Diagnostic and Screening Tools for Gynecologic Cancers

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is
00:03 --> 00:06provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:11Yale Cancer Answers features
00:11 --> 00:13the latest information on cancer
00:13 --> 00:15care by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week it's a conversation about GYN
00:21 --> 00:24cancers with Doctor Peter Dottino. Dr.
00:24 --> 00:26Dottino is a professor of obstetrics,
00:26 --> 00:28gynecology and reproductive sciences
00:28 --> 00:30at the Yale School of Medicine,
00:30 --> 00:32where Doctor Chagpar is a professor
00:32 --> 00:33of surgical oncology.
00:35 --> 00:37Maybe we can start off by you
00:37 --> 00:39telling us a little bit more about
00:39 --> 00:41yourself and what it is you do.
00:42 --> 00:44I'm a board certified obstetrician,
00:44 --> 00:48gynecologist is how I started and
00:48 --> 00:52then I did a subspecialty training in
00:52 --> 00:55gynecologic oncology almost 40 years ago.
00:55 --> 00:58I'm currently board certified in both
00:58 --> 01:00gynecological oncology and obstetrics
01:00 --> 01:03and gynecology and my practice is pretty
01:03 --> 01:06much gynecologic oncology which is women
01:06 --> 01:08with cancer that affects the reproductive
01:08 --> 01:11tract is what I see and treat.
01:11 --> 01:14Not only do I do the surgeries
01:14 --> 01:17for women with those diseases,
01:17 --> 01:18but I also do the treatment
01:18 --> 01:19and the treatment planning.
01:19 --> 01:22I do administer chemotherapy.
01:22 --> 01:26I work with radiation oncologists.
01:29 --> 01:31When we talk about
01:31 --> 01:32women with gynecologic cancers,
01:32 --> 01:36that always seems to me to be a rather large
01:36 --> 01:38bucket of of cancers.
01:38 --> 01:40Can you tell us a little bit more
01:40 --> 01:42about the different types of cancers,
01:42 --> 01:44the frequency with which you
01:44 --> 01:46see them and a little bit
01:46 --> 01:47more about each of the types?
01:49 --> 01:50Good question.
01:50 --> 01:52So the the most common gynecologic
01:52 --> 01:55cancer is uterine cancer or the other
01:55 --> 01:58name it goes by is endometrial cancer.
01:58 --> 02:02And there's roughly about 65,000
02:02 --> 02:06cases in the US a year of women
02:06 --> 02:09that get uterine cancer.
02:09 --> 02:12Uterine cancer is the one
02:12 --> 02:14gynecologic malignancy that is
02:14 --> 02:17increasing in incidence every year
02:17 --> 02:20and that is thought to be due to
02:20 --> 02:24the increasing rates of obesity in our
02:24 --> 02:27society because obesity is directly
02:27 --> 02:30related to women getting endometrial
02:30 --> 02:33cancer, but if you look at the the most common
02:33 --> 02:36overall cancers that affect women today,
02:36 --> 02:38it's number one breast,
02:38 --> 02:41#2 lung and #3 colon.
02:41 --> 02:42But what's going to happen in the
02:42 --> 02:44next two to five years is that
02:44 --> 02:46Colon will fall out of the third
02:46 --> 02:48spot because of all the colonoscopy
02:48 --> 02:50screening that's taking place.
02:50 --> 02:52And uterine cancer will be the
02:52 --> 02:54third most common cancer that
02:54 --> 02:57affects women overall after breast
02:57 --> 03:00and lung cancer following
03:00 --> 03:03Endometrial cancer, ovarian cancer,
03:03 --> 03:06which there's about 22,000 new cases,
03:06 --> 03:10here in the US.
03:10 --> 03:11And unfortunately,
03:11 --> 03:14without a screening test to
03:14 --> 03:17diagnose this disease early,
03:17 --> 03:1985% of the ladies who actually present
03:19 --> 03:22or walk into my office and need
03:22 --> 03:24some specialist who treats ovarian
03:24 --> 03:27cancer will be in very advanced
03:27 --> 03:30stages, stage three and stage 4.
03:30 --> 03:32Following endometrial cancer,
03:32 --> 03:36we will have cervical cancer roughly about
03:36 --> 03:4014,000 cases to 12,000 cases a year.
03:40 --> 03:42And then we have the rarer types
03:42 --> 03:45which would be vaginal cancer
03:45 --> 03:47and vulvar cancer which affects
03:47 --> 03:50the skin on the outside.
03:50 --> 03:53And then that makes up the the range
03:53 --> 03:56of what we see as gynecologic oncologist.
