Tag Archive for: gynecologic oncology

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.

 

Related Programs:

What Are Common Endometrial Cancer Health Disparities?

What Are Common Endometrial Cancer Health Disparities?

Tools for Improving Access to Quality Endometrial Cancer Care

Tools for Improving Access to Quality Endometrial Cancer Care

Advances in Endometrial Cancer Treatment and Research

Advances in Endometrial Cancer Screening and Detection


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.

 

Related Programs:

What Are Common Endometrial Cancer Health Disparities?

What Are Common Endometrial Cancer Health Disparities?

Why Should Endometrial Cancer Patients Engage in Their Care?

Why Should Endometrial Cancer Patients Engage in Their Care?

Advances in Endometrial Cancer Treatment and Research

Advances in Endometrial Cancer Screening and Detection


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 Are Common Endometrial Cancer Health Disparities?

How can a patient’s individual circumstances impact the quality of their endometrial cancer care? Gynecological cancer expert Dr. Nita Karnik Lee reviews common health disparities and their impact on patient outcomes. 

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

 

Related Programs:

Tools for Improving Access to Quality Endometrial Cancer Care

Tools for Improving Access to Quality Endometrial Cancer Care

Why Should Endometrial Cancer Patients Engage in Their Care?

Why Should Endometrial Cancer Patients Engage in Their Care?

Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches


Transcript:

Katherine Banwell:  

Dr. Lee, disparities in healthcare can impact a patient’s experiences and their outcomes. What are common health disparities that gynecological cancer patients can face? 

Dr. Nita Karnik Lee:  

Yeah, this is really – I always think about the cancer care continuum. This is the model that I think of. I think of what is risk reduction and prevention? What is early diagnosis and getting to the right person to take care of your cancer? Did you get the right treatment? And then did you get the right follow-up? 

Disparities can happen along those ways, and some of it can be related to access to care. Access, oftentimes, people just think it’s insurance, but it’s not. It is insurance. That’s a big part of it. We know that our states that don’t have as much insurance support for our patients who are poorer actually do worse. There’s worse survival. 

But I think it’s also does the person feel comfortable with the healthcare system? Are they connected with their doctor? Is it a language issue? Is it a bias issue that they’ve felt that they haven’t been comfortable in their health system before? All of those things can create these roadblocks along that whole cancer care continuum. Access really means more than just like it has to be acceptable. It has to be available. 

It has to be something that the person can feel comfortable with when they make a decision about treatment. That’s where we see things like people say, oh, that person declined surgery. I’m like, but did they really decline? Why did they decline? Did anyone get into what they were worried about, what their experience had been? So, we can’t just blame the patient and say, oh, they just didn’t want treatment. It’s really a complex area. The biggest disparity we see is in uterine cancer. 

So, Black women are much more likely to die of uterine cancer at any stage, especially older Black women. Some of this is access, but some of this is that there are actually differences in biology, and it’s kind of tricky because nobody thinks there is. Race is really a construct, right? It’s not really a biological difference, but there are differences in the types of more aggressive cancers that Black women get, and there are a lot of different reasons that people have started to look at that, both genetically, but also environmental influences, stress influences. 

So, the biggest disparity is probably in the uterine cancer, but unfortunately, we still see disparities by race in ovarian and cervical cancer. We also see disparities by income and insurance type. And so, I think those are kinds of things that are just the larger picture. 

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

Related Resources:

Advances in Endometrial Cancer Detection

Advances in Endometrial Cancer Detection

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches


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. 

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

How does biomarker testing impact endometrial cancer screening? Gynecologic expert Dr. Nita Karnik Lee reviews genetic mutations related to endometrial cancer and outlines key considerations for women with a family history of the disease. 

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

Related Resources:

Advances in Endometrial Cancer Detection

Advances in Endometrial Cancer Detection

What Questions Should You Ask About Endometrial Cancer Detection?

What Questions Should You Ask About Endometrial Cancer Detection?

Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches


Transcript:

Katherine Banwell:  

What is the role of genetic and biomarker testing as screening tools?  

Dr. Nita Karnik Lee:  

Those two things are different in certain ways, and it’s actually really important to think about that as well because for genetic testing if you do have a strong family history, there may be times where you are going to see a cancer genetics person. They may say, hey, your mom had uterine cancer. Maybe they are diagnosed with a certain syndrome. Lynch syndrome is the most common one, which is caused by a mutation in some of the repair proteins that normally repair DNA. That’s something that can get diagnosed and predispose people to many cancers, the most common of which is colon or uterine cancer.  

