Title: Healthy YOU Podcast, Episode 24: Navigating Gynecologic Cancer
Host: Frankye Myers, Chief Nursing Officer for Riverside Health System
Expert Guest: Lindsay Borden, M.D., gynecologic oncologist with Riverside Partners in Women's Health Gynecologic Oncology
[00:00:00] Frankye Myers: From Riverside Health System, this is the Healthy You Podcast, where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health.
[00:00:18] So let's dive in to learn more about becoming a healthier you.
[00:00:28] I am really excited to have with me today in the Healthy You Studio for this episode of the Healthy You Podcast. Dr. Lindsay Borden, Dr. Borden is fellowship trained gynecologic oncologist with partners in women oncology. That was a mouthful. This episode we're going to be talking about and understanding more about GYN cancers.
[00:00:55] Insight into ovarian and cervical and endometrial cancers. So, thank you for joining us. Thanks for having me. We're so excited to have you. very much. You're welcome. Dr. Borden, tell me a little bit about why you pursued a career in medicine, and then more specifically, As a GYN oncologist.
[00:01:18] Lindsay Borden: I pursued medicine to take care of people.
[00:01:20] Um, I really always loved taking care of people, um, throughout high school and college. And I knew OBGYN, uh, fit as a career because I focused exclusively on women's health. And that was very exciting to me, um, to focus on somewhat of a marginalized population. And the patients in GYN oncology were who, uh, kind of stole me away from general OBGYN and their relationships with their oncologists.
[00:01:46] So they, um, encouraged me to subspecialize.
[00:01:49] Frankye Myers: Okay, well, thank you so much for your commitment to women's health and such an important, um, topic and aspect. I wanted to talk a little bit more about ovarian cancer, uh, just because it's so hard to detect sometimes, um, and often diagnosed in late stages. Can you talk to us a little bit more about why that exists?
[00:02:15] Lindsay Borden: Yes, so ovarian cancer is a cancer of the ovaries, which is generally found in postmenopausal women, usually about the age of 60. So your ovaries should be about the size of a large marble at that age, and they can enlarge up to Kind of any size. And, um, the reason it's so hard to detect is the symptoms are very vague.
[00:02:38] Um, so you might have nausea, vomiting, a little bit of bloating or changes in how, how much you can eat. Um, and these symptoms are all developed slowly over time and they mask themselves as commonly a G. I. Issue. And so it can take a while to be diagnosed.
[00:02:56] Frankye Myers: Okay. Okay. Um, So, you know, going off a little bit here, wanna, you know, I'm really passionate about disease prevention and health promotion, so what do you think is one of the main things that women should focus on to support early detection?
[00:03:13] I know for me, um, having a strong relationship not only with my primary care but my GYN doctor and doing those routine. checks.
[00:03:24] Lindsay Borden: Exactly. So, um, we recommend a yearly exam with a gynecologist to look and feel, um, and your gynecologist may know your body better than others and may notice changes over time that would otherwise kind of may mask themselves.
[00:03:39] Um, and so having a strong relationship either with primary care, especially a GYN can help, um, identify these things a little earlier.
[00:03:47] Frankye Myers: Okay, very good. I know for me in conversation with women, Um, there's sometimes this misunderstanding that after you're beyond the childbearing age, or if you've had a partial hysterectomy, um, which some, which your ovaries can be left intact, that you don't need to have those screenings.
[00:04:04] You want to talk a little bit more about that?
[00:04:06] Lindsay Borden: Yes. So pap smears and a general exam are very different, and people often confuse the two. Um, but a pap smear is a specific screening for cervical cancer, and we'll talk about that a little later. But a pelvic exam can just look and feel for the other organs, and like you said, uh, your ovaries can be retained after a hysterectomy, and so it's important to have those, um, examined.
[00:04:28] And they're really the only way you can do that is with an internal exam.
[00:04:31] Frankye Myers: Internal. Okay, great. Thank you. So we're going to dive into a little more detail. We're familiar with mammograms and colonoscopies for breast and colon cancer, but how do you screen for ovarian cancer specifically?
[00:04:46] Lindsay Borden: So unfortunately, there's no screening for ovarian cancer, um, but typically, again, these are found on exam, um, that you may find a mass or, um, something abnormal on exam with your gynecologist or PCP, and then they typically order imaging after that.
[00:05:03] Frankye Myers: Yes, I think there's so much communication around timeframes for your mammograms and timeframes for your colonoscopies, um, and things like that and what I don't hear a lot about is, you know, the screening and timeframes, um, to, uh, early detect, um, these types of cancers.
