What caused my cancer?
Risk factors for development of only a few cancers are well understood. With only one exception, however, the actual cause of cancers at a molecular level is not known. The single exception involves squamous cancers of the cervix. It is now known that several genotypes of Human Papillomavirus (HPV) can induce a sequence of events in the nucleus of cells covering the cervix which lead to development of an invasive cancer.
My pap smear didn’t detect my cancer. Why?
Believe it or not, the pap smear is not meant to detect any cancer! It is actually a tool designed to detect pre-cancerous changes of the cervix only. This is the beauty of a pap smear. After all, it is much more important to prevent the development of a cancer by treating the changes that immediately precede its appearance than to wait for a cancer to show up first. A single pap smear determination is not nearly as effective as multiple pap smears obtained at regular intervals over time. This is why the American College of Obstetrics and Gynecology suggests that the majority of women should receive this test at a yearly interval.
My pap smear came back a little abnormal. Now what?
Three different techniques are used to fully evaluate the cervix – cytology (pap smear), colposcopy, and histology (biopsy). The pap smear evaluates cells that have already sloughed off of the surface of the cervix. A pathologist looks at these cells under a microscope and makes an educated “guess” about the environment of the cervix. If a pre-cancerous change is suspected the next step is to inspect the surface of the cervix with a magnifying instrument called a colposcope. This technique allows identification of minute abnormal areas that cannot be seen with the naked eye. If such an area is seen then a histologic sample is removed by performing a biopsy.
What is the difference between the stage and the grade of a cancer?
Most cancers can be subdivided by their “stage” and “grade“.
Stage basically describes the location of the tumor at the time of diagnosis. Gynecologic cancers typically have four stages – early cancers with no gross evidence of metastases are classified as stage I, very advanced cancers with extensive metastases are classified as stage IV.
Grade is a description of what the individual cancer cells look like under a microscope. Gynecologic cancers usually have 3 grades – grade I cancers vary little from the tissue of origin, whereas grade III cancers bear little resemblance to the originating tissue.
Now that I have a cancer I want to start eating right. Any suggestions?
It is always a good idea to pay close attention to what you put in your mouth. Most Americans could certainly improve their diet by minimizing saturated fats, red meats, cholesterol, salt and alcohol while increasing fresh fruits and vegetables. It’s probably a good idea to take a multi-vitamin every day, too. Radical changes in your diet or any other bad habits you may have (such as cigarette smoking) should be made after you have completed treatment for your cancer. After all, you are under enough physical and emotional stress just dealing with your cancer—there is no need to compound this by adding further stress in your life right now.
I’ve heard a lot about a new “alternative” treatment. What do you think?
The National Institute of Health’s (NIH) Office of Alternative Medicine (OAM) provides perspective on Complementary and Alternative Medicine (CAM). CAM practices can be divided into a number of categories:
CAM Classification Alternative systems of medical practice – Acupuncture, Ayurveda, Homeopathy, Naturopathy, Shamanism, etc.
Bioelectromagnetic applications – Blue light, Electromagnetic fields, Magnetoresonance spectroscopy, etc.
Diet, nutrition, and lifestyle changes – Gerson therapy, Macrobiotics, Megavitamins, etc.
Herbal medicine – Echinacea, Ginger rhizome, Gingko biloba abstract, Yellowdock, etc.
Manual healing – Acupressure, Alexander technique, Chiropractic, Osteopathy, massage, Rolfing, etc.
Mind-body control – Art therapy, Biofeedback, Meditation, Prayer, Yoga, etc.
Pharmacologic and biologic treatments – Antioxidants, Chelation therapy, Oxidizing agents, etc.
Most CAM therapies are unlikely to adversely affect your cancer treatment. There are exceptions, however. Garlic, for instance, can have beneficial therapeutic effects on blood pressure and cholesterol levels. It inhibits platelet aggregation and may have an adverse reaction in individuals on chemotherapy or aspirin therapy. Colonic therapies administered inappropriately may significantly decrease serum potassium levels. Some herbal products contain large amounts of estrogen and may have an unwanted stimulatory effect on the lining of the uterus. If you have more questions regarding CAM, ask your doctor or nurse or visit the website of the OAM.
