Online Health Chat with Thomas Morrissey, MD
August 27, 2015
Any woman is at risk of developing a gynecologic cancer and that risk increases with age. Gynecologic cancers are the uncontrolled growth and spread of abnormal cells in the female reproductive organs. These organs include the cervix, uterus, ovaries, fallopian tubes, vagina and vulva. Regular screenings with your gynecologist can result in the earlier detection of certain types of gynecologic cancers, when treatment is more likely to be successful and a complete cure is possible. Family history also plays an important role in diagnosis as some women may carry a gene that makes them more susceptible to cancer.
Some symptoms of gynecologic cancers can include:
- A change in bowel or bladder habits
- Soreness in the pelvic area that does not heal
- Unusual vaginal bleeding or discharge
- Thickening or lump that either causes pain or can be seen in the pelvic area
- Pain or pressure in the pelvic area
Cleveland Clinic Florida offers patients access to the latest techniques in the management of gynecologic cancers including the newest drug treatments, advanced surgical options and access to clinical trials. We also have a state of the art Chemotherapy Infusion Suite designed to include the family of our cancer patients in a healing environment. Treatment plans are tailored to each patient’s needs, based on their type of cancer, age, the degree to which their cancer has spread and the individual’s overall health. Log on to speak with a Cleveland Clinic Florida gynecologic oncologist and learn more about the latest innovations in the treatment of gynecologic cancers.
About the Speaker
Thomas Morrissey, MD is a gynecologic oncologist in the Department of Gynecology at Cleveland Clinic Florida. He is board-certified in Obstetrics and Gynecology and Gynecologic Oncology. Dr. Morrissey specializes in the diagnosis and treatment of cancers of the reproductive system in women. His specialty interests include robotic-assisted laparoscopic surgery for cervical, endometrial and ovarian cancers; gestational trophoblastic disease; cervical, vaginal and vulvar dysplasia / HPV-associated disease and gynecologic care of patients with breast cancer.
Let’s Chat About Innovations in Gynecologic Cancers
Welcome to our Online Health Chat "Innovations in Gynecologic Cancers" with Thomas Morrissey, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.
Prevention & Genetics
Diana: Are there currently any new treatments to prevent ovarian and cervical cancers other than the HPV vaccine?
Thomas_Morrissey,_MD: The HPV vaccine will hopefully prevent a significant cervical cancers. The more young women we are able to vaccinate, the greater the decrease we should see. The only truly effective treatment to prevent ovarian cancer is removal of the ovaries, which we do recommend in certain high risk women. Use of birth control pills has been shown to decrease risk of ovarian cancer, as does increasing numbers of pregnancies and breast feeding.
Rita0920: My mother and grandmother both had ovarian cancer and I'm concerned now about my risk. What role do genetics play in developing this type of cancer?
Thomas_Morrissey,_MD: You should definitely be evaluated by a genetic counselor for testing for hereditary breast and ovarian cancer syndrome (BRCA testing). If they test you and you have a gene mutation that we know puts you at high risk for cancer, preventative surgery can be recommended. Alternatively, if your testing is negative for a genetic mutation, routine well-woman care may be sufficient.
Symptoms & Testing
SummerFun: I am over 60. My gynecologist says I only need to come in for a PAP test every three years now. Is this correct?
Thomas_Morrissey,_MD: Thanks for your question. Yes your doctor is correct, the recommendations for pap smear screening is every three years between ages 30-65, and no further routine screening after age 65. However, for people who have a history of abnormal Pap smears or treatment for cervical pre-cancer, Pap smear screening should continue for at least 20 years after that treatment. An alternative strategy is to do a Pap smear and a high-risk HPV virus screen every five years.
Pati51: Are ultrasounds more effective than Pap test at diagnosing early stage gynecologic cancers? I've had people recommend getting an ultrasound, especially given I have a family history of ovarian cancer.
