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Assessing Your Treatment Options

Program: In what way does being female increase your cancer risk? A look at gynecologic cancers
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Andrew Schorr:

One question about hysterectomy, because doesn't it remain still the most common surgery or was for so long the most common surgery, and there are new techniques. Gina mentioned about doing it through the vagina, right? But she chose not to do that to give you, her surgeon, the opportunity to really take a look at her abdomen to see was there a worry of cancer, any cancer spreading. In the end, there was. So putting it into perspective, if it's recommended that a woman have hysterectomy how do you determine when you should go the full boat route and when not?

Dr. Gray:

That's a great question and does require of course a lot of clinical judgment. There are several routes, as you mentioned, to performing a hysterectomy, and actually recently we've looked at doing kind of the more--what we call minimally invasive hysterectomy in patients with what we consider early endometrial cancer. A large study is coming out, some preliminary results have been released from that. But the key is really if you're concerned that this is an early versus more advanced cancer, I think that in cases where you're concerned that maybe there is spread outside the uterus doing an open or abdominal procedure in which you can evaluate the entire abdominal cavity thoroughly for any kinds of spread is really critical.

Andrew Schorr:

Okay. But certainly for most women who have no sign or there is not a suspicion of cancer can they just go ahead and have the vaginal? Or when do you wave a flag and say, well, maybe this isn't the best approach?

Dr. Gray:

Well, certainly if they're having a surgery for other causes that are benign, such as uterine fibroids or pelvic pain or something along those lines, once cancer has been ruled out, for example, if they were having spotting due to fibroids not cancer, but as long as they have had the appropriate workup and negative biopsies the route of the hysterectomy really depends on the skill of the gynecologist. But certainly it's safe in those cases to perform them in a minimally invasive surgery.

Andrew Schorr:

Okay. You mentioned second opinions earlier. So if the woman has some unusual symptoms hysterectomy might be indicated and suggested that this could sort of take care of the symptoms or what you think is the cause. But there are different approaches to doing it. Is that a case before a woman rushes into or proceeds with surgery to get a second opinion? Because it seems like the more I have doctors on here I think of the art or the expert experience, and it varies by doctor, and we as patients have no way of knowing what's happened in your history that lights up different suspicions for you, well, maybe I ought to look further. So what do you say about second opinions when the patient has these sorts of situations?

Dr. Gray:

I'm always an advocate for second opinions. Even people who are coming to me for an opinion if they feel like they haven't had their questions adequately answered or have other concerns I really think that in our community--especially in the gyn oncology community we're very small and we don't look at it as a bad thing to go and poll our other colleagues. I have the benefit of working with five other gyn oncologists. Dr. Greer is one of them who are, again, as you mentioned, experts in this field, and so I use them as resources as well too. But certainly I think that at any time second opinions are worth while for patients.

Andrew Schorr:

And I know it benefitted me with my leukemia. So, Gina, what would you say to the ladies listening to have some symptoms they're kind of worried about but maybe were told relax about it. And certainly sometimes that's true, sometimes you can relax. But what would you say as far as a philosophy that women should have now, now that you've been through it, so that they rule out the really bad things or if there could be something, like the C word, as we've talked about, that it gets handled earlier, or really the treatment you need and deserve is brought to bear earlier.

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