I saw a report of a new cancer treatment. What do you think of it?
Now that you have been diagnosed with a cancer it will seem like every time you turn on the television or pick up a magazine or newspaper you will see something about a “new and amazing” advance in the treatment of cancer. Just remember that media outlets are in the business of making money and they understand that “cancer sells” air time, newspapers, etc. “Advances” in cancer treatment are well known to the medical community and either incorporated into or discarded from clinical practice years before being reported to the general public by television and print reporters. Even in the most respected medical journals there is a lag time of up to 18 months between submission of an article by an investigator and its publication. Because of this, physicians acquire new information most rapidly and efficiently through attendance at Society and sub-specialty meetings. By the time this information filters down to traditional media outlets it simply “ain’t news.” When you have questions about something you see on television or read in a magazine your best bet is to check it out with us and get the “real story.”
Why is my cancer being treated differently than my father’s cancer?
There is a tendency to think of cancer as one disease that just starts in different parts of the body. Actually, every cancer is a unique disease process. As an analogy, you can easily understand that there is a different cause and treatment of a viral sore throat as compared to appendicitis (yet both are “infections”). Your father’s cancer was certainly not gynecologic in origin and would not be treated in the same way as your malignancy. Finally, the advances in cancer treatment appear so rapidly that it is unlikely that any particular cancer is treated today in the same way it was treated several years ago.
What is the difference between a tumor and a mass?
Medical terminology can sometimes be confusing. Here’s a little primer on terms you will hear when we discuss your cancer:
Cancer = Malignancy = Invasive
Benign = not Cancer
“Tumor” comes from the Latin word for “Swelling” (so, technically, something like a pimple could be described as a “tumor”)
Tumor = Mass
Not all Cancers are Tumors (e.g. leukemia)
Not all Tumors are Cancers (e.g. ovarian cystadenoma)
What tests do you perform to follow the progress of my treatment?
You will be followed very closely during and for many years after treatment of your cancer. Each time you come to the office a pelvic and abdominal exam are performed and blood tests (e.g. CBC, CA-125, Squamous Cell Antigen, etc.,) are drawn. You will also have imaging studies (CAT scans, X-rays, Ultrasound, etc.,) performed at various intervals. Initially you will need to be seen every month during your initial treatment. After this period, you will need to be seen in the office every 2-4 months for 2-3 years. After 2-3 years, you will be examined every 6 months.
Have you billed my insurance company?
We will submit claims to the primary and secondary insurance company. The monthly statement indicates the date of service and the insurance company to which your claim was submitted.
Are the doctors Medicare providers?
Yes, we accept Medicare assignment, which means Medicare will pay 80% of the Medicare allowance and the secondary insurance, if any, will pay for the additional 20% of the allowance.
What is CA-125?
CA-125 is a blood test that measures the amount of a substance secreted by many cancers and non-cancerous conditions. It is a helpful way to follow the progress of your treatment for ovarian cancer and, to a lesser extent, other cancers. It is not useful in diagnosing a cancer since too many unrelated conditions can cause false elevations of CA-125. You may have this tumor marker or other similar tests performed on a regular basis. (For a more in depth discussion of the statistical value of CA-125 determinations written by Dr. William Rich click here.)
Do you see a lot of my kind of cancer?
Yes. Gynecologic Oncologists treat only cancers of the female pelvis. There will never be more than a few hundred board-certified Gynecologic Oncologist in the United States. This means that every Gynecologic Oncologist has extensive experience in treating any kind of female pelvic cancer.
I’m on my menstrual period. Should I reschedule my appointment?
No. Your menstrual period does not make interpretation of a pelvic exam or performance of a pap smear any more difficult.
What are the different types of hysterectomies?
A hysterectomy is the removal of the uterus and cervix. Removal of the ovaries is referred to as a bilateral salpingoophorectomy. The common lay terms “partial hysterectomy” and “complete hysterectomy” really do not have any medical meaning.