03:57 --> 04:00You know it's so interesting that
04:00 --> 04:02you say that endometrial cancer
04:02 --> 04:04will likely take the third spot
04:04 --> 04:07instead of colon cancer in large
04:07 --> 04:10part due to the fact that we have
04:10 --> 04:12good screening for colon cancers.
04:12 --> 04:15Are there good screening techniques for
04:15 --> 04:18for the GYN cancers that you mentioned?
04:19 --> 04:24Well, if you look historically the
04:24 --> 04:26screening test that was devised
04:26 --> 04:29I think in the late 1930s,
04:29 --> 04:32the Pap test was one of the
04:32 --> 04:33first screening tests
04:33 --> 04:36in all of cancer and that was
04:36 --> 04:38designed to screen for cervical
04:38 --> 04:41cancer because back in that time
04:41 --> 04:43range cervical cancer was the most
04:43 --> 04:45common cancer that affected women.
04:45 --> 04:48And over the years the Pap test
04:48 --> 04:51has been refined and now not only does
04:51 --> 04:54it pick up cervical cancer but most
04:54 --> 04:56importantly it picks up the precancerous
04:56 --> 04:59lesions that affect the cervix.
04:59 --> 05:02And so what that means is that when somebody
05:02 --> 05:04has a precancerous lesion,
05:04 --> 05:07we can eradicate those in an office setting,
05:07 --> 05:09either with cryotherapy,
05:09 --> 05:11which is freezing it,
05:11 --> 05:14we can use laser to vaporize it,
05:14 --> 05:17or we can just simply excise the lesion.
05:17 --> 05:20And that's why in this country the
05:20 --> 05:22incidence of cervical cancer went
05:22 --> 05:25from the most common cancer to the
05:25 --> 05:2713th most least likely of cancers
05:27 --> 05:30for women because the Pap
05:30 --> 05:32test for women in general access
05:32 --> 05:33health care has made a huge impact.
05:39 --> 05:42If you look at the rest of the
05:42 --> 05:44world and developing
05:44 --> 05:46countries who don't for economic
05:46 --> 05:49reasons have access to PAP testing,
05:49 --> 05:50cervical cancer is either the
05:50 --> 05:52number one or #2 killer of women.
05:52 --> 05:55But worldwide because there is an absence
05:55 --> 05:57of a screening modality and it's
05:58 --> 05:59an absolute tragedy that
05:59 --> 06:01we have a screening modality,
06:01 --> 06:03but yet it
06:03 --> 06:05remains one of the number one and
06:05 --> 06:07#2 killers of women worldwide.
06:07 --> 06:09I mean I guess the other thing that's
06:09 --> 06:11unfortunate for cervical cancer
06:11 --> 06:13is that we also have a vaccine?
06:13 --> 06:16That's correct and that's beginning
06:16 --> 06:18to make an impact
06:18 --> 06:20because I think the vaccines
06:20 --> 06:22now are maybe 10 to 12 years old.
06:22 --> 06:24And so in addition to the
06:24 --> 06:26Pap test with the vaccine,
06:26 --> 06:30this should be and will be
06:30 --> 06:32hopefully an eradicable disease.
06:32 --> 06:36There's still a lot of
06:36 --> 06:38stumbling blocks in the developing
06:38 --> 06:40world to the uptake of the vaccine,
06:40 --> 06:42but in the developing nations there has
06:42 --> 06:45been huge uptake in the
06:45 --> 06:47vaccine and this will make between
06:47 --> 06:49the Pap test and the vaccine
06:49 --> 06:52will make an enormous impact on
06:52 --> 06:54eradication of cervical cancer.
06:54 --> 06:57I'll give you an example that
06:57 --> 07:00roughly maybe 15-18 years ago I used
07:00 --> 07:02to do about 70 radical operations
07:02 --> 07:06for cervical cancer a year.
07:06 --> 07:08Currently now I will do maybe one or
07:08 --> 07:11two a year, that's how good the
07:11 --> 07:14Pap test has been in identifying
07:14 --> 07:16these precancerous lesions that are
07:16 --> 07:19just so easily treatable.
07:25 --> 07:27In my practice people that have
07:27 --> 07:28cervical cancer usually they've
07:28 --> 07:30either migrated here from countries
07:30 --> 07:33that did not have PAP screening
07:33 --> 07:35unfortunately or some people have
07:35 --> 07:36fallen through the healthcare
07:36 --> 07:39cracks in our system and they just
07:39 --> 07:42either don't have money or they don't
07:42 --> 07:45have access to PAP testing,
07:45 --> 07:48which is also a tragedy.
