October 16, 2024 • 22 mins
Moderated by Jennifer Garam, ovarian cancer survivor & advocate and health journalist, and featuring Dr. Melissa Frey, Gynecologic Oncologist at Weill Cornell Medicine
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to What To Know Down Below by Tina's Wish.
We're here to empower you withthe knowledge and tools you
need to advocate for your owngynecologic health. Knowledge
is power, and we encourageeveryone to join us in learning
more about what you need toknow down below.
Speaker 2 (00:28):
Hi everyone. My name is Jennifer Garra , and I am an
ovarian cancer survivor andadvocate and health journalist.
I'm thrilled to be your hostfor the next series of episodes
focused on gynecologic cancers.
In our last series, ovarianCancer 1 0 1, we took a deep
dive into ovarian cancer andits signs and symptoms, risk
(00:51):
factors, and the need for anearly detection test for
ovarian cancer. Ovarian canceris one of the five main types
of gynecologic cancers. Todaywe will be kicking off our next
three part series, A Guide toGynecologic Cancers in which we
will be discussing the othermain types of gynecologic
cancer, uterine cancer,cervical cancer, and vaginal
(01:12):
and vulgar cancers. I am soexcited to introduce our
subject matter expert for thisseries, renowned gynecologic
oncologist at Weill CornellMedicine in New York City. Dr.
Melissa Frey. Welcome Dr. Frey.
And I would love for you tointroduce yourself to our
listeners.
Speaker 3 (01:31):
Uh , thank you so much for having me today. I am
really excited to be here. Myname is Melissa Frey . I'm a
gynecologic oncologist at WeillCornell Medicine, and my
practice focuses on generalgynecologic oncology, but I
also have a special interest inhereditary cancer and genetic
predisposition to cancer,identifying people who are at
(01:51):
higher, who are at higher riskfor cancer and taking steps to
prevent cancer in that group.
Speaker 2 (01:56):
Great. Thank you so much. In today's episode, we
will be talking about uterinecancer. So let's just start
with the basics. What isgynecologic cancer in general
and what is uterine cancerspecifically?
Speaker 3 (02:10):
Gynecologic cancer in general is a cancer of one
of the organs that are part ofthe female reproductive tract .
Um, the uterus, which is amuscle in the pelvis , um, can
have cancer and actuallyuterine cancer is the most
common of the gynecologiccancers in the United States.
(02:32):
In 2023, there are probablyabout 66,000 cases of uterine
cancer.
Speaker 2 (02:39):
Great. And I often hear uterine and endometrial
cancer referred tointerchangeably. Is there a
difference and , and if so,what is the difference between
the two types of cancer ?
Speaker 3 (02:51):
There are several parts to the uterus. Um, so as
I said, the uterus is a muscle, um, and the uterus has , uh,
its muscular component, but italso has the lining of the
uterus. This is the endometrialcavity is the center of the
uterus, and there's a lining ofthat sort of cavity that's
called the endometrium. And themost common , um, and most
(03:13):
frequent , um, types of cancerof the uterus that we see are
located at the endometrium,which is that lining. And that
lining is what kind of getsthicker each month as a woman ,
um, goes through her normalmenses. And then that that
endometrial tissue is sort ofshed at the end of a menstrual
cycle. Um, there also can becancers of the muscular layer ,
(03:33):
um, of the uterus, and thatwould be called a , an a
uterine sarcoma. And so when wesay uterine cancer, we're
usually referring toendometrial cancer because
that's the most common type,but there are other types of
cancers of the uterus that wedo see.
Speaker 2 (03:47):
Okay, great. So uterine cancer is the umbrella
term and then there's differentvariations within that.
Exactly. Um , so in terms ofsymptoms, when I had ovarian
cancer, some of the mainsymptoms that I experienced
were abdominal pain and like apersistent bloating that didn't
go away. It was prettyconstant. Um, what are typical
symptoms or warning signs thatsomeone might have uterine
(04:09):
cancer?
Speaker 3 (04:11):
One of the key differences between , uh,
uterine cancer and ovariancancer is that people actually
very often feel and appreciatesymptoms at an early stage in
the disease course. And that'sbecause most women with , uh,
uterine cancer start to haveabnormal uterine bleeding. So
for a woman who's still havingmenses, she may have increased
(04:34):
bleeding amount or increaseddays of bleeding. And for a
woman who has already gonethrough menopause, it's called
postmenopausal bleeding or ,um, a resurgence of bleeding
after menopause. So that is themost common symptom of uterine
cancer. And because thissymptom is so common, we are
often finding uterine cancersat an early stage because women
present with this abnormalbleeding. Some there are other
(04:58):
possible symptoms, so somewomen may have an abnormal PAP
test. Um, the pap is, is reallya cervical cancer screening
test, and it's not meant toscreen for a uterine cancer,
but occasionally we can seeabnormal cells on a pap test
that indicate a uterine cancer.
Um, and another common way thatwe find endometrial cancer is
in incidentally. So if a , awoman is having , um, imaging
(05:20):
for some other reason , um,whether it's for back pain or
something else going on in herpelvis, we sometimes see a
uterus with a very thickenedlining or endometrial lining.
And that can , um, sometimes bewhat tips us off to a , a
uterine cancer diagnosis.
