Dr. Shelly Seward with The Women’s Healing Center discusses gynecologic cancer awareness. Topics include ovarian cancer, uterine cancer, cervical cancer, …
– Hello, my name is Dr. Shelly Seward,
and I'm a gynecologic oncologist
with the Women's Healing
Center in Orlando,
and also the Department
of Surgery chairman here
at the Oviedo Medical Center.
I'm very happy for you
all to join us today,
'cause I'm very excited as September
is Gynecologic Cancer Awareness Month.
So we are talking about
gynecologic cancers,
what the warning signs are, risk factors,
and what you can do to get early detection
and early treatment
for these malignancies.
So, very exciting that September
is Gynecologic Cancer Awareness Month
because as you know, gynecologic cancers,
aren't that common, otherwise,
you know more about them.
We don't have a pink out the park
and a beautiful Susan G. Komen parade.
And although we are very fond
and support breast cancer research,
we wanna bring attention
to the gynecologic cancers as well.
What are gynecologic cancers?
Those are gonna be cancers
from the ovary, the uterus,
the cervix, the vulva, and the vagina.
So all of those are entailed
gynecologic cancers.
So what do we know about
gynecologic cancers compared
to other cancers?
As you can see behind me, the
number one most common cancer
for women is breast cancer,
followed by the most common
cancer for both sexes,
lung cancer followed by colon cancer.
But what you can see is uterine cancer
is number four on that
list of common cancers
that are seen in the female population.
When you look at the
lower part of the slide,
that's how many deaths or bad
outcomes occur from cancers.
And what we see is just
based on shore numbers,
those top three are
still in the top three,
seeing lung cancer, breast
cancer and colon cancer.
But what you see is ovarian
cancer sneaks up there
into one of the top five, as
far as the amount of deaths
that occur from cancer for women.
And that's because we find
ovarian cancers later,
because their symptoms
aren't as well appreciated
as some of the other cancers.
And we don't have a good
screening test for it,
like we have colonoscopies
for colon cancer
and mammograms for breast cancer.
So today I want to bring
up these important topics
of ovarian cancer and uterine cancer,
because they are common enough
to be on the top five list,
including uterine cancer,
but also because they can be
deadly having ovarian cancer,
not even on the most common list,
but in the top five for most deadly.
How common are the GYN cancers?
So in general, there are
about 14,000 new cases
of uterine cancer per year.
As you can see behind me, I'm sorry,
about 14,000 new cases of cervical cancer.
Uterine cancer is our most
common at about 65,000,
ovarian is a little less common at 22,000.
And then we have a smudge of
vulva and vaginal cancers.
So we're gonna focus primarily on ovarian
because of it's lower incidents,
but higher mortality rates
or complication rates,
than uterine because of its commonality,
than cervical 'cause we
have a lot of screening
and preventative treatment
that we can do for that,
and then touch on vulva
and vaginal cancers.
So, but first let's talk
about cancer in general.
What we know is early detection
equals better outcomes,
meaning if we find your
cancer in stage one
where it hasn't spread to
other parts of the body,
your overall survival is about 90%
for those gynecologic cancers.
However, if you find it
later stages in stage four,
your odds of being alive are at five years
are only about 15%.
So we know that finding these
cancers earlier in stage one,
is gonna let you handle this better
and have better outcomes
and better survival.
Screening tests are made to find precancer
or early stage cancer.
You're familiar with a lot
of these screening things
like the mammogram that's
recommended every year,
once you hit the age of 40 and
then for other populations,
even more regularly or other
things than a mammogram,
you're also aware of the colonoscopy.
It's recommended starting at age 50,
and every five to 10 years afterwards,
depending on your risk
factors and other findings.
The pap smear was one of the
rare first screening test
that really made a splash
in the medical field,
and decreased the amount
of cervical cancer
in the United States and
and the world by about 70%.
Unfortunately we're still
dealing with some problems
with cervical cancer
and its relation to HPV.
So it's very important that
we keep working at that,
with that screening and
the preventative vaccines
to minimize that amount of cancer.
So we're very fortunate
for cervical cancer,
we do have some preventative
techniques with the vaccines,
as well as screening with the pap smears.
Then of course there's
vulva and vaginal cancers,
which are very rare and we
don't have screening for those.
When we talk about cancer,
you come to the office
and we have all kinds of
terminology and mumbo jumbo,
important terms to know
when we speak about cancer,
are histology, or what
kind of cancer you have.
