Online Health Chat with Haider Mahdi, MD, MPH

November 27, 2017


When you have been diagnosed with a female cancer, seeking care from a gynecologic oncologist before surgery or medical treatment increases your odds of total cure. Our physicians have pioneered many treatment methods and have a large experience in treating gynecologic cancers. Each year, women with cervical, ovarian and other cancers of the female reproductive system make approximately 12,600 visits to Cleveland Clinic gynecologic oncologists.

Cleveland Clinic gynecologic oncologists are among approximately 1,000 physicians in the United States who are board certified in gynecologic oncology, as well as obstetrics and gynecology by the American Board of Obstetrics and Gynecology.

Cleveland Clinic’s team approach of involving multiple specialists can be the most important factor in cancer treatment. Our oncologists work closely with gynecologic pathologists, radiation oncologists, radiologists, nurse practitioners and physician assistants. Together, they provide a careful blend of accurate diagnosis, surgical skill, leading-edge radiation therapy, advanced chemotherapy and compassionate care.

Cleveland Clinic understands the fear and uncertainty a diagnosis of cancer can bring. Our specialized team includes nurse practitioners/physician assistants who are licensed independent providers that will work with your gynecologic oncologist to provide care and help coordinate your cancer treatment. Our team also includes nurse navigators, chemotherapy coordinators and social workers who will provide supportive care and patient education. Our multidisciplinary team is here to help you throughout this difficult time.

About the Speaker

Haider Mahdi, MD, MPH, is a gynecologic oncologist in the Ob/Gyn & Women’s Health Institute at Cleveland Clinic. Dr. Mahdi graduated from his obstetrics and gynecology residency at University of Washington, Seattle in June 2012 and from a gynecologic oncology fellowship at Cleveland Clinic in June 2015. He finished his Master’s in Public Health degree at Case Western Reserve University.

Dr. Mahdi sees patients at Main Campus, and Fairview and Medina Hospitals. Dr. Mahdi sees and treats patients with gynecologic cancer and pre-cancer conditions. Dr. Mahdi performs surgery using different approaches including open, laparoscopic, single incision laparoscopic and robotic approaches. Dr. Mahdi administers chemotherapy for patients with gynecologic cancer in different regimens including intra-peritoneal chemotherapy and heated chemotherapy (HIPEC). Dr. Mahdi's research interests are hereditary cancers, genomics of gynecologic cancers, outcomes research and disparities in cancer care and outcomes.

Let’s Chat About Gynecologic Cancer

Surgical Suggestion

Susy1: Can the type of surgeon I select make a difference in my outcome from ovarian cancer surgery?

Haider_Mahdi,_MD,_MPH: Overall, yes. Studies show that ovarian cancer surgeries performed in large, tertiary care centers are associated with better outcomes.

Conversation on Categories

California45: Is vaginal cancer the same as gynecologic cancer?

Haider_Mahdi,_MD,_MPH: Vaginal cancer is one type of gynecologic cancer, but it is one of the least common types.

curious1234: What are the different types of gynecologic cancer?

Haider_Mahdi,_MD,_MPH: There are the common types, which include ovarian and uterine cancer. There are also the less common types, such as cervical, vulvar and vaginal cancer.

gynonc34: What is endometrial cancer?

Haider_Mahdi,_MD,_MPH: Endometrial cancer is cancer of the lining of the uterus. It is more common in women of postmenopausal age, and usually presents with postmenopausal bleeding. It is usually related to high estrogen levels

Probability and Prevention

runner54: Is there anything I can do to decrease my risk for gynecologic cancer?

Haider_Mahdi,_MD,_MPH: Yes. For one thing, prior studies have shown that taking oral birth control pills decreases the risk of ovarian cancer. Also, being compliant with getting your Pap tests significantly lowers the risk of cervical cancer.

beachvibes23: My sister had cervical cancer in her 50s. Am I at a higher risk for that type of cancer?

Haider_Mahdi,_MD,_MPH: Cervical cancer usually is not hereditary. Uterine cancer can be hereditary in two to three percent of people, and ovarian cancer can be hereditary in 15 to 25 percent.

rachelrtg: Are clinical trials offered for gynecologic cancer, and is it safe to participate in them?

Haider_Mahdi,_MD,_MPH: Yes. We have multiple clinical trials ongoing for gynecologic cancer. In general, they are safe with a small risk. We generally counsel our patients extensively about the risks and benefits of participating.

Significant Signals

NTN8908: What are some of the main symptoms of gynecologic cancers to keep an eye out for?

Haider_Mahdi,_MD,_MPH: There are different symptoms you need to watch out for. An example includes vaginal bleeding after menopause, which is a warning sign for endometrial cancer. Heavy bleeding after intercourse can be a warning for cancer in the cervix. Other, non-specific symptoms of the bowel, such as bloating, weight loss or nausea/vomiting can be warnings for ovarian cancer if persistent.

Butterfly1: I frequently have cramping and am wondering if this could be a sign something is wrong with me. Are there symptoms for gynecologic cancer?

Haider_Mahdi,_MD,_MPH: Thank you for your question. There are different symptoms that you need to watch out for. An example includes vaginal bleeding after menopause, which is a warning sign for endometrial cancer. Heavy bleeding after intercourse can be a warning for cancer in the cervix. Other, non-specific symptoms of the bowel such as bloating, weight loss or nausea/vomiting can be warnings for ovarian cancer if persistent.

