By Bonny Osterhage

The late Ruth Bader Ginsburg once famously said, “Women belong in all places where decisions are being made,” and while she may have been referring primarily to the judicial system, that quote stands up in all areas of a woman’s life including, and especially, her gynecological health. However, even the strongest women among us can still fall silent when faced with health issues involving our reproductive organs. Whether due to embarrassment or fear of being seen as “THAT patient,” we often neglect to mention when things seem “off down there.” According to Dr. Georgia McCann, M.D., associate clinical professor in the Division of Gynecologic Oncology at UT Health San Antonio, that is a big mistake.

“I have found that women really know their bodies, and they know when something isn’t right,” she affirms.

McCann, who specializes in the diagnosis, treatment and research of cervical, endometrial, ovarian, and vulvar cancers, explains that some of these cancers, such as uterine, present with “red flag” symptoms including post-menopausal bleeding or bleeding between periods. Others like ovarian aren’t so obvious and may include ordinary issues such as constipation, bloating, or weight gain. So how do you know when that feeling of fullness in your belly is abnormal?

“If the symptom gets better or goes away, it is unlikely that it is related to cancer,” says McCann. “Any symptom that is cancer-related doesn’t get better.”

Tests and Treatments

It used to be that women got a PAP smear along with their pelvic exam at every annual gynecological visit to detect cervical abnormalities. Today, thanks to HPV testing, that is no longer necessary for most women.

“Assuming you have no history of a positive HPV test, irregular PAP smears, and you are not a smoker or have any other high-risk factors it is becoming acceptable to go 3-5 years between PAP smears,” says Dr. James Wilder, M.D., who specializes in cancers of the female organs at South Texas Gynecologic Oncology. He cautions that just because the time between PAPs is longer, that doesn’t mean annual pelvic exams aren’t necessary.

“To some women, PAP and pelvic mean the same thing, but they are not the same at all,” he warns, adding that a pelvic exam can often pick-up additional abnormalities that may be related to ovarian or vulvar cancers.

If abnormalities are detected and cancer is diagnosed, there are several options available to women today that, depending on the stage and type of cancer, can extend life expectancy and/or offer complete remission.

Wilder was among the first to perform Da Vinci Robotic surgery, and today he is one of the leading robotic surgeons in the field with more than 3000 procedures under his belt.

The minimally invasive procedure results in a smaller incision, a shorter hospital stay, and a lower risk of blood clot formation or infection. Patient recovery time is faster, which allows them to receive additional treatments such as chemotherapy or radiation more quickly.

Advances in drug therapies are showing positive results for some ovarian cancer patients, and while not curing the deadly disease, they are prolonging life and with fewer side effects.

“The drug treatment for ovarian cancer has improved significantly,” says Wilder, citing antibodies that halt the growth of the cancer cells, and immunotherapy that uses the body’s own immune system to attack the cancer cells. McCann adds that genetic testing for BRAC mutations in both the patient and the tumors can help determine which treatment is best.

“Some women can get the treatment after their first round of chemo, which can extend their years of remission and even overall survival.”

Prevention

There is no guarantee that you won’t get cancer within your lifetime, especially if you have certain genetic markers or a family history, but there are some preventative measures you can take. First, control your weight. People with higher BMI indexes have been shown to be at greater risk for certain types of cancers, including uterine. Take birth control pills to regulate estrogen and progesterone production. Too much estrogen is directly linked to uterine cancer. Get annual pelvic exams, and make sure that you are getting enough Vitamin D.

Finally, find a doctor you feel comfortable with and ask questions.

“Women are their own last lines of defense and they need to understand that they have to advocate for themselves,” says McCann. “It is okay to speak up.”