Gynecologic Malignancies

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 with
00:08 --> 00:11your host doctor in East Chappar
00:11 --> 00:12Yale Cancer Answers features the
00:12 --> 00:15latest information on cancer care by
00:15 --> 00:16welcoming oncologists and specialists
00:16 --> 00:19who are on the forefront of the
00:19 --> 00:20battle to fight cancer this week.
00:20 --> 00:23It's a conversation about the care of
00:23 --> 00:24gynecologic cancers with Doctor Christie.
00:24 --> 00:27Kim Doctor Kim is an assistant
00:27 --> 00:28professor in clinical medicine
00:28 --> 00:30at the Yale School of Medicine,
00:30 --> 00:32where Doctor Chappar is a
00:32 --> 00:35professor of surgical oncology. So
00:35 --> 00:36Christy, maybe we can start off by
00:36 --> 00:38you telling us a little bit about
00:38 --> 00:40yourself and what it is you do.
00:41 --> 00:44So I consider myself as a
00:44 --> 00:46General Medical oncologist.
00:46 --> 00:51I came as a immigrant from South Korea.
00:51 --> 00:53Unfortunately, I lost my dad from small
00:53 --> 00:56cell lung cancer during my training year,
00:56 --> 00:59so it's been a rough journey.
00:59 --> 01:04Umm? About a month ago I lost my
01:04 --> 01:06sister from El Paso to lung cancer.
01:06 --> 01:09So it's been a tremendous year in challenges,
01:09 --> 01:13but I've seen how the clinical trial impacted
01:13 --> 01:16somebody's outcome in their cancer journey.
01:16 --> 01:20I've seen the Laratta net that was
01:20 --> 01:24she was on as a trial, how it kind
01:24 --> 01:26of melted her cancer in her brain.
01:26 --> 01:29So it was remarkable challenging year,
01:29 --> 01:33but makes you grow as a medical oncologist.
01:34 --> 01:35Yeah? Well, I'm so sorry to
01:35 --> 01:38hear of your losses, but.
01:38 --> 01:40I understand that your practice
01:40 --> 01:42is General Medical oncology,
01:42 --> 01:44but you have a special interest
01:44 --> 01:45in gynecologic cancers.
01:45 --> 01:46Is that right?
01:46 --> 01:52Yes, that's my. My passion, I have a.
01:52 --> 01:56I built up my interest because my
01:56 --> 01:59second job I was hired as mainly.
02:01 --> 02:03Taking care of the gynecologic cancer patient
02:04 --> 02:07and so tell us a little bit
02:07 --> 02:08more about gynecologic cancers.
02:08 --> 02:11What type of cancers do you see?
02:11 --> 02:14What does that entail and and why?
02:14 --> 02:16Why was that your passion?
02:16 --> 02:18What was it about gynecologic cancers
02:18 --> 02:20that was particularly special to you?
02:21 --> 02:24It saw everything that
02:24 --> 02:27kind of packaged into it.
02:27 --> 02:30There is a beginning in cancer
02:30 --> 02:32journey and there's an end
02:32 --> 02:34and some people their cancer.
02:34 --> 02:36They go into remission and some
02:36 --> 02:38people they their disease that come
02:38 --> 02:41to you know they're in and you know,
02:41 --> 02:44I think as a medical oncologist there
02:44 --> 02:47are always something that you can do to
02:47 --> 02:50improve and impact on somebody's life.
02:50 --> 02:54It's a. Provider oncologist I feel I
02:54 --> 02:58see that this is a more like a teamwork,
02:58 --> 03:01like a multidisciplinary.
03:01 --> 03:05And I see a lot of ovarian cancer patients,
03:05 --> 03:08uterine or endometrial cancer.
03:08 --> 03:11And it's a multidisciplinary.
03:11 --> 03:13Helping care with the
03:13 --> 03:14gynecological oncologists,
03:14 --> 03:16radiation oncologists, nursing staff.
03:16 --> 03:19We have a nutritionist.
03:19 --> 03:22We have a social worker.
03:22 --> 03:26And a survival ship and palliative care team.
03:26 --> 03:27It's a challenging work,
03:27 --> 03:30but I think in the end you know
03:30 --> 03:32how we handle somebody's life
03:32 --> 03:33in their cancer journey,
03:33 --> 03:35how we can impact their their lives.
03:35 --> 03:38And I think it's such a very gratifying,
03:38 --> 03:39rewarding job.
