Gynecologic Cancer Awareness Month

Transcript

00:00 --> 00:02Support for Yale Cancer Answers
00:02 --> 00:04comes from AstraZeneca providing
00:04 --> 00:07important treatment options for women
00:07 --> 00:10living with advanced ovarian cancer.
00:10 --> 00:12Learn more at astrazeneca-us.com.
00:14 --> 00:15Welcome to Yale Cancer
00:15 --> 00:17Answers with your host
00:17 --> 00:19Doctor Anees Chagpar.
00:19 --> 00:21Yale Cancer Answers features the
00:21 --> 00:23latest information on cancer care by
00:23 --> 00:24welcoming oncologists and specialists
00:24 --> 00:27who are on the forefront of the
00:27 --> 00:29battle to fight cancer. This week
00:29 --> 00:31it's a conversation about ovarian
00:31 --> 00:32cancer with doctor Elena Ratner.
00:32 --> 00:34Doctor Ratner is an associate professor
00:34 --> 00:36in the Department of obstetrics,
00:36 --> 00:37gynecology,
00:37 --> 00:38and Reproductive Sciences at
00:38 --> 00:40the Yale School of Medicine
00:40 --> 00:42where doctor Chagpar is a
00:42 --> 00:44professor of surgical oncology.
00:45 --> 00:47Maybe you could start off by telling
00:47 --> 00:50us a little bit more about ovarian cancer.
00:50 --> 00:52I know that a lot of people have heard
00:52 --> 00:55about it, but they may not know as much
00:55 --> 00:57about it as they know about other cancers.
00:57 --> 00:59So what exactly is it?
00:59 --> 01:01How common is it, and who
01:01 --> 01:03gets it?
01:03 --> 01:04Perfect questions to start with
01:04 --> 01:07and it is so wonderful to be able
01:07 --> 01:09to discuss this with you today and
01:09 --> 01:11with our listeners as it is ovarian
01:11 --> 01:13cancer month and we're trying to
01:13 --> 01:15raise awareness for this cancer.
01:15 --> 01:17Ovarian cancer overall
01:17 --> 01:19is not very common,
01:19 --> 01:22only 1.4% of lifetime risk
01:22 --> 01:23of getting the cancer,
01:23 --> 01:26and this cancer is more prevalent
01:26 --> 01:27in certain groups.
01:27 --> 01:30Genetic predisposition plays a very
01:30 --> 01:32important role as to some other
01:32 --> 01:35factors that I'm sure you and I will
01:35 --> 01:39discuss today during our conversation.
01:39 --> 01:41But the important thing about
01:41 --> 01:43ovarian cancer is that unfortunately
01:43 --> 01:45it still continues to be
01:45 --> 01:47a very deadly cancer.
01:47 --> 01:4924,000 women get this cancer yearly
01:49 --> 01:52in the United States and as high as
01:52 --> 01:5516,000 women die from this cancer
01:55 --> 01:58and the reason for that is because,
01:58 --> 01:58unfortunately,
01:58 --> 02:01this is a cancer that is very
02:01 --> 02:03difficult to diagnose early.
02:03 --> 02:06We used to say that this is the cancer
02:06 --> 02:07that whispers,
02:07 --> 02:10and during our conversation today
02:10 --> 02:13I would like to prove to you that
02:13 --> 02:15is not the case, but nevertheless,
02:15 --> 02:16these cancers, unfortunately
02:16 --> 02:20are frequently diagnosed at a later stage.
02:20 --> 02:22And even though most of them respond
02:22 --> 02:24very nicely to chemotherapy upfront,
02:24 --> 02:26this is a very, very smart
02:26 --> 02:27cancer and unfortunately they
02:27 --> 02:30learn how to resist the treatment
02:30 --> 02:31that we give them.
02:31 --> 02:33And again, during our conversation today,
02:33 --> 02:35I would like to discuss with you
02:35 --> 02:37as to how the treatment for this
02:37 --> 02:39cancer is really improving,
02:39 --> 02:41and there's so many new treatments
02:41 --> 02:43and new ways of management that
02:43 --> 02:46we are using now that we didn't
02:46 --> 02:48have six months ago, two years ago.
02:48 --> 02:49So the
02:49 --> 02:52outlook for this cancer looks very bright,
02:52 --> 02:54but this is a very important
02:54 --> 02:56cancer to be aware of because we,
02:56 --> 02:58as women are our best advocates
02:58 --> 03:01and we are fighters for our own
03:01 --> 03:02lives and our own bodies.
03:02 --> 03:05And that's why it's very important to know
03:05 --> 03:06about this cancer and to know
03:06 --> 03:08what symptoms to look out for.
03:09 --> 03:11A lot to cover
03:11 --> 03:14in this show and I'm really
03:14 --> 03:16excited to talk about this.
03:16 --> 03:18So let's start with risk factors.
03:18 --> 03:20Who gets ovarian cancer?
03:20 --> 03:23Are all women equally at risk or are
03:23 --> 03:25there some things that really predispose
03:25 --> 03:28some women to getting ovarian cancer?
03:28 --> 03:30You mentioned for example, genetics.
03:31 --> 03:33Yes, there's definitely factors that
03:33 --> 03:36increase your risk of getting ovarian cancer.
03:36 --> 03:39We now understand that genetics
03:39 --> 03:41play such an important role in
03:41 --> 03:43the old cancers most likely,
03:43 --> 03:46but definitely for ovarian cancer,
03:46 --> 03:49and it's not just for women who have
03:49 --> 03:52family history of ovarian cancers.
03:52 --> 03:54We know that there's genetic mutations
03:54 --> 03:57that increase your risk of ovarian
03:57 --> 03:59cancer and breast cancer and pancreatic
03:59 --> 04:02cancer and melanoma and prostate cancer in men.
04:02 --> 04:05When we talk about genetic
04:05 --> 04:07predisposition and when I talk
04:07 --> 04:09to women about their risks,
04:09 --> 04:11I don't just ask whether somebody
04:11 --> 04:14in the family had ovarian cancer,
04:14 --> 04:16even though of course that itself
04:16 --> 04:17would be a risk factor,
04:17 --> 04:19but it's more what other cancers
04:19 --> 04:22run in the family. Is there a
04:22 --> 04:25family member who had breast cancer?
04:25 --> 04:27Is there anybody who is a male who
04:27 --> 04:29had breast cancer and those
04:29 --> 04:32cancers are suspicious for BRCA
04:32 --> 04:33gene mutation.
04:33 --> 04:35There's been quite a bit in the
04:35 --> 04:37news about the BRCA gene mutation over
04:37 --> 04:40the past five years or so,
04:40 --> 04:41as you remember,
04:41 --> 04:42Angelina Jolie,
04:42 --> 04:44who has one of these mutations
04:44 --> 04:46and a number of different
04:46 --> 04:48New York Times Editorials,
04:48 --> 04:49talking about her experience
04:49 --> 04:50with the Mutation.
04:50 --> 04:53So it's called the Angelina Jolie effect.
04:53 --> 04:56And now there's much more known about
04:56 --> 04:58this mutation and about how women with
04:58 --> 05:01this mutation have a higher risk of
05:01 --> 05:04developing ovarian cancer and breast cancer,
05:04 --> 05:04for example.
05:04 --> 05:06But there's a mutation is
05:06 --> 05:09just one of those mutations.
05:09 --> 05:11There's many other mutations that
05:11 --> 05:13predispose you to getting these cancers.
05:13 --> 05:16That's why nowadays it is so important
05:16 --> 05:19to know your family history and to
05:19 --> 05:22know where you come from and to know
05:22 --> 05:25what possible genetic mutations you
05:25 --> 05:27might have that might predispose you
05:27 --> 05:30to having higher risk of different
05:30 --> 05:32cancers. In particular, ovarian cancer.
05:32 --> 05:34So that's important.
05:34 --> 05:36But you know, for women who may
05:36 --> 05:39not have a BRCA gene mutation
05:39 --> 05:41running in their family, or
05:41 --> 05:44who may not have a family history of
05:44 --> 05:47any cancers or for those who really
05:47 --> 05:49don't know their family history,
05:49 --> 05:51maybe they were adopted
05:51 --> 05:53or have come from families where
05:53 --> 05:56they really haven't gotten any of
05:56 --> 05:58that knowledge passed on to them
05:58 --> 06:00before people passed away,
06:00 --> 06:02are there other risk factors that
06:02 --> 06:05also play into your ovarian cancer
06:05 --> 06:07risk?
06:07 --> 06:09Yes, and so much of this
06:14 --> 06:15is truly individualized.
06:15 --> 06:17You know there's no formula.
06:17 --> 06:19There's no specific check list.
06:19 --> 06:21It is really just talking to women and
06:21 --> 06:24kind of understanding what are their risks.
06:24 --> 06:26What are the protective things that
06:26 --> 06:29they bring to the table when we
06:29 --> 06:32look for the risks of ovarian cancer.
06:32 --> 06:33So for example,
06:33 --> 06:36women who have had a lot of children,
06:36 --> 06:38it is very protective.
06:38 --> 06:41For anybody who has had five children,
06:41 --> 06:44that decreases their risk to 50%.
06:44 --> 06:47Anybody who breastfed each one
06:47 --> 06:50of their five children for five
06:50 --> 06:53years cumulatively has a decreased
06:53 --> 06:55risk of ovarian cancer by 50%.
06:55 --> 06:58Women who use birth control pills, those
07:00 --> 07:03are incredibly protective for ovarian cancer.
07:03 --> 07:05Every opportunity I get and every
07:05 --> 07:07girlfriend that I talk to,
07:07 --> 07:09I always tell
07:09 --> 07:11my listeners and my patients and
07:11 --> 07:14my friends
07:14 --> 07:17try to use birth control
07:17 --> 07:20pills for five years if they can.
