Tag Archive for: endometrial cancer
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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Tools for Improving Access to Quality Endometrial Cancer Care |
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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.
Tools for Improving Access to Quality Endometrial Cancer Care
What proactive steps can endometrial patients take to access the best care? Gynecological cancer expert Dr. Nita Karnik Lee walks through self-advocacy steps that may encourage improved patient outcomes.
Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.
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Why Should Endometrial Cancer Patients Engage in Their Care? |
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Transcript:
Katherine Banwell:
How is the medical community dealing with these disparities? How are they handling them?
Dr. Nita Karnik Lee:
You know, I think a lot of it is, again, sort of educating. You have to think about you want patient education. You want provider education. Sometimes I have patients who come to me and say, you know what, I reported these symptoms to my doctor, and they said it was nothing, or they told me it was a UTI. So, we often think about, when we’re making an intervention, we want to make sure that providers who are seeing patients first-line are also hearing about this as in their differential diagnosis, and that patients have enough knowledge that they feel really comfortable advocating for themselves. Many of our patients who are cancer survivors will tell us.
Or when they speak on their own in different ways or say listen to your body, make sure you’re advocating for yourself, and if somebody doesn’t listen, find another doctor. I hate to say it, but you just have to know that those are things that happen. I think structurally, as providers, we have to be really aware of our own biases that we bring to patients and their families and our own health system.
How are we set up to help people more? I think a lot of it is quick access to care. And so, I think that’s where we try to make some differences in terms of both policy and policy within a health system, and then larger policy that’s kind of maybe more not just one hospital, but statewide or nationwide.
Katherine Banwell:
You mentioned advocating for oneself and how important that is. If a patient feels like they’re not receiving good care or they’re being treated unfairly, what steps should they take to access better overall care?
Dr. Nita Karnik Lee:
Well, I mean, a little bit of it’s complicated, because so many of us are kind of limited by our insurance. We don’t always have the ability to do all the things. It can be scary, and it can be intimidating. I think one of the things that could be very helpful is to prepare yourself with a list of questions, to be like these are the questions. These are the things that I’m not feeling are being heard, and potentially even getting a second opinion. You can say this in a way that you can sort of feel like your doctor doesn’t need to feel bad.
I even think second opinions, for me, I’m all for them. More information is better. That’s a way of positing it and saying, look, I know we’ve gone through these symptoms. These are my concerns. I don’t think they’re being addressed, and I would really like to get another opinion. Physicians are often like, yes, get another opinion. And so, those are ways that I think people can find the right fit for the physician that they want.
What Questions Should You Ask About Endometrial Cancer Detection?
Gynecological cancer expert Dr. Nita Karnik Lee explains the importance of self-advocacy in endometrial cancer detection, including speaking up when you have concerns and seeking care early.
Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.
See More from DETECT Ovarian Cancer
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How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection? |
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Transcript:
Katherine Banwell:
What questions should patients be asking their doctor about detection?
Dr. Nita Karnik Lee:
For uterine cancer or endometrial cancer, detection is really based on symptoms. If there are any of those symptoms that are happening, they really should be asking, hey, I need to see a gynecologist. I need to do a biopsy. We do, unfortunately, see many patients who are sort of told, oh, it must be fibroids. But that shouldn’t happen in post-menopausal patients. I’ve heard everything. I’ve heard patients sort of self-reflect, and say, you know what, I was stressed that day, or I moved the couch that day. I’ve heard all the different things we think about, because none of us wants to feel like there could be something wrong. We often justify. It was probably nothing.
But the patients who do the best are the patients who have a spotting episode, they have a bleeding episode, they seek care right away. And then 80 percent of uterine cancers need only surgery, so that’s a good statistic compared to some of the other GYN cancers. I would say advocating for your symptoms, not being afraid of a symptom being worked up, because I think there’s a lot of fear with, if you report something, maybe it will be something.
And getting over that sensation of it may not be. It may be something completely different that’s benign. But I think the earlier that we can see a diagnosis and get people to treatment and/or hysterectomy, that tends to do the best in terms of survival and just getting over this episode.
Expert Perspective | Managing the Emotional Aspects of a Gynecologic Cancer Diagnosis
What emotional support and resource are available for gynecologic cancer patients? Dr. Hinchcliff discusses leveraging personal networks and highlights key resources like the Society for Gynecologic Oncology and ASCO.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
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Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment |
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Transcript:
Katherine Banwell:
How do you counsel patients who might be having emotions around their gynecologic cancer? What advice and resources are available?
