Early Detection of Gynecologic Cancers

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:13latest information on cancer care
00:14 --> 00:15by 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
00:21 --> 00:24gynecologic cancers with Doctor Elena Ratner.
00:24 --> 00:26Dr Ratner is a professor of obstetrics,
00:26 --> 00:28gynecology and reproductive sciences
00:28 --> 00:31at the Yale School of Medicine,
00:31 --> 00:32where Doctor Chagpar is a
00:32 --> 00:34professor of surgical oncology.
00:35 --> 00:37So, Elena, maybe we can start off
00:37 --> 00:39by you telling us a little bit about
00:39 --> 00:41yourself and what it is you do.
00:41 --> 00:45Sure, I take care of women with
00:45 --> 00:47ovarian cancer, uterine cancer,
00:47 --> 00:50cervical cancer, and vaginal cancer.
00:50 --> 00:54My passion is early cancer detection
00:54 --> 00:59and even more so cancer prevention,
00:59 --> 01:01which is really the future and I would argue,
01:01 --> 01:06the present, of cancer treatments.
01:06 --> 01:10I have a lab that deals with drug
01:10 --> 01:14development and new novel targeted
01:14 --> 01:17therapies for ovarian cancer.
01:17 --> 01:19The treatment of ovarian cancer
01:19 --> 01:21nowadays is so different from what
01:21 --> 01:23it used to be in the older days.
01:23 --> 01:26We now truly believe in targeted
01:26 --> 01:29personalized care and that is very much
01:29 --> 01:32what I do and how my practice runs
01:32 --> 01:35and that is what my lab does as well.
01:35 --> 01:38I also have a great interest and again,
01:38 --> 01:40a passion for survivorship and
01:40 --> 01:43taking care of women who are fighting
01:43 --> 01:46cancers or have fought cancers,
01:46 --> 01:49and are survivors.
01:49 --> 01:53I am a cofounder and a director of a sexuality
01:53 --> 01:56and menopause program for Smilow
01:56 --> 01:58where we take care of women who
01:58 --> 02:01are going through hormonal changes
02:01 --> 02:04to aid them in their quality of
02:04 --> 02:05life and survivorship.
02:05 --> 02:07Wow, that's
02:07 --> 02:10a lot. So let's
02:10 --> 02:13dig into a few of those things.
02:13 --> 02:15To start with,
02:15 --> 02:17you mentioned a variety of cancers,
02:17 --> 02:19cervical cancers, vaginal cancers,
02:19 --> 02:22uterine cancers, ovarian cancers.
02:22 --> 02:25It seems like there are so many
02:25 --> 02:29cancers associated with the female
02:29 --> 02:33gynecologic and reproductive system.
02:33 --> 02:36And yet they're all a little bit different,
02:36 --> 02:37if not very different.
02:37 --> 02:40So can you talk a little bit
02:40 --> 02:42about the epidemiology
02:42 --> 02:45of all of these cancers,
02:45 --> 02:48how often do they occur and a little
02:48 --> 02:52bit more about how we can,
02:52 --> 02:55as you say in terms of
02:55 --> 02:56prevention and early detection,
02:56 --> 03:00how we can either prevent or
03:00 --> 03:02detect these cancers early.
03:02 --> 03:04It seems that they all might
03:04 --> 03:06be a little bit different in
03:06 --> 03:08terms of how easy that is to do,
03:08 --> 03:09some might be
03:09 --> 03:12more of the silent cancers
03:12 --> 03:14and some might be things for
03:14 --> 03:16which we have ready screening
03:16 --> 03:19tests.
03:19 --> 03:20That's a wonderful question.
03:20 --> 03:22So you are so right,
03:22 --> 03:25gynecologic cancers are diverse.
03:25 --> 03:28Last month actually marked
03:28 --> 03:31gynecologic cancer month.
03:31 --> 03:33And yes, we are always going to
03:33 --> 03:35be aware that gynecologic cancers
03:35 --> 03:37there are
03:37 --> 03:40so many different cancers that are part of it.
03:40 --> 03:42So let's take it 1 by 1.
03:42 --> 03:45So cervical cancer that is the cancer
03:45 --> 03:49that is more commonly associated with the
03:49 --> 03:50HPV virus,
03:50 --> 03:52this is the kind of cancer
03:52 --> 03:56where Pap smears play a very
03:56 --> 03:57important preventative role.
