Bill Klaproth (Host): Gynecologic cancer is any cancer that starts in a woman's reproductive organs. So, what do you need to know? Here to talk about cancers of the female reproductive system,2 is Dr. Mark Genesen, a gynecologic oncologist at Eisenhower Lucy Curci Cancer Center. Dr. Genesen, thank you so much for your time today. Let me start with this, are all women at risk for gynecologic cancer?
Dr. Mark Genesen, MD (Guest): All women actually are at risk for gynecologic cancer Bill and fortunately, we have now for over a generation had strategies to identify and intervene with certain early abnormalities for instance with cervical cancer and PAP smear screening work, where we can identify patients who are destined to eventually get cancer and preempt the cancer by identifying it in its earliest phases of evolution before it becomes a cancer, treat it and keep the cancer from occurring or in the case of cervical cancer now we can avail ourselves of vaccine strategies that have been able to identify the source and cause of most cervical cancers and by having patients vaccinated during a certain window in their development, we can actually prevent those patients from ever getting cervical cancer. We can develop future strategies moving forward for our other cancers.
Bill: Dr. Genesen, so how would a woman know if she is at a higher risk for gynecologic cancer?
Dr. Genesen: That's a great question and a lot of attention has been addressed on this issue over the last 30 years. We have done a pretty good job with cervical cancer and not as good a job with ovarian cancer because it doesn't lend itself to easy diagnosis. However, the good news is that we do know that a significant percentage of women who develop ovarian cancer do have symptoms of unexplained abdominal pain, more specifically commonly lower abdominal pain, change in their voiding function and urination and or changes in their bowel habits that persist for more than several weeks at a time. Any of those symptoms should trigger a visit to a women's healthcare provider for further assessment.
Bill: So, those are the classic signs and symptoms a woman should be looking for?
Dr. Genesen: For ovarian cancer in particular, yes. In addition to that, sometimes a change in appetite or ability to tolerate food, filling up easily are other signs that the cancer may be more significant. In terms of endometrial cancers, any abnormal bleeding in women over the age of 35, any heavy periods that persist over time or unscheduled bleeding should prompt an evaluation by their women's healthcare provider and any woman after the menopause who has any bleeding at all, should direct their attention to being evaluated and with that strategy for endometrial cancer, we are able to diagnose most endometrial cancers and or their precursors early on so that interventions are very productive.
Bill: And how are these reproductive cancers diagnosed then?
Dr. Genesen: So, in general, we recommend that patients have regular well-women exams that would include an examination of their abdomen and pelvic exam when indicated based on the national guidelines that we now have incorporating PAP smear screening are the most important strategies from the standpoint of prevention and early detection, counseling patients and their parents about the advantages of HPV vaccination is really important in terms of preventing cervical cancer and then for patients who have symptoms with persistent unexplained lower abdominal discomfort, change in their bowel or bladder function, or something that is not quite right on a pelvic exam that might tell you there might be a mass present; usually a follow-up pelvic ultrasound is indicated. For patients again with endometrial cancer potential, we recommend again they undergo an evaluation. They can then if they are having bleeding that is unexplained under appropriate circumstances have a simple office biopsy that is usually well-tolerated and or they can undergo an ultrasound procedure for older women that will sometimes triage a need for that office biopsy and then when indicated, an old-fashioned D&C can be useful which is now supplemented by something called a hysteroscopy where we place a scope into the endometrial cavity to look more specifically for any particular areas that might cause their bleeding.
Bill: And Dr. Genesen, can you talk about the types of cancers of the female reproductive system that you may see most and the type that you operate on?
Dr. Genesen: Certainly, happy to. So, the most common gynecologic cancer is endometrial cancer. Over 40-45,000 women in the United States every year develop endometrial cancer. It is about one in fifty women. Because women tend to get bleeding of some sort that is abnormal, on their radar screen early in the course of that disease, we cure about ¾ of those patients who come to us with those early symptoms because we have caught their tumor at an early phase in its development. For ovarian cancer, we again, try to screen for patients who might be at risk based on family history. So, if a woman is identified through her family history at being at risk for ovarian cancer, we are able to get those patients screened, counseled and then tested if appropriate and if they test positive, we have several interventions that we know can lead to a remarkable reduction in their lifetime risk of ovarian cancer from anywhere from roughly about 50% to less than 1%.