07:20 --> 07:22Anybody who uses birth control pills
07:22 --> 07:24for five years decreases their
07:24 --> 07:26risk of ovarian cancer by 50%.
07:26 --> 07:29Anybody who uses it for 10 years
07:29 --> 07:31decreases it for as high as 80%.
07:31 --> 07:34Anybody who uses for 15 years
07:34 --> 07:36decreases it for as high as 90%.
07:36 --> 07:39So the benefit is really quite
07:39 --> 07:41astounding as to what we can do.
07:41 --> 07:44Women who had their
07:44 --> 07:46fallopian tubes removed,
07:46 --> 07:48in the older days we used to
07:48 --> 07:50do tubal ligations.
07:50 --> 07:50Now,
07:50 --> 07:52in many cases we actually would
07:52 --> 07:55take out the fallopian tube and
07:55 --> 07:57that significantly decreases your
07:57 --> 07:59risk for as high as 70%.
07:59 --> 08:00The hysterectomy,
08:00 --> 08:02even if there is some left behind
08:02 --> 08:05that significantly decreases their risk,
08:05 --> 08:07so there's a number of different
08:07 --> 08:10protective factors that one can
08:10 --> 08:12do to try to decrease the risk.
08:17 --> 08:19There's two different ways that
08:19 --> 08:21we now think about ovarian cancer,
08:21 --> 08:23the traditional theory of ovarian
08:23 --> 08:26cancer was that the more times that
08:26 --> 08:27the woman ovulates, the more
08:27 --> 08:30risk of developing cancer of the
08:30 --> 08:32ovaries and that's why anytime when
08:32 --> 08:34you are not ovulating whether
08:34 --> 08:36it's pregnancy or breastfeeding
08:36 --> 08:37or your birth control pills,
08:37 --> 08:39that decreases your risk.
08:39 --> 08:41The newer thought is that ovarian
08:41 --> 08:43cancers might not actually
08:43 --> 08:44be ovarian cancers at all.
08:44 --> 08:46They actually might be fallopian
08:46 --> 08:48tube cancers that then subsequently
08:48 --> 08:51spread to the ovaries and that's
08:51 --> 08:52why it is so important that
08:52 --> 08:54if you're having hysterectomy,
08:54 --> 08:57fallopian tubes do not have a purpose.
08:57 --> 08:57Ovaries,
08:57 --> 09:00of course do because they give you hormones,
09:00 --> 09:01but fallopian tubes,
09:01 --> 09:04the only purpose
09:04 --> 09:06is for pregnancy so many times
09:06 --> 09:07where women have hysterectomies
09:07 --> 09:10their ovaries left behind.
09:10 --> 09:11It is very,
09:11 --> 09:13very important that the fallopian
09:13 --> 09:15tubes are removed as well.
09:15 --> 09:17Or, if the fallopian tubes are tied,
09:17 --> 09:19that it gets
09:19 --> 09:21removed rather than just tying
09:21 --> 09:24it, because we now know that a great
09:24 --> 09:26number of these cancers originate
09:26 --> 09:29in the fallopian tubes. So if those
09:29 --> 09:31are removed, then the risk
09:31 --> 09:32is significantly decreased.
09:32 --> 09:33All great information.
09:33 --> 09:36Now let's suppose you've tried to
09:36 --> 09:38minimize your risk, but still,
09:38 --> 09:40one of the things that you
09:40 --> 09:44mentioned is that the part of ovarian
09:44 --> 09:46cancer that causes death is because
09:46 --> 09:49it's caught late, and
09:49 --> 09:52we know for many cancers that there
09:52 --> 09:54is effective screening, right?
09:54 --> 09:55We're heading into October.
09:55 --> 09:56Breast cancer awareness.
09:56 --> 10:00We all know that mammograms help us find
10:00 --> 10:01breast cancer early.
10:01 --> 10:03What do we have
10:03 --> 10:06or do we have anything in terms
10:06 --> 10:08of screening to help women to
10:08 --> 10:10find ovarian cancer early?
10:10 --> 10:11So that's
10:11 --> 10:13exactly the trouble with ovarian cancer,
10:13 --> 10:16and that's why we talk so much
10:16 --> 10:18about ovarian cancer prevention with
10:18 --> 10:21identifying risks and trying to do
10:21 --> 10:24anything you can to decrease your risk,
10:24 --> 10:25because unfortunately,
10:25 --> 10:27we do not have as good of
10:27 --> 10:30a test for ovarian cancer
10:30 --> 10:33as we do for breast cancer with
10:33 --> 10:36mammograms and there
10:36 --> 10:40is a lot of literature that shows that
10:40 --> 10:43there's really no benefit to doing
10:43 --> 10:46routine ultrasounds for normal risk
10:46 --> 10:48population because unfortunately
10:48 --> 10:50ultrasounds even in combination with
10:50 --> 10:54a tumor marker blood test called CA 125,
10:54 --> 10:56there's literature that in the
10:56 --> 10:59normal population that does not
10:59 --> 11:01help you detect cancer early.