03:57 --> 04:00The good thing about cervical cancer
04:00 --> 04:02is that usually it is pretty slow
04:02 --> 04:05growing and as long as you keep having
04:05 --> 04:08pap smears routinely per protocol,
04:08 --> 04:10usually we're able to catch a
04:10 --> 04:12great majority of these cancers
04:12 --> 04:14in the pre cancer stage.
04:14 --> 04:16The HPV vaccine very much
04:16 --> 04:19changed the entire nature of
04:19 --> 04:22cervical cancer and cervical cancer became
04:22 --> 04:25much less common and luckily we see
04:25 --> 04:28very little of it in this generation
04:28 --> 04:32of women who were vaccinated for the
04:32 --> 04:35HPV virus with the vaccine.
04:35 --> 04:38This HPV vaccine really is one
04:38 --> 04:41of the few incredibly successful
04:41 --> 04:47examples of cancer prevention in this cancer.
04:47 --> 04:50Uterine cancer is the most
04:50 --> 04:52common gynecologic cancer.
04:53 --> 04:55Here in the states we have
04:55 --> 04:58an epidemic of obesity.
04:58 --> 05:00Obesity unfortunately increases
05:00 --> 05:05women's risk of having endometrial
05:05 --> 05:08cancer very significantly because
05:08 --> 05:12estrogen is produced by this adipose
05:12 --> 05:16tissue when we have extra obesity.
05:16 --> 05:19So that contributes.
05:19 --> 05:20Diabetes contributes.
05:21 --> 05:24But the good news with endometrial cancer
05:24 --> 05:27is that usually women have symptoms.
05:27 --> 05:29And that is actually the most
05:29 --> 05:31important thing about endometrial
05:31 --> 05:33cancer, is that women are always
05:33 --> 05:35aware that once they reach menopause,
05:35 --> 05:37if they start having bleeding again,
05:37 --> 05:39that is not normal.
05:39 --> 05:42And even though most women who do
05:42 --> 05:43bleed after menopause actually
05:43 --> 05:45do not have cancer, some do.
05:45 --> 05:47And the good news about
05:47 --> 05:48endometrial cancer is it's very
05:48 --> 05:50curable and usually detected
05:50 --> 05:53very early as long as women know
05:53 --> 05:55that kind of bleeding is
05:55 --> 05:58abnormal and usually all you would
05:58 --> 06:00need is just a biopsy and that
06:00 --> 06:02would catch again usually either
06:02 --> 06:05an early cancer or pre cancer.
06:06 --> 06:08The most challenging cancer
06:08 --> 06:11within the gynecologic cancers
06:11 --> 06:13remains ovarian cancer.
06:13 --> 06:15You know we call ovarian cancer the cancer,
06:15 --> 06:19that whispers because it is very difficult
06:19 --> 06:21to find these cancers early.
06:23 --> 06:25My passion is early detection, prevention.
06:25 --> 06:27So I actually do not believe
06:27 --> 06:29that ovarian cancer whispers.
06:29 --> 06:31I believe that it is not whispering,
06:31 --> 06:33it is speaking and we're
06:33 --> 06:35just not listening to it.
06:35 --> 06:37So early detection and prevention
06:37 --> 06:41of ovarian cancer relies in huge
06:41 --> 06:44part to advocacy and awareness and
06:44 --> 06:47not only teaching women about signs
06:47 --> 06:50and symptoms of ovarian cancer,
06:50 --> 06:52but making sure that women
06:52 --> 06:55get the care they deserve.
06:55 --> 06:57There's a lot of literature that
06:57 --> 06:59women with ovarian cancer usually feel
06:59 --> 07:02symptoms for a good six months to a year
07:02 --> 07:04to even two years sometimes before
07:04 --> 07:06the cancer is actually diagnosed.
07:06 --> 07:08And there's literature that women go
07:08 --> 07:11from one provider to another provider
07:11 --> 07:13before they are finally appropriately diagnosed.
07:13 --> 07:15So it is very,
07:15 --> 07:17very important for women to know that,
07:17 --> 07:19especially around the time of menopause,
07:19 --> 07:21especially a little bit later than menopause,
07:21 --> 07:23if they start developing things
07:23 --> 07:26like weight gain or their clothes
07:26 --> 07:28not fitting well or some bowel
07:28 --> 07:30symptoms or bladder symptoms,
07:30 --> 07:31early satiety,
07:31 --> 07:32eating a little and not
07:32 --> 07:34being able to eat more,
07:34 --> 07:36getting up at night and especially if
07:36 --> 07:39these symptoms come kind of all at once,
07:39 --> 07:41that is something that they
07:41 --> 07:43need to be seen by their provider.