We're lumping these things
together for the GYN cancers
like ovarian cancer and uterine cancer,
but there are multiple
different types or histologies
of ovarian cancer, as
well as uterine cancer.
We'll touch base on some of those,
but because of its rarity and
the shortness of our time,
we're gonna focus on the most common ones,
and how you can know when you have to have
interventions done, and
what to look out for.
Grade is how atypical the
individual cancer cells are.
Some cancers are
automatically a grade three,
the most atypical and the most aggressive.
Some are graded from grade one,
the least atypical or least aggressive,
then grade two in the
middle, and then grade three.
It all depends on the histology
or the type of cancer.
The next jargon that we use is stage.
Stage refers to how far
the cancer has spread
from the site it started.
So if you have an ovarian cancer
and it's confined to the
ovary, that'll be stage one.
If it spreads to other
areas in the pelvis,
that could be a stage two.
If it spreads to the upper
abdomen or lymph nodes,
stage three, and further
spread to stage four,
If it went to the lungs or outside
of the abdominal cavity
or inside the liver.
So stage is commenting on
how far the cancer spread
from the site of origin,
grade is how atypical the
individual cancer cells are.
And histology is what actual
kind of cancer you have,
'cause not all ovarians,
and not all uterine cancers are the same.
Then we use all kinds of the
words like lesion, tumor,
mass, nodule, these are just
referring to anatomic lumps
or things like that.
So just because you have a nodule,
doesn't mean you have a cancer,
just because you have a tumor,
doesn't mean you have a cancer.
So it's important to know all
of those other terminologies
that go along with that.
And if you don't understand
that at your doctor's office,
slow them down and make
sure you understand.
So let's get started
with gynecologic cancers
and we'll start with ovarian cancer.
What we know is ovarian
cancer, isn't that common.
I like to put it this way,
if you had a women's luncheon
and you had 10 women at a table,
and 10 tables in the room,
so 100 women in the room at this luncheon,
how many women in that room
are gonna get ovarian cancer?
About one, 'cause your
odds are about one in 80
or one in 100.
How many women in that room
are gonna get uterine cancer?
About one in every three tables?
'Cause that's our odds of
that, meaning about one in 33.
How many are gonna get breast cancer?
About one per table?
Because your odds of
developing breast cancer
over your lifetime, are
about one in 10 or one in 12.
So that's just kind of
an easy way to remember.
So what we see is yes,
breast cancer very common,
one person per table,
uterine cancer more common,
about one every three tables,
and then ovarian cancer,
just one in the room.
We know that cervical cancer
has other risk factors,
again, those rates are lower
as well as vulva and vaginal being lower.
But ovarian cancer rare but it's deadly,
and that's because about 70%
or more of ovarian cancers,
are found in that late stage.
Because we don't have
a good screening test,
and the symptoms that we'll
talk about are very vague,
and they're nonspecific,
and that's why I want you to be aware
of what these symptoms are.
So if you do have these,
you can go sooner rather than later,
and hopefully improve your
outcome, by being seen sooner,
There is no screening or
preventative treatment available
for the general population,
but there is for a high risk population.
So if you have a strong
family history of ovarian
and breast cancer, it's gonna be important
that you see your
primary provider and say,
"Hey, I want you to be
aware of this history,"
because if you meet criteria,
they'll test you for certain
mutations that can be carried,
like BRCA 1 and BRCA
2 that are well known,
Angelina Jolie unfortunately
her family has that,
and so you might've seen
that in the mass media.
But there are other less known
ones that we look for too,
like Palp-B and BRIP.
So if you have a strong family history
of ovarian or breast cancer,
it's recommended that you go
see your primary provider,
talk about this family history
and they can either order testing for you,
to see if you're high risk,
or send you to a genetic counselor,
who can help explain it better
and order the appropriate testing.
Because if you are in
that high risk category,
then we would recommend
different treatments,
including screening with ultrasounds,
as well as blood work for a
tumor marker called CA 125.
It's not a great screening test,
and it's not a great blood work test,
but if you're in that
high risk population,
we know that it can
help find things sooner
and get you treated better.
As far as preventative for those people
who carry these mutations,
we do other things.
Giving birth control pills,
when you're not trying to get pregnant,
reduces your risk of
developing ovarian cancer.
We know women who have those mutations,
and they're past their
age of death of fertility
or have childbearing, we
can sometimes do surgery
to help minimize their risk
of developing ovarian cancer
or fallopian tube cancer.
So ovarian cancer, know the symptoms.
