Dr. Emmanuel Soultanakis (Guest): Good morning, and thank you for having me on. I think it’s really important for us to talk for some of these things that may help patients present early with symptoms that we can help to treat early on. The main cancers that we deal with are cervical cancer, endometrial cancer, and ovarian cancer. To some extent, the first one that I mentioned, cervical cancer, is a preventable disease for us. In the United States, with the current screen recommendations, we should be seeing very little of this disease. Currently, what we encourage women is to go forward with their new recommendations for screening with Pap smears and/or HPV testing in some situations. Probably the easiest way to know what these recommendations are is to inquire with either your primary care physician or with your gynecologist. But just to give you an idea of what we’re dealing with in terms of screening for cervical cancer, women less than 21 years of age do not need to be screened. Between the ages of 21 and 30, a woman should undergo a Pap smear every three years. In the age group between 30 and 65, we encourage screening with both HPV testing and Pap smear. And they are done concurrently. They’re done at the same time, and that’s done every five years.
Melanie: If a woman is perimenopausal and she does not have HPV, she’s been tested, then you still get those Pap smears every five years? Do you get them closer together? What if you are negative for HPV but you’re in peri- or in menopause?
Dr. Soultanakis: That’s correct. You still require to have screening. It’s not as often as it used to be. We used to do annual screening with Pap smears. We no longer have to do that. And in that age group of perimenopausal women, we do testing now with both HPV testing and the Pap smear, but we do it less often. It’s done every five years instead of every year. We think that that’s adequate intervals as long as you stick on that schedule and as long as you’re getting both tests on at the same time.
Melanie: Dr. Soultanakis, we’ve heard ovarian cancer, the silent killer, that it doesn’t really have very many symptoms. What do you want women to know about ovarian cancer, and is there any way that we would know if we have it?
Dr. Soultanakis: You’re absolutely correct there. The symptoms of ovarian cancer tend to be what we would call very nonspecific. It’s things that we all get all the time. It could be a little bit of nausea. It could be some bloating. It could be some constipation. It could be a little bit of abdominal pain. All those things that I just mentioned, we all get from time to time. What I tell women that I see to look for are new symptoms that come on sort of in a new onset. We haven’t had a lot of those, but they’re coming often again and that they are not going away. With a symptom such as bloating, you’re bloated for two or three days, it resolves, that’s not a big deal. But once you have bloating that persists for a week or two, this is something that needs to be looked at. It doesn’t mean that you do have ovarian cancer. It may mean that you’re absolutely healthy and have nothing to worry about, but it would be something to bring to the attention of either your primary care physician or your gynecologist and get evaluated. The one other thing that I would say that is very important and that’s become more and more significant is knowing your family history. None of us used to know what happened to Grandma Pam or… in the olden days, we didn't really concentrate very much on family history, but that has become a very important part of our health care. Knowing who has had breast cancer in the family, who has had ovarian cancer or colon cancer have become very important knowledge points in your family history. Also, for women of Ashkenazi Jewish descent, ovarian cancer and breast cancer can be more prevalent.
Melanie: Now, Dr. Soultanakis, tell us a little bit about treatments. Any of these things that you mentioned and how important it is for us to get those screenings at the time schedule that you’ve mentioned, if we experience any red flags, bleeding or any of these things, we get to our doctor, what can be done about them? Give us just an overview of some of the newer treatments.
Dr. Soultanakis: Sure. One other thing that I wanted to mention right before that and we didn’t talk very much about was endometrial cancer. The main presenting symptom of endometrial cancer is vaginal bleeding, most commonly after menopause. What I would encourage women, if after menopause, once they stopped having monthly menses, if they have any type of spotting, bleeding, or increased discharge, I would encourage them to get evaluated because talking about treatment, the earlier you present with a gynecologic cancer, the more successful the treatments become. For cervical cancer, we hope to catch these before they even become cancer, in their pre-cancerous state. For endometrial cancer, we hope to catch them early if you present with the obvious symptoms of vaginal bleeding. Also with ovary cancer, we hope to manage this early on. The treatments that we use currently are a combination of surgery, chemotherapy, and radiation therapy. It also depends on what the presentation is. The earlier the cancer, the less complicated the treatment is and the more effective the treatment is.
Melanie: Women tend to associate this type of gynecological cancers with complete hysterectomy, and they think to themselves, “Well, I’m not gonna be a woman anymore.” There’s a lot of mixed feelings when we worry about this type of cancers. What’s your best advice for women that are scared of these things?
Dr. Soultanakis: I think the best advice is to come in and talk with the physician and hopefully try to alleviate some of the fears that are associated with treatment. I think the most common fear that I see in women is getting treated with chemotherapy. There’s a lot of information that we get from either other family members that were treated with chemotherapy or sometimes from movies and television that may not apply to a particular treatment. The chemotherapy treatments now are so specialized and targeted to the different cancers that it’s best to talk with the physician, try to alleviate as many of the fears of surgery, chemotherapy, and radiation as we can, and put it in the context of what it means to be treated with these modalities.
Melanie: Do certain conditions, endometriosis or cysts we get, ovarian cysts, do these necessarily contribute to cancer?
Dr. Soultanakis: Not necessarily. Women come to our office and say, “Oh, I had a history of ovarian cyst.” I jokingly say, “Well, you and every other woman.” Because that’s what the ovary does. The job of the ovary is to form a cyst that contains an egg and release that. And it’s a constant function of the ovary. The ovaries are a very active, dynamic structure, especially before menopause. It’s not unusual to see that. What we worry more about are cysts that do not go away. If you have the persistent cyst over time and it continues to grow or have features that are worrisome to us, then that becomes a little bit more of a red flag that we need to deal with. But cysts in and of themselves are not necessarily a cause for cancer.
Melanie: When does a woman ask for an ultrasound? When do we ask our doctor and say, “I would just like an ultrasound of my ovaries just to make sure my uterus, everything’s okay in there”?
Dr. Soultanakis: I think discussing imaging studies with your physician is important. They will let you know if that is a necessary intervention or not. More imaging, more CT scans, more ultrasounds are not necessarily better. I think we need to apply them and use them when necessary. And the best way to find that out is to ask those questions of physicians. Be proactive. Ask the question and have a discussion about that.
Melanie: Dr. Soultanakis, it’s just been such great information. In the last minute, if you would, give your best advice for women in gynecological cancers and really the messages you want us to know and why they should come to Maine Medical Partners for their care.
Dr. Soultanakis: I think staying with your screening for cervical cancer and not ignoring symptoms. Most of us, including us physicians, tend to ignore some of the symptoms that we experience. If you’re having symptoms, if you’re having vaginal bleeding, if you’re having belly pain, do present for evaluation. The sooner we find these things out, the easier it is for us to treat. Myself and my partners here are all fellowship-trained physicians, and we take excellent care. One of the things that I want to stress about the care that we provide at Maine Medical Center is that it’s state-of-the-art care. We provide the best surgical care and best treatment modalities that you would find anywhere in the United States. And I don’t want the women of Maine to think that they don’t have available the best treatments or the best doctors.
Melanie: Thank you so much for listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening.