risk of ovarian cancer with about ten years of hormonal birth control use and that effect lasts even beyond when you're not using it anymore.

>> So yeah, I'd never heard that before so interesting.

>> I feel terrible.

We only 15 seconds left.

I should have demanded an hour left so I have to have you back is wonderful.

>> Thank you for having me.

Thank you so much.

You like me to be here.

Big big thing is if something seems out of whack for you you should get it addressed.

Definitely so we have Doctor Duncan we have Dr. Brezinski.

We have Dr. Minsky's.

Thank you so much ladies you thank you and thank you to all of you who called today even though you were shy.

It's OK.

But I'm glad that you called and I got some of your questions answered.

Take care.

We'll be back next week with another HealthLine.

I hope you have a great rest of your week.

Bye bye