Dr. Emily Hinchcliff:
Yeah. So, I think that a cancer diagnosis is a life-changing experience. Even for patients who have early-stage cancers, hearing that word “cancer” on the phone, in the doctor’s office, and having to be the one to then tell family members and understand what that means for their life is truly a pivotal moment, and it does bring up all sorts of emotions and need for support.
So, what I would say is, first and foremost, it can be really common that cancer patients sort of retreat into themselves and want to be more private. I think that I would encourage people to really use their support network that they have. Everyone’s different, and so, I definitely want them to do what feels right for them, but making sure that you leverage whatever support networks you have in your life is sort of the first foundation.
Second, I think that there are just so many excellent resources out there for patients facing a cancer diagnosis. Certainly, in endometrial cancer, there are our big national groups of physicians. We put out a ton of information that is patient-focused, so, that is at a level that patients can understand.
The two that I think of are the Society for Gynecologic Oncology is a big resource for patients with gynecologic cancers, and then, the overarching cancer society ASCO is another place that has a ton of cancer resources. I also think that patient support groups can be really helpful. There are many, many – so, my institution has one that is more specific to our institution as part of our institutional branch of the Woman to Woman program.
There are also national, or city, or state cancer support groups, and I think that those can be really helpful to gain mentorship from someone who’s been through it and from someone who is a little bit further along in their journey than you might be as the patient that’s just getting a diagnosis, for example, and that can be really helpful so that you have that bird’s-eye view that sometimes, right after your own diagnosis, you just don’t have the perspective to understand.
Expert Perspective | The Value of Empowering Endometrial Cancer Patients and Care Partners
How can patients feel empowered after an endometrial cancer diagnosis? Dr. Hinchcliff emphasizes seeing a GYN oncologist, asking questions, and bringing a care partner to appointments for support and understanding key decisions.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
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What Questions Should Patients Ask About Endometrial Cancer Testing? |
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Transcript:
Katherine Banwell:
As a provider, Dr. Hinchcliff, how do you empower care partners and patients who have been diagnosed with endometrial cancer?
Dr. Emily Hinchcliff:
So, I think that one of the most important things about a diagnosis of cancer is to develop the relationship with your physician. I think that it is truly a partnership, and it is an incredibly important thing as you think about the next steps in your treatment. For someone who’s diagnosed with endometrial cancer – or, honestly, cancer in general – making sure that you’re seeing a cancer specialist in obstetrics and gynecology – it can actually be sometimes a little bit difficult.
You might have gotten your diagnosis with a general OB/GYN, but it’s very important to see a GYN oncologist – a cancer-specific doctor – because we’ve actually shown that patients who see GYN oncologists are more likely to get guideline-appropriate care – so, care within what we think of as the right standard – and then they tend to do better with their cancer. So, that’s kind of the first step, is finding that doctor and developing the relationship with them.
The second thing that I would say is that you should ask questions. Bringing people to your appointments to have an extra set of ears is always helpful. Taking notes and trying to keep track yourself of what was talked about in your appointment, I always encourage my patients to do, but really, asking questions. So, making sure that you know what those molecular tests are that your doctor is sending, making sure you know, once they’re sent, what your results were and how that might change what your treatment will be.
Now, you don’t need to go and get a degree in biology or go to medical school. I think that that’s a lot to ask someone going through a cancer journey, but it is really important that you understand where those key decision points might be made because that allows you to feel not only like your own advocate, but that you have some ownership of those decisions and you understand why the decisions are being made in the way that they’re being made.
Questions to Ask About Endometrial Cancer Clinical Trials
What questions should patients ask about endometrial cancer clinical trials? Dr. Hinchcliff outlines key inquiries regarding trial structure and eligibility and encourages patients to explore online resources and support groups for additional information.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
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Where Do Clinical Trials Fit Into an Endometrial Cancer Plan? |
Transcript:
Katherine Banwell:
What questions should endometrial cancer patients ask their doctor about a potential trial?
Dr. Emily Hinchcliff:
I think the two important things to ask are what is the structure, what am I actually going to get, or what could I get, depending on how many of those arms exist on the trial.
Katherine Banwell:
Would the doctor know that specific information, though?