And the problem is, is
that ovary anatomically
is kind of the size of an almond
or a small tennis ball
sitting in your pelvis.
And that area of your body is made
to actually incorporate an
entire baby in the uterus.
So it can expand before you
really get any symptoms.
So that ovary has to get pretty large,
to become painful or noticeable.
And that's why the symptoms
are very, very vague.
Things we worry about are bloating,
where you just kind of feel
distended and bloated and gassy.
We worry about something
called early satiety,
that means you kind of still are hungry,
you sit down to eat, you
put in a couple of bites,
and you just can't have any more.
You feel really full, really quick.
It can also cause new
GERD or reflux symptoms,
or worsening of your current heartburn,
that kind of feeling of that
burning in the mid chest area.
We also worry about pressure
and at sometimes pain.
But ovarian cancer, doesn't
present a lot with pain
and that's concerning because people tend
to respond to pain and get evaluated.
But a little bit of pressure,
a little bit of reflux,
a little bit of bloating,
it doesn't trigger a trip,
and that's why we want
you to be aware of that.
The other thing is once masses
get larger in the pelvis,
it can push on that bladder and cause
increased frequency of urination.
So if you have any of
those or a conglomeration
of those symptoms, it's gonna
be real important to go in
and talk to your provider.
Vague symptoms equal late diagnosis.
So if you're having this
combination of symptoms,
see your provider sooner
rather than later.
Uterine cancer, it's more
common than ovarian cancer,
but it's primary symptom is bleeding.
Bleeding, scares people, so
people tend to come in sooner,
and get diagnosed at a lower stage,
hence the outcomes for uterine cancer
are a little bit better.
There's no screening test available
for uterine cancer either
for the general population.
Those people who have a strong
family history of uterine
or colon cancer, can also
carry genetic changes
like Lynch syndrome that increase
your risk of uterine and colon cancer.
If you were to be one of those patients,
we wouldn't do endometrial biopsies on you
to help prevent missing a
diagnosis of uterine cancer
and prophylactic hysterectomy
after childbearing age.
So for that high risk population,
somebody with a strong
family history of colon
and uterine cancers, who's
gotten tested and carries
that gene mutation in their blood,
then we would do some
screening and some surveillance
and some preventative
surgeries for those folks.
But otherwise in the general population,
we don't have good screening,
but we also know there are risk factors
and people who are at strong risk,
even without that family history.
And that's gonna be obesity, diabetes,
anybody with a history of
polycystic ovarian syndrome,
as well as excess estrogen exposure.
What we know is that adipose or fat cells,
and people who are overweight
create extra estrogen,
that extra estrogen
increases that lining growth
of your uterine canal or the endometrium,
and that gets thicker, thicker, thicker.
It becomes pre-cancerous
changes like hyperplasia
and then can develop into a cancer.
So we know obesity, diabetes,
and polycystic ovarian syndrome,
where you didn't have normal
periods as a youngster,
and you had a steady
state of estrogen also
that was higher than normal,
those high estrogen states,
can preclude you for ovarian cancer,
correction, uterine cancer.
So it's important if you
have those risk factors,
and you have some bleeding,
you get that evaluated.
And what are we really talking about?
It is not normal to have bleeding after
you've gone through menopause
or the change of life.
So if you have postmenopausal bleeding,
meaning new bleeding, whether
it's heavy or even light,
and you've not had a
period for over a year
that needs to be evaluated,
as there's a possibility
of it being cancer.
It doesn't mean it is cancer,
only about 15 to 20% of
postmenopausal bleeding is cancer,
but that's a high enough number,
we really wanna make
sure that's evaluated.
The other kind of bleeding
can be in that perimenopausal
or before menopausal period.
You can have bleeding
in between your cycles,
your cycles can get really
heavy and really long.
So if you are changing the
way you normally have cycles,
heavy bleeding, irregular, that's a reason
to see your provider as well.
A lot of women, once
they stop having babies
no longer see an OBGYN and they think,
"Well, this is just normal,
this is how the change happens.
This is what my neighbor told me.
This is what my mom told
me," t's not always normal,
so make sure you get evaluated.
You can also have some vaginal discharge
and some pelvic pain with uterine cancer,
but our primary symptom
is gonna be that bleeding,
and if you have irregular bleeding,
you should see a provider.
Next we'll talk about cervical cancer,
almost all cervical cancer is related
to the human papilloma
virus or that HPV virus.
What we know about that is kind of recent,
we've just been developing
and discovering some things about HPV,
but what we know is
HPV is almost as common
as the common cold, meaning
it's pretty ubiquitous
or pretty widespread in the environment.
