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18  Dec  13 dee-sparacio-blog category Dee Sparacio

Discovering CA-125 | Dee Sparacio

I didn’t even know CA-125 existed until I was diagnosed with Stage 3 ovarian cancer. CA-125 is a “tumor-associated protein” for ovarian cancer. It is found in the blood. Before surgery my CA-125 level was in the high 100’s (below 35 is considered normal). I learned from other women diagnosed with ovarian cancer that their numbers were in the 1000’s when they were initially diagnosed.

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31  Oct  13 b-j-rimel category B.J. Rimel

Negotiating the pelvic exam | B.J. Rimel, MD

Lately, I’ve been hearing a great deal of negotiating in my office. Now that I’ve been in practice for two years, I’m getting to see some patients back for surveillance visits and unfortunately some for recurrence. Regardless of the reason for the visit the strategy is always the same: is there a way to avoid the pelvic exam portion of the visit? In an attempt to discuss the reasons why we, as gynecologic oncologists, perform what is inevitably an uncomfortable examination, I will answer the top 5 things said in my office after I say, “I’m going to step out now so you can undress.”
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21  Nov  12

Vulvar Cancer

Vulvar Cancer Home | General information | Risk Factors | Symptoms
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What tests might your gynecologic oncologist perform to determine treatment?

Your gynecologic oncologist will review your entire medical history and perform a physical examination, including a pelvic examination. If it has not already been done, your gynecologic oncologist will probably perform a vulvar biopsy. This can usually be done in the office with a medicine to numb the area from which the biopsy will be obtained.

In some cases, other tests such as a CT scan, MRI or PET scan may be recommended prior to treatment to determine if any cancer cells have spread. These tests are performed as an outpatient and require placement of an IV during the test.

Occasionally, if you are too uncomfortable in the office, or if an adequate biopsy cannot be performed, your doctor may recommend an examination with anesthesia in the hospital. A cystoscopy (looking in the bladder) and or proctoscopy (looking in the rectum) may be performed at the same time. Blood work to evaluate liver and kidney function, blood counts, and possibly an HIV test to check your immune system may also be recommended.

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Next: What are the stages of vulvar cancer?

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21  Nov  12

Vaginal Cancer

Vaginal Cancer Home | General information | Risk Factors | Symptoms
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What tests might your gynecologic oncologist perform to determine treatment?

Your treatment will depend in part on the stage of your cancer, so you may need tests to determine how far the cancer has spread. You might need any of the following tests:

  • Biopsy. In this procedure, a sample of tissue is taken to check for abnormal cells. You may need a biopsy of the cervix or the vulva, as these are areas that vaginal cancer commonly spreads to or from. A biopsy can be done as an outpatient procedure in the doctor’s office, or, if a more extensive amount of tissue is needed, can be done in the hospital.
  • Cystoscopy. In this procedure, a narrow tube containing a light and a viewing lens is inserted through the urethra into the bladder, to check for abnormal areas. The cytoscope may also be used to take a biopsy of abnormal cells.
  • Proctoscopy. In this procedure, a narrow tube containing a light and a viewing lens is inserted into the rectum to check for abnormal areas. A proctoscope can also be used to take a biopsy of abnormal cells. Chest X-ray, to determine whether the cancer has spread into any of the organs or bones in your chest
  • CT or CAT scan, also called computed tomography, computerized tomography, or computerized axial tomography. To do a CT scan, a dye must either be swallowed or injected into a vein. The dye helps certain organs to show up better in X-ray images.
  • Magnetic resonance imaging (MRI) scan, sometimes called a nuclear magnetic resonance imaging scan (NMRI). This procedure uses a magnet, radio waves and a computer to make pictures of areas inside the body.
  • Positron emission tomography (PET) scan. In this procedure, radioactive glucose or sugar is injected into a vein. The PET scanner takes pictures of places where glucose is being used up in the body at a greater rate. Cancer cells look brighter in PET scan images because cancer cells are more active, grow and spread faster, and use more glucose than normal cells do.