07:48 --> 07:50What about for endometrial cancer,
07:50 --> 07:52do we have any kind of screening for that?
07:53 --> 07:57No, there is no screening test that
07:57 --> 08:00will detect endometrial cancer today.
08:00 --> 08:02And there's work being
08:02 --> 08:06done on that and one of
08:06 --> 08:08the sort of pushbacks from the
08:08 --> 08:10general community is that endometrial
08:10 --> 08:13cancer, because women start having
08:13 --> 08:16abnormal bleeding very early in
08:16 --> 08:19the course of the disease,
08:19 --> 08:21which leads most of them to
08:21 --> 08:23see physicians very early,
08:23 --> 08:26so probably about 3/4 of the disease that
08:26 --> 08:30we see today is because
08:30 --> 08:32they have bleeding, they come in,
08:32 --> 08:35they have a a biopsy of the uterus
08:35 --> 08:37that cancer is usually detected
08:37 --> 08:39in very early stage one.
08:39 --> 08:42And the cure rates in stage one
08:42 --> 08:44are relatively high exceeding
08:44 --> 08:49over 85 to the low 90% cure rates.
08:49 --> 08:50That's fantastic.
08:50 --> 08:53The caveat I would put to that,
08:53 --> 08:55much like cervical cancer where there is
09:00 --> 09:02a well defined precancerous lesion,
09:02 --> 09:05we also know that there are well
09:05 --> 09:07defined precancerous lesions of
09:07 --> 09:10the uterus called hyperplasia.
09:10 --> 09:13And the time it takes to go from a
09:13 --> 09:15mild hyperplasia to uterine cancer
09:15 --> 09:19is roughly about 8 to 9 years.
09:19 --> 09:21So it's slow growing.
09:21 --> 09:23And what that tells you is
09:23 --> 09:25that if you could pick up these
09:25 --> 09:26precancerous lesions,
09:26 --> 09:29those could be treated without
09:29 --> 09:31surgery in most cases,
09:31 --> 09:32usually with hormonal treatments,
09:32 --> 09:36those can be reversed and spare ladies
09:36 --> 09:39the exposure to hysterectomy,
09:39 --> 09:41potential surgical complications
09:41 --> 09:44and also a loss of time from
09:44 --> 09:46work from family and so forth.
09:46 --> 09:48So there's
09:48 --> 09:50a lot of work being directed towards,
09:51 --> 09:54how can we detect these precancerous
09:54 --> 09:57stages or the earliest cancer stages.
09:57 --> 09:57Because again,
09:57 --> 09:59if you can avoid a hysterectomy,
09:59 --> 10:02that would just be a homerun.
10:04 --> 10:06So tell us more about the
10:06 --> 10:07screening that's being developed.
10:07 --> 10:09Screening has kind of passed
10:09 --> 10:11through a number of different stages.
10:11 --> 10:13And one of the first things that
10:13 --> 10:15had come on that probably about
10:15 --> 10:1810-12 years ago was the use of what
10:18 --> 10:21we call a transvaginal ultrasound,
10:21 --> 10:23where an ultrasound probe is
10:23 --> 10:24inserted into the vagina,
10:24 --> 10:27goes directly against the cervix
10:27 --> 10:30and it allows you to measure very
10:30 --> 10:32accurately in millimeters the
10:32 --> 10:34thickness of the lining of the uterus.
10:34 --> 10:37And we know for certain
10:37 --> 10:38ranges of patients
10:38 --> 10:40how thick we would expect it to be,
10:40 --> 10:43what would be considered normal and
10:43 --> 10:45what would be considered abnormal
10:45 --> 10:47and it was hoped that the
10:47 --> 10:49use of this would lead to
10:49 --> 10:50identifying precursor cases.
10:50 --> 10:55But what we didn't find out what that
10:55 --> 10:58those studies that were done was that
10:58 --> 11:01ultrasound is not inexpensive #1 and #2
11:01 --> 11:03we didn't know what interval do you use?
11:03 --> 11:05Like with your mammogram you do
11:05 --> 11:08it every year, do you do it every two years?
11:08 --> 11:10And the same thing with the Pap
11:10 --> 11:11test, we've now refined
11:11 --> 11:13it so some women can get a PAP
11:13 --> 11:14every year.
11:14 --> 11:18Some may use it every two to three years.
11:18 --> 11:20One of the tasks that
11:22 --> 11:24I with my colleagues have been
11:24 --> 11:26working on is a procedure
11:26 --> 11:27called the uterine lavage.
