Online Health Chat with Mariam AlHilli, MD
Tuesday, September 13, 2016 | Noon
Gynecologic cancers attack a woman’s reproductive organs, including the cervix, uterus, ovaries, endometrium, fallopian tubes, vagina, and vulva. Every woman is at risk for developing gynecologic cancer. The American Cancer Society estimates that 106,000 new cases of gynecologic cancer will be diagnosed and approximately 31,000 deaths will occur in the United States in 2016.
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.
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.
About the Speaker
Mariam AlHilli, MD, is a gynecologic oncologist in the Department of Obstetrics and Gynecology at Cleveland Clinic’s ObGyn & Women’s Health Institute.
Dr. AlHilli specializes in the surgical and chemotherapy management of women with gynecologic cancers including ovarian cancer, endometrial cancer, cervical cancer and vulvar cancer. Her interests include robotic and minimally invasive surgery, gynecologic cancer screening, and evaluation of hereditary gynecologic cancers.
She is a fellow of the American College of Obstetrics and Gynecology and a member of the Society of Gynecologic Oncology.
Let’s Chat About Gynecologic Cancers
Common Cancer Questions
GrannyG: How many different types of gynecologic cancer are there? If you have one type, do you have a higher risk for developing another?
Mariam_AlHilli,_MD: Gynecologic cancers include uterine/endometrial cancer, ovarian/fallopian tube cancer, cervical cancer, vulvar cancer and vaginal cancer. There are many subtypes of these cancers. Cervical and vulvar or vaginal cancer can be linked to HPV. Ovarian and uterine cancer can be linked as part of a hereditary syndrome called Lynch syndrome.
GrannyG: I have heard about a link between breast and ovarian cancer. Is breast cancer also linked to other gynecologic cancers (cervical, uterine, etc.)?
Mariam_AlHilli,_MD: Breast cancer is generally not linked to uterine or cervical cancer.
JMFEIG: Can you describe the symptoms? My grandma passed from cervical cancer, but I am immunosuppressed from a kidney transplant so I am trying to be educated and aware of all possibilities.
Mariam_AlHilli,_MD: Some symptoms to be aware of include: abnormal bleeding related to or not related to the menstrual cycle, bleeding between menstrual cycles, bleeding after intercourse and pelvic or back pain. However, cervical cancer can be screened for effectively with Pap smears and can be detected in a pre-invasive or early stage. Cervical cancer is not hereditary, but immunosuppression is a risk factor for it.
JMFEIG: In addition, I have had a C-section. I am on estrogen birth control now and do not take the sugar pills to stop bleeding altogether; but if don’t, I have periods that last months and terrible pain with them. It’s unbearable and I can handle pain, but this pain is so intense, I have to take 1.5 Vicodin every four hours to even take the edge off. They have not found any cancer and have suggested that the pain is due to scar tissue, but why would my body be doing this? Being immunosuppressed and being on estrogen does not feel like a safe long-term solution, but a hysterectomy is being cautioned due to high risk. Could these be worrisome symptoms for cancer, and do you have suggestions on why my body is doing this?
Mariam_AlHilli,_MD: I believe you would benefit from an office visit with one our specialists to address your concerns more thoroughly. You may call the Women's Health Institute at 216.444.6601 to schedule an appointment. You can also schedule online by visiting https://my.clevelandclinic.org/WebContact/WebAppointment.
Sunny23: I am 59 years old and have had a peritoneal cyst (about 3-4 cm) in the cul-de-sac, near the cervix, for more than 30 years. I had a laparoscopy in 1983, and the gynecologist saw it and removed some adhesions but left it there. I had one child at that time and then had three more. Occasionally, I experience a shooting pain in the rectum or vagina, but this has become less frequent after menopause. Is this something that should be removed, or should I forget about it? My gynecologist has sent me twice (three months apart) for a pelvic and transvaginal ultrasound and CA125 test due to one episode of post-menopausal bleeding and an ovarian cyst. I also had an endometrial biopsy. The cyst is gone, the CA125 was very low (15, then 12) and the cul-de-sac cyst remains unchanged. Thank you.
