Why Should Endometrial Cancer Patients Engage in Their Care?

What role do patients play in their endometrial cancer care and treatment decisions? Gynecological cancer expert Dr. Nita Karnik Lee explains the shared decision-making process and discusses the benefits of engaging in conversations with your healthcare team. 

Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.

 

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Transcript:

Katherine Banwell:  

Would you define shared decision-making, Dr. Lee? Tell us why it’s so important for patients to engage in their care.  

Dr. Nita Karnik Lee:  

Shared decision-making is sort of the idea model, right? It’s this idea that we want to, as physicians, know what values my patient has, and I want to be able to impart information that I think will be helpful for them to make a decision. Sometimes the decisions are do I want to do surgery or not? Sometimes the decision are do I want to do chemo or continue chemotherapy? Those are very different decisions, and shared decision-making is a way of saying we’re going to have some kind of communication back and forth where I’m like, hey, this is what I think is happening. These are the choices that you have.  

And you telling me, okay, these are the things that I’m worried about. These are the things that align with what I want to do. I think it’s really important, though, to not have physicians put it out as, oh, well, I just let the patient decide, right, because just like when my car breaks down or my lights don’t work at my house and I get an electrician to come and see, I have no idea what they’re talking about.  

I have no concept. I really rely on them to say, well, I don’t know what kind of wire for you to use in my house. I have no idea. So, we really want to be careful that shared decision-making doesn’t turn into a menu of choices that we, the physicians, are actually giving up their role in advising if that makes sense. A lot of shared decision-making is in that relationship of trust and saying I really get this. I get what you’re telling me.  

I have patients, for example, who are on chemotherapy for a recurring disease, either uterine or ovarian cancer, and a lot of times you’re making these decisions of, okay, quality of life, like, what are events that are coming up? Sometimes they don’t always align with what I think is best, but if somebody tells me, you know what, I’m going to do these three cycles, but my son’s wedding is coming up. And I really need a month off beforehand, that aligns for me because I think that’s important, but maybe it’s not the standard.  

And so, kind of really knowing your patient, from my perspective, and also, as patients, not being afraid to say these are my values, and this is what’s really important to me. People will hear it, and they’ll feel better equipped to be able to help you guide those decisions with the caveat that sometimes I’ll say, look, you know what, I’m pretty worried about you. Yes, let’s give you a month off before, but let’s scan right after the wedding and see what’s going on.  

And then we can decide what we’re going to do after that. Or holiday times are oftentimes where I really give people sometimes a break. If they’ve been on chronic chemotherapy, sometimes this is a time where I’d say I’m really worried. I don’t think we can give you a break. People will tell me I know you’re worried about me, but this is really important. And we work together on it. I think it’s knowing the medical background, and then making sure you know what your patient wants, from that perspective.  

Katherine Banwell:  

And having an open line of communication. 

Dr. Nita Karnik Lee:  

Yes. 

Katherine Banwell:  

That’s what you’re saying. 

Dr. Nita Karnik Lee:  

Exactly. I think you hit it on the nail. Having an open line of communication, and not feeling that you need to hold back from that. I think it’s much easier for our whole team. I work really closely with our nurses and PAs, and sometimes one of the nurses will be like, you know what, she really wants to talk to you about this. Sometimes it’ll be maybe not even talking to your doctor first, but talking to the person on your team you feel closest to, to say I’ve been really thinking about this. I know Dr. Lee wants to do this, but this doesn’t align with my kid’s graduation, or my grandkid’s something, and those things are really important to get that open.

Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

What are endometrial cancer biomarkers? Dr. Hinchcliff discusses how prognostic biomarkers, namely mismatch repair status and HER2, influence treatment, leading to more tailored strategies for patients.  

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

Download Resource Guide

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Transcript: 

Katherine Banwell: 

Are there prognostic biomarkers that help determine how the cancer may behave? 

Dr. Emily Hinchcliff:  

Yeah. So, endometrial cancer, we now know that the molecular mechanism – so, what I’ve been talking about, these things that are happening inside the cancer cell – we now know that that can drive prognosis, and so, it used to be that we kind of had two big buckets of cancer. 

We used to say there’s Type 1 endometrial cancer and Type 2 endometrial cancer, and now, we’ve actually broken it down into molecular categories – so, into categories much more based on certainly what the cell looks like under the microscope, but also what’s going on inside the cell, not only to impact treatment, but also to give a patient a better look at what their prognosis is expected to potentially be, and we actually have changed our staging system pretty recently to incorporate some of those molecular characteristics that we now know to check for.  

Katherine Banwell:  

Talking about the biomarkers, how do biomarkers impact endometrial cancer treatment options? 

Dr. Emily Hinchcliff:  

Yeah, so I think specifically the two that I mentioned, the mismatch repair status and the HER2 status, have really robust data that tells us that we can better tailor our treatment strategy based on a patient’s status. So, for mismatch repair, for example, if someone is mismatch repair deficient, that tumor is going to respond very well, incredibly well, to immunotherapy. So, we now actually use immunotherapy in combination with chemotherapy to treat those cancers, especially for the cancers that have spread outside the uterus or the cancers that have gone through initial treatment and then come back. 

So, I think that is a really great option. Similarly, that HER2 receptor, there is a medicine that targets that receptor, which is that cell surface molecule, that thing that’s sitting on the cancer surface, and can treat that cancer better if that marker is expressed. 

What Questions Should Patients Ask About Endometrial Cancer Testing?

What questions should patients ask about endometrial cancer testing? Dr. Hinchcliff highlights key questions, while stressing the importance of understanding both germline and somatic tests and their impact on treatment. She emphasizes the value of open, ongoing communication with doctors.  

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

Download Resource Guide

See More from INSIST! Endometrial Cancer

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Essential Endometrial Cancer Testing

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Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

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Transcript: 

Katherine Banwell:  

Right. And so, what questions should patients ask about their test results? 

Dr. Emily Hinchcliff:  

Yeah, so, I think first and foremost, just getting an understanding of what tests your doctor is sending is really important. This should be an open conversation, and it’s a conversation that you should actually have as you are going throughout your cancer journey. It’s not just a conversation at your diagnosis, it’s something that, if your cancer comes back, it should be reassessed. Are there additional markers that we should send that we didn’t send in the upfront setting? Do we have a complete picture of my cancer? 

And so, I think that is definitely a question to ask, is what tests are you sending, and what is the outcome of those tests, right? How would that test change your potential management or change the options that you have for me in terms of my cancer treatment? The other thing that I will say that I think can be confusing for patients as we think about the genomics and genetics of a cancer is that it’s really important to understand the difference between something called germline and something called somatic testing, and so, I’m going to explain that, because I think it can be confusing. 

The first, germline, is a test that is testing the genetics of the whole body – so, of a person – to see if there’s anything that’s hereditary that might have predisposed them to getting cancer. And so, that is something that, if it is abnormal, it may mean that family members need to get tested, and there are things that we can do to try and prevent cancers for other people in your family that might be at risk. So, that is germline testing. 

That’s different than somatic testing. Somatic testing is when we test the tumor itself to understand what about this tumor allowed it to become abnormal, allowed it to grow abnormally and keep growing the way cancer does? And both of those are really important. So, I think as you ask your doctor, “What tests are you sending?”, it’s important to ask about tests in both of those categories. 

Essential Endometrial Cancer Testing

 

What testing should endometrial cancer patients undergo after diagnosis? Dr. Hinchcliff explains the importance of determining cancer stage, histology, and performing biomarker testing, as these factors can guide more targeted treatments.

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

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Transcript: 

Katherine Banwell:   

Dr. Hinchcliff, what testing should people with endometrial cancer undergo after diagnosis? 

Dr. Emily Hinchcliff:  

So, when I think about a cancer diagnosis, there are first two big buckets of things that are important to understand. One is the cancer stage, meaning where did the cancer start, and then, where has it potentially spread to. The other is the cancer histology, or what do the cells look like under the microscope. And in endometrial cancer, there are actually a variety of different subtypes of endometrial cancer that can be differentiated based on what they look like under the microscope. Once you have those as your framework, I think the next step is to better understand what’s called biomarker testing, or the genetics of your cancer. 

Katherine Banwell:  

Would you define biomarker testing? What does that mean? 

Dr. Emily Hinchcliff:  

Yeah. So, biomarker testing – while, under the microscope, we can determine what kind of cancer something is, we can’t tell what’s going on inside the cancer cells itself, and so, biomarker testing is an umbrella term for a variety of different tests that really try and assess what’s going on inside the cancer, what are the genetics making the cancer cells divide and grow abnormally, and also, what are the things that might be expressed or on the cancer cell surface that are potentially targets for us to leverage to treat the cancer better. So, what is unique to that cancer, either the patient’s own cancer individually or that cancer type in general, that we can use to our benefit to treat the cancer better.  

Katherine Banwell:  

What are the most common biomarkers associated with gynecologic cancers?  

Dr. Emily Hinchcliff:  

So, in endometrial cancer specifically, I think if there are a couple take-homes that I can emphasize to patients in this talk today, the first is it is essential to know your what’s called mismatch repair status. So, mismatch repair is one of the things that can happen inside a cancer cell, and when that goes awry, when that becomes abnormal, it means that the cancer has particular features that we can use to treat it better. 

And so, the two categories of mismatch repair are you can be mismatch repair deficient, meaning there’s something abnormal in that machinery inside the cancer cell, or mismatch repair proficient, meaning that that machinery is still intact, and the reason for that being so important is that in endometrial cancer, if someone’s cancer is mismatch repair deficient, we can use a whole class of drugs called immunotherapy, or leveraging your own immune system using medicines to try and treat that cancer better. 

So, I think knowing that about your cancer type is really essential in endometrial cancer. I think the other thing that is important to know is in endometrial cancer, some subsets will express a receptor – so basically, something on the cancer surface – called HER2, and if you are HER2-positive, that also can be a target for potential drugs. So, those are two really important biomarkers in endometrial cancer that I think it’s important that patients know that they have been tested, and then know what their results are. 

How Can Patients Stay Informed About New Treatments and Strategies in Gynecologic Cancer Care?

What gynecologic cancer care questions should patients and families ask? Expert Dr. Ramez Eskander from UC San Diego Health discusses the value of patient education, second opinions, credible resources, and proactive patient advice to help optimize care. 

[ACT]IVATION TIP

“…be informed. Explore your options and opportunities. Again, there are strategies that are available to you both on the Internet, publicly available, but also through colleagues, through friends, and a network that you can build through support groups, even at your institutions. It’s never too early to ask about clinical trials so that you can make sure you’re educated and informed as you look to make decisions. Because if you try to take all of this into consideration and at one time point, it can be a little bit overwhelming.”

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Transcript:

Lisa Hatfield:

Dr. Eskander, as new treatments and strategies emerge, how can patients and their families stay activated and ensure they’re benefiting from the latest advancements? And what should they be asking their care team to make sure they’re up to speed with the latest in gynecologic cancer care?

Dr. Ramez Eskander:

This is so important to me for patients to feel like they’re empowered and educated. I believe that patients are their greatest advocates. This is where family and friends are also an important part of the care team. From my perspective, it’s very beneficial to have someone in the room with the patient as they’re having conversations about treatments and treatment strategies to take appropriate notes, to be informed, and to not feel bad about asking questions, to not feel bad about asking the relevance of a second opinion.

Any provider should never take offense to a patient asking for a second opinion. In fact, I would say, I encourage my patients. I say, listen, if you have questions and you…if you would like to get someone else’s perspective, please do so. I want that, and I want you to come back to me with potentially a different option or a question that my hope is to answer.