11:01 --> 11:03And on the contrary,
11:03 --> 11:06pushes women to have more
11:06 --> 11:07unnecessary surgery.
11:07 --> 11:11But that's not the case for high risk women.
11:11 --> 11:14For women who are at higher risk for whatever
11:14 --> 11:18risk factors that we discussed previously,
11:18 --> 11:20then ultrasounds combined with this
11:20 --> 11:24blood test called CA 125 are a benefit,
11:24 --> 11:27but unfortunately still very limited.
11:27 --> 11:30That's why it is so important for
11:30 --> 11:32this ovarian cancer awareness
11:32 --> 11:35to exist and for women to know
11:35 --> 11:37the signs and symptoms for
11:37 --> 11:39ovarian cancer because that is
11:39 --> 11:41really the best screening or the
11:41 --> 11:43best early detection and risk
11:43 --> 11:46reduction is through awareness of the
11:46 --> 11:48symptoms and listening to your body.
11:48 --> 11:50And so one of the things
11:50 --> 11:53that you said at the outset is that
11:53 --> 11:56for many years ovarian cancer was
11:56 --> 11:58thought about as the cancer that
11:58 --> 12:01whispers because so many of the signs
12:01 --> 12:04and symptoms may be things that
12:04 --> 12:05women may shrug off,
12:05 --> 12:08but they may not be really aware of as
12:08 --> 12:12being potential red flags for ovarian cancer.
12:12 --> 12:15So tell us more about those signs and
12:15 --> 12:17symptoms that women should be aware
12:17 --> 12:20of to be thinking about.
12:20 --> 12:22And when should they be going
12:22 --> 12:24in and seeing their gynecologist?
12:24 --> 12:27For generations we used to say,
12:27 --> 12:30there's just nothing you can
12:30 --> 12:33do for ovarian cancer. It's what it is.
12:33 --> 12:35You just cannot diagnose it early
12:35 --> 12:37because there's no early symptoms,
12:37 --> 12:39but we know that
12:39 --> 12:41that is not the case.
12:41 --> 12:43Multiple very good studies have
12:43 --> 12:46been published to show that yes,
12:46 --> 12:49the majority of women, 97% percent of
12:49 --> 12:51women with advanced ovarian cancer,
12:51 --> 12:53will have symptoms,
12:53 --> 12:57but 89% of women with stage one and two
12:57 --> 13:01cancers will also have have symptoms.
13:01 --> 13:04The trouble is exactly how you said
13:04 --> 13:08that these are also normal symptoms that
13:08 --> 13:10these are symptoms of perimenopause.
13:10 --> 13:14Is this a symptom of having a period?
13:14 --> 13:17There's hormonal changes so the
13:17 --> 13:20majority of the women who have the
13:20 --> 13:22symptoms are actually completely normal
13:22 --> 13:25and the symptoms that we're talking
13:25 --> 13:28about is bloating,
13:28 --> 13:29some Constipation,
13:29 --> 13:32some diarrhea, bladder symptoms, weight gain.
13:32 --> 13:34Clothes not fitting well.
13:34 --> 13:36Feeling like you need to get
13:36 --> 13:37bigger clothes because they're
13:37 --> 13:39not fitting well around the waist.
13:39 --> 13:41The important thing again,
13:41 --> 13:43and this is I think the most important
13:43 --> 13:46thing of our conversation today is
13:46 --> 13:48the great majority of the women
13:48 --> 13:51who are listening to this today we all
13:51 --> 13:53experience symptoms and a great majority of
13:53 --> 13:55these symptoms are completely normal.
13:55 --> 13:58The symptoms that we need to pay attention
13:58 --> 14:00to are the symptoms that don't just
14:00 --> 14:03happen during periods or during ovulation.
14:03 --> 14:05Those are the symptoms that happen
14:05 --> 14:07every single day for two weeks,
14:07 --> 14:09and also symptoms
14:09 --> 14:11that happen together,
14:11 --> 14:13let's say bowel and bladder symptoms,
14:13 --> 14:15bloating and bladder symptoms.
14:15 --> 14:19Those are the symptoms to pay attention to.
14:20 --> 14:23We are going to dig into all of those
14:23 --> 14:25symptoms and how we can actually
14:25 --> 14:28make a diagnosis right after we take
14:28 --> 14:31a short break for a medical minute.
14:31 --> 14:33Please stay tuned to learn more
14:33 --> 14:35about the treatment and diagnosis of
14:35 --> 14:37ovarian cancer with my
14:37 --> 14:38guest doctor Elena Ratner.
14:38 --> 14:41Support for Yale Cancer Answers comes
14:41 --> 14:43from AstraZeneca providing important
14:43 --> 14:45treatment options for patients with
14:45 --> 14:47different types of lung, bladder,
14:47 --> 14:49ovarian, breast and blood cancers.