So, in those patients, some of those patients will actually undergo endometrial biopsies starting at a young age, even if they don’t have any irregular bleeding. Biomarkers are something also really important for somebody who is diagnosed already with endometrial cancer. So, if you get diagnosed with endometrial cancer, we actually use the biomarkers, which are an example of proteins the tumor has on its cell surface that can be turned on and off. And that profile of which biomarkers are on and off gives us an idea, and now can really help guide a little bit of treatment for some patients. 

Katherine Banwell:  

Okay. Should women with a family history of endometrial cancer take extra precautions? 

Dr. Nita Karnik Lee:  

I think they need to be really aware about the symptoms, and they need to be really thinking about whether or not there’s any role for genetic testing. Some patients, they have a family history. They’ve done genetic testing. It’s negative. There’s not anything else that we would do. But in those patients, if there’s any vaginal bleeding, spotting, anything irregular, that might really jump on the symptom diagnosis, or the symptoms leading to diagnosis, or sometimes people have other issues. 

They have fibroids. They have other things going on, and maybe they need a surgery, and maybe having that family history in your background sways you a little bit more. Hey, maybe I will consider surgery. It’s probably not the only reason to do a hysterectomy, but it can contribute to the decision-making if that makes sense. 

Advances in Endometrial Cancer Detection

How are patients currently screened for endometrial cancer? Gynecological cancer expert Dr. Nita Karnik Lee discusses tools for detection and diagnosis of endometrial cancer and factors that may impact risk. 

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

Related Resources:

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

What Questions Should You Ask About Endometrial Cancer Detection?

What Questions Should You Ask About Endometrial Cancer Detection?

Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches


Transcript:

Katherine Banwell:  

Dr. Lee, what are the screening tests for endometrial cancer? 

Dr. Nita Karnik Lee:  

That’s also a situation that we don’t actually have screening tests for uterine cancer. Again, PAP smears are usually normal in patients who have endometrial cancer because the PAP smear collects just the cells from the outside. Occasionally, sometimes cells that are in the endometrial lining can fall down into the cervix and get found on a PAP smear. 

But that’s actually, usually, the exception and not the norm. So, most women I operate on who have endometrial cancer will have had normal PAP smears. But it’s really important to know what symptoms would really trigger the first diagnosis. So, any type of vaginal bleeding after menopause, vaginal spotting, brownish discharge, or anything that seems unusual, really warrants a biopsy. That is not exactly a screening test because screening tests are usually for patients who don’t have any symptoms, but it is really a very important diagnostic test for someone who has any of those symptoms.  

Katherine Banwell:  

Have there been advances in screening or screening technology that patients should know about? 

Dr. Nita Karnik Lee:  

Yeah, people are talking about that. We know that there are certain risk factors for uterine cancer, so there has always been a discussion about, what about maybe we don’t screen everyone. Maybe we don’t biopsy everyone, but maybe we should be biopsying some people. So, the issue of patients who have obesity is one of the risk factors, not all of them, because some patients who have obesity don’t have this, and vice versa. 

Some patients are very thin and get endometrial cancer, because there are so many different types of endometrial cancer. But I think people have talked about the idea of people who have had a real cycle of irregular periods before menopause, and then may have some risk factors such as obesity, or metabolic syndrome, or diabetes, maybe they should get screened, but that has not been advocated at a public health level. Now, patients who do have a genetic mutation should get screening tests by the endometrial biopsy.  

Katherine Banwell:  

So, you mentioned some things to look for. How is endometrial cancer diagnosed? 

Dr. Nita Karnik Lee:  

It’s diagnosed when somebody usually comes in. Most of the people will be diagnosed because they have a symptom such as vaginal bleeding or vaginal discharge. Then they will have either an office-based biopsy, which is called an endometrial pipelle or endometrial biopsy. 

Or they can have something that people have heard of before, called a D&C. That stands for dilation and curettage. That means opening up or dilating the cervix just a little bit to allow an instrument to come in and do a small scraping of the lining of the uterus. So, one of those two ways is going to be the way this is diagnosed. 

What Are the Symptoms of Ovarian Cancer?

What should women know about ovarian cancer symptoms? Gynecological cancer expert Dr. Nita Karnik Lee reviews potential symptoms of ovarian cancer and emphasizes the importance of regular communication with the healthcare team. 

