Episode Transcript
[00:00:00] Speaker A: 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. So let's dive in to learn more about becoming a healthier you.
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, insight into ovarian and cervical and endometrial cancers. So thank you for joining us. We're so excited to have you.
[00:01:06] Speaker B: Thank you very much.
[00:01:07] Speaker A: 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.
[00:01:17] Speaker B: I pursued medicine to take care of people. I really always loved taking care of people throughout high school and college, and I knew obgyn fit as a career because it focused exclusively on women's health. And that was very exciting to me to focus on somewhat of a marginalized population. And the patients in gyn oncology were who kind of stole me away from general Ob GYN and their relationships with their oncologists, so they encouraged me to subspecialize.
[00:01:49] Speaker A: Okay, well, thank you so much for your commitment to women's health and such an important topic and aspect.
I wanted to talk a little bit more about ovarian cancer, just because it's so hard to detect sometimes and often diagnosed in late stages. Can you talk to us a little bit more about why that exists?
[00:02:15] Speaker B: 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 the reason it's so hard to detect is the symptoms are very vague, so you might have nausea, vomiting, a little bit of bloating, or changes in how much you can eat. And these symptoms all develop slowly over time, and they mask themselves as commonly a GI issue, and so it can take a while to be diagnosed.
[00:02:56] Speaker A: Okay, so going off a little bit here, 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. I know for me, having a strong relationship not only with my primary care, but my gyn doctor and doing those routine checks.
[00:03:24] Speaker B: Exactly. So we recommend a yearly exam with a gynecologist to look and feel, and your gynecologist may know your body better than others and may notice changes over time that would otherwise kind of may mask themselves. And so having a strong relationship, either with primary care, especially a gyn, can help identify these things a little earlier.
[00:03:47] Speaker A: Okay, very good. I know for me, in conversation with women, there's sometimes this misunderstanding that after you're beyond the childbearing age or if you've had a partial hysterectomy, which your ovaries can be left intact, that you don't need to have those screenings. You want to talk a little bit more about that.
[00:04:06] Speaker B: Yes. So pap smears and a general exam are very different, and people often confuse the two. 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, your ovaries can be retained after a hysterectomy. And so it's important to have those examined. And really, the only way you can do that is with an internal exam.
[00:04:31] Speaker A: Internal. Okay, great. Thank you. So we're going to dive into a little more detail. So we're familiar with mammograms and colonoscopies for breast and colon cancer. But how do you screen for ovarian cancer specifically?
[00:04:46] Speaker B: So, unfortunately, there's no screening for ovarian cancer. But typically, again, these are found on exam, that you may find a mass or something abnormal on exam with your gynecologist or PCP, and then they typically order imaging after that.
[00:05:03] Speaker A: Yes. I think there's so much communication around time frames for your mammograms and time frames for your colonoscopies and things like that. And what I don't hear a lot about is the screening and time frames to early detect these types of cancers.
[00:05:26] Speaker B: Exactly. And so I would recommend a yearly exam, and this includes a speculum exam or an internal exam.
[00:05:32] Speaker A: Okay. And you mentioned a little bit about some of the symptoms that women may experience.
Always say if you don't feel like yourself, if something doesn't feel different, if something feels different, or you're just not yourself, that you should explore those things a little bit further, 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.
Any other things that you want to highlight, just from a symptom perspective?
[00:06:12] Speaker B: Exactly. The changes over time are really what we're looking for. And so people can kind of ignore one episode of nausea or a meal that didn't sit quite right. But I think anything that's persistent over the course of a month really should be brought up with a doctor.
And I think the symptoms of bloating and the changes in how you feel full after a meal are really some of the things you can look out for.
[00:06:39] Speaker A: Okay, that's good. That's really good stuff there.
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?
I think our younger populations, and I was there once upon a time, we think we're healthy and we're not at risk for some of those things. And we may not always dig down into what our family history looks like, which could help us be on alert and start some of that early screening.