14:49 --> 14:51More information at astrazeneca-us.com.
14:51 --> 14:55This is a medical minute about breast cancer,
14:55 --> 14:57the most common cancer in
14:57 --> 14:58women. In Connecticut alone
14:58 --> 15:00approximately 3000 women will be
15:00 --> 15:03diagnosed with breast cancer this year,
15:03 --> 15:05but thanks to earlier detection,
15:05 --> 15:06non invasive treatments,
15:06 --> 15:07and novel therapies,
15:07 --> 15:10there are more options for patients to
15:10 --> 15:12fight breast cancer than ever before.
15:12 --> 15:14Women should schedule a baseline
15:14 --> 15:17mammogram beginning at age 40 or
15:17 --> 15:19earlier if they have risk factors
15:19 --> 15:21associated with breast cancer.
15:21 --> 15:23Digital breast tomosynthesis or 3D
15:23 --> 15:25mammography is transforming breast screening
15:25 --> 15:27by significantly reducing unnecessary
15:27 --> 15:30procedures while picking up
15:30 --> 15:32more cancers and eliminating
15:32 --> 15:34some of the fear and anxiety,
15:34 --> 15:36many women experience.
15:36 --> 15:37More information is available
15:37 --> 15:38at yalecancercenter.org.
15:38 --> 15:42You're listening to Connecticut public radio.
15:42 --> 15:43Welcome
15:43 --> 15:45back to Yale Cancer Answers.
15:45 --> 15:46This is doctor Anees Chagpar
15:46 --> 15:49and I'm joined tonight by
15:49 --> 15:50my guest doctor Elena Ratner.
15:50 --> 15:52We're talking about ovarian cancer
15:52 --> 15:54and right before the break Elena,
15:54 --> 15:56you started to tell us some of
15:56 --> 15:58the signs and symptoms that women
15:58 --> 16:01should really be aware of in terms
16:01 --> 16:03of trying to find ovarian cancer
16:03 --> 16:05early because we simply do not
16:05 --> 16:07have really good screening tests.
16:07 --> 16:09So it's really up to women to
16:09 --> 16:11pay attention to their bodies.
16:11 --> 16:14But one of the things that
16:14 --> 16:15struck me was that
16:15 --> 16:17many of the symptoms you mentioned,
16:17 --> 16:19a little bit of bloating,
16:19 --> 16:21a little change in bowel
16:21 --> 16:22habits or bladder function,
16:22 --> 16:23a little bit of weight
16:23 --> 16:25gain, your pants not fitting,
16:25 --> 16:27I mean those happen to all
16:27 --> 16:29of us all the time right?
16:29 --> 16:32You go out for a big meal and you
16:32 --> 16:34feel a little bloated after that.
16:34 --> 16:36You might have a little bit
16:36 --> 16:37of Constipation or diarrhea.
16:37 --> 16:39Your pants don't fit right and
16:39 --> 16:41you think Oh my God,
16:41 --> 16:43I'm gaining weight.
16:43 --> 16:45But should women be going
16:45 --> 16:46to their gynecologist
16:46 --> 16:48every time one of those things
16:48 --> 16:50happens? Tell us more about
16:50 --> 16:52what are really the triggers
16:52 --> 16:54that you would say you know what
16:54 --> 16:56this has gone on a bit too long,
16:56 --> 16:59you really need to get to your gynecologist,
16:59 --> 17:01you need to advocate for
17:01 --> 17:03yourself that this is something
17:03 --> 17:05that needs to be looked into.
17:06 --> 17:08Yes, that's exactly correct.
17:08 --> 17:11You really nailed it
17:11 --> 17:13when we discussed before
17:14 --> 17:16all of us experiencing it.
17:16 --> 17:17It's totally normal.
17:17 --> 17:20The key is to know what is normal
17:20 --> 17:23for you and then be aware when
17:23 --> 17:25something happens is not
17:25 --> 17:27within what's norm for you.
17:27 --> 17:29So usually what I tell women
17:29 --> 17:31is pretty much consistent symptoms
17:31 --> 17:34when you wake up every single day,
17:34 --> 17:36and it's something that you are
17:36 --> 17:38aware of constantly and that
17:38 --> 17:40lasts for two to three weeks.
17:40 --> 17:43That is the time to just get checked out.
17:44 --> 17:46I'm a huge proponent that just
17:46 --> 17:48talking to somebody or getting things
17:48 --> 17:51checked out is of such benefit.
17:51 --> 17:52The interesting thing is when
17:52 --> 17:55I speak to women with ovarian
17:55 --> 17:57cancer and then in their minds they
17:57 --> 18:00go back to when everything began.
18:06 --> 18:07It just wasn't considered by
18:07 --> 18:10them to be anything that they
18:10 --> 18:11should really pay attention to.