03:39 --> 03:42Yeah, you know some of the concepts
03:42 --> 03:44that you mentioned in terms of dealing
03:44 --> 03:46with a multidisciplinary team and
03:46 --> 03:49the challenges and so forth are are
03:49 --> 03:51really ubiquitous when we think about
03:51 --> 03:54cancers in general, so why you know,
03:54 --> 03:56with your family history and and
03:56 --> 03:59you started off by telling us
03:59 --> 04:01about your dad and your sister
04:01 --> 04:04who both succumbed to lung cancer.
04:04 --> 04:06What drew you to gynecologic
04:06 --> 04:07cancers in particular?
04:09 --> 04:11So I. I saw I was seeing more of the
04:11 --> 04:13kind of ecologic cancer patients
04:13 --> 04:16so you built up your interest.
04:16 --> 04:18You read more about it,
04:18 --> 04:20you engage in and you reach out
04:20 --> 04:21some answers and you settle.
04:21 --> 04:22Don't settle for less.
04:22 --> 04:24You always want the challenging part.
04:24 --> 04:26You want the best treatment for
04:26 --> 04:28all your patients and people who
04:28 --> 04:30are heavily treated and you want
04:30 --> 04:32to go beyond what's available.
04:32 --> 04:34You won't settle for,
04:34 --> 04:37I think that's really impactful.
04:37 --> 04:40But patients also motivates you.
04:40 --> 04:42And they really motivate you
04:42 --> 04:43to challenge things and kind
04:43 --> 04:45of improve and impact.
04:45 --> 04:48And going back to my sister's cancer journey,
04:48 --> 04:50she was on clinical trial drug
04:50 --> 04:52that was not yet at the approved.
04:52 --> 04:54I've seen how it melts her
04:54 --> 04:57cancer in her brain and I think
04:57 --> 04:59it's very important that we.
04:59 --> 05:02So we want the best really
05:02 --> 05:04effective drug to be available
05:04 --> 05:08so that many people can take.
05:08 --> 05:09Get, you know,
05:09 --> 05:12benefit from and being able to live longer.
05:12 --> 05:14Being able to improve their
05:14 --> 05:17quality of lives and be able
05:17 --> 05:19to attend their grandchildren's
05:19 --> 05:20birthdays and social gatherings.
05:20 --> 05:24And that's really meaningful to them,
05:24 --> 05:25I think as oncologists.
05:25 --> 05:26That's really important.
05:28 --> 05:30And so thinking about gynecologic
05:30 --> 05:33cancers in particular and a
05:33 --> 05:37couple of questions, how does the
05:37 --> 05:39prognosis of gynecologic cancers?
05:39 --> 05:41Vary when you compare it
05:41 --> 05:42to other malignancies.
05:43 --> 05:44So.
05:46 --> 05:48For example, ovarian cancers.
05:48 --> 05:51There's no really effective
05:51 --> 05:52screening markers,
05:52 --> 05:57and because the symptoms are very vague and.
05:57 --> 06:00Important part of the.
06:00 --> 06:02The best alchemist to detect
06:02 --> 06:04early or prevention.
06:04 --> 06:06There is no such effective
06:06 --> 06:09preventions or screening process,
06:09 --> 06:11and so unfortunately the patients present
06:11 --> 06:13with when they are in advanced stage
06:13 --> 06:16and where their value is full of cancers.
06:16 --> 06:20So this is a challenging part.
06:20 --> 06:24A certain type of cancers are preventable,
06:24 --> 06:25such as like ATB related,
06:25 --> 06:27and cervical cancer, for example,
06:27 --> 06:30is a number one kind of classic cancer
06:30 --> 06:33worldwide in us it's uterine cancer.
06:33 --> 06:35Again, there is a you know screening,
06:35 --> 06:37but just kind of don't let
06:37 --> 06:39your symptoms down and just do.
06:39 --> 06:40You know,
06:40 --> 06:42seek medical help and medical
06:42 --> 06:44pensions when you are not right.
06:46 --> 06:49Yeah, so I mean gynecologic cancers as
06:49 --> 06:52you point out, is really a spectrum,
06:52 --> 06:55and within that spectrum are are things
06:55 --> 06:57that are potentially preventable,
06:57 --> 07:00like HPV related cervical cancer and
07:00 --> 07:05other things that are really kind of the
07:05 --> 07:07the silent killer or the silent cancer.
07:07 --> 07:10Things like ovarian cancer that can
07:10 --> 07:13present very late where we really
07:13 --> 07:15don't have a good screening and
07:15 --> 07:18don't really have good prevention.
