Gynecologic Cancer Awareness Month: What Every Woman Should Ask Her Doctor

Gynecologic cancers involve the uterus, cervix, fallopian tubes, ovaries, vulva and vagina — and for many women, the term itself is unfamiliar until a diagnosis makes it personal. Some of these cancers have screening tools. Many do not, which makes recognizing symptoms and knowing who to bring them to that much more important.

In an interview with CURE for Gynecologic Cancer Awareness Month, Dr. Ami P. Vaidya, co-chief of the Division of Gynecologic Oncology and vice chair of the Department of Obstetrics and Gynecology at John Theurer Cancer Center at Hackensack University Medical Center in Hackensack, New Jersey, discussed how molecular testing has reshaped treatment planning, which side effects patients should never push through, when to raise fertility concerns and what to say about life outside the clinic when getting to appointments is a hardship.

CURE: What does Gynecologic Cancer Awareness Month mean to you, and what do you most want patients to take away from it?

Vaidya: For me, awareness ends up being the key word for the month. I don't think it really should just be limited to a month, but that's how the name's been given, and the awareness piece gives us a really good opportunity to educate women and their partners out in the community about what gynecologic cancers are.

For so many people, they're not even sure what that really means. These are cancers that involve the reproductive organs — organs that belong, if you will, only to biological women. So we're talking about the uterus, the cervix, the tubes, the ovaries, the vulva and the vagina. Just having people be aware of what the term "gynecologic" refers to is helpful.

Then we can really use the time to talk about what screening tools do exist for these cancers, and where we don't have screening tools — because unfortunately there are many situations where we don't have screening tools. What symptoms are important to report, and to which doctors should they report them? So for me, the month is a real opportunity to focus on this teaching and training and education in every way we can, helping women understand their bodies better and know what's normal and what's not, and then helping them figure out, when something doesn't feel right, who to go to for help.

What has changed most in how gynecologic cancers are treated in the past few years?

A lot has changed, and for the better. I kind of put these changes into some buckets.

First and foremost, we are now really utilizing what's called molecular testing to help shape how we create treatment plans. We're looking at things like tumor DNA, RNA and proteins that are expressed by a tumor, and using that sort of fingerprint of the tumor — that's how I think of it — to help make decisions about what treatments will best help that particular patient.

In addition, we have better, newer, different targeted drugs, including immunotherapy, which has made a big difference in terms of options for patients, especially in the recurrent cancer setting. More choices for women if their cancers recur after standard upfront treatment.

We've also really pushed the envelope on technologies for surgery, which is often a very big part of gynecologic cancer care. It is a multimodal approach to most of these cancers, so surgery is a big part of treatment, and over the last several years we've really advanced minimally invasive surgery and robotic surgery. We've started thinking about ways we can be more specific and selective in how we stage cancers surgically, and as a result, that ends up really helping patients have fewer side effects. As we get better at treating these cancers, we're talking about long-term quality of life.

And finally, as we look at the surgical advances, we also similarly see more targeted, focused radiation treatment. Not all gynecologic cancer patients will undergo radiation therapy, but for those who will, there's more image-guided therapy that has really helped reduce some of the toxicity and focus the radiation to the area of disease. That's also been really helpful for patients' longer-term quality of life.

Which side effects do patients most often tell you caught them off guard, and when should they speak up rather than push through?

Lots of treatments result in side effects. There's a trade-off that we talk about all the time with patients. We think about the benefit of this treatment — whether it's surgical, medical or related to radiation — as our ability to try to cure, or in some cases, if cure is not possible, control disease. And then we know there's going to be some side effects.

So I tell patients it's really important to talk to their doctors and get information about what the side effects are, so they themselves can monitor a bit on their own in between treatments, and to answer all the questions their providers have for them. Most providers will be asking questions before each treatment — about nausea, vomiting, and questions related to neurotoxicity.

The ones I don't want patients to miss are the ones that are more likely to become permanent. Neurologic side effects of chemotherapy, for example. If we keep pushing through and someone has tingling in their fingers, numbness in their toes, difficulty doing little tasks like picking up a spoon or a fork, buttoning a button, tying a shoelace — and if that's all new, meaning it started since they began treatment — that type of side effect is one that's not reversible. So if they just plow through and pretend like nothing's happening, that's going to be really difficult to reverse, and then we're talking about possibly long-term quality of life issues. Those neurological side effects are not that common, but they can happen, and it's really important for patients to discuss them with their providers.

I think providers overall are doing a pretty good job of talking to patients about side effects. I don't often have patients coming and saying, "I got caught off guard, I didn't expect this" — probably with the exception of fatigue. That one is hard to measure. We don't have a blood pressure cuff that goes on your arm and says you are fatigued, and even if we did, it's really hard to treat. There are so many factors that go into it. That's probably the one that catches patients off guard, because they may not realize just how taxing treatment sometimes can be.

Fertility, early menopause and sexual health come up often with these diagnoses. When should those conversations happen, and what can patients do if their team doesn't raise them?

We're going to divide them up a little bit, because they're very different issues.

Fertility is one that patients have to bring up as early as possible. As soon as the diagnosis is made, one needs to talk about where they're at with fertility. Many of the gynecologic cancers are treated with surgery, in some cases chemotherapy and radiation, and so there can be a major, profound impact on fertility. For our younger patients who are premenopausal and still in their reproductive years, if there is a desire to maintain fertility, they need to have that conversation upfront and early before any treatment is started, so that nothing is compromised.

There may be situations where options exist for those patients, whether it be to harvest eggs and freeze them, or a consultation with an infertility doctor. There may be things that can be done to protect the eggs that exist in a woman's ovaries if she's receiving treatment — let's say radiation for cervical cancer — but there may be a way to preserve ovarian function for that patient if that is a priority for her. The best thing to do is ask the questions and share fertility plans with the doctors, so that together a plan can be made that makes the most sense. We don't want to compromise cure, but we also don't want to take away something a patient is hopeful for.

If we then look at menopause and sexual health, some of those concerns can be discussed early on, but those are conversations that are going to continue over the course of treatment. They may be brought up early by a patient who has concerns about whether her surgery or treatment will put her into menopause, and what her options are afterward. She may have concerns about sexual function. Some of those questions can initially be addressed, some reassurances can be given upfront, or options for how to manage should symptoms arise. And then those conversations have to continue over the course of treatment, because then you may implement what you can do to help minimize or mitigate problems of menopause or sexual dysfunction.

Transcript has been edited for clarity and conciseness.

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