- Type of Hysterectomy – Abdominal
- Reason – Benign conditions, early uterine cancers
- What is Done – Removal of the uterus and cervix, with/without removal of the ovaries and fallopian tubes
- Type of Hysterectomy – Supracervical
- Reason – Benign conditions
- What is Done – Removal of the uterus, with/without removal of the ovaries and fallopian tubes
- Type of Hysterectomy – Vaginal
- Reason – Benign conditions, early uterine cancers
- What is Done – Removal of the uterus and cervix, with/without removal of the ovaries and fallopian tubes.
- Type of Hysterectomy – Radical
- Reason – Cancers of the cervix and uterus. Some cancers of the ovary.
- What is Done – Removal of the uterus, cervix, upper vagina, parametria, with/without removal of lymph nodes, ovaries and fallopian tubes.
How long will it take to get an appointment?
If you have a newly diagnosed cancer you will usually be scheduled for an initial appointment within one week.
What is a consultation appointment?
The doctor will examine you and review any records you have. You, your family and the doctor will then discuss the best treatment for your problem.
If I need surgery, how long will it take to schedule?
Surgery is usually scheduled within 1 – 2 weeks from initial consultation if your situation is not an emergency.
Will I lose my hair?
No. Radiation affects only the part of the body being treated. It does not “circulate” throughout your whole body. Since treatment of gynecologic cancers never involves radiation to the head or scalp it does not cause hair loss.
What is the difference between radiation and chemotherapy?
Radiation is a way of killing cancer cells with energized photons produced by a machine or radioactive material. It provides intense treatment usually to a very small defined area of your body. Chemotherapy drugs are delivered directly into the bloodstream and kill cancer cells by damaging necessary enzyme systems or reproductive mechanisms. Because they circulate throughout your body, chemotherapy agents can affect cancer cells almost anywhere they are hiding.
How long does the treatment last?
The number of treatments is determined by the area being treated and the type of radiation administered. Sometimes a radiation source is placed directly into the vagina and requires only one or two sessions that last a few hours each. More often a beam of radiation is directed from a machine to your abdomen and is given daily for several (2-5) weeks. This type of radiation takes only a few minutes a day to administer.
What kind of side effects can I expect?
The Radiation Oncologist will go into great detail about side effects when you meet with him/her. If you receive the most common type of external radiation give to your lower abdomen you can expect to have some diarrhea (which can be managed with medication), bladder and rectal irritation. These effects go away once the radiation is completed. The most common long term side effects include vaginal dryness.
Can radiation be used to treat any cancer?
No. Not all cancers are sensitive to radiation treatments. For instance, radiation is often an important part of the treatment of uterine adenocarcinoma but it is of no use in the management of uterine leiomyosarcoma.
Radiation is used to treat only a small part of the body at any given time. It, therefore, is not useful if cancer involves a large area of the body. So, primary radiation of an early cancer of the cervix makes sense because only a portion of the pelvis needs to be treated in order to destroy most of the cancer cells. On the other hand, cancer of the ovary typically spreads to many locations throughout the entire abdominal cavity early in its course. Radiation treatment of the entire abdomen is impractical and dangerous. For this reason, radiation does not have a place in the modern treatment of ovarian cancer.
Will I lose my hair?
Several, but not all, chemotherapy drugs cause temporary hair loss. These drugs include Taxol, Taxotere, Topotecan, Etoposide, Cytoxan, and Ifosfamide. You will notice hair loss within 10-14 days after your first treatment. Hair grows back after completion of therapy. If you do lose your hair, it is wise to purchase turbans, scarves and hats in addition to a wig since most women find wigs to be a little uncomfortable. We can help you obtain a free wig from the American Cancer Society wig bank. Many insurance plans will also cover the cost of a wig.
- Hot tip #1 – The short sleeve of a man’s T-shirt can be cut off and worn on the head under turbans and scarves to provide warmth and prevent slippage.
- Hot tip #2 – Many wig shops and wig banks have strips of bangs to wear under your hats, scarves and turbans to give the illusion of hair.