[00:07:14] Speaker B: Absolutely. So, cervical cancer is the cancer of the bottom part of the uterus, so it's what's at the top of the vagina. And this is something that'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] Speaker A: Okay.
All right. Since most 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] Speaker B: Yes. So hpv, or the human papillomavirus, has a lot of different types. So there are over 100 strains of hpv. And so this vaccine, called gardasil, prevents against the nine most common strains. So it protects for a lot of cervical cancer and other cancers. So the two most common types of hpv that are related to cervical cancer are prevented with this vaccine.
It is ideally given at an age of eleven or twelve to boys and girls, because even though boys aren't at risk for cervical cancer, they can carry the virus to their partners. And this vaccine is approved up until age 45. But ideally, we are getting boys and girls when they're a little bit younger.
[00:08:44] Speaker A: Okay. Yeah.
That's great information. I know that early on, there were a lot of concerns for parents around the age of their children and getting this particular vaccine, have we seen that change and evolve over time?
Have we improved in that space?
[00:09:04] Speaker B: Yeah, I think we've been able to show that the age of introduction of sexual activity has not changed with the vaccine, which I think is reassuring to parents. And I think the best way to explain it is that prevention is always better than treating. So if we can prevent these children from getting infected when they're older, I think that's always the best way to affect people's lives in the future.
[00:09:27] Speaker A: Right. And I think the benefit of having that relationship and consistency around who you see, and there's a trust factor, really helps with that. Definitely. The age has extended over time. It has from my first introduction as a parent and having a daughter as well. Why did that occur?
[00:09:48] Speaker B: So we've shown that 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, especially the ones that go on to cause hpv related cancers.
[00:10:06] Speaker A: Okay. But once you're diagnosed as having hpv, will that help at all to get the vaccine after that, or how does that work?
[00:10:17] Speaker B: So it hasn't been shown to help the strains of hpv that you already have. But this is an area of.
This is an area of investigation.
[00:10:26] Speaker A: These are some big words we're having to go through, and they're long. Like long syllabus.
[00:10:33] Speaker B: Exactly.
This is an area of investigation that people are looking at across the country.
[00:10:39] Speaker A: Okay. So more to come on that, and just wanted our viewers to know from the aspect of having hpv, I know it's all individualized, but what would someone expect?
[00:10:58] Speaker B: 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. Sometimes it means some additional biopsies, and sometimes you may need an additional procedure to your cervix to remove the abnormal cells. But the goal is to treat this when it's in a precancer or dysplasia stage, as opposed to waiting till it gets to a cancer.
[00:11:33] Speaker A: Okay, and could that include having more frequent pap smears to make sure they're not abnormal than the normal annual checks? Can you talk a little bit about that compliance?
[00:11:44] Speaker B: 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. 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] Speaker A: Okay.
And then what about a young person childbearing age? Is there a way to be proactive and still that not negatively impact 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] Speaker B: 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] Speaker A: Okay. All right. A lot of great information there. So I've talked about, and I went off script a little bit there, but really great information. And I know what I hear women inquire about from me as a healthcare professional. So we've talked a lot about ovarian cancer, cervical cancer, and there is little conversation as it regards to endometrial cancer, which is the most common of the gym cancers to be caught early on. So you want to talk a little bit about that. So there's some different naming there in the various presentations, which I know can sometimes be confusing for women.
[00:13:25] Speaker B: Yes. So endometrial cancer is the same thing as uterine cancer. Those two are used interchangeably. So when we talk about the endometrium, we're really talking about the inner lining of the uterus, and this is what grows and sheds every month with your menstrual cycle. So it's a little bit easier to understand what the endometrium is by thinking about it in that way.
[00:13:45] Speaker A: Okay.
[00:13:46] Speaker B: 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 have bleeding, they present to their doctor, and we generally catch these things earlier than some of the other cancers, like ovarian cancer.
[00:14:08] Speaker A: Obviously, early detection is so pivotal to treatment and outcomes. So is this the endometrial type of cancer, an easier one to treat? I don't know if that's the right.
