dailyRx News recently had the privilege of visiting with some of the nation’s leading specialists in various types of cancers at The University of Texas MD Anderson Cancer Center in Houston.
We talked with these oncologists about their specialties. We asked about their patients, the disease, its symptoms and the best way patients can take care of themselves after diagnosis.
We also asked what these leaders think ordinary folks should know about the cancers they’ve spent years studying and treating.
The first in this series is a conversation we had with Pamela T. Soliman, MD about uterine, also known as endometrial cancer. This is the most common female reproductive cancer that's diagnosed in some 47,000 American women every year. .
Dr. Soliman is assistant professor in the Department of Gynecologic Oncology at MD Anderson Cancer Center, where she provides both medical and surgical care to women with gynecologic cancers.
dailyRx: Dr. Soliman, tell us about your patients.
Dr. Soliman: With endometrial cancer patients, we’ve actually seen more and more younger patients. I’ve seen patients as early as their late twenties, and then obviously it goes up to even patients in their 70s and 80s. The average age for diagnosis is around sixty.
dailyRx: Why do you think you’re seeing more younger patients?
Dr. Soliman: I think probably the biggest risk factor for any endometrial cancer is obesity. Especially over the last 10 years, the incidence of obesity has really increased, and I think it has affected younger generations too. So we think, although we don’t know, that obesity has a lot to do with why we are seeing younger women with endometrial cancer.
dailyRx: What are the screening guidelines for endometrial cancer?
Dr. Soliman: There aren’t screenings for endometrial cancer. It’s just more awareness of abnormal symptoms.
You know, the one misconception is that PAP smear is a screening test for uterine cancer, and it’s NOT. It’s just a screening for cervical cancer. So really, we rely on patients who have abnormal symptoms to contact their doctor and be evaluated.
dailyRx: What are the signs of this cancer that shouldn’t be ignored?
Dr. Soliman: One thing about endometrial cancer is that there are actually relatively obvious signs. In women that have gone through menopause, if they have any vaginal bleeding, that’s something that should be assessed by their doctor - even if there’s just a little bit.
For women who have not gone through menopause, if they notice that their period has changed so that they are a lot heavier or if they have bleeding in between their periods, those are all symptoms that should be evaluated by a physician.
dailyRx: What is typical treatment for uterine cancer?
Dr. Soliman: It usually starts with surgery, so a hysterectomy. We usually remove the fallopian tubes and ovaries at the same time. Then, depending on where the cancer is located, we may also remove lymph nodes in the pelvis and the abdomen.
Based on the information gathered during surgery, we then decide if patients need radiation and/or chemotherapy after surgery. Depending on the type of cancer, additional treatment is required by up to 25 percent of patients.
dailyRx: When a woman is diagnosed with endometrial cancer, what’s the best thing for her to do?
Dr. Soliman: One thing that is very important is for patients to have their surgery performed by an oncologist. General gynecologists do hysterectomies all the time for other problems.
But if they have a cancer and they need to have lymph nodes removed and things like that, a general gynecologist generally would not be able to offer that.
What we try to do is let the patient have only one surgery. So, at the time of surgery, we would do the hysterectomy and remove the lymph nodes, if needed.
If they have the surgery by a general gynecologist, then they would potentially get under-treated, or when referred, would need another surgery. So, I think one thing to stress is that someone who is diagnosed with a cancer should really be evaluated by an oncologist before having surgery.
So treating endometrial cancer isn’t just about having a hysterectomy. We see people from smaller towns who come to us after having had a hysterectomy – but it’s not the same surgery.
dailyRx: Even if a patient is seen at a cancer center, they can still be under the care of somebody else back home – right?
Dr. Soliman: Oh yeah, absolutely! We have a lot of patients who will even come and have surgery here, and then follow-up with their doctor at home or do some kind of combined follow-up. So, we definitely work with a lot of the doctors outside of the institution for follow-up patient care.
dailyRx: How can a woman who wants to have children protect her fertility before or during treatment?
Dr. Soliman: It depends on the actual type of endometrial cancer she has. There are what we call fertility sparing types of treatments. There are also anti-hormone treatments or progesterone treatments.
We actually have a study now looking at progesterone IUD (intrauterine device) to treat early cancers so that potentially people can have kids in the future. So there definitely are options in particular patients.
dailyRx: What’s new in terms of treatment and research?
Dr. Soliman: There are a couple of things that we have going on for treatment. One is, we’re looking at different kinds of imaging and lab studies to help predict which patients are at higher risk for cancer spread at the time of surgery.
We’re going to look at CT (computerized tomography) scans and lymph node mapping, as well as some molecular markers to see if we can predict which patients are at higher risk for the spread to the lymph nodes at the time of surgery. A couple of those studies should be open by the end of the year.
Also, researchers are currently looking at new treatments or new combination treatments of medications for treating recurrent endometrial cancers.
dailyRx: What do you want our readers to know about endometrial cancer?
Dr. Soliman: Well, the first most important thing is for people to understand that obesity is a risk factor for endometrial cancer. I got my Masters in Public Health, and my thesis was actually looking at patient knowledge about obesity and cancer risks.
What we found was that less than half of women - primarily college educated women - had no idea that obesity increased risks for cancer, in particular endometrial cancer.
So, I think we really want to stress awareness that weight can contribute to cancer risks.
Women should also know that Pap smears do not screen for endometrial cancer – only cervical cancer. In fact, there are no screening tests for this type of cancer.
The other thing to know is what the signs and symptoms are. So if they have either abnormally painful periods, bleeding in between their periods or post-menopausal bleeding, they should let their doctor know because it would require further evaluation.
And finally, if they are diagnosed with endometrial cancer, they should visit an oncologist prior to getting treatment.
dailyRx News extends our thanks to Dr. Soliman for taking the time to share her expertise with us.