11:27 --> 11:29And what that means is when a
11:29 --> 11:31woman comes in for her Pap test,
11:31 --> 11:34which literally takes 15 seconds to do,
11:34 --> 11:36after we do the Pap test,
11:36 --> 11:39then we take about a teaspoon of saline
11:39 --> 11:43and we put it
11:43 --> 11:45inside the uterus and then we rinse
11:45 --> 11:47out the inside of the uterus and we
11:47 --> 11:49take that fluid and we take it to our
11:49 --> 11:52laboratory and we look for specific
11:52 --> 11:55different protein markers that are
11:55 --> 11:57indicative of these precancerous
11:57 --> 12:00and early cancer states.
12:00 --> 12:04And so far today we've done this
12:04 --> 12:06uterine lavage technique on over
12:06 --> 12:10750 women and we found this to
12:10 --> 12:13be as a screening test greater
12:13 --> 12:16than 90% sensitive and specific.
12:16 --> 12:20So we are currently expanding that
12:20 --> 12:23to increase our numbers and that's
12:23 --> 12:26something that again it's easy to do,
12:26 --> 12:30it's very inexpensive like a Pap test,
12:30 --> 12:32and it can pick up these
12:32 --> 12:33kind of precancerous conditions.
12:35 --> 12:36That's amazing.
12:36 --> 12:38It sounds like that could really have
12:38 --> 12:41a huge impact for uterine cancer.
12:41 --> 12:43When do you think that might become
12:44 --> 12:46something that we can see
12:46 --> 12:48in regular clinical practice?
12:51 --> 12:52The way these are going now,
12:52 --> 12:56it possibly could be
12:56 --> 12:5918 to 24 months you know depending
12:59 --> 13:01upon you know a lot of external
13:01 --> 13:03factors and how soon it takes to
13:03 --> 13:05recruit this many patients
13:05 --> 13:07or to get your application to the
13:07 --> 13:09FDA for approval and so forth.
13:09 --> 13:12But it's very, very encouraging.
13:12 --> 13:14Fantastic. Well, we're going to take
13:14 --> 13:16a short break for a medical minute.
13:16 --> 13:18Please stay tuned to learn more
13:18 --> 13:20about the care of GYN cancers with
13:20 --> 13:22my guest doctor Peter Dottino.
13:22 --> 13:24Funding for Yale Cancer Answers
13:24 --> 13:26comes from Smilow Cancer Hospital,
13:26 --> 13:28where their one-of-a-kind
13:28 --> 13:29Sexuality, intimacy,
13:29 --> 13:31and menopause program combines medical
13:31 --> 13:33and psychological interventions
13:33 --> 13:35for women who experience sexual
13:35 --> 13:37dysfunction after cancer.
13:37 --> 13:40Smilowcancerhospital.org.
13:40 --> 13:43Over 230,000 Americans will be
13:43 --> 13:45diagnosed with lung cancer this year,
13:45 --> 13:47and in Connecticut alone there
13:47 --> 13:50will be over 2700 new cases.
13:50 --> 13:52More than 85% of lung cancer
13:52 --> 13:54diagnosis are related to smoking,
13:54 --> 13:57and quitting even after decades of use,
13:57 --> 13:59can significantly reduce your risk
13:59 --> 14:01of developing lung cancer each day.
14:01 --> 14:04Patients with lung cancer are surviving
14:04 --> 14:06thanks to increased access to advanced
14:06 --> 14:08therapies and specialized care.
14:08 --> 14:10New treatment options and surgical
14:10 --> 14:11techniques are giving lung cancer
14:11 --> 14:13survivors more hope than they
14:13 --> 14:14have ever had before.
14:14 --> 14:17Clinical trials are currently underway
14:17 --> 14:19at federally designated Comprehensive
14:19 --> 14:21cancer centers such as the battle
14:21 --> 14:23two trial at Yale Cancer Center and
14:23 --> 14:25Smilow Cancer Hospital to learn if a
14:25 --> 14:28drug or combination of drugs based
14:28 --> 14:30on personal biomarkers can help to
14:30 --> 14:33control non small cell lung cancer.
14:33 --> 14:35More information is available
14:35 --> 14:36at yalecancercenter.org.
14:36 --> 14:38You're listening to Connecticut public radio.
14:40 --> 14:42Welcome back to Yale Cancer Answers.
14:42 --> 14:43This is doctor Anees Chagpar
14:43 --> 14:45and I'm joined tonight by my guest,
14:45 --> 14:47doctor Peter Dottino.