07:43 --> 07:45There's a lot of literature that
07:45 --> 07:47there's many different things that cause
07:47 --> 07:49these symptoms that are not cancer.
07:49 --> 07:51We actually all experience them.
07:51 --> 07:53And a lot of them are hormonal.
07:53 --> 07:56But the difference between the women who
07:56 --> 07:57experience these symptoms hormonally
07:57 --> 08:00is that those symptoms come and go.
08:00 --> 08:01The women who subsequently
08:01 --> 08:03develop ovarian cancer,
08:03 --> 08:05these symptoms usually happen
08:05 --> 08:08every single day for two weeks.
08:08 --> 08:10So it is very important for women to
08:10 --> 08:12always be aware and listen to their
08:12 --> 08:14bodies and when they listen to their
08:14 --> 08:16bodies and present to their providers,
08:16 --> 08:18for providers to be educated
08:18 --> 08:21and to understand this kind of
08:21 --> 08:23constellation of symptoms.
08:23 --> 08:26That would require further workup.
08:26 --> 08:27Prevention is key.
08:27 --> 08:30You know, early detection is challenging.
08:30 --> 08:31Prevention is so,
08:31 --> 08:33so important because we know that many
08:33 --> 08:36of these cancers are actually genetic
08:36 --> 08:38and have certain genetic mutation
08:38 --> 08:40that predispose women to these cancers.
08:40 --> 08:42So that is why it is so important
08:42 --> 08:44to know your family history and what
08:44 --> 08:47genes you carry and do that kind of
08:47 --> 08:49risk reduction from that knowledge.
08:51 --> 08:53And then the last kind of
08:53 --> 08:55group of gynecologic cancers that
08:55 --> 08:58you had mentioned earlier were
08:58 --> 09:00vaginal cancers and cancers of
09:00 --> 09:02kind of the external genitalia.
09:02 --> 09:03Those are often cancers that we
09:03 --> 09:05don't hear a lot about.
09:05 --> 09:06Can you tell us a little
09:06 --> 09:07bit more about those?
09:08 --> 09:09Yeah, you're exactly correct.
09:09 --> 09:12Those cancers are much more rare.
09:12 --> 09:16They are also commonly HPV driven and a
09:16 --> 09:21lot of them also involve the cervix.
09:21 --> 09:24But with more commonly either cancer of
09:24 --> 09:27the vulva or pre cancer of the vulva.
09:27 --> 09:30And again, luckily a lot of these
09:30 --> 09:34are caught in the precancerous stage.
09:34 --> 09:36And as long as women again are aware
09:36 --> 09:39of their anatomy and aware if they
09:39 --> 09:41have some ulcers or bleeding or some
09:41 --> 09:43nodules on the outside of their body
09:43 --> 09:46that doesn't feel normal or feels new,
09:46 --> 09:49that they should be seen by their provider
09:49 --> 09:52and that lesion should be biopsied.
09:52 --> 09:53Again, luckily,
09:53 --> 09:55those are usually seen or felt,
09:55 --> 09:59and usually they can be cured or even better,
09:59 --> 10:01caught in the precancerous stages.
10:02 --> 10:06So, you know, it sounds like really
10:06 --> 10:10you need to be very concerned about
10:10 --> 10:14#1 getting an HPV vaccine if you can.
10:14 --> 10:18If you meet guidelines for that, number 2,
10:18 --> 10:22making sure that you get a a PAP smear
10:22 --> 10:25on a regular basis and #3 that you're
10:25 --> 10:28really paying attention to to symptoms.
10:28 --> 10:30Can you talk to us a little bit
10:30 --> 10:33more about the HPV vaccine and
10:33 --> 10:35who is eligible for it?
10:35 --> 10:38It seems to me that historically
10:38 --> 10:41it has only been for young girls.
10:41 --> 10:45And now the criteria have expanded
10:45 --> 10:48for women who may not have had it
10:48 --> 10:51before up to a certain age limit.
10:51 --> 10:53Can you talk more about that?
10:53 --> 10:54Yeah, absolutely.
10:54 --> 10:57So HPV vaccine, as I mentioned before,
10:57 --> 10:58really just has been miraculous.
10:58 --> 11:03You know, we have in the cancer industry
11:03 --> 11:06talked about and thought about and
11:06 --> 11:08researched vaccines for generations.
11:08 --> 11:13This one truly made a tremendous difference.