Development Dialogue

bethany5567: I’ve always had normal Pap smears and have just received a diagnosis of cervical cancer. How is this possible? Could this be a mistake?

Haider_Mahdi,_MD,_MPH: Pap tests are not perfect, and we still see instances of cervical cancer despite normal Pap results, especially if the cell type is an adenocarcinoma.

swimmerSTV: I get cysts on my ovaries frequently. Can these turn into cancer?

Haider_Mahdi,_MD,_MPH: That does not occur very often. It depends on the size and appearance of the cysts. If they are complex, the risk is about five to ten percent, but it could be higher if there are other symptoms or something on the radiologic findings.

BETHELMOM: I have been diagnosed with an abnormal endometrial cavity for my age. I was tested and had a biopsy in September 2016, which came back negative. My question is: Is this something that needs to be followed up yearly, etc., or was the benign test sufficient?

Haider_Mahdi,_MD,_MPH: It depends on what you mean by “abnormal cavity”? Does it have a thickened lining? If it has a thickened lining, a biopsy is needed every time this is discovered. Also, a biopsy is typically indicated for postmenopausal bleeding or for abnormal pre-menopausal bleeding if there is suspicion for uterine cancer, especially in high risk pre-menopausal women.

How About HPV

NTN8908: If someone has been diagnosed with HPV, what are the odds of it turning into cervical cancer?

Haider_Mahdi,_MD,_MPH: The odds are not high, but it can occur. Usually, that takes several months to years, but HPV transforms first to pre-cancer then to cancer. The key is to do frequent follow-ups and observation to detect any change at the pre-cancer stage.

cancer78: Does HPV turn into cancer? How can a Pap smear help prevent cancer?

Haider_Mahdi,_MD,_MPH: Yes, HPV can lead to cancer. It causes the cells in the cervix to transform into cancer. In fact, cervix cancer is almost always caused by high-risk HPV infection. Pap tests help detect the problem at the pre-cancer stage before it progresses to cancer. It is easy to treat at the pre-cancer stage with overall excellent outcomes.

Carie: I am in my 60s and have been in a mutually monogamous marriage for many years. I always had negative Paps until two years in a row when I had positive PAPs for HPV. Both times, colposcopy was negative. My most recent Pap was negative for HPV. Have you found that this is something that comes and goes in older women?

Haider_Mahdi,_MD,_MPH: It can. Our bodies can clear the infection from our systems. That is more likely to occur in younger women than older women, but it is possible in older age. The key is to do follow ups and observation to make sure to detect any changes in the HPV at the pre-cancer stage before it transforms to cancer. That's why regular Pap and HPV tests are beneficial.

Sandy123: How long does it take for HPV infection to progress to cervical hyperplasia?

Haider_Mahdi,_MD,_MPH: I am sure you meant dysplasia, which is pre-cancer. That is variable, but it generally takes a long time, several months to years. As I mentioned earlier, the key is serial follow up and repeated Pap and/or HPV tests for early detection and prevention.

Drug Difference

Sandy123: Does a history of uterine/endometrial polyps that have been surgically removed, but with the root still there increase the risk of uterine or endometrial cancer? How about with the inclusion of taking Tamoxifen for past breast cancer (1 centimeter, ER+95% PR+95% Her2 neg)?

Haider_Mahdi,_MD,_MPH: A history of polyps, if the polyps were benign, does not increase the risk of cancer. However, Tamoxifen does increase the risk. Therefore, it is always recommended to check with your doctor and have a biopsy of the lining of the uterus if you start to have vaginal bleeding while on Tamoxifen.

XOXOXO: My doctor has me taking Estrace cream for vaginal atrophy. He says I will be taking it for the rest of my life. The increased risk of cancer of the uterus concerns me. Is there a safer long-term alternative?

Haider_Mahdi,_MD,_MPH: Local estrogen is safe.


That is all the time we have for questions today. Thank you, Dr. Mahdi, for taking time to educate us about gynecologic cancers.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online.

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About the Ob/Gyn & Women’s Health Institute
The Ob/Gyn & Women’s Health Institute is designed to meet the unique and changing medical needs of women from adolescence to mature adulthood. Our team offers coordinated and supportive care for the programs that affect women’s lives, from infertility, incontinence, gynecologic cancers, pelvic floor disorders, menopause and more. We are committed to providing world-class care to women of all ages.

The Ob/Gyn & Women’s Health Institute offers a full complement of subspecialty services that fall within the field of women’s health, from general gynecologic care to complex oncology surgery for gynecologic malignancies. The Institute model has streamlined the care of women, enhanced research opportunities, and improved the education of physicians, nurses and other health care professionals. Services are available at locations throughout northeast Ohio including our main campus, as well as in family health centers and hospitals throughout the region. The Ob/Gyn & Women’s Health Institute works closely with Cleveland Clinic Cancer Center to provide the best care for gynecologic oncology patients.

The Department of Obstetrics and Gynecology was the top-rated program in Ohio and ranked number five nationally by U.S. News & World Report's “2017-18 Best Hospitals.”

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