Speaker 2 (05:33):
And in terms of symptoms that a person would
experience themselves. So yousaid the the bleeding of the
abnormal bleeding. Are thereany other symptoms , um,
fatigue or anything like that,anything else that they would
experience typically? And thenwhat would be the difference
between that and other benignconditions? Um, because for
(05:53):
instance, fatigue is an ovariancancer, you know, something
people , uh, um, experience,but it's also could be
attributed to any number ofbenign conditions as well.
Speaker 3 (06:04):
The reason why ovarian cancer often presents
with fatigue or nausea orvomiting or , uh, changes in
bowel function is because it'soften diagnosed at an advanced
stage, and that can happen withuterine cancer as well. So if
the disease is more advanced ,um, if the uterus is very large
or if there is what we callmetastatic disease or spread
outside of the uterus, that cancause abdominal pain, pelvic
(06:28):
pain, changes in appetite,changes in bowel or bladder
function , um, fatigue. Butusually thankfully , um, we
catch this before thosesymptoms come on because , um,
because a woman haspostmenopausal bleeding or
abnormal uterine bleeding, andso we actually find it before
those symptoms. So it's lesscommon with uterine cancer to
(06:49):
have those general symptomsthan it is with a disease like
ovarian cancer.
Speaker 2 (06:53):
So if a person is experiencing this abnormal
bleeding, at what point shouldsomeone go see their doctor?
Speaker 3 (07:01):
So I would recommend that anyone who is having
abnormal or postmenopausalbleeding see their gynecologist
right away. There are manybenign things that can cause
this . So we know that , um,there can be what's, what , you
know, there can be , um,endometriosis or , um, um,
(07:21):
pregnancy or, you know, there ,there are many things that are
benign, are totally normal thatcan cause changes in menstrual
patterns. Um, but I think thatthe most important step is to
check in with the gynogynecologist to make sure that
whatever's causing the abnormalbleeding is not something that
needs to be further evaluated.
And so often that would involvean exam with the gynecologist
(07:41):
and often imaging in the formof a pelvic ultrasound to try
to get the best view of theendometrial cavity.
Speaker 2 (07:49):
Um, and immediately, is that correct? Like as soon
as you start to experiencethis, don't wait a month, two
months? Um ,
Speaker 3 (07:55):
Absolutely, I think immediately.
Speaker 2 (07:57):
And would you say to advocate to get, I mean,
sometimes if you call thedoctor's office, they don't
have an appointment for, youknow, three months. So would
you recommend saying when youcall like, I have a concerning
SY symptom, I need to get inright away?
Speaker 3 (08:09):
Absolutely. Um , for , for many, if not most women,
it's going to turn out to besomething non-cancerous. And so
I'm, I'm not saying that to getpeople , uh, to make people
feel nervous, but I just thinkthat if someone is one of the ,
you know, one of the one of thewomen who does have a cancer,
you want that evaluated rightaway. But that's not to scare
people that everything is gonnabe a cancer. It's more just
that we should have promptfollow up so we can, we can
(08:30):
rule out a cancer.
Speaker 2 (08:32):
Yeah, that's, especially because you said
uterine has that chance of anearly diagnosis, which is less
likely in things like ovariancancer. So you want to take
advantage of that and really goin as soon as you start to
experience Exactly . Symptoms.
It sounds like , um, youtouched on this, but I wanted
to talk about how someone getsofficially diagnosed with
uterine cancer. Is, is thereany early detect detection
(08:53):
screening test at the, thedoctor's office? You said a pap
sometimes can detect it. Um,you know, like they , we have a
pap smear for cervical cancer,mammogram for breast cancer. Is
there anything like that or howdo you get an official
diagnosis?
Speaker 3 (09:06):
We don't routinely screen for uterine cancer. We
really respond to symptoms.
And, and , and so if a , ifsomeone is having bleeding or
having any new symptoms, or ifon an exam a gynecologist , um,
notices that the uterus feelslarger than they would expect ,
um, for the woman's age andbased on her history, then we
(09:27):
would start the, the workup.
And , and usually that involves, uh, a pelvic ultrasound or
sonogram. That's the mostcommon imaging that we use. And
if there's any concern aboutthe endometrial lining being ,
um, thicker than we wouldexpect, or if there's any
concern for cancer, then weusually do an endometrial
sampling. This can be in abiopsy that's done in the
office, or sometimes this isdone in the operating room, and
(09:49):
then it's called a dilation andcurettage or DNC is their term.
Speaker 2 (09:53):
Okay. And you said a pap smear sometimes detects it,
but that's what is , that's notsomething you can rely on, it
sounds like. Right .
Speaker 3 (10:00):
So the pap is really meant to be a cervical cancer
screening test. Occasionally ,um, if a woman has endometrial
cancer, some of the endometrialcancer cells will be shed from
the uterus through the cervixand be picked up with a pap.
But we do know that there canbe , um, many, many women that
have a normal pap who haveendometrial cancer. And so we
(10:21):
don't use it as a routinescreening. It just sometimes ,
um, sort of comes up during,during , uh, a routine
evaluation. And of course we'dfollow it up.
Speaker 2 (10:29):
Great. Dr . Frey , what are some of the risk
factors of things that may putyou at higher risk for uterine
cancer?
Speaker 3 (10:36):
So the, the most common risk factor for uterine
cancer is obesity. We know thathaving increased adipose tissue
results in increased levels ofestrogen, and it's that
estrogen that is driving a lotof the endometrial cancers that
are diagnosed in this country.
Along those same lines , um,taking extra estrogen. So
(10:59):
taking hormone replacementtherapy, especially if it's
estrogen alone, which we do notrecommend, we recommend taking
estrogen and progesterone, butestrogen alone and any extra
estrogen can also increase therisk of endometrial cancer. We
do know that , um, patients whohave , um, diabetes and high
blood pressure seem to have aslightly higher risk for
endometrial cancer, and thismay be linked to , um, obesity
(11:22):
or , or carrying extra weight.
We know that people who have ,um, um, more menses, so , um,
more periods having earlier ageof your first period and later
onset of menopause can haveincreased risk just from a
longer time being exposed toestrogen. Um, and then also for
people who have , um, a lot of, uh, uterine cancer in their
(11:43):
family, having relatives withuterine cancer can increase the
, uh, risk of one developinguterine cancer, often due to
some of the , um, uterinecancer related genetic
syndromes.
Speaker 2 (11:54):
I just wanna touch on something you mentioned. I
think you said HRT . Did youmention that this, I feel like,
is , there's a lot of confusinginformation about this going
through menopause. If youshould be on HRT , if you
should not, do you have arecommendation, like if it's
individual, if people shouldreally talk to their doctor and
not get their information ,information on social media?
Like how, I mean, I just hear alot of conflicting information
(12:15):
about this.
Speaker 3 (12:17):
The topic of hormone replacement therapy is so
complex, and I think sort of asa society, the pendulum has
sort of swung back and forth.
Um, as far as, you know,everyone should be on it, no
one should be on it. And Ithink really it's, it's
somewhere in the middle for theright person. Um, who's having
symptoms after menopause,hormone replacement therapy can
(12:37):
be great and is a great , um, agreat medication for, for it .
It's critical to also note thattaking estrogen can increase
the risk for , um, uterinecancer. And so it's very
important that if someone'sgoing to use hormone
replacement therapy, it'sprescribed and monitored by a
clinician with experiencebecause , um, one must take
(13:01):
estro estrogen and progesteronebecause the progesterone
actually is what protects theuterus for someone who's taking
estrogen. And so what I wouldsay is the , um, decision to be
on hormone replacement therapyhas to be an individualized
decision with one's physician ,where we very carefully weigh
the risks and benefits, but formany women, it is the right
decision.
Speaker 2 (13:20):
Great. Thank you for clarifying that. So I am BRCA
one positive, which puts me athigh risk for ovarian cancer
and breast cancer, and I diddevelop ovarian cancer. Does
BRCA status affect uterinecancer at all, or if not, is
there any other geneticcomponent at all? Um,
Speaker 3 (13:39):
There are genetic contributions or genetic risk
factors to endometrial cancer.
Um, there has been someevidence to suggest that people
with a b RCA one mutation havea higher risk of an aggressive
uterine cancer called a uterineserous cancer. The data are
really limited. And socurrently the standard
(14:00):
guidelines would say that weshould mention this to someone
who has A-B-R-C-A one mutation,that she may be at higher risk
for uterine cancer. And if awoman with A-B-R-C-A mutation
is thinking about risk reducingsurgery to prevent ovarian
cancer, in addition to removingher ovaries, fallopian tubes,
she can consider removing heruterus as well. We don't know
enough to make an absoluterecommendation that all women
(14:23):
with BRCA one should have theiruterus removed, but it is
certainly something that awoman should discuss with her
physician. We have not seen thesame rates for BRCA two, but
that's an area that's underinvestigation. There are other
genetic syndromes that canincrease the risk for uterine
cancer. So one of the mostcommon is called lynch
syndrome. This is a syndromethat increases one's risk for ,
(14:46):
um, uterine cancer in additionto colon cancer, ovarian
cancer, and some other cancers.
And so for women who have Lynchsyndrome, we do recommend , uh,
surgical removal of the uterusto prevent a uterine cancer.
Speaker 2 (15:01):
And similar to other cancers, when you look at
family history, is thatsomething to consider too when
you're evaluating a patient tosee if they might be high risk
? You talk to 'em about if isthere uterine cancer , um,
history in your family?
Speaker 3 (15:14):
Absolutely. So any person who has a family history
with , um, relatives that haveuterine cancer and colon
cancer, and actually ovariancancer can be part of this
syndrome that should , um, geta physician sort of thinking,
this is a family that couldhave Lynch syndrome or that
should get a person thinking,you know, is my family at risk.
And, and the, the , um, genetictesting that we do now for
(15:37):
syndromes like BRCA one andtwo, actually, it's usually a
large panel and that coverslynch syndrome and there are
several genes that can causeLynch syndrome. So absolutely
for any family that has thesecancers, I would recommend
genetic testing and so that wecan determine who's at risk.
Speaker 2 (15:51):
That's, you know, great advice because I think
that BRCA one or BICA one andtwo are kind of the most
commonly known in terms ofhereditary cancer, but there
are so many other mutationsthat put people at risk for so
many other types of cancers. Soit's really good to know about
Lynch syndrome and familyhistory. Um, and then is there
any way to reduce your risk?
Speaker 3 (16:14):
I think the , the best way to minimize risk of
uterine cancer for someone ataverage risk is just to
maintain a healthy weight , um,healthy diet exercise. And that
that's really the best , um, ofcourse to follow up with any
symptoms. But then for peoplewho have a significantly higher
risk, so that would be anindividual with Lynch syndrome
(16:36):
where we can see the risk evenexceed 50% over one's lifetime.
We recommend preventativesurgery to remove the uterus.