14:47 --> 14:49We're talking about the care of
14:49 --> 14:51patients with Gyn cancers and
14:51 --> 14:53diagnostic and screening tools.
14:53 --> 14:55And right before the break,
14:55 --> 14:58Doctor Dottino was telling us about how
14:58 --> 15:00Pap smears have really revolutionized
15:00 --> 15:03the care for cervical cancer and some
15:03 --> 15:06of his recent work looking at lavage,
15:06 --> 15:07which can be done at the same
15:07 --> 15:10time as a pap smear that can
15:10 --> 15:12screen for endometrial cancer,
15:12 --> 15:16which is set to become the third
15:16 --> 15:18most common cancer in women.
15:18 --> 15:20So doctor Dottino,
15:20 --> 15:22the other cancer that women often
15:22 --> 15:25talk about and think about in terms
15:25 --> 15:27of GYN cancers is ovarian cancer.
15:27 --> 15:31Can you tell us a little bit more about
15:31 --> 15:35ovarian cancer in terms of its prognosis and
15:35 --> 15:38kind of how it presents?
15:38 --> 15:40It's often called the silent cancer.
15:40 --> 15:40Is that right?
15:41 --> 15:43You know, it is called that,
15:43 --> 15:47but it turns out that it's actually
15:47 --> 15:50not a silent cancer and by that I
15:50 --> 15:53mean the following, it turns out that
15:53 --> 15:55extensive studies that have been done
15:55 --> 15:58show that all women will have symptoms
15:58 --> 16:01for at least three to four months and
16:01 --> 16:04those symptoms they usually report to
16:04 --> 16:08their doctor or they feel that those
16:08 --> 16:09symptoms are with
16:09 --> 16:10menopause or with aging.
16:10 --> 16:11These would be symptoms of,
16:11 --> 16:14say, what we call early satiety,
16:14 --> 16:16so that when you eat something you have
16:16 --> 16:18a couple of bites but you feel full.
16:18 --> 16:20Sometimes it could be urinary frequency,
16:20 --> 16:22where you think maybe I'm getting
16:22 --> 16:22a little older,
16:22 --> 16:24I could have a urinary infection.
16:24 --> 16:26Sometimes it could be symptoms
16:26 --> 16:27of where it's a little difficult
16:27 --> 16:30to buckle your pants and
16:30 --> 16:32your pants feel very tight.
16:32 --> 16:35And it could be lower back
16:35 --> 16:37pain or pain with intercourse,
16:37 --> 16:38sexual intercourse.
16:38 --> 16:42And those symptoms could go sometimes
16:42 --> 16:44with either urinary infection,
16:44 --> 16:47GI inflammation or many other things
16:47 --> 16:48and most often either patients
16:48 --> 16:50don't think that they possibly
16:50 --> 16:52could be developing ovary
16:52 --> 16:55cancer and a lot of times even
16:55 --> 16:56their primary care physicians,
16:56 --> 16:59whether that be a primary care OBGYN
16:59 --> 17:02or a Primary Health care provider
17:02 --> 17:04don't think that these could
17:04 --> 17:06be related to ovary cancer.
17:06 --> 17:11And because of the delay,
17:11 --> 17:1485% of the ladies who actually finally
17:14 --> 17:17make it in to see myself or anybody else
17:17 --> 17:19who's a gynecologic oncologist will
17:19 --> 17:22either be in stage three or stage four.
17:22 --> 17:25And at that stage actually the medical
17:25 --> 17:27student can establish the diagnosis
17:27 --> 17:30because the stomach area and
17:30 --> 17:32the abdominal area is swollen with
17:32 --> 17:34fluid and patients are unable to
17:34 --> 17:37eat, their legs could be swollen.
17:37 --> 17:39So at that point it's very
17:39 --> 17:42easy to make a diagnosis and that
17:42 --> 17:45course then usually follows some kind
17:45 --> 17:47of an ultra radical surgery procedure
17:47 --> 17:50to remove all of the disease and
17:50 --> 17:53then either six or eight months of
17:53 --> 17:57chemotherapy and then what we call
17:57 --> 17:59maintenance or consolidation
17:59 --> 18:02therapy to keep the disease away.
18:02 --> 18:05And so even in the best of circumstances,
18:05 --> 18:08most people with advanced disease
18:08 --> 18:10unfortunately will relapse even
18:10 --> 18:12after having ultra radical surgery.
18:12 --> 18:16Six or eight months of chemotherapy.