Bill: And Dr. Genesen: Can you tell us about the da Vinci Robotic Surgery System as one way of providing minimally invasive surgeries?
Dr. Genesen: Yeah, that's actually a great topic. We have had remarkable improvement in our ability to tailor patients particular interventions and treatments to their particular circumstance and the robotic assisted laparoscopic approach to staging for endometrial cancer in particular, has allowed us to perform procedures with the same ability to provide curative intent at times with less hospitalization and decreased discomfort for the patient as well as less blood loss, less incidence of side effects like blood clots while providing the same goal of curative intent and a thorough assessment of the patient's disease status. It's has allowed us to perform more of these procedures laparoscopically than we could without the assistance of the robotic platform. It certainly has enhanced our ability to improve the quality of life for our patients who are undergoing these procedures compared with the previous approaches which required a larger incision.
Bill: So, many benefits all the way around it sounds like certainly on that recovery time, seems like the minimally invasive surgery would really enhance that and Dr. Genesen, you are one of the only physicians in the Coachella Valley offering expertise and a narrow focus on gynecologic cancers. Can you tell us how having someone with your experience benefits patients on their quality of life, survival and risk of occurrence, future fertility, sexual function, etc.?
Dr. Genesen: Yeah, the last thirty years have been characterized by gynecologic oncologists trying to improve access to women who have either need for complicated gynecologic surgery or gynecologic cancers and the Coachella Valley was a great example of that. Back in the 1990s women who had an endometrial cancer and ovarian cancer would either be operated on here by a non-gynecologic oncologist with a gynecologist general surgeon and urologist, well-intended as they were; none of whom had focused expertise and training to specifically address these issues. So, I was recruited here in 1999 as a collaborative effort together with the directors at the time of programs at Scripps, Hoag, USC, former directors at UCLA, Cedar's Sinai, former directors at City of Hope, etc. And I was charged with developing the same services here that patients would get if they drove two hours into the city. What we had found before my arrival, was most of those patients weren't driving into the city or if they were, it was an added burden. So collaboratively with the local institutions, we were able to develop that background and environment within which I was able to develop the same services that patients would be provided if they went into the city. We do know from several studies that have been done, that especially with ovarian cancer, that treatment by a specialist with formal training and board certification in gynecologic oncology does have a positive effect on overall outcomes. So, our goal has been and will continue to be to provide the same care here in the Coachella Valley without patients having to drive two hours to a major university medical center.
Bill: So tremendous benefits to the community and all of the things you just mentioned there and earlier, you were talking about wellness checks. I just wanted to re-circle back with you on that. So, if you could tell us why wellness checks are important for women and why they should speak to their doctor if they notice pains or other symptoms that are not normal for them instead of writing them off; why they should speak to their doctor.
Dr. Genesen: Bill, that's a great question, very important. We still in medicine today, do so much better in identifying patients at risk for problems and then attempting to adapt to their course so that they avoid a problem before it becomes more troubling and challenging issue to deal with. And so, early evaluation, prevention of these diseases and or early detection will allow us to impact on patient care remarkably. We have known for many years that over half of the cancers, 50% of the cancers in the United States that occur every year; we could prevent with the knowledge and technology that we have had available for over 15 years if we could simply have patients engage the system for the prevention and early detection strategies and healthy living with diet and exercise interventions that we know are remarkably useful and that enhance patients' overall wellness.
Bill: So, you mentioned prevention there a couple of times. Are there prevention strategies that women should use?
Dr. Genesen: The most important prevention strategy is prioritizing your health, body, mind and spirit. And then having a healthcare provider who you know and trust who follows evidence-based guidelines for healthcare maintenance and then implements appropriate detection and prevention strategies. It's one thing to talk about it. It's another thing for us all to stop out of our busy days and remind ourselves that we can be healthier, happier and better contributors to our communities when we are at the top of our game. And we can all be at the best and the top of our game when we treat our health as a priority.
Bill: That's all great information and thank you so much for your time today Dr. Genesen. To find a gynecologist and for helpful tips sheets for every stage of a woman's life, visit www.women.eisenhowerhealth.org that's www.women.eisenhowerhealth.org . This is Living Well with Eisenhower Health. I'm Bill Klaproth. Thanks for listening.