We have a shared goal of making sure our patients have the best possible clinical outcome. That is our north star. So as new treatments and strategies emerge, try to stay informed. There are multiple platforms available, of course, via the Internet, for example. I will just be cautious in saying not all of that information is accurate. So if you’re going to use a platform that’s publicly available, the web, make sure that you’re trying to go to areas where a resource is vetted and reliable.

The National Cancer Network, the NCCN, the National Cancer Institute, clinicaltrials.gov for clinical trials, vetted and established advocacy organizations, and then taking that information, using it as a foundation in which you can build upon when you have conversations with your providers. But again, this is where I think not just the patient alone, but patient, family, and friends can really work together to try to develop.

And all of our meetings, the cancer meetings that we have, for example, for gynecologic cancer as a Society of Gynecologic Oncology, there’s a foundation for women’s cancer. There are opportunities for education, the American Society of Clinical Oncology. These are publicly available resources, websites where you can go to and look for patient facing material to make informed decisions about the management of your cancers.  And, of course, when you’re asking to talk about clinical trials, how do I stay up to date? Again, it’s a dialogue. It’s never too early to ask. I worry sometimes that patients don’t want to bring up a clinical trial, because they fear that bringing that up means that they’ve exhausted all treatment strategies.

Quite contrary to that, the earlier you begin the conversation, the greater opportunity you’re going to have to potentially identify a clinical trial for which you may be eligible. And that will help you through your treatment paradigm. Because if you don’t, you may pass that up, because you’re no longer eligible, because you’ve had too many prior lines of treatment, for example. And having that conversation early will also help you prepare as you go through the treatment paradigm so that if you need to make a decision about potentially enrolling in a trial, you’re established, you’re ready to do so rather than trying to effectively push this forward quickly without making sure that you have the required information that you need.

So it’s a multi-pronged approach. It’s going to require support systems, undoubtedly, multiple resources are available, and then subsequently engaging those resources to use that information to guide your conversations.

My activation tip is be informed. Explore your options and opportunities. Again, there are strategies that are available to you both on the Internet, publicly available, but also through colleagues, through friends, and a network that you can build through support groups, even at your institutions. It’s never too early to ask about clinical trials so that you can make sure you’re educated and informed as you look to make decisions. Because if you try to take all of this into consideration and at one time point, it can be a little bit overwhelming.

Lisa Hatfield:

Okay. Thank you so much. And I really appreciate your comment about it’s okay to talk to your provider about getting a second opinion. I was terrified of that, because I really love my doctor. He is great. And I didn’t want to bring that up, but anybody who’s watching this, Dr. Eskander said it’s okay to talk to your provider about seeking out a second opinion.

And it may help in your care in making decisions too. So I appreciate that you said that. And also that you said to make sure you go to vetted sites for information. When I was diagnosed with blood cancer, the first place I went to that I wasn’t supposed to was Google, got all kinds of information that I didn’t want to read. So go to those vetted sites. I think that’s great advice. So thank you so much.

Dr. Ramez Eskander:

Thank you, Lisa.

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Empowered Care: A Patient’s Guide to Navigating Endometrial Cancer

Empowered Care: A Patient’s Guide to Navigating Endometrial Cancer from Patient Empowerment Network on Vimeo.

Meet Sharon, a 61-year-old endometrial cancer survivor who knows firsthand the importance of being an active participant in her healthcare. After a two-year struggle with misdiagnosed symptoms and a dismissive doctor, she took charge and found the right medical support, leading to a diagnosis of endometrial cancer.

Sharon’s journey, from diagnosis to treatment and recovery, highlights the vital role of self-advocacy and patient activation. Her story is a beacon for others, especially women of color facing similar challenges, emphasizing the power of being informed, asking questions, and seeking support.

Download Guide | Descargar Guía en Español

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Transcript:

Being activated is a critical part of endometrial cancer care, especially for patients like me. 

