Page 16 - Layout 1

PREVENTATIVE
MEDICINE

Q & A: Understanding Risk of

Gynecological Cancers

By Jaron Mark, MD

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

16 SAN ANTONIO MEDICINE • June 2022