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20  Nov  12

Uterine Cancer

Uterine Cancer Home | General information | Risk Factors | Symptoms
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What tests might your gynecologic oncologist perform to determine treatment?

Most endometrial cancer cases are diagnosed by taking a biopsy of the uterine lining. If this has not already been done by your primary doctor, it will most likely be done in the office. The procedure involves passing a very narrow suction catheter (like a thin straw) through the cervix into the uterus. It does not require anesthesia. The main side effect of a uterine biopsy is brief cramping (lasting minutes to hours). This may be minimized by taking an over-the-counter pain medication prior to your biopsy. Some women, however, cannot tolerate a biopsy in the office and need to have a surgical procedure called a dilation and curettage (D&C) performed in conjunction with a hysteroscopy, which involves the use of a small camera that allows the surgeon to see inside the uterine cavity.

The uterine tissue taken during a biopsy is sent to a pathologist to be examined under a microscope to determine whether cancer is present. The pathologist can also determine the cancer grade and cell types, which are preliminary indicators of how aggressively the cancer may behave. The biopsy alone cannot determine what stage the cancer is. Your doctor may want to get your slides reviewed by a pathologist at his or her institution to confirm the diagnosis before surgery or any other treatment.

Sometimes endometrial cancer is suspected based on an abnormal ultrasound or MRI finding, but a biopsy must be performed to confirm the diagnosis. Ultrasound may be performed to determine the size of the uterus to see if it can be removed safely with minimally invasive surgery. An MRI may be done in women who might be candidates for fertility-sparing non-surgical management. A chest X-ray is routinely done to look for spread of the cancer to the lungs. A CT or PET scan might be ordered in certain situations but not routinely.

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20  Nov  12

Ovarian Cancer

Ovarian Cancer Home | General information | Risk Factors | Symptoms
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What tests might your gynecologic oncologist perform to determine treatment?

Most ovarian cancers are diagnosed at advanced stages (Stage III or IV). This means that at the time of diagnosis, the cancer has already spread beyond the female organs into the upper abdomen, lymph nodes or the chest. Despite this, the ability to surgically remove bulky tumors and the high likelihood that ovarian cancer will respond to chemotherapy means that most women with ovarian cancer will be in remission after their initial treatment. How long remission will last is impossible to predict.

If the cancer never comes back, that remission is considered a cure. However, most often, ovarian cancer does recur. The first two years after finishing initial treatment is the highest risk period. At the current time, recurrent ovarian cancer is not generally curable. The goals of treatment are to maximize quality of life while prolonging survival. Chemotherapy is the most common form of treatment for recurrent disease. Although this disease is known for its recurrent nature, there is increasing hope that a woman’s life may be extended with new treatments and lifestyle interventions.

If you have not already had the tests listed below, your gynecologist oncologist might order them prior to determining the appropriate treatment plan for your cancer.

Blood tests

Tumor markers (CA-125, CEA, CA 19-9, CA 27-29 and others): These tests give the doctor a better understanding of the likelihood that you have a cancer in your body. However, these tumor markers may be elevated even in the absence of a cancer, and some ovarian cancers do not have abnormal tumor markers. These tests may also help determine whether the cancer is coming from other parts of the body.

Complete blood count and comprehensive metabolic panel: Prior to performing surgery or administering chemotherapy, these tests help to determine your nutritional status in addition to low blood counts (requiring blood transfusion) and your ability to tolerate anesthesia and surgery. They may also help predict your ability to recover.

Imaging and tests

Ultrasound (U/S), CT (CAT) scan, or MRI

  • To better understand the location of your mass, cyst or tumor
  • To better understand if your tumor has spread to other parts of your body
  • If your doctor is not concerned about distant spread of your disease, it is reasonable to only have an ultrasound prior to surgery.

Chest X-ray and EKG

These tests may be performed before surgery to help you anesthesiologist know that your heart and lungs are healthy.

Stress test, echocardiogram, pulmonary function tests

These tests may be performed before surgery if you have an abnormal chest X-ray and EKG, or if you have complaints of chest pain or shortness of breath.

