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Home , Cervical cancer, Vaginal cancer, Vulvectomy

Presented by David P. Bender, M.D. What are gynecologic ?

Any originating from the female gynecologic tract

• Ovarian, , peritoneal • Uterine • Cervical • Vaginal • Vulvar • Gestational trophoblastic disease

What You Need to Know

• Risk factors

• Symptoms

• Diagnosis and treatment

• Prevention – Regular checkups – and diagnostic tests – Lifestyle

Ovarian Cancer (Fallopian tube, peritoneal)

In 2015, approximately 21,290 women will be affected by

• Symptoms tend to be vague • Often see multiple physicians before a diagnosis is made • Difficult to detect in early stages • Most deadly of all gynecologic cancers • Fifth leading cause of cancer deaths in women

Ovarian Cancer Risk Factors

• Older age – risk increases with age

• Female infertility - If you have never been pregnant, or have undergone fertility treatments your risk is increased.

• Family history (10% cases) – Hereditary ovarian cancer – increased risk with affected family members – Ashkenazi Jewish descent – BRCA1 / BRCA2 mutation

• Early menarche, late menopause

Oral contraceptive use, , tubal resection reduce risk Advocates in the News

• Gilda Radner, born to Jewish parents, underwent 10 months of testing until she was diagnosed in October 1986. She died in May 1989 at 42 years of age. • Angelina Jolie announced she had her breasts removed due to a predisposition to . She plans to have her removed as well. • Jolie discovered she carries a mutation of the BRCA1 gene, which significantly increases her risk of breast and ovarian cancer. • Jolie’s mother died of ovarian cancer. Her aunt died of breast cancer.

When to Consider Genetic Testing

• A personal history of breast cancer diagnosed at a young age (premenopausal), breast cancer affecting both breasts (bilateral breast cancer), or both breast and ovarian cancers

• A personal history of ovarian cancer and a close relative with ovarian cancer or premenopausal breast cancer or both

• A history of breast cancer at a young age in two or more close relatives, such as your parents, siblings and children

• A male relative with breast cancer

• A family member who has both breast and ovarian cancers

• A family member with bilateral breast cancer

• Two or more relatives with ovarian cancer

Symptoms of Ovarian Cancer

• Abnormal or discharge • or pressure • Abdominal or back pain • Bloating • Loss of appetite or feeling full quickly • Changes in bowel or bladder habits • Sudden weight gain or loss • Constant fatigue • Persistent indigestion or nausea

Treatment for Ovarian Cancer

Surgical staging and debulking TAH-BSO, pelvic/paraaortic LND Omentectomy

Optimal cytoreduction Suboptimal cytoreduction < 1 cm residual > 1 cm residual

Chemotherapy

Carboplatin and Intravenous vs. Intraperitoneal

In 2015, about 54,870 women will be diagnosed with uterine cancer

The most common gynecologic cancer seen in the U.S. • Highly curable when detected early • Incidence and death rates have been rising

Uterine Cancer Risk Factors

• Unopposed estrogen • Therapeutic (HRT, estrogen cream) • Tumor-related (granulosa tumor)

• Obesity

• Endometrial hyperplasia

• Tamoxifen use

• Family history (Lynch Syndrome)

• Prior radiation to pelvis

Uterine Cancer Symptoms

• Vaginal bleeding after menopause

• Bleeding between periods or unexpected watery discharge

• Pain during intercourse

• Vaginal spotting after intercourse

• Feeling a mass in your pelvis

• Pelvic pain

Uterine Cancer Treatment

SURGERY

Total with removal of fallopian tubes and ovaries Pelvic and paraaortic dissection (Majority of cases diagnosed with early stage disease)

Postoperative Postoperative Hormonal therapy

In 2015, approximately 12,900 women will be diagnosed with cervical cancer

GOOD NEWS! This is a preventable cancer This is a highly curable cancer

Risk Factors for Cervical Cancer

• Abnormal pap smear / cervical • Early sexual activity – HPV infection – STD’s (, GC) • • Immunosuppression (organ recipient, HIV) • Multiple full-term pregnancies (3) ??? - HPV • Age at first pregnancy (younger than 17 years – 2X ) • DES exposure (clear cell ) • Family history – unclear • Oral contraceptives (>5 years – declines when stopped) • IUD – possible lower risk

HPV Infections and Cervical Cancer

Many cervical cancers are caused by the human , or HPV.

• Most sexually active men and women will be infected with HPV some time in their lives. • All women over age 30 should have an HPV DNA test • All females and males between the ages of 11 and 26 should have the HPV

About the

If your Pap test comes back abnormal…

• Retest to verify an abnormal finding • Test for HPV • Look more closely at your in a procedure called a • Obtain a to look at the tissue under a microscope

Cervical Cancer Treatment

Tissue-based diagnosis Physical Exam to stage

Surgery Chemoradiation (Radical hysterectomy and Pelvic LND)

Cisplatin/Taxol/Bevacizumab

Vaginal Cancer

In 2015, about 4,070 women will be diagnosed with

• It is the rarest of all gynecological cancers • Highly curable when detected early • Treatment is similar to cervical cancer • Risk factors have some overlap with cervical cancer • (Increased age, DES exposure, smoking)

Symptoms of Vaginal Cancer

• Abnormal bleeding between periods, after intercourse, or after menopause

• Unusual vaginal discharge

• A lump in your

• Pelvic pain

• Painful urination

• A change in bowel habits

Vulvar Cancer

In 2015, about 5,150 women will be diagnosed with

• Most are surgically curable when treated early • Regular gynecologic exams will detect most vulvar cancers in early stages • Biopsy is recommended for any suspicious or persistent lesion

Risk Factors for Vulvar Cancer

• Increasing age

• Smoking

• Immunosuppression

• Vulvar dyplasia (VIN)

• Lichen sclerosus

• Other gynecologic cancers (cervix, vaginal)

Symptoms of Vulvar Cancer

• Itching that doesn't go away

• Changes in color or texture of the skin in the vulvar region

• Feeling a lump

• The appearance of pimple- or -link bumps

• Open sores or ulcers

• Abnormal bleeding

Treatment of Vulvar Cancer

• Surgery – radical vulvectomy and inguinofemoral lymph node dissection

• Radiation – as a postoperative treatment for disease found in lymph nodes

• Chemotherapy or chemoradiation for advanced or recurrent disease

Your Lifestyle Matters

• Be physically active. • Maintain a healthy weight. • Don't smoke. • Manage stress. • Eat a healthy diet, low in saturated and trans fats, with an emphasis on fruits and vegetables. • Use sunscreen. • Drink alcohol in moderation. • Have regular physical exams. • Use pills to suppress periods if you're not trying to get pregnant.

Am I feeling normal?

Gynecologic cancer symptoms are not always specific to your reproductive system

Be on the lookout for: • Chronic or severe fatigue • Sudden weight gain or loss • Fever • Pain

Here’s the problem…

• Many of the symptoms of gynecologic cancers may be vague

• Many of these symptoms are also present in much less serious conditions

• Many reasons can be used for delaying or avoiding a gynecologic exam

Be an advocate for yourself and others… Learn more about gynecologic cancers.

www.uihealthcare.org/womenshealth

UI Women’s Health Center: 319-356-2294 Iowa River Landing: 319-467-2000