Um, if someone is not ready forthat surgery yet, or still in
their childbearing years, orsomeone who's at very high
risk, we do offer routineultrasounds and also
endometrial biopsies, but wereally limit that to those
(16:56):
women who are at highest risk.
Speaker 2 (16:59):
Um, that is a great point that you bring up , which
is bring , if you have a familyhistory or you're concerned you
might be at higher risk, wouldyou recommend like talking to
your regular GYN andpotentially being followed by a
specialist such as yourself, aGYN oncologist?
Speaker 3 (17:17):
Absolutely. I think a lot of what a gynecologic
oncologists do right now iscancer prevention and people
who live at elevated risk. Andso I think that is a , a very
good idea for someone who's athigher risk.
Speaker 2 (17:28):
And two , it sounds like just see the specialist,
and maybe you won't, it turnsout you're not at high risk,
but at least like a specialist,they see this all the time.
They can more thoroughlyevaluate you.
Speaker 3 (17:37):
Absolutely.
Speaker 2 (17:38):
And then , um, we touched on this, but what
advice do you have? So you'reexperiencing these symptoms,
you say co contact your doctorright away, get in right away.
Um, are there other ways, youknow, what recommendations you
have for how to bring this upwith your doctor? How to
advocate for yourself? What ifyour doctor is not taking your
concerns seriously? I, youknow, hear a lot of women's
(18:00):
health concerns brushed off,like, oh, it's just your
period, or it's just thisnormal whatever, this or that.
Like, what are yourrecommendations for getting
taken seriously at your doctorand advocating for yourself?
Speaker 3 (18:12):
Um, I think unfortunately when that
happens, it just falls on thewoman, the patient, to be their
own best advocate. And I thinkif you feel like your clinician
is not listening to you, thenyou know, you may have to find
another clinician because thisis critical. And unfortunately,
I think there is , um, often adelay because people think that
(18:33):
, um, it's gonna resolve on itsown, or abnormal bleeding is
something that's uncomfortable, um, or embarrassing to talk
to a clinician about. But thisis what your doctor, especially
your gynecologist is reallythere , therefore . And so I
would say, you know, kind of beyour best advocate. If you have
symptoms, bring them to theattention of your clinician.
And if you feel like you're notbeing listened to, then then
find someone who is listeningto you and taking this
(18:56):
complaint seriously.
Speaker 2 (18:57):
Um, yeah , I just echo that it's so important to
advocate for yourself. I wasvery lucky with being taken
seriously , um, initiallymisdiagnosed and then correctly
diagnosed within 18 hours. Sovery quickly, but I see a lot
of people that that doesn'thappen to, and they're
dismissed for months. So justwanna , um, emphasize for the
listeners the importance ofadvocating for yourself in your
(19:19):
healthcare . Um, and that , um,there we have an episode about
that as well on this podcast.
So check out our past episode,how to advocate for yourself as
a patient for more informationand tips where we go into that
, um, in more detail. Um, andbefore we wrap up, I just wanna
go back to something that yousaid earlier that a very early
(19:40):
onset of menopause or , uh, orof your period, onset of your
period or going into menopauselater could be risk factors.
And I was wondering if youcould just give like an age
range, like what is consideredan early onset of your period
and what is considered a latemenopause?
Speaker 3 (19:57):
Absolutely. So the average age of , um, first
period in this country is about12, I believe, although that
that number is coming down andthe average age that a woman
goes through menopause is about51. But we certainly see
variation , um, earlier andlater , um, for both of these.
(20:17):
And I think it's important toknow because , um, having more
lifetime periods is a risk foruterine cancer. It's also a
risk for ovarian cancer. And soI think that, you know, for
women who have had more periodsor have long histories of
irregular menses or irregularperiods, those are women who
really wanna be cautious and,and be on top of this.
Speaker 2 (20:37):
Um, so it just sounds like these are all
things to bring up to yourdoctor at your routine GYN
exam, if you have to see aspecialist to bring, just pay
attention, know your normal ,um, and, and note all the
anything that may be out of theordinary to talk to your doctor
about. Um, is there anythingelse important that you want to
add on this topic that wehaven't uh, talked about yet
(20:58):
today?
Speaker 3 (21:00):
No, I, I think I would echo what you say that
it's very important to have agynecologist. I think that a
lot of women sort of might havean obstetrician if they had
children, and then sort ofafter that they don't see a
gynecologist as regularly orthere's an assumption, you
know, they've had a , a papsmear and so they're okay for
five years, they don't need anyfollow up . And I would just
say that having a gynecologistas part of your care team is
(21:22):
critical. It's critical forroutine care and preventative
care. And then also, you know,if you have any complaint to
have someone there who knowsyou and that the pap is , is
very good as a cervical cancerscreening, but that is, that is
what it is meant for. It is notmeant to screen for uterine or
ovarian cancer. And so just tokeep that in mind
Speaker 2 (21:40):
And how often in I ideal situations should someone
be seeing their regular GYNI
Speaker 3 (21:47):
Think that it has to be very individualized. And so
I, so I would kind of meet witha gynecologist and then based
on your exam, based on, youknow, your own meta personal
and family history, you'd makethat decision. But, you know,
often it's every one to twoyears.
Speaker 2 (22:01):
Okay. Great. Well, thank you so much. Um, Dr. Faye
, thank you so much for joiningus today and a huge thank you
to everyone out therelistening. We hope that you
walk away from today's episode,having learned something new
and feeling more empowered inyour health. Be sure to tune in
for the rest of our three partseries as we explore cervical
cancer and vaginal and vulgarcancers.
