UCLA doctor’s perspective: gynecologic cancer awareness month
Written by: Dr. Sanaz Memarzadeh
Listen to your body and make time for your routine gynecologic exams
In my practice as a gynecologic cancer surgeon over the last 13 years I have seen that women often forget to take care of themselves. They are busy being mothers, daughters, wives and career women but in many instances neglect their own body. While gynecologic cancers may sometimes be silent, many are associated with signs and symptoms. Recognizing those, being aware of them and bringing them to the attention of your primary care physician and gynecologist is important.
Here are some examples of what women with a gynecologic cancer may experience:
Uterine (endometrial) cancer: postmenopausal bleeding or clear change in bleeding patterns for premenopausal women (e.g. an increase in frequency or amount of normal menstrual flow)
Ovarian cancer: bloating and abdominal pain that is persistent for days, decreased appetite or feeling full quickly
Cervical and vaginal cancer: bleeding after intercourse, irregular or post-menopausal bleeding
Vulvar cancer: persistent pain, itching and/or bleeding
Prevention and early detection strategies
It is important to remember that as women, we have control over our bodies and can take strategies to reduce our risk.
Vaccination against the human papilloma virus provides significant risk reduction against cervical, vulvar and vaginal cancers. The vaccine is covered by insurance in women ages nine to 26. But women can pay out of pocket and still get vaccinated if they are older than age 26.
An endometrial biopsy in women with vaginal bleeding can help detect uterine (endometrial) cancer in early stages.
Pap smear and HPV testing often help detect cervical cancer in early stages when the disease is curable. Similarly, biopsies of the vulva or vagina in patients with suspicious lesions can help detect these cancers in early and curable stages.
Women with strong family history of hereditary cancers (breast, ovarian cancer, uterine and colon cancer) should consider genetic testing. In the presence of a genetic mutation such as BRCA1/ BRCA2 or genetic changes associated with Lynch Syndrome risk reduction surgery with bilateral removal of ovaries and tubes with hysterectomy (particularly in Lynch carriers) should be considered. These surgeries can significantly reduce the risk of tumors arising from these organs.
Surgical advancements in therapy of gynecologic cancers
From a surgical stand point we have made great strides in improving quality of life for women with gynecologic cancers through the adoption and implementation of minimally invasive surgeries. Simultaneously, we have modified old radical surgical approaches that we now recognize do not improve clinical outcomes of patients. Wide embracement of these surgical approaches in general will continue to improve quality of life for women while minimizing surgical risks.
Discovery of more effective and personalized therapies
Personalizing therapy for women diagnosed with gynecologic cancers must be the next major focus in the field. Patients and clinicians are acutely aware of the fact that one treatment regimen does not fit all. But what regimens should be used and which combination therapies will be most effective? These are critically important questions that still need to be addressed. Answers to these questions will arise from research that examines tumors at a cellular and molecular level while recognizing that all cells within a tumor are not the same. The goal should be eradicating the subset of tumor cells resistant to standard treatment: in ovarian cancer this may be cells resistant to carboplatin chemotherapy and in endometrial cancer this may be cells resistant to progesterone hormonal regimens. Dissecting pathways of resistance in tumor cells that evade standard treatment will provide clues to therapy options. The new therapeutic options that are discovered should move to clinical trials and their effectiveness in conjunction with standard therapy must be tested. But each therapeutic combination should only be tested in biomarker positive patients. These are patients predicted to benefit the most from a specific therapeutic approach.
As a practicing gynecologic cancer surgeon, a scientist and professor at UCLA I am dedicated to helping advance the field of gynecologic cancer care in collaboration with an incredible group of clinical and scientific colleagues at our institution. What I have outlined here are approaches we are taking at the UCLA Health system, the UCLA Jonsson Comprehensive Cancer Center, the UCLA Broad Stem Cell Research Center and the UCLA G.O. Discovery Laboratory to improve the lives of women impacted by gynecologic cancers.