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Ask The Expert Archive

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GYN Cancer Archive Questions

Below are Dr. Gautam Rao’s answers to GYN Cancer questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 17.

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Q : 1

I recently had laproscopy where my right ovary was removed secondary to an endometrioma. It was discovered that I have severe endometriosis and it is recommended that I have a complete hysterectomy via an abdominal incision. Since there appears to be significant adhesions, should I consult with a GYN oncologist surgeon to have this done with the best results?

Often gynecologic oncologists are asked to act as surgical backup for complex benign gynecologic cases. It depends on the surgical comfort level of your own gynecologist and the availability of a gynecologic oncologist as backup in their hospital.

Q : 2

My mother died of ovarian cancer in 1999. I was evaluated and found not to have the BRAC gene. Are there tests that I should have that might detect ovarian or other gynecologic cancers at an early stage, such as pelvic ultrasounds?

There is currently no screening test for ovarian cancer or uterine cancer. Ca-125 testing and ultrasound have been studied extensively and found not to alter cancer deaths. At times, prophylactic surgery for patients such as yourself is indicated.

Q : 3

My maternal grandmother had cervical cancer twice. Neither my mother nor my aunt has been diagnosed with cervical cancer. Is there a chance that I might get cervical cancer or that the gene has been passed on to me?

Cervical cancer is not usually genetically passed. The cause of cervical cancer is the HPV virus. In order to prevent cervical cancer we generally recommend good general health, safe sexual practices, the HPV vaccine and regular pap smear screening when you reach that age. You should discuss these all with your physician.

Q : 4

My mother was diagnosed with uterine sarcoma. Is this something that my sisters and I should be regularly screened for?

Generally, the risk of developing a uterine sarcoma is not genetically linked. Nor is there a screening test for sarcoma as this is a very rare disease. I would recommend following up with your physician and following general guidelines for preventative health (pap smears, cholesterol monitoring, mammography). If you have specific anxieties relating to uterine sarcoma, these should be discussed with your physician.

Q : 5

I had a partial hysterectomy 10 years ago. I now have a complex cyst in my left ovary which may be a hemorrhagic cyst and the adjacent fallopian tube is dilated. I am having pain and urinary problems. Should I see a GYN or a GYN oncologist?

The decision to remove and ovary following a hysterectomy is based upon multiple factors, pain being one of them, suspicion of malignancy may at times be another. There are many findings that would make your ovary more or less suspicious for malignancy. Your gynecologist should always refer you to a GYN oncologist if the suspicion for malignancy is high. Any further recommendations would require a complete review of your history, a physical examination and a review of your radiographic records. Alternatively, if the suspicion for malignancy is low, a gynecologist should have the appropriate skills to manage on ovarian cyst. I recommend discussing your concerns with your gynecologist.

Q : 6

My mother died at 70 from ovarian cancer. I am 51 and want to have my ovaries removed. What kind of specialist should I see? Is there someone at your hospital that deals with this?

This procedure can technically be performed by any gynecologist, although a gynecologic oncologist may be more familiar with the indications and procedure. I also recommend that the procedure is done in a place where the pathologist is familiar with the process of completely examining the fallopian tubes and ovaries which is standard for women with a genetic risk of ovarian cancer, but not necessarily for other patients. I am happy to provide this sort of consultation if you would like to schedule an appointment.

Q : 7

In 2000, I had an abnormal pap, had a colposcopy, and a LEEP procedure. After the LEEP, the dysplasia was classified as the highest level of abnormality (without being cancer). A month ago, I had another abnormal pap, but a pelvic/vaginal ultrasound revealed nothing. My doctor is advising a follow up pap, but wouldn't my history indicate a need for biopsy?

A pap showing atypical glandular cells does require a colposcopy with an endocervical sampling and with or without an endometrial biopsy depending on your age and other risk factors. I would discuss getting a referral to a gynecologist from your family doctor.

Q : 8

I just learned that my 85-year-old mother may have vulvar cancer. She had ostomy surgery 10 years ago for urethral cancer, and they did a hysterectomy then. She's also Type II diabetic, and is only slightly overweight, nonsmoker. Any thoughts on seeking treatment? She went to her GYN because she had small grwoths on one side of her vulva and had a burning sensation for about a year.

Your mother definitely needs a biopsy. There are many things that can cause bumps or rashes in elderly women that are not cancerous. These include lichen sclerosis, atrophy, infection etc. Depending on the biopsy results, the treatment will vary. You should be referred to a gynecologic oncologist if the biopsy reveals cancer.

Q : 9

Can robotic gynecologic surgery for hysterectomy be performed safely without using general anesthesia?