07:18 --> 07:22So in thinking about the spectrum
07:22 --> 07:25of these cancers, and in thinking
07:25 --> 07:27about your your sister's journey,
07:27 --> 07:30where it seems like you were particularly
07:30 --> 07:31passionate about clinical trials,
07:31 --> 07:33talk to us a little bit more about
07:33 --> 07:36some of the clinical trials that are
07:36 --> 07:38ongoing in gynecologic cancers are.
07:38 --> 07:41Do you find that those are more frequent
07:41 --> 07:44in the more advanced cancers like ovarian?
07:45 --> 07:53So our goal are to bring the more powerful,
07:53 --> 07:56effective drug front,
07:56 --> 07:58because that's the best chance to
07:58 --> 08:00cure disease or best chance to
08:00 --> 08:02keep the disease in remissions.
08:02 --> 08:04Unfortunately, ovarian cancer,
08:04 --> 08:06or 70% of the cancer relapse
08:06 --> 08:08or recur at later time,
08:08 --> 08:10and the progression free
08:10 --> 08:11subsequent interval for children
08:11 --> 08:13and shorter and subsequently
08:13 --> 08:15patient succumb to their disease.
08:15 --> 08:17So you can imagine you want to
08:17 --> 08:19bring the most effective treatment,
08:19 --> 08:23so nowadays are with more like
08:23 --> 08:25a molecular biomarker driven.
08:25 --> 08:27You want to test the BRACA
08:27 --> 08:28mutations for everybody.
08:28 --> 08:30The genetic testing,
08:30 --> 08:32regardless of their family history,
08:32 --> 08:36because there is a powerful effective
08:36 --> 08:39drug called PARP inhibitor,
08:39 --> 08:41so you don't want to miss that chance,
08:41 --> 08:44and there are combining 2
08:44 --> 08:46immunotherapy again, I think.
08:46 --> 08:48It's not for one size fits all.
08:48 --> 08:50I think it's just very personalized.
08:50 --> 08:52You know, manner that.
08:52 --> 08:55I think we are getting closer to
08:55 --> 08:58success treating having patients more cured.
08:58 --> 09:00And I think we live in an era where
09:00 --> 09:05we're here, myeloma. Colleagues.
09:05 --> 09:08Seeing cure it's unheard of.
09:08 --> 09:09My training,
09:09 --> 09:11so I think it's totally encouraging.
09:11 --> 09:12But again,
09:12 --> 09:15this is a very collaboration to
09:15 --> 09:17and having effective if there's
09:17 --> 09:18a clinical trial available,
09:18 --> 09:21that's the best chance to move forward.
09:21 --> 09:23That's the best to have the impact on
09:23 --> 09:25somebody's life, so have them enrolled.
09:25 --> 09:26Have them screen.
09:26 --> 09:28We have such a wonderful clinical trial,
09:28 --> 09:29people,
09:29 --> 09:31they're really willing to work
09:31 --> 09:33with you and we want to do
09:33 --> 09:35everything that we can to have
09:35 --> 09:37impact on somebody's life.
09:38 --> 09:40Especially when
09:40 --> 09:42disease can be very advanced,
09:42 --> 09:45you know ovarian cancer as we've
09:45 --> 09:47talked about previously on the show
09:47 --> 09:49is one of these that can sneak up
09:49 --> 09:51on people because the the symptoms
09:51 --> 09:53that people present with are are
09:53 --> 09:56generally things that are overlooked.
09:56 --> 09:57A little bit of abdominal pain,
09:57 --> 09:58maybe some Constipation.
09:58 --> 10:01Maybe you know a little bit of
10:01 --> 10:03bloating and people kind of,
10:03 --> 10:05you know, put it aside and say,
10:05 --> 10:06Oh well, that's nothing.
10:06 --> 10:08And then you know one thing.
10:08 --> 10:09Kind of leads to another,
10:09 --> 10:12and by the time that they actually
10:12 --> 10:14present they they've presented
10:14 --> 10:16with quite advanced disease,
10:16 --> 10:19so you know when you talk about cancer
10:19 --> 10:22being biomarker driven and clinical trials.
10:22 --> 10:25Tell us about some of the clinical
10:25 --> 10:26trials that you're particularly
10:26 --> 10:28excited about that are ongoing now
10:28 --> 10:31in the space of ovarian cancer,
10:31 --> 10:33or there are things that you're
10:33 --> 10:36really excited about that might be,
10:36 --> 10:36you know,
10:36 --> 10:38the next therapy that will melt away.
10:38 --> 10:41Answer Very much like it did for your sister.
10:42 --> 10:45So to ovarian cancers are you know
10:45 --> 10:48there are many subtype. It's not.
10:48 --> 10:51One size fits all high grade serous cancers
10:51 --> 10:53are treated differently versus low grade,
10:53 --> 10:56and they're more and more paper published.