- Hot tip #3 – Eyebrows are very difficult to pencil in when you do not have a line to follow. Instead of using an eyebrow pencil, try using a medium brown eyeshadow (not sparkly). It gives a softer look and is easier to apply.
Will I get nauseated?
Some chemotherapy drugs can cause nausea. These drugs include Cisplatinum, Carboplatinum and Adriamycin. The nausea produced by these medications is counteracted by several additional drugs such as Zofran, Kytril, Dexamethasone and Benadryl given intravenously just before your chemotherapy. Oral and rectal anti-nausea medications are also given to you for home use if needed.
- Hot tip #1 – If you start to feel nauseated at home, take your anti-nausea medications immediately. Don’t wait for nausea to get really bad.
- Hot tip #2 – If you are a little nauseated then eat small, frequent meals rather than 3 large meals a day. Try drinking fluids between rather than during meals.
Will chemotherapy suppress my “immunity”?
The chemotherapy regimens used to treat gynecologic cancers generally do not adversely affect your immune system. Brief, mild to moderate suppression of your white blood cell count (WBC) is expected with many regimens. This does not make you more likely to catch a viral illness such as a cold or flu syndrome. On the other hand, an otherwise minor infection, such as a bladder infection, can be more difficult to treat if it occurs while your WBC is low. Check with us before having any minor surgery or dental work so that it can be performed when your blood counts are not suppressed.
How long does the chemotherapy stay in my body?
Not very long. Most agents are completely metabolized and excreted within several hours. The damage sustained by cancer cells from chemotherapy agents, however, may not result in the death of the cell for several days.
Where do chemotherapy drugs come from?
Some chemotherapy drugs are developed and completely synthesized in the laboratory. Many drugs are first found in nature and distilled from plant sources.
Who gives me my chemotherapy?
The type, dose, schedule and duration of your chemotherapy is determined by your Gynecologic Oncologist. Administration of your chemotherapy is performed by chemotherapy certified nurses. All of our Chemotherapy Certified Nurses have extensive knowledge and some good “down home” advice about how to get through treatment of gynecologic cancer as easily as possible.
What is a portacath?
A portacath is an implantable device that makes it much easier to draw blood for tests and much safer to administer chemotherapy. It consists of a catheter (small flexible tube) that is placed in a large vein and connected to a “port” about the size of a quarter. The port is placed under the skin of your upper chest. Once inserted we recommend that a portacath not be removed until the likelihood of a recurrence of your cancer is minimal.
Where do I go to get my chemotherapy?
Very few regimens require hospital admission in the current era. A few chemotherapy drugs come in an oral form and can be taken at home. Advances in the miniaturization of computerized chemotherapy infusion pumps allow many regimens that require prolonged, constant administration of these drugs (e.g. 24-72 hours) to be given to you as an outpatient. By far the most common setting for chemotherapy administration, however, is in a specialized Chemotherapy Center. This consists of a specially equipped room where chemotherapy-certified nurses administer bolus or short-infusion chemotherapy to you.
How is the chemotherapy administered to me?
Depending on the type of agent used chemotherapy for gynecologic cancers can be given orally, intravenously or directly injected into the abdominal cavity. By far, the most common method of administration is directly into your bloodstream (intravenously), usually via a portacath (see above). Direct injection into the abdominal cavity (intraperitoneal chemotherapy) is sometimes used in the treatment of ovarian cancers. Heated intraperitoneal chemotherapy (HIPEC), given with the patient under an anesthetic, is also sometimes used in the treatment of gynecologic cancers limited to the abdominal cavity.
Why do I need a bowel prep?
For most major pelvic surgeries, your colon must be completely evacuated. This dramatically decreases the risk of getting a fever after surgery. More importantly, if surgery needs to be performed on the colon itself a temporary colostomy can be prevented if an adequate pre-operative bowel prep is ordered.
Will I need a blood transfusion?
Probably not. Blood products are administered sparingly nowadays. It is a reality, however, that surgical management of advanced gynecologic cancers often requires rather extensive procedures associated with significant intra-operative blood loss. Unfortunately, surgery of malignant conditions is a relative contraindication for intra-operative auto-transfusion. The risk of viral transmission (Hepatitis, HIV) is estimated to be only 1:100,000 units of blood. If transfusion is foreseen you will be counseled on Donor Designation programs where you can select family or friends to provide blood products for you.