Speaker 1 (22:29):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wH-A-T-T-O-K-N-O-W. And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
Welcome to What To Know Down Below by Tina's Wish.
We're here to empower you withthe knowledge and tools you
need to advocate for your owngynecologic health. Knowledge
is power, and we encourageeveryone to join us in learning
more about what you need toknow down below.
Speaker 2 (00:28):
Hi everyone. My name is Jennifer Garra , and I am an
ovarian cancer survivor andadvocate and health journalist.
I'm thrilled to be your hostfor the next series of episodes
focused on gynecologic cancers.
In our last series, ovarianCancer 1 0 1, we took a deep
dive into ovarian cancer andits signs and symptoms, risk
(00:51):
factors, and the need for anearly detection test for
ovarian cancer. Ovarian canceris one of the five main types
of gynecologic cancers. Todaywe will be kicking off our next
three part series, A Guide toGynecologic Cancers in which we
will be discussing the othermain types of gynecologic
cancer, uterine cancer,cervical cancer, and vaginal
(01:12):
and vulgar cancers. I am soexcited to introduce our
subject matter expert for thisseries, renowned gynecologic
oncologist at Weill CornellMedicine in New York City. Dr.
Melissa Frey. Welcome Dr. Frey.
And I would love for you tointroduce yourself to our
listeners.
Speaker 3 (01:31):
Uh , thank you so much for having me today. I am
really excited to be here. Myname is Melissa Frey . I'm a
gynecologic oncologist at WeillCornell Medicine, and my
practice focuses on generalgynecologic oncology, but I
also have a special interest inhereditary cancer and genetic
predisposition to cancer,identifying people who are at
(01:51):
higher, who are at higher riskfor cancer and taking steps to
prevent cancer in that group.
Speaker 2 (01:56):
Great. Thank you so much. In today's episode, we
will be talking about uterinecancer. So let's just start
with the basics. What isgynecologic cancer in general
and what is uterine cancerspecifically?
Speaker 3 (02:10):
Gynecologic cancer in general is a cancer of one
of the organs that are part ofthe female reproductive tract .
Um, the uterus, which is amuscle in the pelvis , um, can
have cancer and actuallyuterine cancer is the most
common of the gynecologiccancers in the United States.
(02:32):
In 2023, there are probablyabout 66,000 cases of uterine
cancer.
Speaker 2 (02:39):
Great. And I often hear uterine and endometrial
cancer referred tointerchangeably. Is there a
difference and , and if so,what is the difference between
the two types of cancer ?
Speaker 3 (02:51):
There are several parts to the uterus. Um, so as
I said, the uterus is a muscle, um, and the uterus has , uh,
its muscular component, but italso has the lining of the
uterus. This is the endometrialcavity is the center of the
uterus, and there's a lining ofthat sort of cavity that's
called the endometrium. And themost common , um, and most
(03:13):
frequent , um, types of cancerof the uterus that we see are
located at the endometrium,which is that lining. And that
lining is what kind of getsthicker each month as a woman ,
um, goes through her normalmenses. And then that that
endometrial tissue is sort ofshed at the end of a menstrual
cycle. Um, there also can becancers of the muscular layer ,
(03:33):
um, of the uterus, and thatwould be called a , an a
uterine sarcoma. And so when wesay uterine cancer, we're
usually referring toendometrial cancer because
that's the most common type,but there are other types of
cancers of the uterus that wedo see.
Speaker 2 (03:47):
Okay, great. So uterine cancer is the umbrella
term and then there's differentvariations within that.
Exactly. Um , so in terms ofsymptoms, when I had ovarian
cancer, some of the mainsymptoms that I experienced
were abdominal pain and like apersistent bloating that didn't
go away. It was prettyconstant. Um, what are typical
symptoms or warning signs thatsomeone might have uterine
(04:09):
cancer?
Speaker 3 (04:11):
One of the key differences between , uh,
uterine cancer and ovariancancer is that people actually
very often feel and appreciatesymptoms at an early stage in
the disease course. And that'sbecause most women with , uh,
uterine cancer start to haveabnormal uterine bleeding. So
for a woman who's still havingmenses, she may have increased
(04:34):
bleeding amount or increaseddays of bleeding. And for a
woman who has already gonethrough menopause, it's called
postmenopausal bleeding or ,um, a resurgence of bleeding
after menopause. So that is themost common symptom of uterine
cancer. And because thissymptom is so common, we are
often finding uterine cancersat an early stage because women
present with this abnormalbleeding. Some there are other
(04:58):
possible symptoms, so somewomen may have an abnormal PAP
test. Um, the pap is, is reallya cervical cancer screening
test, and it's not meant toscreen for a uterine cancer,
but occasionally we can seeabnormal cells on a pap test
that indicate a uterine cancer.
Um, and another common way thatwe find endometrial cancer is
in incidentally. So if a , awoman is having , um, imaging
(05:20):
for some other reason , um,whether it's for back pain or
something else going on in herpelvis, we sometimes see a
uterus with a very thickenedlining or endometrial lining.
And that can , um, sometimes bewhat tips us off to a , a
uterine cancer diagnosis.
Speaker 2 (05:33):
And in terms of symptoms that a person would
experience themselves. So yousaid the the bleeding of the
abnormal bleeding. Are thereany other symptoms , um,
fatigue or anything like that,anything else that they would
experience typically? And thenwhat would be the difference
between that and other benignconditions? Um, because for
(05:53):
instance, fatigue is an ovariancancer, you know, something
people , uh, um, experience,but it's also could be
attributed to any number ofbenign conditions as well.