10:56 --> 11:00We just had a esgo side of comicology
11:00 --> 11:02oncology annual meetings that clear
11:02 --> 11:05self examples are responsible.
11:05 --> 11:06Better to therapy.
11:06 --> 11:08There's more key risk mutation.
11:08 --> 11:10There are two mutations that
11:10 --> 11:12are noted in certain type.
11:12 --> 11:13There's a map.
11:13 --> 11:16Inhibitor that are really work really
11:16 --> 11:18effective in low grade serous carcinoma.
11:18 --> 11:22So as you can imagine and also there's
11:22 --> 11:25a mucinous ovarian subtype that respond
11:25 --> 11:28well to GI driven treatment modality.
11:28 --> 11:30So I think knowing upfront that you
11:30 --> 11:33want to know what the patients have
11:33 --> 11:35so I think it's really important to
11:35 --> 11:38kind of try to stratify and kind
11:38 --> 11:40of know what their subtypes are.
11:40 --> 11:42What are their markers so that
11:42 --> 11:43we can better serve.
11:43 --> 11:46To effective drug that are going to
11:46 --> 11:49have an impact on their outcome.
11:50 --> 11:53Yeah, so so one can imagine that the
11:53 --> 11:56clinical trials that are ongoing at
11:56 --> 11:59the moment may be directed based on
11:59 --> 12:01particular biomarkers. Is that right?
12:01 --> 12:03And and are there any that are are
12:03 --> 12:06exciting for you for particular biomarkers?
12:08 --> 12:11The monoclonal antibody against
12:11 --> 12:14you know 25 and it's actually
12:14 --> 12:18available at Yale as a first line,
12:18 --> 12:20the exclusion criteria is, if patient,
12:20 --> 12:23has a BRACA mutation that disqualifies
12:23 --> 12:25because of heart inhibitor is
12:25 --> 12:27supposed to be more effective,
12:27 --> 12:28but these are something that
12:28 --> 12:31we want to have a move forward
12:31 --> 12:33and have more people to engage.
12:33 --> 12:35If it's really effective drug that we
12:35 --> 12:38want this to be available to everybody.
12:38 --> 12:42There is another one that's
12:42 --> 12:43called Antifolate Alpha.
12:44 --> 12:45Antibody, drug conjugates and these
12:45 --> 12:47are something that's really we've
12:47 --> 12:48been seeing time and time again.
12:48 --> 12:50For, you know from journal to
12:50 --> 12:52Journal and from national meetings
12:52 --> 12:54that people are responding.
12:54 --> 12:56These are platinum resistant that we
12:56 --> 12:59really have a really dismal prognosis.
12:59 --> 13:01And we want this to be bring up and
13:01 --> 13:04to be available for these ladies
13:04 --> 13:06who are suffering from brain cancer.
13:06 --> 13:06We are.
13:06 --> 13:09Our goal is to keep the brain
13:09 --> 13:12cancer as a more like a chronic
13:12 --> 13:15disease where you know they are
13:15 --> 13:16as long as they are on the right
13:16 --> 13:18medications and they are going to,
13:18 --> 13:18you know,
13:18 --> 13:21live long as long as they can and we.
13:21 --> 13:24Can mitigate the toxicity and
13:24 --> 13:26improve their outcome.
13:26 --> 13:30Yeah yeah. It's so important to really
13:30 --> 13:34try to tailor therapy for cancer patients,
13:34 --> 13:37and the hope really is that we
13:37 --> 13:39we control cancers so that people
13:39 --> 13:42can go on living their lives.
13:42 --> 13:43Well, we're going to take a short
13:43 --> 13:45break for a medical minute,
13:45 --> 13:47but please stay tuned to learn more
13:47 --> 13:49about the care of gynecologic cancers
13:49 --> 13:51with my guests. Dr Christie Kim.
13:51 --> 13:54Funding for Yale Cancer answers comes
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13:58 --> 14:00Survivorship resented by the Smilo Cancer
14:00 --> 14:04Care Center in Trumbull, April 14th.
14:04 --> 14:06Register at yalecancercenter.org or
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14:10 --> 14:13The American Cancer Society estimates that
14:13 --> 14:16over 200,000 cases of Melanoma will be
14:16 --> 14:18diagnosed in the United States this year,
14:18 --> 14:21with over 1000 patients in Connecticut alone.
14:21 --> 14:24While Melanoma accounts for only
14:24 --> 14:26about 1% of skin cancer cases,
14:26 --> 14:29it causes the most skin cancer deaths,
14:29 --> 14:31but when detected early,
14:31 --> 14:33it is easily treated and highly curable.