11:13 --> 11:16You know from my world of
11:16 --> 11:18clinical practice, I see cancer,
11:18 --> 11:21cervical cancer or even cervical severe
11:21 --> 11:24precancer so much more rarely now
11:24 --> 11:27that this vaccine became commonplace.
11:27 --> 11:28And you're exactly correct.
11:28 --> 11:30When this became available,
11:30 --> 11:33it was for
11:33 --> 11:35young girls from age 9 to 25.
11:35 --> 11:37There was a lot of thought that
11:37 --> 11:40we wanted to give it before girls
11:40 --> 11:43or women were sexually active.
11:43 --> 11:46Before they actually were exposed to HPV,
11:46 --> 11:48but then a lot of studies came out
11:48 --> 11:50and a lot of literature came out and
11:50 --> 11:52now that's this vaccine is actually
11:52 --> 11:55indicated for women up to age 45.
11:55 --> 11:57And there is some thought that even
11:57 --> 11:59for women who have some sort of
11:59 --> 12:01HPV strains that getting a vaccine
12:01 --> 12:03would help them fight the other
12:03 --> 12:05strains that they don't yet have,
12:05 --> 12:08especially if they have new partners and
12:08 --> 12:11would be exposed to other strains of HPV.
12:12 --> 12:15I wholeheartedly recommend the HPV vaccine,
12:15 --> 12:16but not just to girls,
12:16 --> 12:17but also to boys.
12:18 --> 12:21Yeah, because it it sounds like
12:21 --> 12:23it can certainly prevent
12:23 --> 12:26a number of cancers.
12:26 --> 12:29Talk to us a little bit more about screening.
12:29 --> 12:32You had mentioned Pap smears,
12:32 --> 12:34and many women know that they should
12:34 --> 12:37be getting Pap smears but may not be
12:37 --> 12:39familiar about things like, well,
12:39 --> 12:41when should we start that and how
12:41 --> 12:43often should we get pap smears?
12:43 --> 12:44And when should they stop?
12:44 --> 12:48And is it just a pap smear or do people
12:48 --> 12:51do HPV testing at the same time?
12:51 --> 12:53Can you help us to understand a
12:53 --> 12:54few of those questions?
12:57 --> 13:00That's a discusson that a lot of us have frequently.
13:00 --> 13:04The guidelines for Pap smears have really
13:04 --> 13:07been changing quite greatly over the years.
13:07 --> 13:10And we understood that these
13:10 --> 13:12cancers are really HPV driven.
13:12 --> 13:14We now understand that it's
13:14 --> 13:16really HPV that drives them.
13:16 --> 13:18So right now, even more important
13:18 --> 13:21than the Pap smear is the HPV testing.
13:21 --> 13:25And for women who don't have the HPV,
13:25 --> 13:26for them, the Pap smear
13:26 --> 13:27guidelines are much more relaxed.
13:27 --> 13:29So that's the key for that.
13:31 --> 13:33And so we are going to pick up the
13:33 --> 13:36conversation and learn a little bit
13:36 --> 13:37more about screening and perhaps
13:37 --> 13:39treatment right after we take a
13:39 --> 13:41short break for a medical minute.
13:41 --> 13:44Please stay tuned to learn more about
13:44 --> 13:45gynecologic cancers with my guest,
13:45 --> 13:47doctor Elena Ratner.
13:47 --> 13:49Funding for Yale Cancer Answers
13:49 --> 13:51comes from Smilow Cancer Hospital,
13:51 --> 13:54where their liver cancer program brings
13:54 --> 13:56together a dedicated group of specialists
13:56 --> 13:59whose focus is determining the best
13:59 --> 14:01personalized treatment plan for each patient.
14:01 --> 14:06Learn more at smilowcancerhospital.org.
14:06 --> 14:09The American Cancer Society estimates that
14:09 --> 14:11more than 65,000 Americans will be diagnosed
14:11 --> 14:14with head and neck cancer this year,
14:14 --> 14:17making up about 4% of all cancers
14:17 --> 14:19diagnosed when detected early,
14:19 --> 14:21however, had a neck cancers are
14:21 --> 14:23easily treated and highly curable.
14:23 --> 14:25Clinical trials are currently
14:25 --> 14:27underway at federally designated
14:27 --> 14:29Comprehensive cancer centers such
14:29 --> 14:31as Yale Cancer Center and its Milo
14:31 --> 14:34Cancer Hospital to test innovative new
14:34 --> 14:36treatments for head and neck cancers.