Speaker 3 (06:04):
The reason why ovarian cancer often presents
with fatigue or nausea orvomiting or , uh, changes in
bowel function is because it'soften diagnosed at an advanced
stage, and that can happen withuterine cancer as well. So if
the disease is more advanced ,um, if the uterus is very large
or if there is what we callmetastatic disease or spread
outside of the uterus, that cancause abdominal pain, pelvic
(06:28):
pain, changes in appetite,changes in bowel or bladder
function , um, fatigue. Butusually thankfully , um, we
catch this before thosesymptoms come on because , um,
because a woman haspostmenopausal bleeding or
abnormal uterine bleeding, andso we actually find it before
those symptoms. So it's lesscommon with uterine cancer to
(06:49):
have those general symptomsthan it is with a disease like
ovarian cancer.
Speaker 2 (06:53):
So if a person is experiencing this abnormal
bleeding, at what point shouldsomeone go see their doctor?
Speaker 3 (07:01):
So I would recommend that anyone who is having
abnormal or postmenopausalbleeding see their gynecologist
right away. There are manybenign things that can cause
this . So we know that , um,there can be what's, what , you
know, there can be , um,endometriosis or , um, um,
(07:21):
pregnancy or, you know, there ,there are many things that are
benign, are totally normal thatcan cause changes in menstrual
patterns. Um, but I think thatthe most important step is to
check in with the gynogynecologist to make sure that
whatever's causing the abnormalbleeding is not something that
needs to be further evaluated.
And so often that would involvean exam with the gynecologist
(07:41):
and often imaging in the formof a pelvic ultrasound to try
to get the best view of theendometrial cavity.
Speaker 2 (07:49):
Um, and immediately, is that correct? Like as soon
as you start to experiencethis, don't wait a month, two
months? Um ,
Speaker 3 (07:55):
Absolutely, I think immediately.
Speaker 2 (07:57):
And would you say to advocate to get, I mean,
sometimes if you call thedoctor's office, they don't
have an appointment for, youknow, three months. So would
you recommend saying when youcall like, I have a concerning
SY symptom, I need to get inright away?
Speaker 3 (08:09):
Absolutely. Um , for , for many, if not most women,
it's going to turn out to besomething non-cancerous. And so
I'm, I'm not saying that to getpeople , uh, to make people
feel nervous, but I just thinkthat if someone is one of the ,
you know, one of the one of thewomen who does have a cancer,
you want that evaluated rightaway. But that's not to scare
people that everything is gonnabe a cancer. It's more just
that we should have promptfollow up so we can, we can
(08:30):
rule out a cancer.
Speaker 2 (08:32):
Yeah, that's, especially because you said
uterine has that chance of anearly diagnosis, which is less
likely in things like ovariancancer. So you want to take
advantage of that and really goin as soon as you start to
experience Exactly . Symptoms.
It sounds like , um, youtouched on this, but I wanted
to talk about how someone getsofficially diagnosed with
uterine cancer. Is, is thereany early detect detection
(08:53):
screening test at the, thedoctor's office? You said a pap
sometimes can detect it. Um,you know, like they , we have a
pap smear for cervical cancer,mammogram for breast cancer. Is
there anything like that or howdo you get an official
diagnosis?
Speaker 3 (09:06):
We don't routinely screen for uterine cancer. We
really respond to symptoms.
And, and , and so if a , ifsomeone is having bleeding or
having any new symptoms, or ifon an exam a gynecologist , um,
notices that the uterus feelslarger than they would expect ,
um, for the woman's age andbased on her history, then we
(09:27):
would start the, the workup.
And , and usually that involves, uh, a pelvic ultrasound or
sonogram. That's the mostcommon imaging that we use. And
if there's any concern aboutthe endometrial lining being ,
um, thicker than we wouldexpect, or if there's any
concern for cancer, then weusually do an endometrial
sampling. This can be in abiopsy that's done in the
office, or sometimes this isdone in the operating room, and
(09:49):
then it's called a dilation andcurettage or DNC is their term.
Speaker 2 (09:53):
Okay. And you said a pap smear sometimes detects it,
but that's what is , that's notsomething you can rely on, it
sounds like. Right .
Speaker 3 (10:00):
So the pap is really meant to be a cervical cancer
screening test. Occasionally ,um, if a woman has endometrial
cancer, some of the endometrialcancer cells will be shed from
the uterus through the cervixand be picked up with a pap.
But we do know that there canbe , um, many, many women that
have a normal pap who haveendometrial cancer. And so we
(10:21):
don't use it as a routinescreening. It just sometimes ,
um, sort of comes up during,during , uh, a routine
evaluation. And of course we'dfollow it up.
Speaker 2 (10:29):
Great. Dr . Frey , what are some of the risk
factors of things that may putyou at higher risk for uterine
cancer?
Speaker 3 (10:36):
So the, the most common risk factor for uterine
cancer is obesity. We know thathaving increased adipose tissue
results in increased levels ofestrogen, and it's that
estrogen that is driving a lotof the endometrial cancers that
are diagnosed in this country.
Along those same lines , um,taking extra estrogen. So
(10:59):
taking hormone replacementtherapy, especially if it's
estrogen alone, which we do notrecommend, we recommend taking
estrogen and progesterone, butestrogen alone and any extra
estrogen can also increase therisk of endometrial cancer. We
do know that , um, patients whohave , um, diabetes and high
blood pressure seem to have aslightly higher risk for
endometrial cancer, and thismay be linked to , um, obesity
(11:22):
or , or carrying extra weight.