18:14 --> 18:15The other important thing
18:15 --> 18:17is that a lot of women,
18:17 --> 18:19when these things happen,
18:19 --> 18:21actually do not go to gynecologist.
18:21 --> 18:23Most women go to urologists because
18:23 --> 18:24they having bladder symptoms.
18:24 --> 18:27They go to a gastroenterologist because
18:27 --> 18:29they're getting bowel symptoms, interestingly
18:29 --> 18:31a lot of women go to chiropractors
18:31 --> 18:33because they having this discomfort
18:33 --> 18:36and they're trying to make that better.
18:36 --> 18:38So we actually do
18:38 --> 18:40education not just to women,
18:40 --> 18:41but to providers.
18:41 --> 18:43I actually do tons of talks
18:43 --> 18:46in the state of Connecticut to
18:46 --> 18:48different physicians and different providers.
18:48 --> 18:50We have this designation that
18:50 --> 18:53we created to certify physicians and
18:53 --> 18:56providers who know how to
18:56 --> 18:58identify symptoms for varying cancer,
18:58 --> 19:00because unfortunately not all
19:00 --> 19:03of this is just women symptoms.
19:03 --> 19:04Many times,
19:04 --> 19:06women go to the physicians
19:06 --> 19:08appropriately because they know that what
19:08 --> 19:10they are experiencing is not normal,
19:10 --> 19:13and that provider checks out this
19:13 --> 19:16area, and clears that up.
19:16 --> 19:17But unfortunately they don't
19:17 --> 19:18piece things together,
19:18 --> 19:20and this delay in diagnosis continues,
19:20 --> 19:22and this is actually a very persistent problem,
19:22 --> 19:24and something that a lot of women
19:24 --> 19:26feel so passionate about
19:26 --> 19:28that we started this whole program
19:28 --> 19:30where we are doing a lot of Education,
19:30 --> 19:31not just for women,
19:31 --> 19:33but for providers to make sure
19:33 --> 19:35that they know exactly what
19:35 --> 19:36symptoms and how to identify it,
19:36 --> 19:39and when to refer and
19:39 --> 19:41when to order an ultrasound.
19:41 --> 19:41But you know,
19:41 --> 19:43at the end of the day this should
19:43 --> 19:45not be yet another thing that
19:45 --> 19:47we don't have to worry about.
19:47 --> 19:49You know it's important to know
19:49 --> 19:52your body and listen to your body.
19:52 --> 19:54It's important to be your advocate,
19:54 --> 19:56but at the end of the day
19:56 --> 19:58we need to assure that providers
19:58 --> 20:00also know the symptoms and know how
20:00 --> 20:02to piece things together and
20:02 --> 20:03take best care.
20:04 --> 20:06But I can imagine that many
20:06 --> 20:08providers are thinking
20:08 --> 20:11hings are common and so really
20:11 --> 20:14having patients say,
20:14 --> 20:16I agree that things are common,
20:16 --> 20:19but this isn't common for me,
20:19 --> 20:21so I think that while you're quite
20:21 --> 20:24right that it's important that providers
20:24 --> 20:26really know the signs and symptoms,
20:26 --> 20:28it's also really critical that
20:28 --> 20:30women advocate for themselves.
20:30 --> 20:33So Elena is the first step in diagnosis
20:33 --> 20:35getting an ultrasound or CT?
20:35 --> 20:37What should women expect
20:37 --> 20:39when they go to their family doctor
20:39 --> 20:41or their gynecologist or their
20:41 --> 20:44GI doc or somebody
20:44 --> 20:47with these vague symptoms and we're
20:47 --> 20:49trying to rule out ovarian cancer.
20:49 --> 20:50Yeah, so the important
20:50 --> 20:53part is to be seen by a gynecologist
20:53 --> 20:55and to do a pelvic exam.
20:55 --> 20:57Those are always very important
20:57 --> 20:59and there's a lot of information
20:59 --> 21:01that we as providers can get
21:01 --> 21:04out of a physical examination.
21:04 --> 21:07Pelvic examination. Second step would
21:07 --> 21:08be together just an ultrasound.
21:08 --> 21:11You know cat scans and mris are
21:11 --> 21:12usually not necessary and actually
21:12 --> 21:15not the best test for these at all.
21:15 --> 21:17So we would get as a trans
21:17 --> 21:18vaginal ultrasound.
21:18 --> 21:21And usually we would not do tumor marker
21:21 --> 21:23unless we have two 2 markerS called CA
21:23 --> 21:25125 and it is not a great test.
21:25 --> 21:27There's a lot of times that is
21:27 --> 21:29falsely positives or false negative
21:29 --> 21:31so we won't order it always.
21:31 --> 21:32We order it in circumstances,
21:32 --> 21:34but only after the ultrasound.
21:34 --> 21:36So that's what you would expect.
21:37 --> 21:38Great and
21:38 --> 21:40let's suppose you do that.
21:40 --> 21:42You've been having these vague symptoms.
21:42 --> 21:44You go to your doctor.