Dr. Emily Hinchcliff:
It’s a good question, actually. So, generally speaking, most of us as physicians, in order to offer a trial to you, we have an overarching structure of that clinical trial. There may be some nuances about what the exact enrollment is in terms of the majority of the patients get this treatment, whereas a small minority get this treatment, or because of this patient’s specific mutation profile, they must be enrolled on this subset of the trial.
So, there are some nuances there that, generally speaking, if I as the physician don’t know, I will contact what’s called my clinical trial coordinator or my research nurse, and they can come spell out some of those nuances, but if your doctor’s recommending a trial to you, they generally know what is the overarching goal, and what is the overarching treatment being tested.
Katherine Banwell:
Okay. How can patients learn more about clinical trials?
Dr. Emily Hinchcliff:
So, there are a lot of resources online. To some extent, it can be really overwhelming for patients to try and tease out am I a candidate, would I be eligible for a trial, or this trial, is this trial available at my institution. So, what I would say – first and foremost, ask your physician. I think that your physician is your advocate in this and your partner in your cancer care, and I think that certainly I and all of us as physicians feel really strongly that we can help you weigh those different options as you see them and as we learn about them.
So, I think that that’s where I would start. I think there are a lot of online resources. The FDA and the government have a cancer trials website that you can go to and search for your specific cancer type.
Many institutions – my own included – will have their own institutional trials website, where, on my institution, you can look up and see what trials do we have open on my institution, because obviously, the government will speak nationally, but your particular treating physician might not have the availability to give you that particular trial. And then, I also will say I think patient support groups are an incredible opportunity to understand what others have been going through and what treatments have been offered, and that can be a really helpful resource as well to get hooked into as a patient is trying to tease all this out.
Where Do Clinical Trials Fit Into an Endometrial Cancer Plan?
What role do clinical trials play in endometrial cancer treatment plans? Dr. Hinchcliff highlights that clinical trials can be crucial at every stage of the cancer journey, offering access to innovative therapies and alternatives to standard care.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
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Transcript:
Katherine Banwell:
Dr. Hinchcliff, where do clinical trials fit into a treatment plan for endometrial cancer?
Dr. Emily Hinchcliff:
So, I think clinical trials are an incredibly valuable part of a patient’s cancer journey. Every institution and every provider is going to have potentially different clinical trials available to the patients in their practice, and so, it’s important to understand what clinical trials might be available to a patient as they both start their cancer journey, but certainly as their cancer progresses or comes back.
I think that there is – it should be something that is on the back of your mind at all phases of a cancer journey. It may not be right for a patient if they are first diagnosed and have a clear standard-of-care option, but there are certainly clinical trials that add to or investigate what we consider to be the current standard of care to try and move that forward. So, even in that first diagnosis phase, I think it’s worth asking your doctor, “What’s available to me?”
And then, certainly, when a cancer comes back, especially when a cancer has developed resistance to some of the more standard options that we would use, then I think clinical trials are an incredibly – it’s an incredible opportunity to have access to a toolbox that you would not have access to otherwise. And so, I think that – when I think about clinical trials, I think that they fit into all phases of a cancer journey, but that there are certain times in every individual patient’s journey that I would say this clinical trial might be right for you at this particular time.
Katherine Banwell:
What would you say to patients who are hesitant about trial participation?
Dr. Emily Hinchcliff:
So, I think that that is very common, and what I would say is information is power. I think that if there is a trial that you are eligible for, it’s really important to understand what the actual structure of that trial is and also understand what the phase of that trial is. So, let me explain those two things, because I think they’re a little bit different.
When I think about a trial structure, I think about what is the trial testing, what is it looking at, and what are the potential arms of therapy. When we say “arms,” that just means what is a patient going to actually receive. And so, some trials, there’s only one option. Anyone who’s enrolled on the trial gets a certain thing. Other trials have some comparison arms. So, some patients that are enrolled get a certain treatment; some patients that are enrolled get a different treatment.
And so, as you think about the structure, it’s important to know what might I get? Am I always going to get the treatment arm – for example, the drug that’s being investigated – is there a placebo arm – an arm that says I might get something that’s standard, like chemotherapy, but I’m going to get chemotherapy plus a placebo, which means an inactive agent, as compared to chemotherapy plus an inactive drug.