14:33 --> 14:35Clinical trials are currently
14:35 --> 14:37underway at federally designated
14:37 --> 14:39Comprehensive cancer centers such
14:39 --> 14:41as Yale Cancer Center and its Milo.
14:41 --> 14:43Cancer Hospital to test innovative
14:43 --> 14:45new treatments for Melanoma.
14:45 --> 14:47The goal of the specialized programs
14:47 --> 14:49of research excellence and Skin Cancer
14:49 --> 14:51Grant is to better understand the
14:51 --> 14:54biology of skin cancer where the focus
14:54 --> 14:56on discovering targets that will lead
14:56 --> 14:58to improved diagnosis and treatment.
14:58 --> 15:01More information is available at
15:01 --> 15:03yalecancercenter.org you're listening
15:03 --> 15:04to Connecticut Public Radio.
15:07 --> 15:09Welcome back to Yale Cancer answers.
15:09 --> 15:12This is Doctor Annise Chapparo and I'm joined
15:12 --> 15:14tonight by my guest doctor Christie Kim.
15:14 --> 15:17We're learning about the care of patients
15:17 --> 15:19with gynecologic cancers and you know,
15:19 --> 15:21before the break, Christie you
15:21 --> 15:24were talking about how you know you
15:24 --> 15:27really treat a variety of cancers,
15:27 --> 15:28including ovarian cancer.
15:28 --> 15:33We talked a little bit about how this tends
15:33 --> 15:37to present late and how now this is more.
15:37 --> 15:41Biomarker driven and that there are clinical
15:41 --> 15:44trials that really try to personalize
15:44 --> 15:47therapy for patients trying to find
15:47 --> 15:50the right drug for the right patients.
15:50 --> 15:53Cancer taking into consideration the
15:53 --> 15:57biology of that particular patients
15:57 --> 16:00cancer I want to kind of take a step back.
16:00 --> 16:03We we had mentioned that gynecologic
16:03 --> 16:06cancer was really a spectrum and
16:06 --> 16:07from the very advanced.
16:07 --> 16:10Very in cancers,
16:10 --> 16:13too potentially preventable cancers
16:13 --> 16:16talk a little bit about HPV related
16:16 --> 16:19cervical cancer and you know,
16:19 --> 16:21have you found that screening has
16:21 --> 16:24really made a difference in terms of the
16:24 --> 16:27management of patients with cervical cancer?
16:27 --> 16:28So in other words,
16:28 --> 16:30are the number of cervical cancer
16:30 --> 16:33patients that you see with HPV related
16:33 --> 16:35disease decreasing in terms of both
16:35 --> 16:38their frequency with which they present?
16:38 --> 16:40With cancer and the severity.
16:41 --> 16:45So in in us as much as the
16:45 --> 16:48vaccines that were promoting,
16:48 --> 16:50which is quite effective,
16:50 --> 16:54you know the vaccine rate is so sadly
16:54 --> 16:57low compared to worldwide global.
16:57 --> 16:58So this is a global issue.
16:58 --> 17:00This is also a problem in
17:00 --> 17:02the United States as well,
17:02 --> 17:03and this is a preventative disease,
17:03 --> 17:06and so we want to, you know,
17:06 --> 17:08educate general populations as
17:08 --> 17:11the importance of having kids.
17:11 --> 17:13Girls and boys and to get
17:13 --> 17:15vaccinated when they're young,
17:15 --> 17:17because that's the word the vaccine
17:17 --> 17:18works the most effectively.
17:18 --> 17:20I mean, that would be fantastic,
17:20 --> 17:23but it sounds like what really will be
17:23 --> 17:26required in order to eradicate cervical
17:26 --> 17:29cancer is to get people vaccinated.
17:29 --> 17:32And given the fact that you know,
17:32 --> 17:34I think it's around 1/3 of
17:34 --> 17:36eligible patients actually do
17:36 --> 17:38avail themselves of a vaccines.
17:38 --> 17:42We might be a ways off on that are there.
17:42 --> 17:44Diet says to how we can do that.
17:44 --> 17:46Any thoughts as to how we can
17:46 --> 17:48get more people vaccinated
17:48 --> 17:51to achieve that goal by 2045?
17:51 --> 17:54Definitely, I think as a in in school
17:54 --> 17:57program or like a pediatricians and I
17:57 --> 18:00think it's something that we should really
18:00 --> 18:03have a general awareness in this disease.
18:04 --> 18:06Such a preventable and having HPV
18:06 --> 18:10doesn't mean that the guarantee that the.