21:44 --> 21:46Your doctor says, you know,
21:46 --> 21:48maybe we ought to send you
21:48 --> 21:49to your gynecologist.
21:49 --> 21:51The gynecologist does a pelvic
21:51 --> 21:53exam and a trans vaginal ultrasound,
21:53 --> 21:55and they think that they
21:55 --> 21:56feel something or they
21:57 --> 21:58see something in the ovary.
21:58 --> 21:59Now, what happens?
22:01 --> 22:03So women with ovarian cancer,
22:03 --> 22:06women for whom we suspect of having cancer,
22:06 --> 22:09are managed usually by team of doctors.
22:09 --> 22:11You know, the gynecologist,
22:11 --> 22:13of course plays a very important role
22:13 --> 22:16and then works together with other
22:16 --> 22:18colleagues like myself,
22:18 --> 22:20who specializes in treatment and surgeries
22:20 --> 22:22and chemotherapy for these cancers.
22:22 --> 22:25So the point I wanted to make is
22:25 --> 22:28how much better things are today
22:28 --> 22:31than they have been in the past.
22:31 --> 22:33We now truly provide
22:33 --> 22:34personalized care.
22:42 --> 22:45I now can do surgeries laparoscopically
22:45 --> 22:47or robotically where women
22:47 --> 22:50can go home the same day whereas four
22:50 --> 22:53years ago they will stay in the
22:53 --> 22:55hospital for a week if not longer.
22:56 --> 22:56So surgically
22:56 --> 22:59if you were concerned about ovarian
22:59 --> 23:02cancer you would have a hysterectomy
23:02 --> 23:05and then you would get a
23:05 --> 23:08biopsy and we would look
23:08 --> 23:08under a microscope,
23:08 --> 23:11to try to identify the cells and
23:11 --> 23:13that's how a diagnosis would be made,
23:13 --> 23:15but everything now starts
23:15 --> 23:17from that first step where you
23:17 --> 23:20have surgery and again now we do
23:20 --> 23:22everything truly in the personalized
23:22 --> 23:24fashion where most women are
23:24 --> 23:26now great candidates for this
23:26 --> 23:28robotic surgery and they
23:28 --> 23:30go home
23:30 --> 23:33same day and they go back to work
23:33 --> 23:35within a week and then extending to
23:35 --> 23:38chemotherapy where we no longer treat
23:38 --> 23:41women the same way that we used to treat.
23:41 --> 23:43We no longer treat somebody the
23:43 --> 23:46same way just because they have
23:46 --> 23:48the same cancer as somebody else.
23:48 --> 23:49We truly study
23:49 --> 23:51their mutations and truly understand what
23:51 --> 23:54is driving and causing the cancer in
23:54 --> 23:55particular women,
23:55 --> 23:58and then the treatment that we recommend
23:58 --> 24:00and then we provide is
24:00 --> 24:01based specifically on that.
24:01 --> 24:04So we use a lot of targeted therapies.
24:04 --> 24:07We use a lot of pills nowadays.
24:07 --> 24:09You know some chemotherapies
24:09 --> 24:13are still through IV how they used to be.
24:13 --> 24:16But a lot of them now are just oral
24:16 --> 24:18pills that you don't even have
24:18 --> 24:20to come into the office to get.
24:20 --> 24:22You can get from home.
24:22 --> 24:23There's immunotherapy.
24:23 --> 24:26There's a lot of these targeted achievements,
24:26 --> 24:27again specifically for that patient,
24:27 --> 24:30and I think that's the key to success.
24:30 --> 24:32And more and more
24:32 --> 24:35of these cancers are going to be cured.
24:35 --> 24:36So that's really encouraging.
24:36 --> 24:39I want to take a step back though,
24:39 --> 24:41so at the point where you've gone
24:41 --> 24:43to the gynecologist, they felt
24:43 --> 24:45something they've done an ultrasound.
24:45 --> 24:48in many of the cancers
24:48 --> 24:50that we talk about on this show,
24:50 --> 24:52the next step is a biopsy,
24:52 --> 24:54but it sounds like that might not
24:54 --> 24:56always be the case in ovarian cancer.
24:56 --> 24:57Is that right?
24:57 --> 25:00Do we always get a biopsy before surgery?
25:00 --> 25:02Or do we kind of sometimes just say,
25:02 --> 25:05well you're at a certain age.
25:05 --> 25:07You can have a hysterectomy
25:07 --> 25:08instead and that will accomplish
25:08 --> 25:10two goals with one stone.
25:10 --> 25:11How does that work?
25:11 --> 25:12That's an excellent
25:12 --> 25:13question because
25:13 --> 25:15in many other cancers
25:15 --> 25:17we would not proceed to surgery directly.
25:17 --> 25:20We usually will try to get a biopsy.
25:20 --> 25:22Ovarian cancer is the exception
25:22 --> 25:25to that because of where the
25:25 --> 25:27ovaries are and how they are.
