A Question and Answer Session with Abbie Fields, MD.
Q: What are the most common types of gynecologic cancers?
Cervical cancer is the most prevalent gynecological cancer, and the fourth most common cancer in women worldwide. In the US, endometrial (uterine), cervical and ovarian cancer are more frequently diagnosed, while vulvar and vaginal cancer are less common. However, there has been an upswing in the number of vulvar and vaginal cancers diagnosed in older women for whom the HPV vaccine was not available when they were young.
Endometrial cancer is often diagnosed at an early stage due to the common symptom of bleeding after menopause. Risk factors include increased exposure to estrogen, due to supplementation without progesterone, or due to factors like obesity, late menopause, high blood pressure, diabetes or family history.
Cervical cancer is almost always related to Human Papillomavirus infection (HPV), as are malignancies of the vulva, vagina, anus and sometimes throat.
Lastly, ovarian cancer is less common, but it is responsible for many of the deaths among women with GYN cancer. This is because it tends to be diagnosed in later stages due to subtle symptoms such as bloating, pelvic/abdominal pain or swelling, and urinary symptoms. Ovarian cancer in a patient’s family history indicates increased risk.
Q: Is there a way to screen for or otherwise detect these cancers early?
Uterine cancer is generally diagnosed earlier based on symptoms of bleeding or abnormal discharge. Cervical cancer is diagnosed by following through with regular PAP/HPV screening protocols. For women eligible and appropriate (age-wise), requesting immunization to protect against HPV-related disease is an important prevention measure. Additionally, the use of condoms decreases the risk of infection with HPV.
Unfortunately, there’s no screening tool for ovarian cancer, so it is often diagnosed at a late stage. It’s important to be aware of subtle changes in your body and your family history, and to be open to genetic testing if your physician feels it is warranted.
Q: How are these cancers treated?
Surgery to remove the cervix, uterus, fallopian tubes, ovaries and lymph nodes is often the first step in managing uterine cancer.
For cervical cancer, only early-stage disease can be treated by surgery, sometimes followed by chemotherapy and/or radiation. Later-stage disease is managed by chemotherapy and/or radiation, and possibly immunotherapy.
With ovarian cancer, the goal of surgery is to remove the majority of visible disease. Depending on the stage/grade/molecular features of the cancer, additional treatments might include radiation, chemotherapy, hormone therapy, or targeted therapy/immunotherapy.
Cases diagnosed at UM Shore Regional Health that warrant a wider review, for a variety of reasons, are presented at a weekly tumor board, where surgeons, medical oncologists, and radiation oncologists discuss the case and together plan a course of therapy that will most benefit the patient.
Q: What about vaginal and vulvar cancers?
Associated with human papilloma virus (HPV) exposure – often decades earlier – these cancers are often diagnosed in older patients. I have found that here on the Shore, many women believe that after menopause or hysterectomy, they no longer need to see a women’s health provider. As a result, these cancers are diagnosed late — once symptoms of advanced disease are present. These may include unusual discharge, bleeding, pain during intercourse or urination, a vaginal lump or sore that does not heal, and leg swelling. Precancerous changes of the vulva can include persistent itching, pain, tenderness, or burning in the genital area, along with noticeable skin changes like thickening or discoloration.
Q: How can women be proactive in managing their gynecological health?
First, keep up with your annual gyn check-ups, regardless of your age. That is paramount. Women are taught to look after others more than themselves, to “power through” discomfort, fatigue, and so on. But I also think women are very intuitive – if you are paying attention to your body, you will likely know when something is wrong, so don’t ignore it or keep putting off getting medical attention. Call your GYN, or if you don’t have one, your primary care provider, and let them know you need to be seen. In most cases, your care can be managed here on the Shore, including surgery if needed, and my colleagues in Women’s Health and I are here to help you through the process. There are also many women’s health resources in other parts of the state through our University of Maryland Medical System colleagues.
Q: What is your approach to patient care?
I look at my role as a partner and patient advocate to get the best outcome for each woman. The medical aspects are important, but so is open, honest communication. I ensure that every patient has a full understanding of her particular condition and available treatments, and I present a spectrum of options and associated outcomes for each choice.
Concerned about your gynecological health?
Abbie Fields, MD, the featured author, is an important addition to the UM Shore Medical Group (UM SMG) – Women’s Health provider team and also to cancer care for women in the five-county region served by UM Shore Regional Health. As a specialist in gynecologic oncology, she sees women of all ages for treatment of gynecologic cancers. In this interview, she offers important information for women about gynecologic cancers and strategies for their management.
For a referral to see Dr. Fields, contact your primary care provider or women’s health provider. UM Shore Medical Group – Women’s Health is located at 522 Idlewild Avenue in Easton, and providers also see patients in Cambridge, Chestertown, Denton, and Queenstown, as well as via telemedicine.
For more information, call University of Maryland Shore Medical Group – Women’s Health at 410-820-4888 or visit our webpage.