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

Related Resources:

How Is Ovarian Cancer Detected?

How Is Ovarian Cancer Detected?

How Does Biomarker Testing Impact Ovarian Cancer Screening and Detection?

How Does Biomarker Testing Impact Ovarian Cancer Screening and Detection?

Patient Empowerment | Advice From an Ovarian Cancer Expert

Patient Empowerment | Advice From an Ovarian Cancer Expert


Transcript:

Katherine Banwell: 

What symptoms should people look for? 

Dr. Nita Karnik Lee:  

So, this is a very important point. I think the symptoms that people should look for are symptoms that are in the bowel and bladder function area that are different or new to them. This can be changes in urinary frequency, or urgency, or sense of pressure, or not having as much bladder capacity, like having to run to the bathroom more frequently.   

Sometimes it can be changes in bowel movements, such as constipation, or not feeling like they’re emptying, or it can be changes in appetite, where people feel full really quickly, where they eat a small amount, and all of the sudden, they just feel like they can’t eat anymore. Obviously, worsening symptoms such as nausea or even throwing up, that’s a little more extreme, but that can happen.  

Again, if you’ve had these symptoms for years every time you eat a certain food or something like that, those are probably not new, and that probably is not going to be something cancerous. But if there’s something that’s new or different, the symptom seems to stick out to you that this isn’t your usual routine, and it seems persistent over two or three weeks, and it’s happening almost daily, or at least more frequently than you would expect, then I think that warrants telling your doctor about it, and really advocating, and knowing that not everyone is going to have ovarian cancer, which is good, but knowing that they should do the workup for this just to rule it out.  

Katherine Banwell:  

How reliable are PAP smears in detecting ovarian cancer? 

Dr. Nita Karnik Lee:  

PAP smears do not detect ovarian cancer at all. So, people with ovarian cancer have normal PAP smears. It would be very unusual to have an abnormal PAP smear due to ovarian cancer. A lot of the misconception is that patients have said, “Well, I had my annual exam last year. I got my PAP smear every three to five years. That seems negative. So, why did I get this cancer?” But the two are completely unrelated. 

How Does Biomarker Testing Impact Ovarian Cancer Screening and Detection?

What role does biomarker testing play in ovarian cancer detection? Dr. Nita Karnik Lee reviews genetic mutations related to ovarian cancer and discusses key steps women with a family history of the disease should consider. 

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

Related Resources:

How Is Ovarian Cancer Detected?

How Is Ovarian Cancer Detected?

What Are the Symptoms of Ovarian Cancer?

What Are the Symptoms of Ovarian Cancer?

Patient Empowerment | Advice From an Ovarian Cancer Expert

Patient Empowerment | Advice From an Ovarian Cancer Expert


Transcript:

Katherine Banwell:  

What is the role of genetic and biomarker testing as screening tools? 

Dr. Nita Karnik Lee:  

Genetic testing is very important. When we get, for example, and I’ll kind of back up a little bit to say if somebody gets diagnosed with ovarian cancer, that is actually everyone who has a diagnosis of ovarian, fallopian tube, or peritoneal, because those are all sort of the same cancer, should get genetic testing to see if there’s a hereditary predisposition in their genetics that are passed on.  

That’s called germline testing. And those patients, and 20 percent of them, may actually have a hereditary condition that could be passed on. Then that’s where you can see how important it is. If I have somebody, and her children now know that the person has the BRCA gene, for example, then it’s really important for her children, men and women, to get screened, because then they may be able to do preventive measures, such as preventive surgery, preventive medications, or more frequent screening, to be able to prevent cancer from happening. 

Katherine Banwell:  

Okay. What genetic mutations are associated with ovarian cancer? 

Dr. Nita Karnik Lee:  

The ones that are most common that you hear about are something called BRCA, or B-R-C-A, 1 and 2. Those make up the majority of those mutations. There are some other less common ones such as Lynch syndrome, which is more associated with colon and endometrial cancer but can have about 10 percent to 12 percent of patients related to ovarian cancer as well.   

Nowadays, when we do genetic testing, we do a panel, so there are like 35 genes that are tested. There are a whole lot of different genes that can have an association with ovarian cancer, but the BRCA genes are the ones that most people hear about.   

Katherine Banwell:  

Should women with a family history of ovarian cancer take extra precautions? 