25:27 --> 25:30We never biopsy ovaries because
25:30 --> 25:32you can rupture an ovary and
25:32 --> 25:34potentially you can make that worse
25:34 --> 25:37if cancer cells are present,
25:37 --> 25:39so most of the time if something
25:39 --> 25:42looks suspicious on the ultrasound
25:42 --> 25:43and pelvic examination,
25:43 --> 25:47or if women get a cat scan and MRI,
25:47 --> 25:50or there's some sort of imaging
25:50 --> 25:52that shows us especially suspicious
25:52 --> 25:54we would just remove it.
25:54 --> 25:56We would just take out the ovary
25:56 --> 25:59and then be able to look at
25:59 --> 26:01it at the microscope directly
26:01 --> 26:02without the biopsy.
26:02 --> 26:03And so when that's done,
26:03 --> 26:05is a hysterectomy always
26:05 --> 26:06done at the same time?
26:06 --> 26:08Or does it matter where the
26:08 --> 26:10woman is in her life cycle?
26:10 --> 26:12So young woman versus an
26:12 --> 26:13older woman, for example?
26:13 --> 26:16Or is that just part and parcel of the
26:16 --> 26:17same surgery?
26:17 --> 26:20Exactly the same as what we talked before,
26:20 --> 26:22everything is truly individualized.
26:22 --> 26:24I have a lot of women in their
26:24 --> 26:2630s who have had this diagnosis
26:26 --> 26:28and I would never remove the ovaries
26:28 --> 26:31I always allow them to continue
26:31 --> 26:33how it was meant to be,
26:33 --> 26:36and we certainly can do a lot of these
26:36 --> 26:38surgeries and
26:38 --> 26:40remove that normal ovary
26:40 --> 26:42other things that we have to remove,
26:42 --> 26:44but allow them to continue their
26:44 --> 26:46normal lives and have normal fertility
26:46 --> 26:48and be able to carry pregnancies.
26:48 --> 26:50There's times where that's not possible,
26:50 --> 26:53but most times with the young
26:53 --> 26:56women we find a way to make it happen.
26:56 --> 26:58If the woman is older
26:58 --> 27:00then yes,
27:00 --> 27:03of course we would remove the uterus
27:03 --> 27:05as well and do a total hysterectomy
27:05 --> 27:07but not the younger women.
27:07 --> 27:10And so when you do that surgery,
27:10 --> 27:12you had mentioned
27:12 --> 27:15that many of these
27:15 --> 27:16cancers are not caught early
27:17 --> 27:19unfortunately and that's one of the
27:19 --> 27:21things that leads to the high mortality
27:21 --> 27:23rate associated with ovarian cancer.
27:23 --> 27:26How many of these cancers have
27:26 --> 27:28spread outside the ovary when
27:28 --> 27:29their first diagnosed?
27:29 --> 27:32What impact does that have in
27:32 --> 27:34terms of treatment and prognosis?
27:36 --> 27:38So at this point a lot of them,
27:38 --> 27:41the great majority of them 75% or so
27:41 --> 27:44spread to outside of the ovary at
27:44 --> 27:47the time of diagnosis and because of
27:47 --> 27:49that once we complete their surgery
27:49 --> 27:53women need some sort of additional
27:53 --> 27:55treatment which is usually chemotherapy
27:55 --> 27:58or some sort of targeted therapy but
27:58 --> 28:00myself among with many other experts
28:00 --> 28:03who now spend so much of our
28:03 --> 28:06time just doing surgery and not
28:06 --> 28:08just doing chemotherapy, but really
28:08 --> 28:11providing education to women.
28:14 --> 28:16The future will be that more and
28:16 --> 28:18more of these cancers will be
28:18 --> 28:20found earlier and localized and
28:20 --> 28:23surgery will be able to cure them.
28:23 --> 28:24The key again,
28:24 --> 28:26is just knowing your body and
28:26 --> 28:28listening to your body and then
28:28 --> 28:30seeing the physicians and seeing the
28:30 --> 28:32providers and getting the
28:32 --> 28:35care that you deserve, not turning away.
28:44 --> 28:46And with that more and more of
28:46 --> 28:48these cancers will be found early
28:48 --> 28:50and the nature of
28:50 --> 28:51this disease will change.
28:51 --> 28:53Doctor Elena Ratner is an associate
28:53 --> 28:56professor in the Department of obstetrics,
28:56 --> 28:57gynecology, and Reproductive Sciences
28:57 --> 28:59at the Yale School of Medicine.
28:59 --> 29:01If you have questions,
29:01 --> 29:02the address is canceranswers@yale.edu
29:02 --> 29:04and past editions of the program
29:04 --> 29:06are available in audio and written
29:06 --> 29:08form at Yalecancercenter.org.
29:08 --> 29:10We hope you'll join us next week to learn
29:10 --> 29:13more about the fight against cancer.
29:13 --> 29:15Here on Connecticut public radio.

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September 27, 2020

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

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