My name is Sharon, I’m 61, and my diagnosis came after a two-year struggle with unidentified symptoms. Sharing my experience is my way of reaching out, hoping it might provide guidance to others facing similar challenges.

My symptoms began with abnormal vaginal bleeding, but my periods had ended over 10 years ago. That had me worried, and my sister encouraged me to see a doctor after I told her about the bleeding. I scheduled an appointment, but my doctor dismissed my symptoms. I felt like he wasn’t really listening to me and decided to find a doctor who looks more like me and would be more likely to listen to me. I found a Black female doctor who was concerned about my symptoms, which had worsened by then. I was also feeling pelvic pain. My new doctor scheduled an endometrial biopsy, and I was diagnosed with papillary serous carcinoma shortly afterward.

With an aggressive type of cancer, my oncologist scheduled a laparoscopic hysterectomy to remove my uterus along with my ovaries, fallopian tubes, and sentinel lymph nodes. I had the surgery within a few days, which was quickly followed by radiation to help ensure any remaining cancer cells were wiped out. My recovery went smoothly, and I continue to live a full life while getting regular scans to ensure I remain cancer-free.

After my cancer experience, I want to educate other women about what I’ve learned about endometrial cancer. Black women have nearly twice the death rate from endometrial cancer compared to white women. Hispanic, Black, and Asian women are not represented in clinical trials at equal rates to white women. And Black women are also diagnosed more frequently with rare but aggressive endometrial cancer forms. Remember that you shouldn’t have to suffer with your pain, and you can advocate for yourself and ask about patient advocates to advocate on your behalf.

Here are my activation tips for patients facing an endometrial cancer diagnosis:

  1. Ask your care team questions to learn about the status of your endometrial cancer, treatment options, and what to expect during and after treatment.
  2. Join a patient support group to offer and receive emotional support.
  3. Last but not least, inquire if a clinical trial may be a potential treatment option for your endometrial cancer.

Remember, stay activated by being informed, empowered, and engaged in your cancer care.


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Are Beauty Products a Risk Factor for Endometrial Cancer?

Are Beauty Products a Risk Factor for Endometrial Cancer? from Patient Empowerment Network on Vimeo.

Do some beauty products pose a risk factor for endometrial cancer? Expert Dr. Charlotte Gamble from MedStar Health discusses studies that investigated endometrial cancer risk and beauty products that may be a risk factor.

[ACT]IVATION TIP

“If patients have a concern about hair straightener products in general, then maybe it’s time to start avoiding them. But if it’s something that is really important to you and is a crux of who you are as a human being, then I’m not sure we have enough data to say you should absolutely avoid this, and this is contributing to your cancer risk.”

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Transcript:

Lisa Hatfield:

Dr. Gamble, there are often questions around the use of hair products and gynecological cancers. Can you speak to this and whether there are any correlations or risk factors with the use of these hair products?

Dr. Charlotte Gamble:

Absolutely. This is also an area of some controversy, and the data has yet to really be accepted or validated. And it’s, I think, an area that needs so much additional research. So, you know, within the past few years, there have been a few major studies that have looked at patients, looking back at patients who have then developed endometrial cancer and seeing what kind of risk factors they might have had compared to patients who didn’t develop endometrial cancers. And looking at the types of patients within these studies, there are some subtle differences that need to be addressed.

The overall conclusion from these studies was that the frequent use of hair straightener products might increase the risk or is associated, I should say, with a risk of developing uterine or endometrial cancer. But the nuances within how these studies were conducted and which populations they were done in, I think deserves a little bit of detail and insight.

One of the major studies was done in a cohort group of patients who had actually close family members who had breast cancer. And so this is actually a very specific type of patient population where they were already at somewhat of an increased risk of developing a type of a cancer, because they had a relative that had breast cancer. And in this cohort of patients, they found that the frequent use of hair straightener products was associated with a higher likelihood of developing uterine cancer.

