First in a series: Male and female specific cancers

BY SHEILA HELMBERGER

The word cancer can stop you in your tracks.

Advancements in research have given oncologists more options than ever for treatment, but a diagnosis still means making tough decisions and trusting your physicians.

Men and women both have their own gender specific types to be aware of. While testicular and prostate cancer affect only men, those assigned female at birth could face vulvar, vaginal, cervical, uterine and ovarian cancer.

Dr. Wade Swenson is an oncologist and hematologist at Lakewood Health System in Staples. He practices full-spectrum medical oncology and hematology, including breast, colon, lung and prostate cancers.

Dr. Alisha Lindberg is an obstetrician and gynecologist and serves patients at both Cuyuna Regional Medical Center (Crosby and Baxter locations) and Riverwood Healthcare in Aitkin. She is passionate about comprehensive women’s healthcare (from adolescent years through menopause) and empowering women with the knowledge they need to take charge of their health.

Both physicians help patients navigate through the discovery and treatment of a cancer diagnosis.

Prostate And Testicular Cancer

The prostate is a male organ found where the reproductive system and urinary systems meet.

Cancer in the prostate is one of the most common cancers found in men. Typically, patients are in their late 60s or early 70s. “But there are exceptions,” says Dr. Swenson. Commonly, it will affect about 10-20% of men in their lifetime.

In the initial stages of prostate cancer there are often no symptoms at all. “Still, the majority of the time these cases are caught early,” he says. “Difficulty urinating is the primary presentation we see, but that is also a normal part of the aging process.” Sometimes an abnormal physical exam or imaging will raise a red flag. The Prostate-Specific Antigen test, or PSA reading, is used as part of the screening process for the diagnosis of prostate cancer. A high reading is a signal there is cancer. Imaging is used to determine if the cancer has spread beyond the prostate.

Then, a patient will begin a treatment plan. “We tend to not use chemo for prostate cancer,” says Dr. Swenson, “Typically, if we have an early cancer, we will look at surgery, radiation, or sometimes we will use hormone therapy.”

Depending on the patient and the stage, prostate cancer can be a serious life-threatening condition, or it can be a nuisance diagnosis. If it is not lifethreatening, and determined to be slow growing, it is possible to use observation as a treatment, where a doctor will do periodic testing to watch for progression.

A bump or growth on the testicles is the first sign of possible testicular cancer for a man. While prostate cancer is common, Dr. Swenson says testicular cancer is rare.

It is a disease found more often in younger men, from teenagers to men in their 20s. There are less than 200,000 testicular cases per year in the United States.

“It is a very treatable and typically very manageable cancer,” says Dr. Swenson. Still, there can be a tendency, because of the unknown and uncertainty, to put off having a lump checked by a physician.

The first step for diagnosis will be an ultrasound. Once confirmed, surgery is possible as a treatment, followed by chemotherapy.

Ovarian And Uterine Cancer

Symptoms of ovarian cancer are extremely subtle, and can include bloating, pelvic pain and early satiety. Patients often attribute these symptoms to stress or diet, which can lead to a delay in diagnosis.

“We do not have a good screening test for ovarian cancer,” says Dr. Lindberg, “The symptoms patients experience are often nonspecific. An ovarian mass is usually an incidental finding, noticed during a pelvic ultrasound or other imaging, which means it is discovered in the later stages.” Seventy-five percent of ovarian cancers are already in stage three and four at the time of diagnosis and the survival rate after diagnosis is only 44 percent at five years.

Increasing age is the largest risk factor for developing ovarian cancer. Although younger women can also have ovarian tumors, the median age at time of diagnosis is 63. Other risk factors include family history of ovarian cancer, early age at onset of menstrual periods, late menopause and white race. If someone in your family carries the BRCA1 or BRCA2 mutations, this could increase your risk and you may qualify for genetic testing to look for these mutations. The use of birth control pills is thought to reduce the risk by 30-60% depending on the duration of use. Having both fallopian tubes removed can also decrease the risk of ovarian cancer.

Once suspected, additional imaging is used to determine if it has spread and affected any other areas. “We typically do not biopsy an ovarian mass itself because of the potential risk of spreading it throughout the pelvis. Occasionally a biopsy of an enlarged lymph node, abdominal fluid or other tissue is used to make the diagnosis.” Elevated tumor markers in the blood (like CA-125) can also aid in diagnosis.

Surgery and chemotherapy are the mainstay of treatment — which one comes first is dependent on the extent of disease. If the patient is young, the gynecology oncologist could consider a fertility sparing procedure. In older women the uterus, cervix, both fallopian tubes and both ovaries are removed during surgery.

“The news on uterine cancer is a little better than ovarian cancer, more than 70% of cases are Stage 1 at the time of diagnosis,” says Dr. Lindberg, “and the five year survival rate is 90%.” It is typically discovered earlier because of the presence of more notable symptoms. Heavy vaginal bleeding, bleeding between periods or bleeding after menopause can be a sign and help to catch the disease early. The median age for those diagnosed is 63. “Postmenopausal bleeding is the most common sign. It should always be evaluated by a physician,” says Dr. Lindberg, “no matter how light.”

Surgery will often be done to remove the uterus, cervix, both fallopian tubes and both ovaries and to determine the stage of disease. Once stage is determined, additional therapy may be warranted such as chemotherapy or radiation.

Of all the female cancers, Dr. Lindberg stresses cervical cancer is the most preventable with proper screening. “Pap smear screening is so important,” she says. “And should start at age 21.” The frequency of screening depends on your results over time. An abnormal result may require more frequent screening. She also urges patients to consider the HPV vaccine which offers the most protection against cervical cancer.