So, it’s really important to understand the structure of a trial. The second thing that I think is important to understand is the phase. So, clinical trials are grouped into phases. Phase I, Phase II, Phase III are the most common that you’ll hear about, and those are a description of how far along is that particular drug or treatment in development.
So, Phase I, that treatment is very early. It does not mean that there’s not promising data around it, but it means that that drug doesn’t have data, for example, in lots and lots of patients with your particular cancer type, right? Instead, usually, a Phase I trial is looking at a drug in humans or in a particular group of tumors – or patients with a particular group of tumors – for the first time or early on.
Phase II trials are looking at that drug maybe a little bit later, after they’ve gotten some good data, or trying to expand a drug that might have been used in a different cancer type to a new cancer type, for example. And then, Phase III is the bigger studies where you’re looking to enroll more patients in a specific cancer type for a specific reason to say, “Okay, we’ve had good evidence that this drug has some amount of efficacy, so now we’re really trying to look to see how does it compare to what we have out there, and could this help us move forward?”
Advances in Endometrial Cancer Treatment and Research
What new developments in endometrial cancer treatment should patients know about? Dr. Hinchcliff highlights advancements in immunotherapy for newly diagnosed patients and ongoing clinical trials focusing on molecular pathways and drug combinations for more personalized care.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
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Where Do Clinical Trials Fit Into an Endometrial Cancer Plan? |
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Transcript:
Katherine Banwell:
Are there endometrial cancer treatment developments that patients should know about?
Dr. Emily Hinchcliff:
Yes. So, I think within literally the past year/two years, we’ve had some truly groundbreaking work that has changed the way all of us practice in GYN oncology, and that is specifically around this immunotherapy. So, it used to be that we would save immunotherapy for when someone’s cancer had returned. So, they would get their initial, for example, chemotherapy if they needed it, and then, when the cancer came back, that’s when we would start thinking about immunotherapy.
There are now two big randomized controlled trials, which is sort of our best data, that tells us that adding immunotherapy in the first line, meaning when someone is first diagnosed, if their cancer has spread outside the uterus, that adding immunotherapy at that point can be really helpful for certain patients, and so, I would say that as an avenue of treatment – understanding is immunotherapy right for me, why or why not – is kind of my second takeaway for patients.
Katherine Banwell:
You mentioned trials. Are there ongoing trials that are showing promise?
Dr. Emily Hinchcliff:
Absolutely. I think it is an incredible time to be a GYN oncologist because the field is advancing so rapidly.
I think that now, we are really focused on some of these molecular pathways to try and not only understand which patients should we be giving these therapies to, who are they most effective in, which patients can we actually be pulling back, who has a better prognosis, so we may not need to give them the toxicity level that comes with all of the standard chemotherapy options, and then, also, are there drug combinations that may work better for patients, and how do we choose which combination therapies we should use. And so, I think that there are a lot of really exciting clinical trials going on in endometrial cancer right now.
Katherine Banwell:
Dr. Hinchcliff, what areas of research are you focused on?
Dr. Emily Hinchcliff:
So, I have spent a lot of my research time working in immunotherapy. As you can tell, I’m pretty jazzed about it. I think it really has changed the game in terms of cancer care. And so, a lot of my work centers around the use of immunotherapy in gynecologic cancers.
I also am very interested in looking at how we can better understand a cancer’s response to treatment. As we give treatment, often, endometrial cancer doesn’t have an easy blood test to say, “My cancer’s getting better,” so we kind of have to wait until we get a CT scan, which we usually do three months apart, and so, there are some newer blood tests out there that we’re trying to understand how to use and how to best leverage for our cancer patients, and that allows us to potentially switch treatments sooner if something isn’t working, or choose a better treatment up front, depending on which test we’re looking at. So, that’s really where my research centers.
Katherine Banwell:
Is there anything you’d like to add about the evolution of endometrial cancer care? What are you excited about?
Dr. Emily Hinchcliff:
I think I am really excited that our field has made this big switch to focusing on some of these molecular aspects. It has always been so hard to treat all endometrial cancer with one hammer-and-nail-type pairing, and now we’re able to be a little bit more nuanced with our tools, and that’s always a really exciting place to be. I also think that it’s really important to highlight some of the disparities that still exist in endometrial cancer, and honestly in cancer more generally, and I think that we as a field are starting to really highlight that and understand – or at least try to understand – how can we better provide care to every single patient who is diagnosed with an endometrial cancer.