[00:05:25] Lindsay Borden: Exactly. And so I would recommend a yearly exam, um, and this includes a speculum exam or an internal exam.
[00:05:32] Frankye Myers: Okay, and you mentioned a little bit of, about some of the symptoms, um, that we may, you know, women may experience. Um, I always say, you know, um, Um, if you don't feel like yourself, if something doesn't feel different, um, you know, if something feels different or you're just not yourself, that you should explore those things a little bit further.
[00:05:54] Because sometimes to your point, those symptoms mimic like GI symptoms. Women may think, oh, I may be pregnant, but they would follow up from that perspective. Um, any other things that you want to highlight just from a, um, symptom? Um, perspective.
[00:06:10] Lindsay Borden: I think the, um, exactly, the, the changes over time are really what we're looking for and so people can, um, kind of ignore one episode of nausea or a meal that didn't sit quite right.
[00:06:21] But I think anything that's persistent over the course of a month really should be brought up with a doctor, um, and I think the, the, Symptoms of bloating and, um, the changes in how you feel full after a meal are really some of the, um, things you can look out for.
[00:06:38] Frankye Myers: Okay. That's good. That's really good stuff there.
[00:06:42] Um, so, can we just talk a little bit more about comparison when we're talking about cervical cancer, which is unlike ovarian cancer and typically seen in younger populations? Um, I think our younger populations, um, and I was there once upon a time, um. You know, we think we're healthy and we're not at risk for some of those things and, um, we may not always, um, Dig down into what our family history looks like, um, which could help us be on alert and start some of that early screening.
[00:07:14] Lindsay Borden: Absolutely. So, um, cervical cancer is the cancer of the bottom part of the uterus, so it's at, what's at the top of the vagina. And um, this is something that's It's easy to screen for with a pap test, but the trick is you have to get your pap smears and they have to be on a regular schedule. So this is another reason having a relationship with a gynecologist and making sure that you're up to date on those is important.
[00:07:38] Frankye Myers: Okay. Alright, since most cancers, um, causes of cervical cancers are caused by the human papillomavirus or HPV, can you talk about HPV vaccines and their potential for preventing some of those cervical cancers?
[00:07:56] Lindsay Borden: Yes, so, um, HPV or the human papillomavirus has a lot of different types, so there are over a hundred strains of HPV and so this vaccine called Gardasil prevents against the nine most common strains.
[00:08:10] So it protects, um, for a lot of cervical cancer and other cancers. So the two most common types of HPV, um, that are related to cervical cancer are prevented in with this vaccine. It is ideally given at an age of 11 or 12, um, to boys and girls, because even though boys aren't at risk for cervical cancer, they can carry the virus to their partners.
[00:08:34] And, um, this vaccine is approved up until age 45, um, but ideally we are, uh, getting boys and girls when they're a little bit younger.
[00:08:44] Frankye Myers: Okay. Yeah. Yeah. Um, that's great information. I know that, you know, early on, there were a lot of concerns, uh, for parents, um, around the age of their children and getting this particular vaccine.
[00:08:59] Have we seen that change and evolve over time? Have we improved in that space?
[00:09:04] Lindsay Borden: Yeah, I think we've been able to show that the age of introduction of sexual activity has not changed with the, um, with the vaccine, which I think is reassuring to parents. And I think the, the best way to explain it is that prevention is always better than treating.
[00:09:19] And so if we can prevent these, um, children from getting infected when they're older, I think that's always the best way to, um, affect people's lives in the future.
[00:09:27] Frankye Myers: Right. And I think the, you know, benefit of having that relationship Um, and consistency around who you see and there's a trust factor, um, really helps with that.
[00:09:37] Definitely. The age has extended over time. It has. From, from my first introduction as a parent and having a daughter as well. Why did that occur? So
[00:09:48] Lindsay Borden: we've shown that, um, vaccinating even up to age 45 can prevent these other strains from HPV. So it doesn't protect you from the strains you've already been exposed to, but it can help protect against those other ones, um, especially the ones that go on to cause HPV related cancers.
[00:10:06] Frankye Myers: Okay, but once you're diagnosed as having HPV, will the, will that help? at all to get the vaccine after that, or how does that work?
[00:10:17] Lindsay Borden: So, it hasn't been shown to help the strains of HPV that you already have, um, but this is an area of, excuse me, this is an area of investigation.
[00:10:26] Frankye Myers: These are some big words we're having to go through, and they're long, like, long syllabus.
[00:10:29] This is an area of Syllables.
[00:10:33] Lindsay Borden: Exactly. This is an area of investigation that people are looking at across the country.