Mariam_AlHilli,_MD: Peritoneal (inclusion) cysts are benign. However, they may become large/grow and produce symptoms. If you have had it for 30 years and it has remained stable/unchanged and has not been causing symptoms, it does not need to be removed.
auntieC: I was recently diagnosed with a uterine fibroid that is approximately 8 cm. I have had symptoms for 10+ years. I do not want a hysterectomy. How worried should I be that this might be uterine cancer? Is there a test to determine if it is cancer without surgery?
Mariam_AlHilli,_MD: Uterine fibroids are generally benign and are not associated with cancer. There are some non-surgical options for treatment of uterine fibroids that can be offered. An endometrial biopsy can be done to rule out endometrial cancer.
What About Bleeding?
Gyna: When would “Wait and Watch” be an option after minimal post-menopausal spotting?
Mariam_AlHilli,_MD: Any postmenopausal bleeding or spotting should be investigated with an ultrasound and endometrial biopsy. We would not recommend watching and waiting unless investigations were negative. However, at times, if the endometrial biopsy is negative, a D&C and hysteroscopy may be needed.
Gyna: I'm almost 90 and in good health. I had scant vaginal spotting two months ago, and nothing since. A pelvic ultrasound and MRI were inconclusive, as the radiologist could not see clearly past fibroids. Four years ago, spotting was caused by irritation from a bike saddle. Some endometrial lining thickening has occurred but not more than four years ago. Without spotting, are there other symptoms?
Mariam_AlHilli,_MD: In addition to the ultrasound and pelvic MRI, an endometrial biopsy is needed. Even without a thickened endometrial lining, postmenopausal bleeding may be a sign of endometrial cancer. A pelvic exam is also needed.
Gyna: I wondered without spotting for two months, whether I would be considered asymptomatic.
Mariam_AlHilli,_MD: Any bleeding or spotting after menopause would need to be evaluated and considered an abnormal symptom. If you have already been evaluated, I would recommend following up with the doctor who is treating you.
keroppi: Can signs of endometrial cancer or other gynecologic cancers ever be detected via transvaginal ultrasound, and are the signs ever misread as "calcifications or mineralizations”? Would any gynecologic cancer ever show up on transvaginal ultra as spots or "foci" of "increased echogenicity?"
Mariam_AlHilli,_MD: Ovarian cancer may be seen as a mass or complex cyst on one or both ovaries. Endometrial cancer may be first detected with a thickened endometrial lining. Some of these descriptions (calcifications or increased echogenicity) may need to be evaluated further or explained in the context of the ultrasound and their location.
Gyna: What is the success rate of an endometrial biopsy when an earlier D&C failed because of cervical stenosis?
Mariam_AlHilli,_MD: If a D&C is not successful due to cervical stenosis, an office endometrial biopsy may be very difficult. However, a medication to "soften" the cervix can be given to facilitate the procedure.
pest02basil: I have uterine/ovarian cancer that was detected so early that CT scans did not pick it up. Now that I have completed six months of chemo and radiation, repeated CT scans show nothing. How do I know that the cancer is in remission?
Mariam_AlHilli,_MD: Recurrence of uterine or ovarian cancer is most often detected based on new symptoms and signs, with an office examination with your oncologist. A blood test (CA125) may be a marker of early recurrence if elevated prior to surgery.
Gyna: What is a pelvic exam? What is the procedure? Who does it? Where? How?
Mariam_AlHilli,_MD: A pelvic exam includes a speculum exam to look at the cervix and vagina, and an internal/vaginal exam to feel the cervix and uterus for any abnormalities. This is done in the office by an OB/GYN physician, nurse practitioner or primary care physician. You can learn more about pelvic exams here: my.clevelandclinic.org/health/diagnostics/pelvic-exam-ob-overview.
auntieC: How often should a woman get a Pap smear? I hear differing guidance now.
Mariam_AlHilli,_MD: The new guidelines recommend screening starting at the age of 21 with Pap smear (without HPV test) every three years up to the age of 29, then every three to five years until the age of 65.
Concerns After Treatment
nonagreen: My daughter is 31 and was just diagnosed with ovarian cancer. Will it still be possible for her to have children?
Mariam_AlHilli,_MD: Depending on the surgery performed or to be performed and the stage of the cancer, she may be able to have children if the uterus and one of the ovaries is preserved.
kehawk01: My mom just had an emergency hysterectomy with stage III ovarian cancer and now has an issue with fluid building up. She is being treated and now has a drain. Will this be an ongoing issue or will her body correct the fluid reaction?