The kind of challenges I have with this is not only the patient population looking at it being predominantly groups of folks who already have a relative with a cancer, but then also the cohort itself is predominantly Caucasian or white, with 85 percent being white and a very small percentage of those patients being Black. And it’s hard to actually draw conclusions based on that, again, with just not a great representation of Black women who can be frequent users of hair straightener products.

And then there are nuances of like, what is a hair straightener product? What does that mean? Is that a chemical relaxer? Is that a Brazilian? And how does that actually affect the endometrial cancer risk? And we don’t know. Again, it’s a correlation, an association, but not a causation. The other study was done in a cohort of patients who were Black in the Black Women’s Health Study. And so it was a much better representation of patients that I take care of and are at risk of endometrial cancer. And the challenge with this study was that there are several different nuances and kind of when the cancer occurred and if it was pre-menopausal, before menopause or after menopause and the type of cancers they were.  And I think a lot of this data is pretty compelling that there’s probably some degree of an association.

But it’s very difficult to know how that actually relates to the type of cancers that we see most frequently in Black women, which are aggressive, non-hormonally responsive cancers that might not have any sort of risk that’s tied to hair straightener products that generally do a hormonal cascade. So my activation tip for this question is we do not know. The jury is out. There are some initial studies that look at this association and for patients and how they take care of their hair. If patients have a concern about hair straightener products in general, then maybe it’s time to start avoiding them. But if it’s something that is really important to you and is a crux of who you are as a human being, then I’m not sure we have enough data to say you should absolutely avoid this, and this is contributing to your cancer risk.


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Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality from Patient Empowerment Network on Vimeo.

What are endometrial cancer risk factors for patients should know about? Expert Dr. Emily Hinchcliff from Northwestern Medicine discusses endometrial cancer risk factors, incidence and mortality rates, and patient advice to help guard against endometrial cancer.

[ACT]IVATION TIP

“…lifestyle modification is really important here. Obesity is a known risk factor for endometrial cancer. So working with your primary care physician to try to improve your health more generally, especially as it surrounds weight, is really important in terms of endometrial cancer prevention. I also think it’s important to know…that obesity and changing your obesity can impact your cancer’s response to certain therapies, especially with hormonal therapy.”

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See More from [ACT]IVATED Endometrial Cancer

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Transcript:

Lisa:

Dr. Hinchcliff, for patients wondering about their risk, what are risk factors for endometrial cancer, and what should patients be aware of?

Dr. Emily Hinchcliff:  

So I think that it’s really important to highlight that endometrial cancer is one of the few cancers that is actually increasing in both number and also mortality. The numbers from the American Cancer Society for 2024 are over 70,000 women, or around 70,000 women will be diagnosed, and around 13,000 women will die of their disease. And I think that unlike many cancers where we’re actually making progress, endometrial cancer, the incidence, how many people are getting it is rising. And it’s rising faster in non-white ethnicities and groups.

So as I think about risk factors, I think the important ones to highlight are certainly obesity. This I think is a large driver of why there is increasing incidence of endometrial cancer. This relates to kind of the hormonal regulation. Obesity results in increasing levels of estrogen that disproportionately affect the endometrium. And then similar to that, certain hormonal syndromes where women have irregular or infrequent periods like polycystic ovarian syndrome can also put them at higher risk. More globally, I think age, family history are also risk factors. And then as I mentioned, unfortunately, women who are non-white have a higher risk of endometrial cancer mortality, especially as relates to some of the higher risk endometrial cancer subtypes.

Lisa:

Do you have an activation tip for patients for that question?

Dr. Emily Hinchcliff: 

Yeah, so I think that lifestyle modification is really important here. Obesity is a known risk factor for endometrial cancer. So working with your primary care physician to try to improve your health more generally, especially as it surrounds weight, is really important in terms of endometrial cancer prevention. I also think it’s important to know, given that this is often a patient audience that I’m speaking to, that obesity and changing your obesity can impact your cancer’s response to certain therapies, especially with hormonal therapy. So for women who are diagnosed with early stage endometrial cancer, for example, who may desire fertility preservation or may want to know what they can do to impact their own cancer care, I think that’s a really important point.