Thomas_Morrissey,_MD: Pap tests are only useful for detecting cervical (and sometimes vaginal) cancers. Pap tests do not detect problems with the ovaries and uterus. There is no effective screening test for ovarian cancer. For patients with strong family histories of cancer, a consultation with a genetic counselor can determine whether genetic testing is indicated, which could help determine if there is a genetic predisposition toward cancer and whether or not preventative surgery is indicated. The first step is to have a careful family history taken by your primary doctor or gynecologist.
LucyintheSkies: As a woman is nearing menopause, what symptoms should alert you to see a physician for examination? For instance, I had one extremely heavy period which I did not think to be unusual since my friends talked about unbelievably heavy periods with the beginning of menopause. Mine lasted 19 days and I just happened to casually mention it to my physician when I was in for a checkup. A few tests later and it was determined to be endometrial cancer and I had a hysterectomy. So I am concerned for other women to be aware of possible signs and symptoms.
Thomas_Morrissey,_MD: Pelvic pressure or fullness, swelling of the abdomen, or heavy bleeding or bleeding or discharge that continues for longer than usual period are some reasons to contact your doctor for evaluation. Many people do in fact see a change in the length of their cycles and may have increased bleeding as they near menopause, and most don't have cancer. Good luck with your treatment.
Gail Ann: Which tests and imaging would be done to determine if gynecological cancer is present? Thank you for answering my question.
Thomas_Morrissey,_MD: For patients who have a history of ovarian cancer, we use physical exams, CT scans, PET scans, and a tumor marker blood test called CA125 to follow progress and help determine if there is cancer present. For someone who has symptoms or a growth in the ovary that is worrisome for ovarian cancer, we also use exams, ultrasounds, CT scans and blood tests as your doctor may feel is appropriate for evaluation; if a mass is found then surgery is the only way to get a definite diagnosis.
Dbba50: Are vaginal lesions cancerous?
Thomas_Morrissey,_MD: Some can be, many are not. Any new lesion or suspicious or bleeding lesion should be evaluated by a qualified doctor and biopsy done if necessary.
HPV & Gynecologic Cancers
Carie: If a woman had HPV in the past but now tests negative for it, is she still at increased risk of cervical cancer or does her risk go back to normal?
Thomas_Morrissey,_MD: We are still learning about HPV and its natural history; it is possible for someone to have a positive HPV test, then test negative for HPV for a long period and then have reemergence of detectable HPV again years later which could cause problems. So while I cannot tell you what the exact risk is, it would be very low, but not quite as low as someone who never had HPV.
Carie: I was told by my doctor's assistant that the HPV virus never really goes away once you have it, and instead lays dormant in the body and can reactivate again in the future, such as when your immune system is weakened. Is that true?
Thomas_Morrissey,_MD: Yes that is true. We are still learning more about HPV all the time. But yes we see patients with undetectable HPV, later have reoccurrence of positive HPV tests with no new exposures, so the thinking is that there must be a "dormant" phase in at least some patients.
Carie: Does HPV raise the risk of other cancers besides cervical?
Thomas_Morrissey,_MD: Yes. HPV increases risk and is a partial cause of cervical, vaginal and vulvar cancers, as well as anal/rectal cancers and also head and neck cancers. We are learning more about HPV, how it works, what it causes, and how to treat/prevent the problems it can cause.
socworker: I was diagnosed with Stage IV PPC or ovarian cancer in 2011. I had surgery at a teaching hospital outside Chicago, but my oncologist is in a smaller clinic. My sense is that there aren't a lot of new chemos available. So far I've had Carboplatin/taxol 3 times (18 weeks each) with remission ranging from 7-11 months. Most recently, Doxil was tried but the side effects have been very bad and my CA 125 has gone up. So we are looking at having to change the protocol. Should I be at a teaching hospital or is the treatment fairly standard once surgery is over? (I'm aware of how critical good surgery is, and mine was excellent.) Thanks.