Mariam_AlHilli,_MD: Usually, this issue resolves with time.
victoria12: I had a hysterectomy for endometrial cancer laparoscopically through the belly button plus three radiation bouts, and I have developed an abdominal hernia. Why does this develop in 25 percent of women? I’m not a good candidate for future surgeries to repair [the hernia].
Mariam_AlHilli,_MD: The risk of hernia after laparoscopic surgery is in fact very low (less than 1 percent). Most hernias can be repaired surgically if symptomatic. A consultation with a general surgeon may be helpful.
Seeking a Provider
ghernandez: I was diagnosed (CA125) with H/O squamous cell carcinoma cervical cancer metastatic to lymph node in Puerto Rico in 2014. My doctor, Dr. Pedro Escobar, did a radical hysterectomy surgery. Then I received radiotherapy and five chemotherapies of carbonplatin and Taxol. In 2015 at Hershey Penn State Hospital, I was diagnosed again with lymph node in the right inguinal area and received cisplatin and 11 radiotherapies. Presently in 2016, it came back again, and I am receiving five chemotherapies of Gemzar. Now I am working as teacher in Baltimore. My leg is swollen and I can touch the nodules in my right inguinal area. I don't want to take more therapies because I feel too weak to work. I don't know what doctor to go to here. What can I do?
Mariam_AlHilli,_MD: I would recommend a second opinion from a GYN Oncologist. The Society of Gynecologic Oncology has a search tool that may help you find a specialist in your area: www.sgo.org/seek-a-specialist/. Cleveland Clinic also offers an online second opinion service called MyConsult: my.clevelandclinic.org/online-services/myconsult.aspx.
kehawk01: I don't think my mom is getting very good care at her current hospital. There have been a few episodes of negligence, and she just had her hysterectomy 10 days ago and has a long road to recovery. I am trying to talk her into exploring the idea of switching hospitals and cancer care teams. She is hesitant because the current hospital already is treating her, and they diagnosed her and operated on her, so she feels she is too far down the path to switch. What is your recommendation? Is this process too much trouble than it is worth at this point?
Mariam_AlHilli,_MD: If her cancer treatment has not started already after surgery, it is not too late to seek a second opinion. Generally, review of medical and surgical records would help guide additional treatments. I would recommend a second opinion if you are not comfortable. For an evaluation at Cleveland Clinic, you may call the Women's Health Institute at 216.444.6601 to schedule an appointment. You can also schedule online by visiting https://my.clevelandclinic.org/WebContact/WebAppointment.
That is all the time we have for questions today. Thank you, Dr. AlHilli, 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 at my.clevelandclinic.org.
To make an appointment with Dr. AlHilli, or any of the other specialists in Cleveland Clinic’s ObGyn & Women’s Health Institute, please call 216.444.6601, toll-free at 800.223.2273 (extension 46601) or visit us at clevelandclinic.org/obgyn for more information.
For More Information
About Cleveland Clinic
Through a multidisciplinary approach, Cleveland Clinic gynecologic oncologists explore all medical, surgical and radiation options to ensure that our cancer treatment program results in the best possible outcome for each patient. While you have many treatment options, you should consider the experience of the program where you will receive your care. Cleveland Clinic is top-ranked in Ohio and No. 3 in the nation in gynecology, according to U.S. News & World Report.
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. 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. Our membership in NRG Oncology, an international cooperative research group funded by the National Cancer Institute, offers patients access to investigational treatments through a wide range of ongoing clinical trials. Additional studies give patients access to other new treatments under investigation.
The Cleveland Clinic gynecologic oncology team understands the fear and uncertainty a diagnosis of cancer brings. Our specialized services and supportive care are here to help, providing access to support groups and home care arranged by clinical nurse specialists who also provide counseling. For your convenience, we have several locations across Northeast Ohio.
Cleveland Clinic Health Information
Learn more about symptoms, causes, diagnostic tests and treatments for gynecologic cancers:
For more information about a variety of health topics, please visit clevelandclinic.org/health.
Download our free treatment guide to learn more: Gynecologic Cancer Treatment Guide.
For additional information about clinical trials, visit: ClinicalTrials.gov.
MyChart® is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: email@example.com.
A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.
This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2016. The Cleveland Clinic Foundation. All rights reserved.