I guess I can also just bring up a quick one-liner regarding the recent publication of studies surrounding hair product use. So this is a question that we have been getting asked a lot after the publication of both the study and then the big New York Times article, but there was an NIH study that showed a potential association between hair product chemical straightener use and uterine cancer, especially for those who identify as frequent users. I think that the important key point here is that around 60 percent of the women who reported using hair products self-identified as Black and tend to initiate use earlier, so this is another risk factor that may be important.

Yeah, we’re still learning a lot more about that. Right now, there’s an unclear association in terms of what we should be doing about it.


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How Is Endometrial Cancer Staged?

 

How Is Endometrial Cancer Staged? from Patient Empowerment Network on Vimeo.

What are the stages of endometrial cancer? Expert Dr. Emily Ko explains factors involved in analysis for staging and what occurs in the body during each stage.

Dr. Emily Ko is a gynecologic oncologist and Associate Professor of Obstetrics and Gynecology at the University of Pennsylvania. Learn more about Dr. Ko.

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What Are Treatment Options for Endometrial Cancer?


Transcript:

Katherine:

How is endometrial cancer staged? 

Dr. Ko:

So, the most classic, rigorous way to stage endometrial cancer is through a surgical procedure. So, what that usually involves is it does include a hysterectomy, removing the uterus and the cervix, usually also includes removing the fallopian tubes and the ovaries.  

And, at the same time, the surgeon will do a very thorough assessment of the abdominal pelvic cavity, basically looking around all those areas to see if there’s any signs of visible disease, anything they can see that looks like it could be tumor deposits in the abdominal cavity. If anything is seen, those deposits will be removed and biopsied, so that’s part of the staging procedure. 

And additionally, it’s important to try to assess the lymph nodes, typically. So, there are lymph nodes in the pelvic area, and then, higher up along the aortic area, and so, there are different surgical techniques that we can use to basically test or sample some of those lymph nodes, be able to remove them, send them to the pathologist, look under the microscope to see if there are any microscopic cancer cells that have traveled to those lymph nodes. 

So, that is all part of a surgical procedure, and with all the information collected from those tissue samples that are removed from the body and sent to the pathologist, but the pathologist then reviews all of that under a microscope, and then can issue a very thorough report describing where the cancer cells are located, and by definition, where the cancer cells are located then defines what the stage is of the cancer. 

Katherine:

Can you give me an example?  

Dr. Ko:

Of course. So, for example, if the cancer cells are located only in the uterus, and they’re not found anywhere else, then that is a stage I. If the cancer cells have traveled to the cervix area specifically, this we call a cervical stroma, that becomes a stage II. If the cancer cells have, for example, traveled to the fallopian tubes, or the ovaries, or the lymph nodes, then that becomes a stage III, and there are sort of substages within those categories as well. 

Katherine:

But stage III would be the highest or most severe? 

Dr. Ko:

So, there’s stage III, and then there’s actually stage IV. So, if the cancer cells have traveled outside of the pelvis into the abdominal area, then we consider that a stage IV. 

Katherine:

And that would be considered advanced endometrial cancer? 

Dr. Ko:

Right. So, by definition, “advanced” typically refers to stage III or IV. 

What Disparities Exist in Treating Patients With Endometrial Cancer?

What Disparities Exist in Treating Patients with Endometrial Cancer? from Patient Empowerment Network on Vimeo.

What do endometrial cancer patients and advocates need to know about disparities? Expert Dr. Ebony Hoskins shares noted endometrial cancer disparities in care and how patients can take action to ensure their best care.

Dr. Ebony Hoskins is a board-certified gynecologic oncologist at MedStar Washington Hospital Center and assistant professor of Clinical Obstetrics and Gynecology at Georgetown University Medical Center.

[ACT]IVATION TIP

“…I always think it’s important that patients feel that they’re heard by their providers or doctors, feel free to ask any questions and so having that or talking about…we are not going to be able to change the biology, right? But we can change our voice, and we can change making sure the patient is heard, making sure they have a comfortable relationship with their provider.”