We know that people who have ,um, um, more menses, so , um,
more periods having earlier ageof your first period and later
onset of menopause can haveincreased risk just from a
longer time being exposed toestrogen. Um, and then also for
people who have , um, a lot of, uh, uterine cancer in their
(11:43):
family, having relatives withuterine cancer can increase the
, uh, risk of one developinguterine cancer, often due to
some of the , um, uterinecancer related genetic
syndromes.
Speaker 2 (11:54):
I just wanna touch on something you mentioned. I
think you said HRT . Did youmention that this, I feel like,
is , there's a lot of confusinginformation about this going
through menopause. If youshould be on HRT , if you
should not, do you have arecommendation, like if it's
individual, if people shouldreally talk to their doctor and
not get their information ,information on social media?
Like how, I mean, I just hear alot of conflicting information
(12:15):
about this.
Speaker 3 (12:17):
The topic of hormone replacement therapy is so
complex, and I think sort of asa society, the pendulum has
sort of swung back and forth.
Um, as far as, you know,everyone should be on it, no
one should be on it. And Ithink really it's, it's
somewhere in the middle for theright person. Um, who's having
symptoms after menopause,hormone replacement therapy can
(12:37):
be great and is a great , um, agreat medication for, for it .
It's critical to also note thattaking estrogen can increase
the risk for , um, uterinecancer. And so it's very
important that if someone'sgoing to use hormone
replacement therapy, it'sprescribed and monitored by a
clinician with experiencebecause , um, one must take
(13:01):
estro estrogen and progesteronebecause the progesterone
actually is what protects theuterus for someone who's taking
estrogen. And so what I wouldsay is the , um, decision to be
on hormone replacement therapyhas to be an individualized
decision with one's physician ,where we very carefully weigh
the risks and benefits, but formany women, it is the right
decision.
Speaker 2 (13:20):
Great. Thank you for clarifying that. So I am BRCA
one positive, which puts me athigh risk for ovarian cancer
and breast cancer, and I diddevelop ovarian cancer. Does
BRCA status affect uterinecancer at all, or if not, is
there any other geneticcomponent at all? Um,
Speaker 3 (13:39):
There are genetic contributions or genetic risk
factors to endometrial cancer.
Um, there has been someevidence to suggest that people
with a b RCA one mutation havea higher risk of an aggressive
uterine cancer called a uterineserous cancer. The data are
really limited. And socurrently the standard
(14:00):
guidelines would say that weshould mention this to someone
who has A-B-R-C-A one mutation,that she may be at higher risk
for uterine cancer. And if awoman with A-B-R-C-A mutation
is thinking about risk reducingsurgery to prevent ovarian
cancer, in addition to removingher ovaries, fallopian tubes,
she can consider removing heruterus as well. We don't know
enough to make an absoluterecommendation that all women
(14:23):
with BRCA one should have theiruterus removed, but it is
certainly something that awoman should discuss with her
physician. We have not seen thesame rates for BRCA two, but
that's an area that's underinvestigation. There are other
genetic syndromes that canincrease the risk for uterine
cancer. So one of the mostcommon is called lynch
syndrome. This is a syndromethat increases one's risk for ,
(14:46):
um, uterine cancer in additionto colon cancer, ovarian
cancer, and some other cancers.
And so for women who have Lynchsyndrome, we do recommend , uh,
surgical removal of the uterusto prevent a uterine cancer.
Speaker 2 (15:01):
And similar to other cancers, when you look at
family history, is thatsomething to consider too when
you're evaluating a patient tosee if they might be high risk
? You talk to 'em about if isthere uterine cancer , um,
history in your family?
Speaker 3 (15:14):
Absolutely. So any person who has a family history
with , um, relatives that haveuterine cancer and colon
cancer, and actually ovariancancer can be part of this
syndrome that should , um, geta physician sort of thinking,
this is a family that couldhave Lynch syndrome or that
should get a person thinking,you know, is my family at risk.
And, and the, the , um, genetictesting that we do now for
(15:37):
syndromes like BRCA one andtwo, actually, it's usually a
large panel and that coverslynch syndrome and there are
several genes that can causeLynch syndrome. So absolutely
for any family that has thesecancers, I would recommend
genetic testing and so that wecan determine who's at risk.
Speaker 2 (15:51):
That's, you know, great advice because I think
that BRCA one or BICA one andtwo are kind of the most
commonly known in terms ofhereditary cancer, but there
are so many other mutationsthat put people at risk for so
many other types of cancers. Soit's really good to know about
Lynch syndrome and familyhistory. Um, and then is there
any way to reduce your risk?
Speaker 3 (16:14):
I think the , the best way to minimize risk of
uterine cancer for someone ataverage risk is just to
maintain a healthy weight , um,healthy diet exercise. And that
that's really the best , um, ofcourse to follow up with any
symptoms. But then for peoplewho have a significantly higher
risk, so that would be anindividual with Lynch syndrome
(16:36):
where we can see the risk evenexceed 50% over one's lifetime.
We recommend preventativesurgery to remove the uterus.
Um, if someone is not ready forthat surgery yet, or still in
their childbearing years, orsomeone who's at very high
risk, we do offer routineultrasounds and also
endometrial biopsies, but wereally limit that to those
(16:56):
women who are at highest risk.