[00:10:39] Frankye Myers: Okay, so more to come on that and just wanted our viewers to know because, you know, um, and so from the aspect of having, um, HPV, what You know, I know we can't, it's all individualized, but what would someone expect, um?
[00:10:58] Lindsay Borden: So when you have a pap smear that comes back with HPV, the physician will look at both the cells and what they came back as and the HPV result. And with the combination of those two things, you decide about the next steps. Sometimes this includes a colposcopy, which is a very detailed exam of the cervix with a microscope.
[00:11:17] Sometimes it means some additional biopsies. Um, and sometimes you may need an, an additional procedure to your cervix to remove the abnormal cells. But the goal is to treat this when it's a, in a pre cancer or dysplasia stage, as opposed to waiting until it gets to a cancer.
[00:11:33] Frankye Myers: Okay. And could that include having more frequent pap smears to make sure they're not abnormal than the normal annual checks?
[00:11:42] Can you talk a little bit about that compliance?
[00:11:44] Lindsay Borden: Absolutely. Yes. Yes. So. As we've gotten better with the HPV screening, we've been able to space out how often you need a pap smear. This doesn't mean you don't need an annual exam, but typically if pap smears are normal, we can space them out to every five years.
[00:11:59] And when they're abnormal, we increase that to either every three years or every year, again, depending on your specific results.
[00:12:06] Frankye Myers: Okay. Okay. And then what about a young person, you know, childbearing age, is there a way to be proactive and still How would that not negatively impact, um, your, your ability to get pregnant and then more importantly, I'm sure there are concerns about once I get pregnant, if I have this, what would be the impact on my fetus?
[00:12:27] Lindsay Borden: Absolutely. So the best way to do this is by getting a pap smear now and so that we can prevent and treat anything when it is at a very early stage and the less we have to do in terms of biopsies or procedures, the safer a future pregnancy is going to be.
[00:12:44] Frankye Myers: Okay. All right. A lot of great information there.
[00:12:49] So I've talked about, and I went off script a little bit there, but really great information and I know what, you know, I hear women inquire about, um, for me as a healthcare professional. So we've talked a lot about ovarian cancer, cervical cancer, um, and there is little conversation or, um, Um, as it regards to endometrial cancer, um, which is the most common of the GYN cancers, um, to be caught early on.
[00:13:17] So you want to talk a little bit about that. So there's some different naming there in the, in the various presentations, which I know can sometimes be confusing for women.
[00:13:25] Lindsay Borden: Yes. So, uh, endometrial cancer is the same thing as uterine cancer. Those two are, are used interchangeably. So when we talk about the endometrium, we're really talking about the inner lining of the uterus.
[00:13:36] And this is what grows and sheds every month with your menstrual cycle. So, um, it's a little bit easier to understand what the endometrium is by thinking about it in that way. Okay. This is typically diagnosed around 60 years old, and the reason we've been so effective at treating it is because it presents with bleeding, and so women who are postmenopausal or after menopause, um, have bleeding, they present to their doctor, and we generally catch these things earlier than, um, some of the other cancers like ovarian cancer.
[00:14:06] Frankye Myers: Um, would, so obviously early detection is so pivotal to treatment and outcome, so is Is this, the endometrial type of cancer, an easier one to treat? I don't know if that's the right word to say. I think, um,
[00:14:21] Lindsay Borden: typically the uterine cancer, um, or endometrial cancer can be treated with surgery. Um, and I think that often times surgery is all the patient will need, depends a little bit on what type of cancer.
[00:14:34] found and some other specifics, but oftentimes we can treat it with just surgery. Um, and this is again related to how we usually find these cancers at an earlier stage.
[00:14:45] Frankye Myers: Okay. Is there an association with any of these cancers and fibroids, which can be common in women?
[00:14:53] Lindsay Borden: Good question. Fibroids have not been associated with these cancers, um, and, but I think the, the biggest thing is to get checked out if you have any postmenopausal bleeding.
[00:15:03] I think, uh, I really want to stress that to patients that any bleeding after menopause is not normal. It does not always mean cancer, but it's important to see a gynecologist if you have them.
[00:15:13] Frankye Myers: Have them. Okay. All right. Really, really good information there. Is there anything, I mean, we've talked about a lot.
[00:15:22] Is there anything that you feel would be beneficial, instrumental to share with our viewers?
[00:15:28] Lindsay Borden: I think the only other thing I wanted to mention about endometrial cancer is that this lining of the uterus is responsive to hormones and just like you're during your menstrual cycle, the lining is growing with hormones.
[00:15:45] These hormones can be produced in other places in your body. And so one place that they can be produced is fat cells or adipose. And so with the increasing, um, and with increasing obesity, these, uh, cancers are being diagnosed more commonly. Um, and it's one of the only cancers in the country that's, uh, increasing in its size.