There is no way to safely perform any laparoscopic or robotic surgery without general anesthesia. Because of the gas that is used to inflate your abdomen which allows for surgery to be performed, there is too much pressure on your airway and on your lungs to be safely managed with any other form of anesthesia. Plus, with the steep upside down positioning required for robotic hysterectomy, only general anesthesia can be used. However, an open or old-fashioned hysterectomy can be performed with epidural analgesia. If you are trying to avoid general anesthesia, you may want to talk to your physician about the old fashioned route of surgery.

Q : 10

My mom has been suffering from cervical cancer after menopause for the last two years. A biopsy revealed necrotic tissue with invasion and differentiated squamous cell carcinoma. She was told that she needed radiation first and then would be eligible for surgery. Is this the right process given her biopsy results? She'd rather have her uterus removed with surgery instead of receiving the radiation. Would that be dangerous?

Treatment of cervical cancer is going to depend upon the stage at which it is diagnosed. Radiation can be used at any stage and it typically combined with a small dose of chemotherapy. However, radiation is typically used to treat locally advanced (Stage II-IV) disease whereas surgery is typically used to treat stage I disease or cancer confined to the cervix. There are of course variations to these standards based upon the patient's individual differences. But if the cancer has spread outside of the cervix, surgical management does not allow for surgical margins due to the position of the cervix, adjacent to the bowel, bladder and ureters. This means that if the cancer has spread outside the cervix, surgery will cut through cancer and not be curative - leading the patient to need further treatment with radiation anyway.

Q : 11

My sister is experiencing recurrent radiation enteritis more and more frequently. She had radiation therapy for uterine cancer after a hysterectomy 25 years ago. She is 78 and is beginning to weaken now from weekly gastric attacks, losing weight, etc. Can anything be done?

Radiation enteritis is a terribly difficult late complication of radiation. There are simple things to try such as dietary changes and fiber (see this NCI bulletin: There also may be some steroid suppositories that your sister may find helpful as well as other anti-inflammatory medications. Otherwise I would try to find a gastroenterologist to work with. This is a long standing problem that often requires patience and time to decrease symptoms.

Q : 12

Would a cold knife cone biopsy or a D&C procedure cause heavy periods and pain? I had surgery two months ago.

The usual time course for heavy periods and pain following a cone biopsy or D&C is 2-3 weeks. By 2 months later, most of the pain and bleeding from the procedure should have resolved. Perhaps the reason for initially undergoing the procedure is the still causing these symptoms. I would follow up with your surgeon to let them know that you are still feeling this way. Also make sure that you have received final pathology from your provider. There may be other treatments that you need in order to alleviate these symptoms.

Q : 13

I have used bio identical hormones (estradiol & progesterone) for management of Menopause symptoms for several years. What routine tests do you recommend to monitor the increased possibility of cancer from hormone replacement therapy? Do you routinely test estradiol and progesterone levels?

There is a screening test for cervical cancer (the pap smear), but no screening tests exist for other gynecologic malignancies (ovarian and endometrial cancer). The risk of cancer from HRT, although higher than controls in the women's health initiative, is still quite small and to many patients an acceptable risk given the alternative of menopausal symptoms. I do not routinely test estradiol or progesterone levels. Your routine health maintenance (mammogram, colonscopy, etc.) should be discussed with your physician and any other testing should be individualized to your health needs.

Q : 14

I am 43 years old. I have had abnormal paps for the last three years and three cone biopsies. The results showed adenocarcinoma in situ and squamous cell in situ. My gynecologist has recommended a laparoscopic hysterectomy. Should I ask for a referral to a gynecologic oncologist?

I would agree that this history is an indication for a hysterectomy. It is never the wrong thing to get a second opinion -- and a gynecologic oncologist may be a good person from whom to get a second opinion. The type of hysterectomy performed for in-situ disease (which is pre-cancerous) is the same type of hysterectomy that a general ob/gyn is trained and certified to do. It certainly depends on the level of comfort that you have with your physician.

Q : 15

I just had a few questions regarding HPV. My first question is if I stay with the same partner who infected me with the virus, will I continuously get reinfected? My second question is, will HPV affect the possibility of having a baby? I had a biopsy done which confirmed cervical dysplasia and got a laser treatment but I'm finding it difficult to find answers to my questions.

The HPV virus is carried by approximately 70% of the US population. We don't generally treat the virus unless there is a symptom (such as warts) or a precancerous finding on pap/colposcopy/biopsy (dysplasia). Over time you and your partner should clear the virus -- your immune systems will figure out how to destroy the virus, but removing the cells which have made the cervix abnormal is still necessary (eg. laser treatment). Outside of very specific circumstances the presence of HPV or even treatment for dysplasia should not affect your ability to get pregnant or carry a pregnancy.

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