18:10 --> 18:11People develop cancer,
18:11 --> 18:13but at least once you get the cancer,
18:13 --> 18:15it can be quite deadly.
18:15 --> 18:17So having that education early
18:17 --> 18:20on through the school.
18:20 --> 18:22I we're aiming, you know,
18:22 --> 18:26school age, you know 910 eleven.
18:26 --> 18:28Those are the the group of age
18:28 --> 18:30that we start having vaccinations,
18:30 --> 18:31and I think it's important
18:31 --> 18:33that it comes from school.
18:33 --> 18:36You know, teacher, the teacher,
18:36 --> 18:39school, nurses, and pediatricians
18:39 --> 18:40when they're going through that.
18:40 --> 18:43You know, age, appropriate vaccinations.
18:43 --> 18:45I think it's important to have that
18:45 --> 18:48work out and educate more people.
18:48 --> 18:50Yeah. And so for the people
18:50 --> 18:52who do present to you.
18:52 --> 18:54These days with cervical cancer,
18:54 --> 18:56is it fair to say that the majority
18:56 --> 18:58of them are not vaccinated?
18:59 --> 19:01Unfortunately, Madura that
19:01 --> 19:04people are not vaccinated.
19:04 --> 19:07So and more and more that you want to
19:07 --> 19:10have this to move forward and improve.
19:10 --> 19:12You know vaccinations. Yeah,
19:12 --> 19:15do you see any people who are vaccinated
19:15 --> 19:17who get cervical cancer? And if so
19:17 --> 19:20is their stage at presentation lower
19:20 --> 19:22from? I'm not aware of patients
19:22 --> 19:25who already had a vaccinations,
19:25 --> 19:27but there are, you know,
19:27 --> 19:30it's vaccination is now 100% applications.
19:30 --> 19:34So then I am not aware of.
19:34 --> 19:36The number in terms of the statistic,
19:37 --> 19:39but I mean it would seem that that
19:39 --> 19:41would be very fair that you don't
19:41 --> 19:43really see anybody who's been vaccinated
19:43 --> 19:45presenting with cervical cancer.
19:45 --> 19:47I, I believe that.
19:47 --> 19:51The HPV vaccine is about 98% effective,
19:51 --> 19:56so to try to try to find the 2%
19:56 --> 19:59for whom it may not be effective
19:59 --> 20:01would be would be pretty rare.
20:01 --> 20:04So important to get to get vaccinated
20:04 --> 20:07listener, so I think it's important to
20:07 --> 20:10kind of have their listener to hear that
20:10 --> 20:13you know vaccination is quite effective.
20:13 --> 20:15Yeah, I mean the other piece
20:15 --> 20:17to the cervical cancer.
20:17 --> 20:19Story, of course is screening
20:19 --> 20:21and unlike ovarian cancer,
20:21 --> 20:22where there is no screening test,
20:22 --> 20:24we actually do have screening
20:24 --> 20:26tests for cervical cancer.
20:26 --> 20:28Do you find that that really
20:28 --> 20:30allows you to find cervical
20:30 --> 20:32cancer at an earlier stage?
20:32 --> 20:34And how does that impact
20:34 --> 20:35your treatment? Yes,
20:35 --> 20:39definitely. At age 21 is so.
20:39 --> 20:41First patients who get you know,
20:41 --> 20:43start screening.
20:43 --> 20:46If you're negative for.
20:46 --> 20:48Then you have or you get
20:48 --> 20:50retested in after three years.
20:50 --> 20:52So just talk to your
20:52 --> 20:54gynecologist and you know.
20:54 --> 20:56We want to detect early
20:56 --> 20:58we want to screen them.
20:58 --> 20:59Want to get vaccinated early on?
21:01 --> 21:03And the rationale there, of course,
21:03 --> 21:06is that unlike ovarian cancer,
21:06 --> 21:09where you said you know, for many patients,
21:09 --> 21:11this presents when it's widespread.
21:11 --> 21:13It may be metastatic at the time
21:13 --> 21:15of presentation, there's, you know,
21:15 --> 21:17little that you can really do
21:17 --> 21:19in terms of curative therapies,
21:19 --> 21:24although we do try to kind of mitigate.
21:24 --> 21:26The effects of cancer making
21:26 --> 21:28it more of a chronic disease.
21:28 --> 21:30If you catch cervical cancer
21:30 --> 21:33early and you detect it early,
21:33 --> 21:35it is potentially a highly
21:35 --> 21:37treatable and almost curable.
21:37 --> 21:37Isn't that right?
