Janet L. Osborne, MD, Division Director of Gynecologic Oncology and an Assistant Professor of Obstetrics and Gynecology at the Medical College of Wisconsin. "It's unusual to see advanced gynecologic cancers in women who undergo regular checkups," says Dr. Osborne, who practices at Froedtert Hospital. (An exception, she notes, is ovarian cancer, which can be difficult to diagnose.) A pelvic exam includes both an external and internal examination of the reproductive organs and usually a simple procedure called a Pap test to detect abnormal cell growth in the cervix, which can signal a precancerous condition or actual cancer.
Cervical Cancer
Cervical cancer typically has no symptoms until it reaches an advanced stage. Before the Pap smear came into widespread use in the United States during the1970s, an estimated 75% to 80% of cervical cancer in the United States was invasive at the time of diagnosis. Since then, routine Pap test screening has helped to dramatically decrease the incidence and mortality of invasive cervical cancer. Today, about 78% of cervical cancer cases in the United States are diagnosed early, when they are most easily treated. Now undergoing research trials is a new vaccine that combats the sexually transmitted human papilloma virus, which accounts for 90% of all cervical cancer cases.
"Worldwide, cervical cancer is the most common gynecologic cancer," Dr. Osborne says, because few women in underdeveloped countries have access to the Pap test. Cervical cancer, in fact, is the second most common of all cancers in women worldwide.
Pap tests are not 100% accurate, she says, resulting in some false positive and false negative results. But accuracy has been improving in the past few years, thanks to better methods for taking Pap smears, new national guidelines for interpreting Pap results more clearly, and better understanding of the viral causes of cervical cancer.
Endometrial Cancer Most Common
In the United States, the most common gynecologic cancer is endometrial, affecting the lining of the uterus, Dr. Osborne says. Unlike cervical cancer, there is no screening test for endometrial cancer. "However," she says, "women with endometrial cancer typically do experience symptoms, chiefly abnormal bleeding - between periods in younger women, and after menopause in older women." Malignancies are diagnosed with a biopsy that can be performed during an office visit.
Ovarian Cancer Most Deadly
Ovarian cancer is the most deadly gynecologic cancer - "but that's because it's often not diagnosed until it's well advanced," says Dr. Osborne. "Women with ovarian cancer do have symptoms, but they're vague and not specific. Often, they have intestinal problems - abdominal distension, bloating, loss of appetite, changes in bowel habits or digestive problems. But because these symptoms seem to point to gastrointestinal disorders, patients' primary care physicians might order screenings like endoscopy or colonoscopy to view the digestive tract. Had someone considered the possibility of a gynecologic cancer, that patient could have had her cancer detected and treated sooner."
If caught in its early stages, about 70% to 80% of ovarian cancers can be cured; unfortunately, most are not diagnosed until they are Stage III or Stage IV. Researchers have long been working on developing a screening test for ovarian cancer, but nothing is currently available for general use.
Some patients have asked about an ovarian cancer blood test called CA125, but "it is not a screening test," Dr. Osborne emphasizes. "It's a tumor marker that can evaluate abnormal masses. It's helpful in monitoring patients with a known diagnosis of ovarian cancer, measuring how well they are responding to therapy or whether they have had a recurrence."
Treatments for Gynecologic Cancers
Depending on type and stage, gynecologic cancers can be treated with surgery, radiation or chemotherapy, or a combination of these therapies. At Froedtert & The Medical College, each patient's case is discussed by a multidisciplinary gynecologic cancer team at the weekly Gynecologic Oncology Tumor Board, and a treatment program is developed. Members include a radiation oncologist, pathologist, radiologist, two nurse practitioners, as well as Dr. Osborne and her two fellow GYN oncologists, David Boruta II, MD, and Denise Uyar, MD, both assistant professors of Obstetrics and Gynecology at the Medical College.
For appropriate patients whose treatment involves a radical hysterectomy - removal of the uterus, ovaries and fallopian tubes as well as the surrounding connective tissue and the pelvic lymph nodes - the Medical College is the only facility in Wisconsin that performs minimally invasive laparoscopic surgery. Unlike open abdominal surgery, laparoscopy uses a series of small incisions, which can reduce recovery time and decrease pain.
Other advances available at Froedtert & The Medical College are both external beam radiation and brachytherapy, in which radioactive material is implanted near the cancer cells. As a research center, Medical College specialists are taking part in research studies that are exploring ways to help some ovarian cancer patients overcome resistance to chemotherapy. The Medical College is also part of clinical trials involving improvements in chemotherapy and radiation therapies.
What Women Should Look For
Dr. Osborne says women should be alert for symptoms that might signal gynecologic cancer. These include unusual vaginal discharge, persistent irritation, a sore or lump in the genital area, pelvic pain or pressure, or changes in bowel or bladder habits.
"If a gynecologic cancer is known or suspected," Dr. Osborne says, the patient would be wise to be seen by a gynecologic oncologist - a physician specializing in women's reproductive cancers. "It's common sense," she says. "We spend an additional three years of training, learning the newest techniques for diagnosing and treating these cancers."
Of the 11 GYN oncologists practicing in Wisconsin, three are at the Medical College. Their practice is limited to referrals from primary care physicians and OB-GYN specialists. In addition to evaluating and treating referral patients, they provide second opinions, and work with patients suspected of having a strong hereditary risk for ovarian or breast cancer, or both. Although many women have a family history of ovarian or breast cancer, only about 5% to10% of ovarian cancers are thought to be the result of an inherited cancer susceptibility gene mutation known as BRCA1 or BRCA2. Those women have a 30% to 50% chance of developing ovarian cancer, compared with a risk of less than 2% among women generally. If they have a family history of breast cancer with this gene mutation, their risk of developing breast cancer is 80% to 85%.
Although most gynecologic oncologists do practice in larger cities and at university medical centers, Dr. Osborne urges women who live in outlying communities to also see a GYN oncologist for a comprehensive evaluation and a treatment plan. "For patients who must travel some distance, we are glad to coordinate their treatment with their local oncologist," she says.
Barbara Abel
HealthLink Contributing Writer
Article Created: 2005-11-09
Article Updated: 2005-11-09
MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.