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Next: What are the stages of ovarian cancer?

Photo courtesy of the Ovarian Cancer Alliance of Ohio

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20  Nov  12

Cervical Cancer

Cervical Cancer Home | General Information | Risk Factors | Symptoms
First Appointment | Diagnostic Tests | Stages | Treatment Options | Post-Treatment

What tests might your gynecologic oncologist perform to determine treatment?

The first step is to confirm the diagnosis of cervical cancer and to establish the stage of your cancer. The diagnosis of cervical cancer requires a biopsy from the cervix for the pathologist to review under the microscope. This biopsy might be done in the office or in the operating room. Your doctor will review which option is best for you. The stage of cervical cancer is a standardized way to describe the extent of the cancer in the body and to establish whether the cancer has spread outside the cervix elsewhere in the body. The stage of a cervical cancer is based on a thorough pelvic and rectal exam in addition to some radiologic studies and possibly other diagnostic tests. Your gynecologic oncologist will recommend treatment based on the stage of the cancer, your overall health status, and, if appropriate, your desires about preserving fertility.

Additional Testing

Further tests may be necessary to either establish the stage of the. During your consultation, your gynecologic oncologist may order additional testing. Common tests and procedures performed during the workup of cervical cancer are as follows:

  • Rectovaginal exam. This is a relatively simple type of pelvic exam done in the office performed by examining the vaginal area and the rectal area at the same time. This allows your doctor to better determine if the cervical cancer extends past the cervix.
  • CT or CAT scan, also called computed tomography, computerized tomography, or computerized axial tomography. To do a CT scan, a dye must be swallowed or injected into a vein. The dye helps certain organs to show up better in x-ray images.
  • MRI (magnetic resonance imaging) scan, sometimes called an NMRI (nuclear magnetic resonance imaging scan). This procedure uses a magnet, radio waves, and a computer to make pictures of areas inside the body.
  • PET (positron emission tomography scan). In this procedure, radioactive glucose is injected into a vein. The PET scanner takes pictures of places where glucose is being used up in the body at a greater rate. Cancer cells look brighter in PET scan images because cancer cells are more active and use more glucose than normal cells do.
  • Chest X-ray, to determine if cancer has spread into your chest or lungs.
  • Blood tests evaluating your blood count, kidney function, and related issues.
  • Cystoscopy. An outpatient procedure that uses a very small lighted camera to look inside the bladder. Your doctor might recommend this test if there is any concern that the cancer involves the bladder or has caused a blockage of urine going from the kidney to the bladder. Biopsies can be taken using the cystoscope.
  • Proctoscopy. This is another outpatient procedure that uses a small lighted camera to look inside the anal and rectal canal. Your doctor might recommend this test if the clinical exam raises concern about growth of the cancer from the cervix into the rectal area.
  • Exam under anesthesia. This is an outpatient procedure that may be recommended by your doctor to perform a more thorough examination with the assistance of intravenous sedation by an anesthesiologist. This may be recommended to you if the office exam is too painful for you and your doctor needs to perform a better exam to determine the stage. This is often done with cystoscopy, proctoscopy, and tumor biopsies at the same time.

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19  Nov  12

What is a gynecologic oncologist?

A gynecologic oncologist is a physician who specializes in diagnosing and treating cancers that are located on a woman’s reproductive organs. Gynecologic oncologists have completed obstetrics and gynecology residency and then pursued subspecialty training through a gynecologic oncology fellowship. Residency takes four years to complete, while fellowship involves three to four additional years of intensive training about surgical, chemotherapeutic, radiation, and research techniques that are important to providing the best care for gynecologic cancers. Physicians who complete this training are eligible to take both the obstetrics and gynecology board exam and the gynecologic oncology board exam.

The gynecologic oncologist serves as the captain of a woman’s gynecologic cancer care team. It is important to consult with a gynecologic oncologist before treatment is started so that the best treatment regimen is chosen for you.

Seek a Specialist

SGO’s Seek a Specialist includes actively practicing specialists in all professions related to gynecologic cancer.