PREVENTATIVE MEDICINE
Q & A: Understanding Risk of Gynecological Cancers By Jaron Mark, MD
1.) What is the importance of “knowing your risk”? a.) Family History: Family history is an important risk factor for ovarian, fallopian tube and primary peritoneal cancer, as well as for endometrial cancers. It’s important to know if multiple members of your family are affected by certain cancers, such as having two or more family members with breast cancer, pancreatic cancer, ovarian, fallopian tube, primary peritoneal or prostate cancer, as this may be a sign of having a hereditary syndrome and should prompt family members to undergo genetic counseling for consideration of genetic testing. Some endometrial cancers are related to a genetic predisposition related to Lynch syndrome (also known to increase the risk of ovarian cancer). If multiple members of the family have been affected by colon cancer or endometrial cancer, this should be a red flag to discuss genetic testing with your doctor. b.) Obesity: Obesity is associated with increased risk of ovarian cancer as well as endometrial cancer, with over 50% of endometrial cancers being attributed to obesity. c.) Age: Increased age is a risk factor for ovarian, fallopian tube and primary peritoneal cancers. d.) HPV: HPV causes over 95% of cervical cancers which highlights the importance of regular, routine pap tests to detect for cervical precancers so they can be treated before transforming into cervical cancer. HPV is also associated with development of vulvar and vaginal cancers. 2.) What is the available testing, screening and prevention? a.) Pap tests: Pap tests are used to screen for cervical and vaginal dysplasia caused by HPV in order to prevent untreated lesions from progressing into cancer. Testing is usually started initiated when women become 21 years of age. Women with a history of highgrade cervical dysplasia and those who have undergone a hysterectomy should still have vaginal pap tests to screen for vaginal dysplasia which, if high grade, can progress into vaginal cancer. b.) HPV vaccines: HPV vaccines have been around since 2006 and are approved for both boys and girls. These vaccines are very effective at reducing the risk of cervical, vulvar and vaginal cancers, as they immunize patients against the high-risk subtypes of HPV responsible for causing these cancers. In 2018, the FDA approved these vaccinations in adults up to age 45. 16
SAN ANTONIO MEDICINE • June 2022
c.) Healthy diet and lifestyle: Living a healthy lifestyle by eating a healthy well-balanced diet supports a healthy weight which in turn decreases the risk of ovarian and endometrial cancers which are associated with obesity. Living a tobacco-free life is not only important to prevent lung cancer but it is also a risk factor for cervical, vulvar and vaginal cancers. d.) Genetic testing: Genetic testing is indicated for all patients with a new diagnosis of ovarian, fallopian tube or primary peritoneal cancer. There are many different genetic testing companies and large multi-gene panels that can be used to assess for hereditary breast and ovarian cancer syndromes. Pathogenic mutations discovered on testing may warrant genetic testing on other immediate family members. Patients with endometrial cancer should also undergo genetic testing if the cancer is known to have defective mismatch repair genes which are routinely tested for while undergoing pathological evaluation after surgery. 3.) What are the differences between these cancers? What are the common/potential signs and symptoms? a.) Cervical cancer: Cervical cancer often presents with thin, clear or bloody vaginal discharge, painless vaginal bleeding or bleeding after intercourse. As the cancer progresses, symptoms can include flank pain, low back pain, leg pain, leg swelling, hematuria, rectal bleeding and vesicovaginal or rectovaginal fistulas. b.) Endometrial cancer: The majority of endometrial cancer presents with abnormal uterine bleeding such as vaginal bleeding or pinkish vaginal discharge in the menopausal period. A minority of endometrial cancer cases present with signs of uterine cavity enlargement such as pelvic pressure or pelvic pain. c.) Ovarian cancer: Ovarian cancer is the most lethal gynecologic cancer with no effective screening strategies. Most patients are diagnosed at an advanced stage because the symptoms are very subtle. Often called a “silent disease” since symptoms include decreased appetite, early satiety, bloating, increasing abdominal girth, increased urinary frequency, urgency, back pain and eventually abdominal pain or pelvic pain which most people experience at some point in their lives.