18:16 --> 18:18So it's a difficult disease,
18:18 --> 18:20but what we do know that about 8%
18:20 --> 18:22of ovarian cancer is picked up by
18:22 --> 18:25mistake where somebody may have a
18:25 --> 18:26gallbladder operation and they look
18:26 --> 18:29at the ovary and they see there's
18:29 --> 18:31something abnormal or they may go
18:31 --> 18:33for an MRI for back pain that they
18:33 --> 18:36may see a growth on the ovary.
18:36 --> 18:38And what we do know that if ovary
18:38 --> 18:40cancer is picked up in stage one,
18:40 --> 18:43the cure rates are over 90% long term
18:43 --> 18:46survivors that's greater than 10 years.
18:46 --> 18:48So what we've been struggling with in
18:48 --> 18:50the field is to develop a screening
18:50 --> 18:53tool that would allow us to pick it
18:53 --> 18:55up in early stage because an early
18:55 --> 18:59stage cure is possible.
18:59 --> 19:01Cure is remotely possibly even in advanced disease
19:01 --> 19:02unfortunately
19:02 --> 19:03even today.
19:04 --> 19:07And so what has been your progress
19:07 --> 19:09in terms of developing screening
19:09 --> 19:11tools for ovarian cancer?
19:11 --> 19:13Can you tell us more about
19:13 --> 19:14whether there are any bright
19:14 --> 19:15lights on the horizon there?
19:16 --> 19:19Sure. We've got
19:19 --> 19:22a blood test that was
19:22 --> 19:24developed and it's called a CA 125
19:24 --> 19:27and that was a blood test that
19:27 --> 19:29again is about 25 years old now,
19:29 --> 19:32but it was one of the first markers that
19:32 --> 19:34was found to be in the blood for ovary
19:34 --> 19:36cancer and we thought that
19:36 --> 19:38that would be a home run.
19:38 --> 19:40But what unfortunately we found out as
19:40 --> 19:43the test went into widespread use is that
19:43 --> 19:45there were many other things besides
19:45 --> 19:48cancer that would make the test elevated,
19:48 --> 19:51such as uterine fibroids,
19:51 --> 19:52endometriosis.
19:52 --> 19:54These are benign conditions
19:54 --> 19:55that could affect women.
19:55 --> 19:57Any kind of inflammation in
19:57 --> 20:00the body or the pelvic area
20:00 --> 20:02like diverticular disease could
20:02 --> 20:05elevate this so that it had
20:05 --> 20:07no value, it turns out,
20:07 --> 20:09as a screening test for
20:09 --> 20:13ovarian cancer at all,
20:13 --> 20:15unfortunately.
20:15 --> 20:18The other thing that again,
20:18 --> 20:21as we discussed in the first
20:21 --> 20:23segment you're using the uterine lavage,
20:23 --> 20:26what we found is 2 things have happened
20:26 --> 20:31one through multiscale Genomics we are able to
20:31 --> 20:33demonstrate, not myself,
20:33 --> 20:35but in the archaeological
20:35 --> 20:36community, that
20:36 --> 20:39the majority of ovary cancer actually
20:39 --> 20:42does not originate in the ovary,
20:42 --> 20:44but it originates in the
20:44 --> 20:46end of the fallopian tube.
20:46 --> 20:49The thought of the fallopian
20:49 --> 20:52tube that sits over the ovary
20:52 --> 20:55and collects an egg and so
20:55 --> 20:57that portion of the fallopian tube
20:57 --> 20:59it develops a precancerous lesion,
21:02 --> 21:04which has been estimated by
21:04 --> 21:06mathematical modeling to take about
21:06 --> 21:096 years until it turns into cancer.
21:09 --> 21:09Now,
21:09 --> 21:12when we were doing our uterine lavage
21:12 --> 21:14for screening for uterine cancer,
21:14 --> 21:15we noticed by chance that we were
21:15 --> 21:17actually picking up cells
21:17 --> 21:19from the fallopian tube that would
21:19 --> 21:21fall into the uterus and that
21:21 --> 21:23would give us a clue and
21:23 --> 21:25we have now done this test and
21:25 --> 21:29been able to detect early ovarian
21:29 --> 21:31cancer utilizing this test.
21:31 --> 21:35So we think that it will be a
21:35 --> 21:37combined test that uterine lavage
21:37 --> 21:40that will allow us to detect early and
21:40 --> 21:42endometrial and early ovarian cancer.
21:42 --> 21:44So we're very excited about it.
21:44 --> 21:47It's kind of what we call the Holy
21:47 --> 21:49Grail in this field because early detection,
21:49 --> 21:51it becomes a game changer,
21:51 --> 21:52absolute game changer.
21:54 --> 21:56And it certainly sounds exciting.