14:36 --> 14:38Yale Cancer Center was recently
14:38 --> 14:40awarded grants from the National
14:40 --> 14:42Institutes of Health to fund the
14:42 --> 14:45Yale Head and neck Cancer Specialized
14:45 --> 14:47program of Research Excellence,
14:47 --> 14:48or SPORE,
14:48 --> 14:50to address critical barriers to
14:50 --> 14:53treatment of head and neck squamous cell
14:53 --> 14:55carcinoma due to resistance to immune
14:55 --> 14:58DNA damaging and targeted therapy.
14:58 --> 15:00More information is available
15:00 --> 15:01at yalecancercenter.org.
15:01 --> 15:04You're listening to Connecticut public radio.
15:05 --> 15:07Welcome back to Yale Cancer Answers.
15:07 --> 15:09This is doctor Anees Chagpar
15:09 --> 15:11and I'm joined tonight by my guest,
15:11 --> 15:12doctor Elena Ratner.
15:12 --> 15:14We're talking about the care of
15:14 --> 15:16patients with gynecologic cancers.
15:16 --> 15:18And Elena, right before the break,
15:18 --> 15:21you were talking a little bit about
15:21 --> 15:23some of the controversies with
15:23 --> 15:26regards to screening and how these
15:26 --> 15:28screening guidelines have changed.
15:28 --> 15:31You mentioned that these days
15:31 --> 15:35HPV testing is really important and it may
15:35 --> 15:38influence what the guidelines
15:38 --> 15:40are for PAP tests.
15:40 --> 15:42Can you tell us a little bit more about that?
15:43 --> 15:48The thing with Pap smears and
15:48 --> 15:51really how I look at all cancer treatment,
15:51 --> 15:53prevention, testing, screening,
15:53 --> 15:56everything has to be personalized.
15:56 --> 16:00You know, we are now living in an era where
16:00 --> 16:01not everybody should be
16:01 --> 16:03treated exactly the same.
16:03 --> 16:05Everything should be individualized,
16:05 --> 16:07everything should be personalized.
16:07 --> 16:09So we use these guidelines
16:09 --> 16:10that are available.
16:10 --> 16:13But again, I wholeheartedly feel that
16:13 --> 16:16these are just guidelines and depending
16:16 --> 16:19on specific presentation history,
16:19 --> 16:22family history, concerning symptoms,
16:22 --> 16:25think these screening tests
16:25 --> 16:27could be done more frequently.
16:27 --> 16:29But the guidelines are now much more relaxed.
16:32 --> 16:35We start checking Pap smears at age 21.
16:35 --> 16:39Regardless of when the patient
16:39 --> 16:41first starts having intercourse.
16:41 --> 16:46Women who are 21 to 29 can have
16:46 --> 16:50pap smears alone every three years.
16:50 --> 16:53HPV testing alone can be considered
16:53 --> 16:56for women who are aged 25 to 29,
16:56 --> 17:00but Pap smear tests are still preferred.
17:00 --> 17:01But then the bigger
17:01 --> 17:04group is women aged 30 to 65, and
17:04 --> 17:06those women have three options for testing.
17:06 --> 17:08They can have a pap smear and
17:08 --> 17:11an HPV test every five years.
17:11 --> 17:13That is kind of what's preferred.
17:13 --> 17:15Again, HPV is really associated
17:15 --> 17:17with these cancers or precancers,
17:17 --> 17:20so it's important to test.
17:20 --> 17:21Or they can just have a
17:21 --> 17:22pap smear by itself
17:22 --> 17:24every three years.
17:24 --> 17:28Or they can have HPV testing
17:28 --> 17:30alone every five years.
17:30 --> 17:30And again,
17:30 --> 17:33the thinking for this is that
17:33 --> 17:35so many of these cancers are HPV
17:35 --> 17:37driven and HPV is actually a very,
17:37 --> 17:39very common virus.
17:39 --> 17:42A lot of women in their 20s will
17:42 --> 17:44have positive HPV Pap smears
17:44 --> 17:46and those actually don't matter
17:46 --> 17:48that much because it is super,
17:48 --> 17:49super prevalent.
17:49 --> 17:52The ones that matter are the
17:52 --> 17:54ones that are long living.