Current Endometrial Cancer Treatment Approaches
What are the common treatment approaches for endometrial cancer? Dr. Hinchcliff explains that options typically include surgery, radiation, and chemotherapy, or a combination.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
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Where Do Clinical Trials Fit Into an Endometrial Cancer Plan? |
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Transcript:
Katherine Banwell:
Dr. Hinchcliff, what are the common approaches for endometrial cancer?
Dr. Emily Hinchcliff:
So, endometrial cancer – when I think about any cancer treatment, there are sort of three big buckets of treatment. There’s surgical management, radiation, and then, chemotherapy or some form of systemic treatment, meaning treatment that goes into the vessels, that’s going to spread throughout your body, and endometrial cancer can be treated by, actually, all three of those, or combinations of the three of those, depending on that cancer stage and depending on that cancer subtype.
And so, what I would say is for endometrial cancer that is confined to the uterus, generally speaking, surgery is your upfront first line of defense, and then, once you understand – after taking that uterus out – what the risk level is, your doctor may recommend chemotherapy after, they may recommend radiation after, and that sort of is dependent on what they see under the microscope.
But for cancer that’s thought to be confined to the uterus, it’s surgery, and then maybe additional treatment afterwards. For endometrial cancer that has spread outside the uterus already to the lymph nodes, elsewhere in the abdomen, or more distant, then we start to think about that systemic therapy, and that can include chemotherapy, which works by killing rapidly dividing cells, as well as what I mentioned before, which is immunotherapy.
Immunotherapy is medicine that kind of takes your own immune system and tries to rev up your immune system to better fight the cancer, because the immune system is predisposed to recognizing abnormal things, and cancer is inherently abnormal. But cancer is smart and develops ways to cloak itself, so the immunotherapy takes that cloak off and revs up the immune system to try and get an immune response.
Endometrial Cancer | What Is Personalized Medicine?
What are the common treatment approaches for endometrial cancer? Dr. Hinchcliff explains that options typically include surgery, radiation, and chemotherapy, or a combination.
Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.
See More from INSIST! Endometrial Cancer
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What Questions Should Patients Ask About Endometrial Cancer Testing? |
Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment |
Transcript:
Katherine Banwell:
How would you define personalized medicine?
Dr. Emily Hinchcliff:
So, personalized medicine I think is a big umbrella term that is sort of a buzzword in cancer right now – in a good way – but I think that it is important to understand how it affects each different cancer type. So, personalized medicine, what we mean as physicians when we say that is we are trying to better tailor treatments to the individual patient and the individual cancer.
So, whether that is the cancer subtype, treating endometrial cancer with endometrial-cancer-specific drugs rather than drugs that have been used to treat ovarian cancer, and kidney cancer, and prostate cancer, so, using drugs that are potentially really good for your tumor type, but also using medicines that might best treat your individual tumor based on the genetics and the molecular features inside your tumor.
One of the ways that I’ll explain it to patients is that your tumor is sort of like base camp, and it depends on certain supply chains for oxygen and nutrients to grow, and some supply chains are common to all cancer types, so if we block that supply chain, that drug might work on any different kind of cancer. But some supply chains are really specific to a particular patient and a particular tumor, and so, if we have a drug that blocks that supply chain, it might work in that particular patient, but might not work in a patient that has a very, very similar cancer type, and that’s really where personalized medicine can be a huge win. It allows us to say, “This drug would work really well for you when it might not work really well for the patient next door.”
Katherine Banwell:
Yeah. So, I think what used to happen is everyone with a specific cancer was painted with a broad brush.
Dr. Emily Hinchcliff:
Correct.
Katherine Banwell:
And now, we’re able to hone in on what might work for one person.
Dr. Emily Hinchcliff:
Yeah. I think that certainly, those broad brushes, they worked for a reason, and they still are in our arsenal and our toolbox, and so, it doesn’t mean those brushes are bad, but it does mean that now, hopefully, we can paint a little bit more within the lines. We can be a little bit more nuanced with our approach.
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.
See More from INSIST! Endometrial Cancer
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What Questions Should Patients Ask About Endometrial Cancer Testing? |
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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.
See More from INSIST! Endometrial Cancer
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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.
See More from INSIST! Endometrial Cancer
Related Resources:
| What Questions Should Patients Ask About Endometrial Cancer Testing? |
Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment |
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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.