Dr. Nita Karnik Lee:  

That’s a very good question. So, if you have a family history, it’s probably important to talk to your doctor and to maybe even see somebody in cancer genetics who can draw out a family tree for you to see how high is this risk? If people have an ovarian cancer patient, one – or a breast cancer patient – some of it also matters what was the age that that patient got diagnosed. Some genetic mutation syndromes, actually the patient gets diagnosed much younger than average.  

The average age for ovarian cancer is about 60. Some patients will get it. For some genetic mutations, it’s still about that range. So, I think it’s important because even if you don’t have a genetic mutation, having a family member with ovarian cancer slightly increases your risk. 

Knowing those symptoms, knowing that your history will help your doctor dictate how quickly are they thinking about something else is really important, ultrasound, but we know that ultrasound is not perfect. 

How Is Ovarian Cancer Detected?

Dr. Nita Karnik Lee discusses how ovarian cancer is diagnosed, shares challenges in screening tests and procedures, and reviews ongoing research in the field. Dr. Lee also shares key questions to ask one’s healthcare team about ovarian cancer detection.

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

Related Resources:

How Does Biomarker Testing Impact Ovarian Cancer Screening and Detection?

How Does Biomarker Testing Impact Ovarian Cancer Screening and Detection?

What Are the Symptoms of Ovarian Cancer?

What Are the Symptoms of Ovarian Cancer?

Patient Empowerment | Advice From an Ovarian Cancer Expert

Patient Empowerment | Advice From an Ovarian Cancer Expert


Transcript:

Katherine Banwell:  

Dr. Lee, what are the screening tests and procedures to detect ovarian cancer? 

Dr. Nita Karnik Lee:  

So, one of the important things to realize is that we do not actually have a screening test for ovarian cancer. That’s really important for the general public who maybe is at average risk. Patients who have a strong family history or a genetic, hereditary condition, sometimes we do use ultrasound and CA125, but that’s not considered a screening test for average-risk patients. We’re very limited in that sense for ovarian cancer. There’s a lot of research that’s being done about this.  

Katherine Banwell:  

Have there been advances in screening or screening technology that patients should know about? 

Dr. Nita Karnik Lee:  

I think the issue with screening and ovarian cancer is because we have not had any, and there have been really large studies that have been done both in the U.S. and in Europe, trying to see does ultrasound work every six months. Does CA125 and ultrasound work?

There’s some combination of blood tests that have started to become a little bit more researched in terms of going further along, but there’s really nothing that’s the perfect answer. One of the really important things that we talk about is knowing family history to see if there’s something that can be done to help patients who have a family history.  

And then also being really aware of subtle symptoms of ovarian cancer that can trigger you going to your doctor and then really pushing and advocating for yourself and your family member to get a workup done, which can often include an exam, an ultrasound, and maybe even something like a CAT scan or CT scan if any of the symptoms are a little more worrisome.  

Katherine Banwell:  

What questions should patients ask their doctor about detection? 

Dr. Nita Karnik Lee:  

I think that when we’re thinking about detection, or if somebody has these symptoms coming up, definitely asking, like, hey, you know what? I’m seeing you as an internist, but I haven’t had a pelvic exam. So, making sure you’re seeing a gynecologist or an internist or family medicine doctor who can do a vaginal and a rectal exam is one important step. Perhaps getting an ultrasound or perhaps getting a CAT scan if the symptoms are more significant.  

Unfortunately, we still see a lot of women who have these sort of vague symptoms, maybe they’re GI-related, and they get a workup for like six months on an EGD, or a colonoscopy, or they tried Pepcid. And all of those things are good, and they’re not unreasonable to do, but I think something else that can be done in addition would be a pelvic ultrasound, as an example.

I would say that if somebody doesn’t have any of those symptoms, but they have a family history, that’s why we’re in a little bit more of a bind as to know what the right thing to do is. We know that for patients who have a known BRCA mutation and are not ready for risk reduction surgery, we often will use ultrasound, but we know that ultrasound is not perfect. 

Patient Empowerment | Advice From an Ovarian Cancer Expert

How can you feel empowered in your ovarian cancer care? Dr. Heidi Gray highlights the importance of allowing others, like your doctor, to help alleviate fear and regain a sense of control while navigating your journey with hope.

Dr. Heidi Gray is the Division Chief of Gynecologic Oncology and the Director of Gynecologic Oncology Clinical Trials at UW Medicine. Learn more about Dr. Gray.