17:54 --> 17:57So that's why we don't routinely
17:57 --> 18:00start checking HPV or worrying about
18:00 --> 18:02HPV until after age 30,
18:02 --> 18:04because a lot of women will get the
18:04 --> 18:06HPV and then their body will clear it,
18:06 --> 18:09we worry about and we watch more closely
18:09 --> 18:11those HPV infections that stay after
18:11 --> 18:15age 30 and then those we watch and we
18:15 --> 18:18just check the Pap smears together with them.
18:18 --> 18:18Because again,
18:18 --> 18:19whatever this is,
18:19 --> 18:21this is usually pretty slow
18:21 --> 18:23growing and as long as you keep
18:23 --> 18:25checking pap smears and HPV typing
18:25 --> 18:27at these kind of intervals,
18:27 --> 18:30we will catch it usually in the precancerous stage.
18:32 --> 18:35Let's talk a little bit
18:35 --> 18:36more about treatments and you
18:36 --> 18:40had mentioned that everything should
18:40 --> 18:43be personalized and in terms of not only
18:43 --> 18:46the screening but also treatment.
18:46 --> 18:50So for cervical cancer, for example,
18:50 --> 18:54if you should find a precancerous lesion,
18:54 --> 18:55how is that treated?
18:55 --> 18:58How do you kind of go about
18:58 --> 19:00thinking about the management of
19:00 --> 19:01cervical cancer.
19:02 --> 19:06Much in the world of
19:06 --> 19:09gynecologic cancer has become better,
19:09 --> 19:13better and smarter and personalized and
19:13 --> 19:17individualized and much less aggressive.
19:17 --> 19:21Nowadays we are able to replace big
19:21 --> 19:22aggressive, radical surgeries that
19:22 --> 19:24we used to do in the older days,
19:24 --> 19:267-10 years back,
19:26 --> 19:29we're now able to replace the
19:29 --> 19:31surgeries which much less aggressive,
19:31 --> 19:33much more quality of life
19:33 --> 19:34centric procedures.
19:34 --> 19:38So for cervical cancer or moreso
19:38 --> 19:40for surgical precancer,
19:40 --> 19:42there's many procedures that are available.
19:42 --> 19:43We do these surgeries frequently
19:43 --> 19:45for women who are young,
19:45 --> 19:46who still want to have kids,
19:46 --> 19:49and we're able to make that happen.
19:49 --> 19:51We're able to do procedures
19:51 --> 19:54which are fertility sparing and
19:54 --> 19:56get rid of the precancer.
19:56 --> 19:58But even in the world of ovarian cancer,
19:58 --> 20:00which is again kind of the most
20:00 --> 20:02difficult cancer that we deal with,
20:02 --> 20:03we used to do this
20:03 --> 20:04big surgical debulking
20:04 --> 20:06where patients would
20:06 --> 20:08stay in the hospital for weeks.
20:08 --> 20:12Now we can do the same surgeries
20:12 --> 20:13laparoscopically or robotically
20:13 --> 20:16where women can go home the next morning.
20:16 --> 20:18So the paradigm of ovarian cancer
20:18 --> 20:20and really gynecologic cancer
20:20 --> 20:21is really changing drastically
20:21 --> 20:23and in a wonderful way.
20:24 --> 20:27And so tell us a little bit more
20:27 --> 20:30about the management of these cancers.
20:30 --> 20:33So in the older days, five years back,
20:33 --> 20:35we used to treat all these
20:35 --> 20:37cancers in a very similar fashion.
20:37 --> 20:39The women would be
20:39 --> 20:41diagnosed with this cancer,
20:41 --> 20:43then they would have surgery and then
20:43 --> 20:45they would have a standard chemotherapy.
20:45 --> 20:48Nowadays, not only are we making
20:48 --> 20:51great advances with advocacy and
20:51 --> 20:53and awareness and having women
20:53 --> 20:57know exactly what to look out for and make
20:57 --> 21:00sure that they're getting the perfect care.
21:00 --> 21:03But then they can have really personalized
21:03 --> 21:06robotic, still radical
21:06 --> 21:08but very minimally invasive surgery.
21:08 --> 21:10And after that we do not
21:10 --> 21:11treat cancers the same.
21:11 --> 21:14We study the cancers, we take them out,
21:14 --> 21:15we take them to the lab,
21:15 --> 21:17we study them for multiple,
21:17 --> 21:20multiple mutations and then we
21:20 --> 21:22treat specifically that woman.
21:22 --> 21:24And because her cancer is
21:24 --> 21:27not the same as the cancer of somebody else,
21:27 --> 21:28we treat specifically her
21:28 --> 21:31tumor and we're able to
21:31 --> 21:34frequently do so with targeted
21:34 --> 21:37therapies in addition frequently to standard
21:37 --> 21:40therapy that also has great success.