21:56 --> 21:59The one question that I would have
21:59 --> 22:02is it sounds like the test for
22:02 --> 22:04ovarian cancer is really dependent
22:04 --> 22:07upon those cells dropping into the
22:07 --> 22:10the uterus from the fallopian tube.
22:10 --> 22:14Do all cells do that or would you miss some?
22:15 --> 22:17Well, that's what
22:17 --> 22:20we're trying to work out now,
22:20 --> 22:23but we do know that there is peristalsis
22:23 --> 22:26in the muscular length of
22:26 --> 22:29the tube because the tube
22:29 --> 22:31has what they call it the end of the tube,
22:31 --> 22:33is these fimbria, which are tiny,
22:33 --> 22:36like fingers that sit on top of the ovary.
22:36 --> 22:38So that when a woman ovulates and
22:38 --> 22:41an egg burst out of the ovary,
22:41 --> 22:44the fimbria pick up the egg and put it into
22:44 --> 22:47the fallopian tube and then the muscles,
22:47 --> 22:49the peristaltic motion of the tube
22:49 --> 22:52brings the egg down into the uterus
22:52 --> 22:54so that it can be fertilized.
22:55 --> 22:57What we theorize that those same
22:57 --> 22:59precancerous cells are just moved
22:59 --> 23:02along and dropped into the tube
23:02 --> 23:04will that be everybody
23:04 --> 23:06that we will have to workout
23:06 --> 23:08as we go along with our test?
23:10 --> 23:12So it's something to be seen,
23:12 --> 23:14but that is a distinct
23:14 --> 23:15possibility that
23:15 --> 23:17we're definitely picking up these
23:17 --> 23:18precancerous cells.
23:18 --> 23:19There's no question about that.
23:19 --> 23:22And I mean one would
23:22 --> 23:25surmise that picking up some of them,
23:25 --> 23:27even if you don't pick up all of
23:27 --> 23:30them would still be a real boon for
23:30 --> 23:32a cancer where there really isn't
23:32 --> 23:35any other screening test available.
23:36 --> 23:37No question about that.
23:37 --> 23:39So one of the other ways we're
23:39 --> 23:41approaching this is the same techniques
23:41 --> 23:43that we use to analyze the uterine
23:43 --> 23:46lavage fluid where we take the test,
23:46 --> 23:48the lavage for a woman.
23:48 --> 23:50Right now, we also take a blood sample.
23:50 --> 23:51And interestingly,
23:51 --> 23:53what we find is the same signal
23:53 --> 23:55that we're picking up in the
23:55 --> 23:58lavage we can pick up in the blood.
23:58 --> 24:00So it may be that the test is
24:00 --> 24:03done in combination where we do
24:03 --> 24:05a lavage plus a blood sample.
24:05 --> 24:07So that way we might cover for
24:07 --> 24:10those patients where the cells
24:10 --> 24:12actually don't fall into the uterus.
24:13 --> 24:18And so now we have a good
24:18 --> 24:21screening test for cervical cancer.
24:21 --> 24:24We potentially have one for uterine
24:24 --> 24:26cancer and maybe even ovarian cancer.
24:26 --> 24:28The other two cancers that you
24:28 --> 24:31mentioned at the top of the show
24:31 --> 24:33were vulvar and vaginal cancers.
24:33 --> 24:35Anything on the horizon
24:35 --> 24:37for screening in those two cancers?
24:38 --> 24:40For vulvar cancer which is really
24:40 --> 24:43a skin cancer and it's on the
24:43 --> 24:44external part,
24:44 --> 24:48and so the most important thing for that is
24:48 --> 24:49going to be education.
24:49 --> 24:51And it's education of not only
24:51 --> 24:54patients but primary care providers.
24:54 --> 24:56Because when a woman complains the
24:56 --> 24:58typical complaints for vulvar
24:58 --> 25:02cancer are itching, dryness,
25:02 --> 25:05cracking skin and
25:05 --> 25:07those are often ignored where
25:07 --> 25:09somebody will say go to the
25:09 --> 25:11drugstore and put on some cortisone
25:11 --> 25:13cream and that will make it better.
25:13 --> 25:15But the key thing is that if
25:15 --> 25:16somebody has these symptoms and
25:16 --> 25:18their lasting greater than a month,
25:18 --> 25:20you should see a specialist and
25:20 --> 25:23we will then look at their skin
25:23 --> 25:25with a microscope or the colposcope.
25:25 --> 25:27And more often than not we will
25:27 --> 25:30always take a small skin biopsy to
25:30 --> 25:32make sure that there is no malignancy
25:32 --> 25:35because if all cancer is caught early,
25:35 --> 25:38it becomes also curable.