Download Guide  |  Descargar Guía en Español

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

How to Explain Endometrial Cancer to Newly Diagnosed Patients

How to Explain Endometrial Cancer to Newly Diagnosed Patients

What Role Does Hormone Therapy Play in Endometrial Cancer

What Role Does Hormone Therapy Play in Endometrial Cancer?

What Is the Role of Surgery in Treating Endometrial Cancer

What Is the Role of Surgery in Treating Endometrial Cancer?

Transcript:

Mikki: 

Dr. Hoskins, what are the noted disparities seen in endometrial cancer treatment, and what are some of the actions being taken to combat them?

Dr. Ebony Hoskins: 

Well, I mean, first off, we know that Black women are diagnosed pretty much at the same rate as white women, but have a two times higher risk of death. And so that alone is a big disparity. We also see increased, I shouldn’t say increased, but more aggressive tumor types in Black women, and so we know that part. I think in terms of what we’re doing to combat it from a clinical trial standpoint, they, I think some of the clinical trials, have recognized that there is a low number of patients in these trials advancing and so there has been an increased effort in recruiting patients into these trials. I think there is more work being done, to understand the biology and why there’s a difference. Me as a provider I will always think, “Oh, it’s because women went to the doctor late or access to care.”

Dr. Ebony Hoskins:  

And then I’m like, “Well, no, no, no these women have access to care. They have access to insurance. They went to the doctor right away.” And so I think it’s very complex and deserves more study into it. In terms of my activation tips, in terms of disparity, I always think it’s important that patients feel that they’re heard by their providers or doctors, feel free to ask any questions and so having that or talking about…we are not going to be able to change the biology, right? But we can change our voice, and we can change making sure the patient is heard, making sure they have a comfortable relationship with their provider. I think that is important.


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How to Explain Endometrial Cancer to Newly Diagnosed Patients

How to Explain Endometrial Cancer to Newly Diagnosed Patients from Patient Empowerment Network on Vimeo.

How can experts explain endometrial cancer diagnosis to patients? Dr. Ebony Hoskins shares how she explains the diagnosis to newly diagnosed patients and provides advice for questions to ask your doctor.

Dr. Ebony Hoskins is a board-certified gynecologic oncologist at MedStar Washington Hospital Center and assistant professor of Clinical Obstetrics and Gynecology at Georgetown University Medical Center.

Download Guide  |  Descargar Guía en Español

See More from [ACT]IVATED Endometrial Cancer

Related Resources:

What Disparities Exist in Treating Patients with Endometrial Cancer

What Disparities Exist in Treating Patients with Endometrial Cancer?

What Role Does Hormone Therapy Play in Endometrial Cancer

What Role Does Hormone Therapy Play in Endometrial Cancer?

What Is the Role of Surgery in Treating Endometrial Cancer

What Is the Role of Surgery in Treating Endometrial Cancer?

Transcript:

Mikki:

What is endometrial cancer? How do you explain endometrial cancer to newly diagnosed patients?

Dr. Ebony Hoskins:

Great question. So endometrial cancer is a cancer of the lining of the uterus, and the way I typically describe it is the same location where a woman would have menses, and it’s abnormal growth of the same lining. That’s the reason why there is typically abnormal bleeding, either in a postmenopausal woman or a woman who may have not gone through menopause, could have abnormal bleeding.

Mikki:

Awesome. And with that, I know when I had endometrial cancer, and that was just totally new to me. I really didn’t know a lot of people with cancer, I had never heard of endometrial cancer. What are some of the things that I should have asked?

Dr. Ebony Hoskins:

I think asking what is endometrial cancer? Where is the endometrium? I think those are very good questions to ask, especially if you’ve never heard of it, I think anytime there’s something you don’t understand that you should feel free to ask a question and feel comfortable with asking what you may not know.


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  Create your own user feedback survey