And we know it can be passed
through sexual activity
as well as the exchange of bodily fluids.
But what we know now is that
we have developed a vaccine
to help prevent HPV infection,
meaning even if it's very
common in the environment
or society, if you've
been exposed to the virus,
but you've been vaccinated against it,
you have a better shot
of clearing the virus.
That vaccine is just
like, we make vaccines
for diptheria, MMR, and polio.
You need to get the vaccine
before exposure for it to work.
And that's why we recommend
that all boys and girls
between the ages of 11 and 13,
receive at least two
vaccinations with that Gardasil 9
to help build up the immune system,
so if they are exposed to
HPV, it can't take root.
Because we know that while the majority
of people clear the virus,
about 10% will never clear the virus
and it sits there for a long time.
And another 10% don't clear the virus
and that virus can cause
changes in the genital track
that become precancerous lesions
and that eventually cancerous lesions.
It's those that we're
looking for on the cervix
that we're screening
for, with the pap smear.
The pap smear has been a
great discovery in US medicine
in that it has decreased
the rate of cervical cancer.
But I don't think anybody should rely
on the pap smear alone.
And that's actually the case
because now we don't just
do pap smear testing,
we do HPV testing along with pap smears
for certain age ranges,
and we'll get to that in a moment.
Symptoms of cervical cancer,
can be irregular bleeding,
bleeding after intercourse,
also known as post-coital
bleeding, difficulty urinating,
pelvic pain, feeling
pressure down in the pelvis.
So any of those things that are happening,
please come in and see your provider.
But in the meantime,
make sure you're doing
the screening prevention
for preventing cervical cancer,
and that's gonna be the pap smear.
There are a lot of different
organizations out there
with different recommendations,
but in general,
we're beginning to do pap
smears at age 21 for women.
We know younger women have a tendency
to clear the virus as it comes and goes,
and we also know that
these changes take time
to kind of set route.
So you should begin pap smears at age 21,
between the ages of 21 and 29,
you'll get a pap smear every
three years with cytology.
Meaning we just look at the cells.
Then between ages of 30
and 65, we do co-testing.
Not only do we do the pap smear,
where we sweep that cervix
and get the cervical cells,
and look at that cytology or
cells under the microscope,
but we also test for that HPV virus.
And that way it extends it
out to every five years.
Now, as I'll state later, that
doesn't mean you don't need
an annual exam every year.
It's recommended that all women get
one annual well-woman exam per year,
whether you need a pap
smear or a pelvic exam
along with that, depends
on your age, your symptoms,
your prior exams and other factors,
and we'll touch base on that again.
But that's the screening
guidelines for the pap smear.
Then we're always asked questions about,
"Well, I had a hysterectomy,
do I still need a pap smear?"
Well, it depends on the
reason for the hysterectomy.
If you've ever had an abnormal
pap smear in the past,
or had the hysterectomy
for cervical dysplasia
or those precancerous lesions, then yeah,
you might still need some pap
smears of the vaginal cuff.
The amount of testing
depends on your prior tests,
your newest findings, et cetera.
Vulvar and vaginal cancer,
again, these are pretty rare.
But we know there can be a
lot of irritation and itching
on the vulva and the opening to the vagina
that happens especially with age.
What I also know is that's
a hard place to look at
and get really well evaluated.
And that's one of the good things
about an annual well-woman exam.
Even if we're not doing
it inside pap smear,
taking a look at the outside,
making sure there's no lesions
or bumps or anything wrong,
especially if it's harder
for you to see that area
is an important part of
that well-woman exam.
There's a wide range of things
that can happen to the vulva
or the outside of the vagina,
itching, burning irritation,
bleeding with wiping,
these are all things we're worried about.
There's a big array of things
that can cause those symptoms,
precancerous lesions, sebaceous
cyst, lichen sclerosus,
vulvar dysplasia, or
pre-cancerous changes.
But we worry about vulvar cancers,
because it's a difficult
area to treat surgically,
and so it's important if
you have chronic itching,
burning irritation, any
changes, see your provider.
So what can you do to
help prevent these things?
One, know the symptoms and report them,
two get your annual exam.
It is recommended by multiple groups,
that you get an annual well-woman exam.
It's a little more controversial,
how often you need a pelvic exam,
what the pelvic exam will entail.
And it depends on your
age and prior findings.