Download Resource Guide

See More from INSIST! Ovarian Cancer

Related Resources:

Essential Testing Following an Ovarian Cancer Diagnosis

Essential Testing Following an Ovarian Cancer Diagnosis

How Do Biomarkers Impact Ovarian Cancer Treatment and Care?

How Do Biomarkers Impact Ovarian Cancer Treatment and Care?

Understanding Your Role in Your Ovarian Cancer Care

Understanding Your Role in Your Ovarian Cancer Care 

Transcript:

Katherine Banwell:  

Dr. Gray, as a provider, how do you empower patients who have been diagnosed with ovarian cancer?  

Dr. Heidi Gray:  

That’s such an important question. I think that it’s incredibly important. My role is to help alleviate fear. I think when patients have a new diagnosis of cancer the rug’s been pulled out from under them. The patient describes it like being in a car crash.   

You’re numb. It’s hard to even know where to go next. There’s so much fear, because you don’t know what’s next and the loss of control. So, I really spent a lot of time trying to just address that and acknowledge but also help move people forward, because I think it’s always helpful to be able to have a plan or have a sense of what’s going to happen next or have some control around that.  

Of course, I also need to instill a lot of hope for patients. You never know what any one patient’s journey is going to be. The way information is, as I said, you can get all of these information and numbers, and it can be completely scary. Any one patient, their journey is different from the next one from the next one, and it’s very important to be hopeful and thoughtful about what that might look like or thinking about what that might look like. 

How Do Biomarkers Impact Ovarian Cancer Treatment and Care?

How do biomarkers impact ovarian cancer care? Dr. Heidi Gray discusses how genetic biomarkers like BRCA-1, BRCA-2, and HRD inform treatment options, affect prognosis, and guide therapies like PARP inhibitors. 

Dr. Heidi Gray is the Division Chief of Gynecologic Oncology and the Director of Gynecologic Oncology Clinical Trials at UW Medicine. Learn more about Dr. Gray.

Download Resource Guide

See More from INSIST! Ovarian Cancer

Related Resources:

Essential Testing Following an Ovarian Cancer Diagnosis

Essential Testing Following an Ovarian Cancer Diagnosis

Patient Empowerment | Advice From an Ovarian Cancer Expert

Patient Empowerment | Advice From an Ovarian Cancer Expert

Understanding Your Role in Your Ovarian Cancer Care

Understanding Your Role in Your Ovarian Cancer Care 

Transcript:

Katherine Banwell:  

What are the most common biomarkers associated with ovarian cancer? 

Dr. Heidi Gray:  

So, the most common biomarkers, first of all, are the genetic mutations that are associated with higher risk. So, many folks are familiar with BRCA-1 and BRCA-2. There are a couple of lesser-known genetic mutations that fall into that family that also can put patients at an inherited risk. 

Other biomarker testing that we do is for something called HRD, which is a test to look at a profile of the cancer that is similar to having the BRCA-1 and BRCA-2 mutations. It is a spectrum of different testing that may make those cancers more susceptible to PARP inhibitor therapy.  

Katherine Banwell:  

Are there biomarkers associated with prognosis? 

Dr. Heidi Gray:  

Let me back up a little bit. So, the biomarkers associated with prognosis – yes. So, in patients who have BRCA-1 or BRCA-2 mutations, they actually tend to have better prognosis longer term and better responsiveness to chemotherapy and other therapies. 

Patients who also have HRD may also have a little improved responsiveness to some of the therapies as well.  

Katherine Banwell:  

How do these biomarkers impact ovarian cancer treatment options? 

Dr. Heidi Gray:  

Good question. So, the biomarker testing again, particularly for the BRCA-1, BRCA-2, and then the HRD spectrum, there have been several very large studies that have looked at using a variety of drugs that fall under this group called PARP inhibitors, P-A-R-P inhibitors.  

These drugs specifically target cancers that have these mutations – or more susceptible to these mutations and interestingly have found that when we use these PARP inhibitors in a maintenance therapy, so after patients have completed their primary treatment, surgery, chemotherapy, and then go on maintenance therapy to prevent recurrence, they have very, very long improvement in survival and pushing out recurrence very far, significantly so, more than we’ve seen for anything in ovarian cancer in recent years.   

So, it’s very, very exciting. 