[00:16:06] And so, really want to make sure that people who are having abnormal bleeding get checked out and know that this is a possibility.
[00:16:12] Frankye Myers: Right. Every time I get my BMI where it needs to be, it changes. So, um, what is that obesity? indicator. What, you know, what is considered obesity at this point?
[00:16:24] Lindsay Borden: So typically a BMI over 30 is where we consider weight loss would be beneficial.
[00:16:29] Um, and over 35 your risk of this particular cancer goes up,
[00:16:34] Frankye Myers: goes up. Does it have anything to do with the adipose or the The fat tissue, you know, those tissues, particularly.
[00:16:43] Lindsay Borden: So those tissues are what's producing the hormone, um, and this cancer is responsive to that hormone. So it's, um, kind of feeding
[00:16:51] the tumor.
[00:16:51] Frankye Myers: It likes it, so it eats, okay,
[00:16:53] Lindsay Borden: okay. So weight loss can be an important part of, um, reducing your risk for this cancer.
[00:17:00] Frankye Myers: Okay. Alrighty. Well, um. I don't know if we want to talk a little bit about, there's a lot of treatment modalities, um, as it relates to all of these things. I think that's beneficial so that our viewers know that, hey, there's, there's ways to treat these things and the importance of early detection, but if they were to, to, to come up or experience some of these things, what are some of the, um, Procedures you want to highlight?
[00:17:27] I know minimally invasive robotic assisted surgery, um, is something that's out there as well.
[00:17:33] Lindsay Borden: So, um, we do a lot of robotic surgery in GYN oncology and this allows us to have better visualization during the surgery and allows us to do some surgeries through little incisions that in the past we would have had to do through a big open incision.
[00:17:48] And this improves patients healing times and allows them to get back to their life sooner. Um, so it's really an advantage that we have at Riverside.
[00:17:56] Frankye Myers: Right. I'm, I'm really glad you mentioned that because sometimes there can be some views about robotic surgery. Um, but there's a, you know, we have information at our fingertips now with, um, social media and being able to search things prior to surgery that, um, you know, the human factor can be better than the robot, but to your point, the robot can be, you know, even more precise.
[00:18:20] Right?
[00:18:20] Lindsay Borden: Exactly. And it can really, um, really benefit the surgeon and really allow us to do more, um, through little incisions.
[00:18:28] Frankye Myers: Right. And, and less time in the hospital. Absolutely. So, do you want to hear a little bit about chemo and radiation, some of those other, um,
[00:18:37] Lindsay Borden: treatments? So, Riverside Cancer Care Network has, uh, comprehensive offerings for cancer care and this includes chemotherapy and radiation.
[00:18:46] And so, we work with, um, surgeons, radiation oncologists, and medical oncologists to combine and, and treat these patients, um, with any of the modalities that they need.
[00:18:58] Frankye Myers: Awesome. Awesome. That's, that's great. Um, this has been such, such a great discussion. Um, thank you so much for your passion and your commitment to support women.
[00:19:10] Um, and I think that no matter what you're going through, when you feel like you have that support network, you can get through anything. So your commitment as a physician is instrumental in that journey. So thank you so much. Um, just a great reminder again, to women, um, you know, Build that relationship, um, with your GYN, have your regular checks, um, stay on top of things, stay in tune to your body, right, um.
[00:19:38] So anything you want to say before we wrap up, but just great information.
[00:19:42] Lindsay Borden: Well, thank you for having me and yes, I think I encourage women to get checked out if they feel like they're not getting the right answers and to make sure that they have a gynecologist that they, um, They like and they, they trust to take care of them.
[00:19:55] Frankye Myers: Yes, yes. And stay in tune to your menstrual cycles.
[00:19:59] Lindsay Borden: Absolutely. Your menstrual cycle has been said to be an extra vital sign or just another indicator of your health. So it's really important to pay attention to.
[00:20:08] Frankye Myers: That's a good one. And then when you no longer have the menstrual cycle, stay in tune if you're having, you know, as you mentioned, uh, bleeding.
[00:20:16] Lindsay Borden: Absolutely. Um, I would love if any woman that was having postmenopausal bleeding, um, could come in and get checked out. We, um, would impact a lot of people.
[00:20:25] Frankye Myers: Yes. Yes. Thank you so much, Dr. Borden, for joining us today. Please come back any time, um, and I know our viewers, uh, really appreciate you taking the time to help educate them.
[00:20:36] Thank you. So, thank you again. Thank you for listening to this episode of Healthy You. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to RiversideOnline.com.