Will I have pain after surgery?
Yes. All surgery is associated with some degree of pain. However, very “high tech” methods are utilized to minimize the amount of discomfort you experience. In many situations, a small catheter is placed directly into the space around the spinal cord to deliver medication directly to the pain pathways. Patient-Controlled Anesthesia (PCA) devices are utilized in all patients. This is a computerized device which allows you to safely self-administer pain medication. When you leave the hospital, you will be sent home with very effective oral medication to make your recuperation as pain free as possible.
What kind of activity can I undertake after I go home?
For the most part there are very few restrictions on your activity once you leave the hospital. There actually is nothing you can do that will either speed up or slow down your healing processes. It’s a good idea not to drive a car for several weeks. Other than this, however, you can pretty much do anything that you feel like doing. Use common sense: if you feel tired then take a rest. If you are doing something that makes you hurt somewhere, then stop doing it.
Who is going to perform my surgery?
The head of your surgical team will be the Gynecologic Oncologist to whom you were referred. The surgical assistant will be your referring doctor, Gynecologic Oncology Fellow or a Registered Nurse First Assistant (RNFA).
How long will I be in the hospital?
The length of time that you will stay in the hospital after surgery is dictated by the type of surgery performed. Most abdominal procedures require a 3– 5-day postoperative stay. More extensive procedures are associated with longer hospital stays.
What kind of incision will I have?
The location, direction and size of an incision are determined by the type of surgery that is planned. Many pelvic surgeries can be performed through a low transverse (bikini) incision. Some surgical procedures require an “up-and-down” incision that could extend from your pubic bone all the way to the bottom of your breast bone. Minimally Invasive Surgery (Laparoscopic and Robotic techniques) require 1 – 4 very tiny incisions located in your lower abdomen. Click here for photos of various abdominal incisions.
When will you get a Pathology Report?
The microscopic analysis of tissue removed at surgery is performed by a Pathologist. The Gynecologic Oncologist can determine whether additional chemotherapy and/or radiation is required to adequately treat your cancer based on details provided by the Pathologist in his report. Two types of analysis are commonly performed on tissue removed at the time of surgery;
- A “Frozen Section” analysis is obtained at the time of surgery. The Frozen Section is used to provide rapid, but not very detailed, analysis of tissue samples so that important decisions can be made while you are undergoing surgery.
- A “Permanent Section” is performed on a sample of all tissue removed in every surgery. This analysis takes 36 – 72 hours to perform, but gives very detailed and complete information.
Clinical Trials FAQ
How can I get more information about treatment and clinical trials?
Many patients with women’s cancers benefit from participating in clinical trials. This provides them with access to new cutting-edge treatment options. Please visit Women’s Cancer research Foundation (WCRF) to find more about how GOA and WCRF work together in trying to increase our patients’ cure rates.
What exactly is a clinical trial?
Simply put, a clinical trial is a scientifically designed study that is being conducted for one of several reasons:
- To answer specific questions about new therapies, or new applications of known treatments
- To determine the efficacy of a new drug
- To develop and give insight into new procedures and treatments, with the aim of achieving better patient outcomes and advances in medical science.
At its core, a clinical trial is a partnership, where patients, doctors, medical organizations, and sometimes government agencies or other sponsors work together toward a specific goal. Clinical trials are one of the primary functions of WCRF, one of the most productive non-profit foundations in the country that promote these studies specifically in the underserved area of women’s cancers.
What are the benefits of undergoing a clinical trial?
The benefits to clinical trials are manifold. Not only do clinical trials open patients up to advanced, path-breaking treatment options; clinical trials are an opportunity for patients to make a difference in the lives of future generations of cancer patients. Most patients find the process extremely rewarding, and because the parameters of the study often require close monitoring, patients find that they receive excellent care and attention.
If you’re interested in taking part in a clinical trial, contact us.