21:38 --> 21:41Yes, so nowadays. So there are
21:41 --> 21:43techniques called trachelectomy where
21:43 --> 21:46you can preserve the your uterus.
21:46 --> 21:48So if you especially women in childbearing
21:48 --> 21:52age, can have a baby and they can
21:52 --> 21:54have effective treatments, you know.
21:54 --> 21:56And preserve their fertility.
21:57 --> 21:59So the key is to detect early.
22:00 --> 22:01That's the potentially curable.
22:02 --> 22:04So, so we've talked a little
22:04 --> 22:06bit about ovarian cancer.
22:06 --> 22:08We've talked a little bit
22:08 --> 22:10about cervical cancer.
22:10 --> 22:12You know, it seems that the
22:12 --> 22:15other big category of of cancers
22:15 --> 22:17under the gynecologic cancer
22:17 --> 22:19umbrella is endometrial cancer.
22:19 --> 22:22Can you tell us a little bit more
22:22 --> 22:24about that and how it presents
22:24 --> 22:26and and its prognosis?
22:26 --> 22:27Visa V. The other two.
22:28 --> 22:31So endometrial cancers are
22:31 --> 22:35heterogeneous now because we have the
22:35 --> 22:39TCGA that the cancer Genome Atlas.
22:39 --> 22:42We have more genomic
22:42 --> 22:44subclassifications so there is a.
22:44 --> 22:48But the MSI microsatellite instability high.
22:48 --> 22:50There's a Poly mutation there,
22:50 --> 22:53so copy number, low copy number high.
22:53 --> 22:55So you can imagine there
22:55 --> 22:57are very heterogeneous.
22:57 --> 22:58They're very different entities,
22:58 --> 23:01so you cannot categorize you.
23:01 --> 23:02You want to know what the what
23:02 --> 23:04the subtypes are because the
23:04 --> 23:05treatment is really important,
23:05 --> 23:07and that's really going to
23:07 --> 23:10impact the patient's outcome.
23:10 --> 23:13For example, high grades serous carcinoma.
23:13 --> 23:17We know about the 20% exhibit or two
23:17 --> 23:20expressions in the study have shown
23:20 --> 23:23that patient having combination with
23:23 --> 23:26the CARBO Taxol with the tritus map,
23:26 --> 23:28you know it can impact improve
23:29 --> 23:30the patient outcome,
23:30 --> 23:32improve overall survival so you
23:32 --> 23:34don't want to miss that opportunity.
23:34 --> 23:38You know the time of the molecular testing
23:38 --> 23:40is early on at the time of diagnosis.
23:42 --> 23:45And So what is the prognosis of patients
23:45 --> 23:48who present with endometrial cancer?
23:48 --> 23:49Understanding that there's
23:49 --> 23:50obviously variability?
23:50 --> 23:53But in general, what is the prognosis
23:53 --> 23:56of endometrial cancer relative to
23:56 --> 23:58cervical cancer and ovarian cancer?
23:59 --> 24:03So it depending on the subclipse subtype.
24:03 --> 24:07So hybrid the copy number high or high grade
24:07 --> 24:11serous carcinoma or uterine serous carcinoma,
24:12 --> 24:14it tend to have a poorer you know outcome
24:14 --> 24:17for prognosis tend to relapse, relapse
24:17 --> 24:20and it's more like a multidisciplinary
24:20 --> 24:25with the radiation to the pelvis and.
24:25 --> 24:28High dose breaking breaking therapy to
24:28 --> 24:31the vaginal cough because that's the most
24:31 --> 24:33common area of the local recurrence,
24:33 --> 24:37so it's more like a more multidisciplinary.
24:37 --> 24:38And you have a coordination
24:38 --> 24:39just like orchestra.
24:39 --> 24:41You need to kind of have a
24:41 --> 24:43multidisciplinary team to have a
24:43 --> 24:45right treatments in the right setting.
24:46 --> 24:49Yeah, it seems to me that the
24:49 --> 24:50whole concept of multidisciplinary
24:50 --> 24:54care is really something that runs
24:54 --> 24:56across all gynecologic cancers as
24:56 --> 24:59well as all cancers writ large.
24:59 --> 25:01Do you want to talk a little bit
25:01 --> 25:05about the team that you have in,
25:05 --> 25:07place it in gynecologic cancers?
25:07 --> 25:10In terms of a multidisciplinary
25:10 --> 25:12effort and why that's important.