21:40 --> 21:42But we're able to know exactly
21:42 --> 21:45what mutations that patient has
21:45 --> 21:47and especially what mutations
21:47 --> 21:50her tumor has and we're able
21:50 --> 21:52to target them specifically.
21:52 --> 21:56And not only will that allow us to treat
21:56 --> 21:59the cancers better to get better outcomes,
21:59 --> 22:02but as important, it also allows for better
22:02 --> 22:03quality of life.
22:03 --> 22:05And it allows women to continue
22:05 --> 22:07living their lives with much less
22:07 --> 22:10toxicity and much less side effects,
22:10 --> 22:13and that's fabulous.
22:13 --> 22:16But one of the things that people often
22:16 --> 22:20fear about ovarian cancer is that it does
22:20 --> 22:24tend to be deadly in terms of prognosis.
22:24 --> 22:27Can you talk to us about how the
22:27 --> 22:29prognosis of ovarian cancer has changed
22:29 --> 22:32over the past five years, if it has?
22:32 --> 22:37And what that kind of looks like.
22:39 --> 22:43So yeah, so the prognosis is improving.
22:43 --> 22:45Women are living longer,
22:45 --> 22:48the proportion of women who
22:48 --> 22:52are cured is somewhat higher,
22:52 --> 22:58and I really think that is all
22:58 --> 23:00because of the treatments that we
23:00 --> 23:03have been able to come up with and
23:03 --> 23:06develop and use during this time,
23:06 --> 23:08you know, for example.
23:08 --> 23:12in this search for
23:12 --> 23:15genomic or germline mutations,
23:15 --> 23:18we now are able to identify a
23:18 --> 23:21subset of patients who are
23:21 --> 23:23very sensitive to certain targeted
23:23 --> 23:26therapies such as immunotherapy,
23:26 --> 23:29such as something called PARP
23:29 --> 23:32inhibitors and the woman who
23:32 --> 23:35have these mutations,
23:35 --> 23:37who benefit from these treatments
23:37 --> 23:38do marvelously.
23:39 --> 23:41There's really miraculous outcomes
23:41 --> 23:44that we have had over this period
23:44 --> 23:47of time with this new targeted
23:47 --> 23:49therapies specifically for
23:49 --> 23:51women who have these mutations.
23:52 --> 23:54The improved prognosis and
23:54 --> 23:57the improved survival is all due to that,
23:57 --> 23:59to the fact that we are treating
23:59 --> 24:01these things in a better way,
24:01 --> 24:03in a smarter way and we're able
24:03 --> 24:06to test better and know who are
24:06 --> 24:09the right candidates for specific
24:09 --> 24:10targeted therapies and I think
24:10 --> 24:12that's only going to get bigger
24:12 --> 24:13and it's only gonna get better.
24:13 --> 24:15There's so many trials that are
24:15 --> 24:18happening right now looking at a whole
24:18 --> 24:20different variety of targeted therapies.
24:20 --> 24:20And again,
24:20 --> 24:22it's not for everybody.
24:22 --> 24:24Not every target is for everybody.
24:24 --> 24:25That is the future.
24:25 --> 24:28That is the importance of this to
24:28 --> 24:29understand the personal approach
24:29 --> 24:31to what this particular tumor
24:31 --> 24:33carries and then be able to
24:33 --> 24:35treat it with a specific drug,
24:35 --> 24:38specific medicine for that specific tumor.
24:39 --> 24:43So important in terms of really
24:43 --> 24:45promoting clinical trial participation
24:45 --> 24:48so that we can offer patients the
24:48 --> 24:52latest therapies that really might be
24:52 --> 24:54targeted to their particular tumor.
24:54 --> 24:57One of the things that I often think
24:57 --> 24:59about in terms of ovarian cancer is
24:59 --> 25:01the fact that in part because of,
25:01 --> 25:03as you say, a lack of awareness,
25:03 --> 25:06so many of these ovarian cancers
25:06 --> 25:09present late, they present at stage 4.
25:09 --> 25:11With distant metastatic disease,
25:11 --> 25:15has the prognosis of those patients
25:15 --> 25:17also improved with these therapies?
25:17 --> 25:20Can you talk a little bit
25:20 --> 25:22more about metastatic ovarian cancer?