Thomas_Morrissey,_MD: Hello and thanks for your question. There are a number of standard medicines that can be used in your situation. Gemzar and topotecan are medicines that are used; avastin can also be effective. You may also be a candidate for entry on clinical trials testing newer medications; these change frequently; usually a consultation at an academic center that does ovarian cancer research trials should be able to provide you with information on your options.
AllyBell: My sister is scheduled for a hysterectomy following a diagnosis of endometrial cancer. She has Stage 1, grade 3 cancer. What method of surgery is used for that type of diagnosis? A full hysterectomy? Laparoscopic?
Thomas_Morrissey,_MD: The standard surgery will include removal of the uterus cervix both tubes and ovaries, as well as lymph nodes from the pelvic and para-aortic areas. The pathologist with then analyze those tissues and the results will determine the Stage of the cancer. Further treatment after surgery (chemotherapy and/or radiation, or no treatment) will be recommended based of the surgical stage. This surgery is most often performed laparoscopically, unless there are other reasons to perform surgery through a larger incision.
Symonee: Would you explain what an endometrial ablation is and if a biopsy of the endometrium is taken before the ablation to rule out cancer? Or is it common practice to do the ablation then upon exam of the tissue samples to determine whether or not there is cancer? Would this alter the ability to stage the cancer?
Thomas_Morrissey,_MD: Endometrial ablation is a treatment where the lining of the uterus (the part that bleeds each month) is either frozen, burned, or cut away so that there will not be any of the tissue left to bleed each month. An endometrial biopsy is mandatory sometime before the procedure. Ideally this is done and the results received before that ablation, but some doctors may opt to do the biopsy right before the ablation and the results are not received until after the ablation is done. This does complicate the staging and evaluation of cancer because after the ablation it is impossible to determine the exact depth of invasion which is part of the staging criteria.
Angelgrl14: Is a hysterectomy the only option for treating endometrial cancer? Is chemotherapy given after surgery?
Thomas_Morrissey,_MD: Hysterectomy is the best and standard treatment for endometrial cancer. However, in younger patients who want to try to preserve ability to have children, we sometimes can treat with hormonal medications or a hormonal IUD to treat the cancer and save the uterus. The success rates are not as high as hysterectomy, however. In patients with other medical problems and cannot have a hysterectomy, radiation therapy or hormonal therapy can be used to treatment endometrial cancer; those treatments are also not as successful as surgery.
socworker: Do you recommend intraperitoneal chemotherapy even with Stage IV disease that has spread into the lymphatic system? If so, how can it be helpful?
Thomas_Morrissey,_MD: Intraperitoneal chemotherapy is most helpful/effective with cancers that have been optimally debulked with minimal residual tumor. In the largest studies, the effectiveness in patients with metastasis to the retroperitoneal lymph nodes may not be as great as in patients without lymph node involvement. There are many risks and benefits to discuss with your doctor regarding intraperitoneal chemotherapy, and while I believe that it should always be considered a possible option for treatment, it may not be appropriate for everyone.
MandyM6078: I had my first abnormal pap smear and was diagnosed with cervical cancer last month. I'm grateful it was caught early but am wondering what my prognosis is now. Is it curable? What is the reoccurrence rate?
Thomas_Morrissey,_MD: The prognosis is dependent on the stage of the cancer and the cell type. For most cervical cancers that are caught early and have not spread outside the cervix, the cure rate is >95% with appropriate treatment. Your doctor will help you decide what the best treatment option is for you.
socworker: Has the survival rate for Stage IV ovarian/PPC changed significantly in recent years?
Thomas_Morrissey,_MD: Yes. While cure rate has not improved significantly, we have better and more medications that can be used to control cancer and slow its growth and progression in many patients. The average survival is now reportedly over five years from diagnosis for patients diagnosed at stage IIIC/IV.
To make an appointment with Thomas Morrissey, MD, Gynecologic Oncologist or any of the other specialists in the Department of Gynecology at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at my.clevelandclinic.org/florida.
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