25:13 --> 25:16Yes, because of the as we discussed,
25:16 --> 25:18the cancers are very heterogeneous and
25:18 --> 25:21you want to have the best outcome and you
25:21 --> 25:24want to have the multi disciplinary team,
25:24 --> 25:26gynecologic oncologist,
25:26 --> 25:28regional oncologist, nursing staff,
25:28 --> 25:34nursing team, social worker nutritionist?
25:34 --> 25:38Healthcare team involved early on again.
25:38 --> 25:40Some women you know they have full of
25:40 --> 25:43their life and you know with the cancer
25:43 --> 25:45diagnosis of their life is upside
25:45 --> 25:46down and going through this emotion.
25:46 --> 25:48You know social challenges
25:48 --> 25:50and financial toxicity.
25:50 --> 25:52We all have experienced that and
25:52 --> 25:55in our life as a provider we want
25:55 --> 25:58to provide this best care so that
25:58 --> 26:01women are not stressing about their
26:01 --> 26:04finances and we have a, you know.
26:04 --> 26:05Mental counselor social worker
26:05 --> 26:08who would be able to help as much
26:08 --> 26:10we can to help them their cancer
26:10 --> 26:12journey as smooth as possible.
26:12 --> 26:15Yeah, so I think that
26:15 --> 26:17that's a very fair point,
26:17 --> 26:20and in addition to the financial toxicity,
26:20 --> 26:23many of these patients also have
26:23 --> 26:25to deal with physical toxicity and
26:25 --> 26:29side effects of various treatments.
26:29 --> 26:31You know, in many cancer centers
26:31 --> 26:33there is a palliative care team
26:33 --> 26:35which isn't really palliative
26:35 --> 26:38care in terms of end of life,
26:38 --> 26:40but also is very important
26:40 --> 26:42in terms of helping with.
26:42 --> 26:45Side effects and and getting over
26:45 --> 26:48some of the physical toxicities of
26:48 --> 26:50treatment talk a little bit about
26:50 --> 26:52how palliative care is integrated
26:52 --> 26:53into the multidisciplinary
26:53 --> 26:55team and gynecologic cancers.
26:56 --> 26:59So it's important to have that
26:59 --> 27:02penalty care team on board.
27:02 --> 27:04You know, in the beginning, especially
27:04 --> 27:06if it's advanced care advanced disease,
27:06 --> 27:09you know presentations and patients with
27:09 --> 27:12incurable disease and people are facing as a,
27:12 --> 27:15you know, lifelong treatment,
27:15 --> 27:17it really impacts somebody's life.
27:17 --> 27:19And they're not just the patients alone,
27:19 --> 27:22but their families and kind of have their,
27:22 --> 27:22their, you know,
27:22 --> 27:25support that there's A at the end of the day.
27:25 --> 27:27They're always people who are going to.
27:27 --> 27:29Support you, regardless of what stage
27:29 --> 27:32you are in their cancer journey,
27:32 --> 27:34I think it's a misnomer that you know the
27:34 --> 27:36palliative care doesn't translate to Hospice.
27:36 --> 27:37We're not giving up.
27:37 --> 27:39We are supporting as much as
27:39 --> 27:41possible to help the relief.
27:41 --> 27:42You know, suffering relief.
27:42 --> 27:44You know toxicity,
27:44 --> 27:47and I think it's really educate
27:47 --> 27:49the patients you set the stage.
27:49 --> 27:54And as a oncologist to kind of have that you
27:54 --> 27:57know it's holding hands together, it's not.
27:57 --> 27:59In Hospice only a part of
27:59 --> 28:01the palliative care team.
28:01 --> 28:04Does but you know it's a kind embracing.
28:04 --> 28:05You know the cancer journey.
28:05 --> 28:07I think it's really impactful.
28:07 --> 28:08It's very powerful,
28:08 --> 28:11like I think it's you know important
28:11 --> 28:13to kind of stress that and we want
28:13 --> 28:17to have the patients wish to.
28:17 --> 28:21How do they want their cancer turned to be?
28:21 --> 28:23And some people don't want to
28:23 --> 28:25spend their last through the
28:25 --> 28:27end of their cancer life in the
28:27 --> 28:29intensive care in the hospital.
28:29 --> 28:31So have them people to care.
28:31 --> 28:32Spring early on
28:33 --> 28:35Doctor Christie Kim is an assistant
28:35 --> 28:37professor in clinical medicine
28:37 --> 28:39at the Yale School of Medicine.
28:39 --> 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 --> 28:48are available in audio and written
28:48 --> 28:48form at yalecancercenter.org.
28:48 --> 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
28:55 --> 28:56radio funding for Yale Cancer Answers
28:56 --> 29:00is provided by Smilow Cancer Hospital.

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April 10, 2022

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

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