Speaker 2 (16:59):
Um, that is a great point that you bring up , which
is bring , if you have a familyhistory or you're concerned you
might be at higher risk, wouldyou recommend like talking to
your regular GYN andpotentially being followed by a
specialist such as yourself, aGYN oncologist?
Speaker 3 (17:17):
Absolutely. I think a lot of what a gynecologic
oncologists do right now iscancer prevention and people
who live at elevated risk. Andso I think that is a , a very
good idea for someone who's athigher risk.
Speaker 2 (17:28):
And two , it sounds like just see the specialist,
and maybe you won't, it turnsout you're not at high risk,
but at least like a specialist,they see this all the time.
They can more thoroughlyevaluate you.
Speaker 3 (17:37):
Absolutely.
Speaker 2 (17:38):
And then , um, we touched on this, but what
advice do you have? So you'reexperiencing these symptoms,
you say co contact your doctorright away, get in right away.
Um, are there other ways, youknow, what recommendations you
have for how to bring this upwith your doctor? How to
advocate for yourself? What ifyour doctor is not taking your
concerns seriously? I, youknow, hear a lot of women's
(18:00):
health concerns brushed off,like, oh, it's just your
period, or it's just thisnormal whatever, this or that.
Like, what are yourrecommendations for getting
taken seriously at your doctorand advocating for yourself?
Speaker 3 (18:12):
Um, I think unfortunately when that
happens, it just falls on thewoman, the patient, to be their
own best advocate. And I thinkif you feel like your clinician
is not listening to you, thenyou know, you may have to find
another clinician because thisis critical. And unfortunately,
I think there is , um, often adelay because people think that
(18:33):
, um, it's gonna resolve on itsown, or abnormal bleeding is
something that's uncomfortable, um, or embarrassing to talk
to a clinician about. But thisis what your doctor, especially
your gynecologist is reallythere , therefore . And so I
would say, you know, kind of beyour best advocate. If you have
symptoms, bring them to theattention of your clinician.
And if you feel like you're notbeing listened to, then then
find someone who is listeningto you and taking this
(18:56):
complaint seriously.
Speaker 2 (18:57):
Um, yeah , I just echo that it's so important to
advocate for yourself. I wasvery lucky with being taken
seriously , um, initiallymisdiagnosed and then correctly
diagnosed within 18 hours. Sovery quickly, but I see a lot
of people that that doesn'thappen to, and they're
dismissed for months. So justwanna , um, emphasize for the
listeners the importance ofadvocating for yourself in your
(19:19):
healthcare . Um, and that , um,there we have an episode about
that as well on this podcast.
So check out our past episode,how to advocate for yourself as
a patient for more informationand tips where we go into that
, um, in more detail. Um, andbefore we wrap up, I just wanna
go back to something that yousaid earlier that a very early
(19:40):
onset of menopause or , uh, orof your period, onset of your
period or going into menopauselater could be risk factors.
And I was wondering if youcould just give like an age
range, like what is consideredan early onset of your period
and what is considered a latemenopause?
Speaker 3 (19:57):
Absolutely. So the average age of , um, first
period in this country is about12, I believe, although that
that number is coming down andthe average age that a woman
goes through menopause is about51. But we certainly see
variation , um, earlier andlater , um, for both of these.
(20:17):
And I think it's important toknow because , um, having more
lifetime periods is a risk foruterine cancer. It's also a
risk for ovarian cancer. And soI think that, you know, for
women who have had more periodsor have long histories of
irregular menses or irregularperiods, those are women who
really wanna be cautious and,and be on top of this.
Speaker 2 (20:37):
Um, so it just sounds like these are all
things to bring up to yourdoctor at your routine GYN
exam, if you have to see aspecialist to bring, just pay
attention, know your normal ,um, and, and note all the
anything that may be out of theordinary to talk to your doctor
about. Um, is there anythingelse important that you want to
add on this topic that wehaven't uh, talked about yet
(20:58):
today?
Speaker 3 (21:00):
No, I, I think I would echo what you say that
it's very important to have agynecologist. I think that a
lot of women sort of might havean obstetrician if they had
children, and then sort ofafter that they don't see a
gynecologist as regularly orthere's an assumption, you
know, they've had a , a papsmear and so they're okay for
five years, they don't need anyfollow up . And I would just
say that having a gynecologistas part of your care team is
(21:22):
critical. It's critical forroutine care and preventative
care. And then also, you know,if you have any complaint to
have someone there who knowsyou and that the pap is , is
very good as a cervical cancerscreening, but that is, that is
what it is meant for. It is notmeant to screen for uterine or
ovarian cancer. And so just tokeep that in mind
Speaker 2 (21:40):
And how often in I ideal situations should someone
be seeing their regular GYNI
Speaker 3 (21:47):
Think that it has to be very individualized. And so
I, so I would kind of meet witha gynecologist and then based
on your exam, based on, youknow, your own meta personal
and family history, you'd makethat decision. But, you know,
often it's every one to twoyears.
Speaker 2 (22:01):
Okay. Great. Well, thank you so much. Um, Dr. Faye
, thank you so much for joiningus today and a huge thank you
to everyone out therelistening. We hope that you
walk away from today's episode,having learned something new
and feeling more empowered inyour health. Be sure to tune in
for the rest of our three partseries as we explore cervical
cancer and vaginal and vulgarcancers.
Speaker 1 (22:29):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wH-A-T-T-O-K-N-O-W. And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
Popular Podcasts
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com