Katherine Banwell:  

What question should patients ask about test results?  

Dr. Heidi Gray:  

It is interesting now because as many patients have experienced, they sometimes get their test results before their provider has had a chance to review them as part of the patient access program that has been in place. So, I find that many patients have had time to sit with their results or question or go on the Internet about them before they see me. So, some of it is helping direct, okay, where are you getting your information from and all of that, because I think that that is something newer now. 

But I think it’s important for patients to be asking do I qualify for genetic testing, what are those results, what are the implications for myself and/or my family members? Then the molecular testing, as I said, is a very important next step that we do recommend for all, certainly advanced ovarian cancers or recurrent ovarian cancers, to help better guide therapy. 

Essential Testing Following an Ovarian Cancer Diagnosis

 

What essential testing should follow an ovarian cancer diagnosis? Dr. Heidi Gray explains that patients should undergo both genetic testing, which identifies inherited risk factors, and molecular testing, which evaluates specific tumor mutations.

Dr. Heidi Gray is the Division Chief of Gynecologic Oncology and the Director of Gynecologic Oncology Clinical Trials at UW Medicine. Learn more about Dr. Gray.

Download Resource Guide

See More from INSIST! Ovarian Cancer

Related Resources:

How Do Biomarkers Impact Ovarian Cancer Treatment and Care?

How Do Biomarkers Impact Ovarian Cancer Treatment and Care?

Patient Empowerment | Advice From an Ovarian Cancer Expert

Patient Empowerment | Advice From an Ovarian Cancer Expert

Understanding Your Role in Your Ovarian Cancer Care

Understanding Your Role in Your Ovarian Cancer Care 

Transcript:

Katherine Banwell:  

Dr. Gray, what essential testing should people with ovarian cancer have following diagnosis?  

Dr. Heidi Gray:  

That’s a great question. We’re learning more and more about this disease. Therefore, we also have a lot more variety of tools to look at to be able to match better therapies for patients. Historically, when patients were diagnosed with ovarian cancer, it was based on just the pathology at the time of surgery and some lab testing called the CA-125, which many patients with ovarian cancer are familiar with.  

The next level of testing that we are doing for ovarian cancer is really to look at how aspects of either the patient themselves or of the cancer themselves that might better match therapies. So, the first line of testing we recommend for all women for ovarian cancer is genetic testing. Genetic testing is blood-based testing.  

It is testing for if you have an inherited gene or a mutated gene, that’s being passed along through families that may have put you at risk of developing ovarian cancer and potentially breast cancer. That is recommended for all women and patients who have been diagnosed with ovarian cancer because we know about 15 percent to 20 percent of these cancers are due to a genetic cause. 

The other level of testing that we have incorporated is what we call molecular testing. Other terms for it are “tumor-based testing” – I think you use the term “biomarker testing.” Some people use the term “precision medicine,” and that is a little different. That is testing that is actually testing the tumor itself. It’s looking at a variety of different factors but particularly looking at mutations in the cancer itself, in the tumor itself, so different than the genetic, which is an inherited thing. This is in the tumor itself. There is some overlap of that.  

But it has an expanded profile of different targets that we can match therapies to. 

Katherine Banwell:  

Would you define biomarker testing for us? 

Dr. Heidi Gray:  

Yeah. So, biomarker testing is just that. It is more expanded testing, particularly tumor testing is one aspect of it. There can also be some blood testing, genetic testing. Then there is a new realm also of looking at cell-free DNA or ct or tumor DNA in the blood as well too that is gaining a lot of interest. 

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.

 

Related Programs:

Current Endometrial Cancer Treatment Approaches

Current Endometrial Cancer Treatment Approaches

Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

Endometrial Cancer | What Is Personalized Medicine?

Endometrial Cancer | What Is Personalized Medicine?


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.

 

Related Programs:

What Questions Should Patients Ask About Endometrial Cancer Testing?

What Questions Should Patients Ask About Endometrial Cancer Testing?

Questions to Ask About Endometrial Cancer Clinical Trials

Questions to Ask About Endometrial Cancer Clinical Trials

Endometrial Cancer | What Is Personalized Medicine?

Endometrial Cancer | What Is Personalized Medicine?


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.

 

Related Programs:

Current Endometrial Cancer Treatment Approaches
Advances in Endometrial Cancer Treatment and Research
Where Do Clinical Trials Fit Into an Endometrial Cancer Plan?

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.