25:38 --> 25:40And so most
25:40 --> 25:41cases we see are advanced,
25:42 --> 25:44the advanced cases are where women
25:44 --> 25:47have lived for years on these salves,
25:47 --> 25:51creams and so forth that they just keep
25:51 --> 25:52getting and nobody's thought,
25:52 --> 25:54well wait a minute, you know
25:54 --> 25:57there's got to be a reason for this
25:57 --> 25:59and the emphasis really is to
25:59 --> 26:01to take a biopsy and primary care
26:01 --> 26:03doctors are more than capable of
26:03 --> 26:05taking the biopsy because it's just
26:05 --> 26:07looking at the skin and the lesions.
26:09 --> 26:11Very easy to identify.
26:11 --> 26:13Vaginal cancers now are also
26:13 --> 26:15going to be picked up with
26:16 --> 26:19A Pap test also because the Pap
26:19 --> 26:21test can pick up the same kinds
26:21 --> 26:23of precancerous cells that we
26:23 --> 26:25see in cervical cancer can also
26:25 --> 26:27occur in vaginal cancers.
26:27 --> 26:29So the PAP tests can be very
26:29 --> 26:31effective in that way also.
26:31 --> 26:32So you know,
26:32 --> 26:34it's really a matter
26:34 --> 26:36of getting people to
26:36 --> 26:37understand their bodies and always
26:37 --> 26:39to ask that question or you know
26:39 --> 26:41I tell my patients for
26:41 --> 26:42specifically for ovarian cancer
26:42 --> 26:45if they have this constellation
26:45 --> 26:47of symptoms of early satiety,
26:47 --> 26:49a little bit of abdominal swelling
26:49 --> 26:50or discomfort or whatever,
26:50 --> 26:52and if pain or discomfort
26:52 --> 26:54lasts more than four weeks,
26:54 --> 26:56go to your doctor and you say,
26:56 --> 27:00prove to me that I don't have ovary cancer.
27:00 --> 27:03Rather than just continue to live
27:03 --> 27:05with the the symptoms get multiple
27:05 --> 27:08urine cultures and the like and
27:08 --> 27:09two months later,
27:09 --> 27:10you'll find out that those symptoms
27:10 --> 27:12were really of a developing cancer,
27:12 --> 27:13which is unfortunate.
27:14 --> 27:16Yeah, I think that you know
27:16 --> 27:18very often those symptoms,
27:18 --> 27:22right feeling of bloatedness.
27:22 --> 27:24You know, a little bit of urinary frequency,
27:24 --> 27:27a little bit of abdominal pain.
27:27 --> 27:30There can be so many other things
27:30 --> 27:32and many patients think that the
27:32 --> 27:34last thing on their mind is that
27:34 --> 27:37this could be an ovarian cancer,
27:37 --> 27:38particularly if they don't
27:38 --> 27:40have a family history,
27:40 --> 27:44they don't have a genetic mutation.
27:44 --> 27:46And so they tend to put that at
27:46 --> 27:48the bottom of the list.
27:49 --> 27:50Right. And we need to move it up.
27:50 --> 27:52Because if we think about it right,
27:52 --> 27:53the genetic mutations,
27:53 --> 27:56particularly the BRCA genes,
27:56 --> 27:59those are going to account for roughly about
27:59 --> 28:0215 to 18% of people who get ovarian cancer.
28:02 --> 28:04So that means 85% of these are
28:04 --> 28:06going to people going to be in
28:06 --> 28:07people without a family history,
28:07 --> 28:09without a genetic mutation
28:09 --> 28:12that we hardly can identify.
28:12 --> 28:15And so it behooves us,
28:15 --> 28:17again, it's like when we
28:17 --> 28:19all taught our medical students.
28:19 --> 28:22If somebody has pelvic pain, you know,
28:22 --> 28:24give me a differential diagnosis.
28:24 --> 28:26And not three things,
28:26 --> 28:27give me 15 things,
28:27 --> 28:28because if you don't think
28:28 --> 28:30about it as a possibility,
28:30 --> 28:31you'll never find it.
28:31 --> 28:33Doctor Peter Dottino is a
28:33 --> 28:35professor of obstetrics, gynecology,
28:35 --> 28:36and reproductive sciences at
28:36 --> 28:39the Yale School of Medicine.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu,
28:43 --> 28:45and past editions of the program
28:45 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public Radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Diagnostic and Screening Tools for Gynecologic Cancers with guest Dr. Peter Dottino January 15, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095