25:23 --> 25:25Yeah. So the great majority of
25:25 --> 25:27ovarian cancers unfortunately present
25:27 --> 25:29manifestation exactly as you said
25:29 --> 25:31in stage three and stage four.
25:31 --> 25:33So all the cancers I talked about up to
25:33 --> 25:36now with better prognosis and targeted
25:36 --> 25:38therapies is actually about those cancers.
25:38 --> 25:41So yes, for women with advanced disease which
25:41 --> 25:44is very frequently how these are diagnosed,
25:44 --> 25:45prognosis is better,
25:45 --> 25:49therapies are better, toxicity is better,
25:49 --> 25:53but it is really the key to
25:53 --> 25:54curing ovarian cancer.
25:54 --> 25:57The key to eradicating ovarian
25:57 --> 25:59cancer is early detection.
25:59 --> 26:02It is education, it is awareness,
26:02 --> 26:05it is education for the providers.
26:05 --> 26:07Because if these cancers are
26:07 --> 26:09diagnosed in stage one and stage 2, the
26:09 --> 26:12great majority of them are cured.
26:12 --> 26:14So that is why in
26:14 --> 26:17addition to drug development and in
26:17 --> 26:18addition to everything else that we
26:18 --> 26:21do in the lab to try to understand the
26:21 --> 26:23therapy and resistance to chemotherapy
26:23 --> 26:24and side effects,
26:24 --> 26:28it is so important to concentrate on early
26:28 --> 26:31detection because that truly saves lives.
26:33 --> 26:34I I think that there's two
26:34 --> 26:36key messages there, right?
26:36 --> 26:38The first one is that if
26:38 --> 26:41you have been diagnosed with
26:41 --> 26:43metastatic ovarian cancer,
26:43 --> 26:45the first piece of key message
26:45 --> 26:47that I think that you pointed out
26:47 --> 26:49is that all is not lost to that,
26:49 --> 26:51that things are improving and that
26:51 --> 26:54there is still hope and the 2nd is
26:54 --> 26:57about the concept of
26:57 --> 26:59listening to your body and
26:59 --> 27:02trying to find these cancers earlier,
27:02 --> 27:05but a lot of the symptoms that
27:05 --> 27:07you had mentioned earlier are
27:07 --> 27:09things that are really common.
27:09 --> 27:12So is it that people should be
27:12 --> 27:15paying more attention to that when
27:15 --> 27:17they're post menopausal or can
27:17 --> 27:20ovarian cancer occur at any age so
27:20 --> 27:22that you know if you are feeling
27:22 --> 27:24like you are having early satiety
27:24 --> 27:26and that your clothes aren't fitting
27:26 --> 27:28right and you're having bloating
27:28 --> 27:30and so on and that's been going on
27:30 --> 27:32for a couple of weeks but you're
27:32 --> 27:34pre menopausal you should still
27:34 --> 27:36get that checked out or you may
27:36 --> 27:38be feeling like that might be like
27:38 --> 27:40being a bit of a hypochondriac.
27:40 --> 27:42So can you help us with that
27:43 --> 27:44wonderful question.
27:44 --> 27:46So I think it's important to
27:46 --> 27:49remember that the lifetime incidence
27:49 --> 27:51of ovarian cancer is 1.4%,
27:51 --> 27:53which is wonderful.
27:53 --> 27:56So yes, a great majority of women
27:56 --> 27:59who have these symptoms will not have cancer.
27:59 --> 28:02They will only have hormonal changes.
28:03 --> 28:06But women who do develop cancer,
28:06 --> 28:09almost 100% of them say they knew it.
28:09 --> 28:10So that's the key.
28:10 --> 28:12It doesn't matter how old you are,
28:12 --> 28:14doesn't matter what stage of your
28:16 --> 28:18life, you know your body better than anybody else.
28:18 --> 28:21And don't let anybody tell you otherwise.
28:21 --> 28:23If you feel that something is not right,
28:23 --> 28:25you go and you seek help
28:25 --> 28:27see your provider and you have
28:27 --> 28:29a pelvic exam and you just make
28:29 --> 28:30sure that you're being heard.
28:30 --> 28:32Doctor Elena Ratner is
28:32 --> 28:34a professor of obstetrics,
28:34 --> 28:35gynecology and reproductive sciences
28:35 --> 28:38at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu,
28:42 --> 28:45and past editions of the program
28:45 --> 28:47are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:50We hope you'll join us next week to
28:50 --> 28:52learn more about the fight against
28:52 --> 28:54cancer here on Connecticut Public Radio.
28:54 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

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