So your annual well-woman
exam may or may not include
a full pelvic exam, but it's
definitely gonna include
to discussing the symptoms of all
of these gynecologic cancers,
as well as appropriate
screening for other factors.
It's a lot of times the gynecologist
that does the breast exam
and orders the mammogram,
orders the DEXA scan,
screening for bone osteoporosis
and other findings.
So, your annual well-woman
exam is extremely important,
and that's up to you to make
sure you're getting that,
and when you do go,
let your provider know,
what your symptoms could be,
or even if you just have any concerns.
So don't be embarrassed.
The gynecologic cancers and
just gynecology in general
is often something people feel embarrassed
or ashamed about.
Nothing to that, don't be embarrassed,
that's what we're here for, to help you.
Also, don't be dismissed,
it's very easy with those
vague symptoms to, you know,
tell your spouse, tell your sister.
And they're like, "Oh,
you're just a complainer,
don't worry about it," et cetera.
Don't be dismissed by family, friends,
and definitely not your provider.
If you were having
symptoms, make sure you go,
make sure you're heard, and
make sure you're evaluated.
Also don't delay, very, very important,
because we talked about earlier
that finding cancers early,
is gonna give you a better outcome.
And that leads us to
medical care during COVID,
these are scary times for everybody,
but the biggest issue is
please don't delay care.
What we're seeing in the
medical field for non-cancer
is that people are showing up
later and later with symptoms,
meaning what would have been a mild TIA,
or transient ischemic attack,
if they hadn't come in
at that point in time, and
people wait an extra week
or two weeks because they're afraid
of contracting COVID in the ER,
we're finding they have more
serious sequelae from strokes
and they actually have
longterm side effects.
Same thing with mild angina
and heart pain or chest pain
that can be treated with
medications or angioplasty,
people are waiting until they
have a full blown heart attack
and having poor outcomes and more sequelae
or side effects from this.
We're seeing the same thing for cancer.
We're seeing people not coming
for their annual screenings.
We're seeing people not showing
up for those mammograms.
And what we're predicting is that
we're gonna find more
cancers at a later stage.
We've decreased the amount
of cancer diagnosis in the US
by about 30% from recent reports.
We don't know how that's
gonna affect cancer mortality,
or death rates in the upcoming year.
But those delays we
think are gonna increase
about 10 to 30,000 more
cancer deaths per year.
So please, I'm asking
you, come in and be seen,
especially if you're having any symptoms,
but even for that annual screening.
All of our offices and
facilities here at Oviedo
and from the HCA family are
taking special precautions
to help prevent the transmission
or the risk of catching
COVID in the office.
We're having universal masking,
where everybody has to wear a mask.
We have temperature checks
and symptoms screening
on the way in the door.
For me and my office, we actually
let you wait in your car,
and we give your cell phone a call,
when it's time to come up.
So you don't have to sit in a
busy, crowded, waiting room.
All of our rooms are cleaned
in between every visit
with every piece of
equipment being wiped down
with sanitizing wipes for your safety.
So, also if you don't really
need to come in and be seen
and maybe just discuss symptoms,
maybe get ultrasounds or
other imaging ordered,
and then come for a face to face visit,
the upside of this COVID pandemic,
maybe the developments we're making
with the technology and medicine,
we're doing a lot of
tele-visits these days,
so that we can hear you,
figure out what you need,
get you on track,
and make sure we're not
delaying any diagnosis.
So I really wanna thank you for tuning in,
and taking this time to share with me
in the month of September,
Gynecologic Cancer Awareness Month,
what gynecologic cancers are,
what are those symptoms
you should be aware of,
annual screening exams
with a well-woman exam,
screenings for pap smears and
their indications, et cetera.
What I have behind me
is a list of resources
that you might want to take time to go to.
The Foundation for Women's
Cancer partners with SGO,
and their website is really good,
as far as all of this
information and symptomology,
they also have pamphlets
to print out in that.
So if you wanna share that information
with your friends and family.
The American Cancer
Society is www.cancer.org,
also a very good source,
as well as Women's Preventive
Services Initiative by ACOG,
the American College of
Obstetrics and Gynecology,
is a very good website
for all women's care
and preventative services and
has nice graphs and charts
to let you know what you need and when,
including skin screening for
skin cancers, mammograms,
blood work, colonoscopies, pap smears,
annual well-woman exams, et cetera.
So once again, I wanna
thank you for your time,
leave you with this list of resources,
and know that we here at
Oviedo Medical Center,
and me and my partner, Dr. Bryant
at the Women's Healing Center
are always here for you.
Thank you so much.

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