[00:14:19] Speaker B: Word to say I think typically the uterine cancer or endometrial cancer can be treated with surgery. And I think that oftentimes surgery is all the patient will need. Depends a little bit on what type of cancer is found and some other specifics, but oftentimes we can treat it with just surgery. And this is, again, related to how we usually find these cancers at an earlier stage.
[00:14:45] Speaker A: Okay. Is there an association with any of these cancers and fibroids, which can be common in women?
[00:14:53] Speaker B: Good question. Fibroids have not been associated with these cancers, but I think the biggest thing is to get checked out. If you have any postmenopausal bleeding, I think 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.
[00:15:13] Speaker A: You have that, have them. Okay. All right. Really good information there.
Is there anything, I mean, we've talked about a lot. Is there anything that you feel would be beneficial, instrumental, to share with our viewers?
[00:15:28] Speaker B: 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 during your menstrual cycle, the lining is growing with hormones.
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 increasing obesity, these cancers are being diagnosed more commonly, and it's one of the only cancers in the country that's increasing in its incidence. 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] Speaker A: Right. Every time I get my bmi where it needs to be, it changes. So what is that obesity indicator?
What is considered obesity at this point?
[00:16:24] Speaker B: So, typically, a bmi over 30 is where we consider weight loss would be beneficial. And over 35, your risk of this particular cancer goes up.
[00:16:34] Speaker A: Goes up. Does it have anything to do with the adipose or those tissues particularly?
[00:16:43] Speaker B: So those tissues are what's producing the hormone. And this cancer is responsive to that hormone. So it's kind of feeding the tumor.
[00:16:51] Speaker A: It likes it, so it eats. Okay, exactly.
[00:16:53] Speaker B: So weight loss can be an important part of reducing your risk for this cancer.
[00:17:00] Speaker A: Okay.
All right, well, I don't know if we want to talk a little bit about. There's a lot of treatment modalities as it relates to all of these things. I think that's beneficial so that our viewers know that, hey, there's ways to treat these things, and the importance of early detection. But if they were to come up or experience some of these things, what are some of the procedures you want to highlight? I know minimally invasive robotic assisted surgery is something that's out there as well.
[00:17:33] Speaker B: So we do a lot of robotic surgery in gway and 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. And this improves patients healing times and allows them to get back to their life sooner. So it's really an advantage that we have at Riverside.
[00:17:56] Speaker A: Right. I'm really glad you mentioned that. Sometimes there can be some views about robotic surgery, but we have information at our fingertips now with social media and being able to search things prior to surgery, that the human factor can be better than the robot. But to your point, the robot can be even more precise.
[00:18:20] Speaker B: Right, exactly. And it can really benefit the surgeon and really allow us to do more through little incisions.
[00:18:28] Speaker A: Right. And less time in the hospital.
[00:18:30] Speaker B: Absolutely.
[00:18:31] Speaker A: So do you want to hear a little bit about chemo and radiation, some of those other treatments?
[00:18:38] Speaker B: So, Riverside cancer care network has comprehensive offerings for cancer care, and this includes chemotherapy and radiation. And so we work with surgeons, radiation oncologists, and medical oncologists to combine and treat these patients with any of the modalities that they need.
[00:18:58] Speaker A: Awesome.
That's great.
This has been such a great discussion.
Thank you so much for your passion and your commitment to support women.
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.
Just a great reminder, again, to women, build that relationship with your gyn. Have your regular checks, stay on top of things. Stay in tune to your body. Right.
So anything you want to say before we wrap up, but just great information.
[00:19:42] Speaker B: 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 like and they trust to take care of them.
[00:19:55] Speaker A: Yes. And stay in tune to your menstrual cycles.
[00:20:00] Speaker B: 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] Speaker A: That's a good one. And then when you no longer have the menstrual cycle. Stay in tune. If you're having, as you mentioned, bleeding.
[00:20:16] Speaker B: Absolutely. I would love if any woman that was having postmenopausal bleeding could come in and get checked out. We would impact a lot of.
[00:20:25] Speaker A: Yes, yes. Thank you so much, Dr. Borden, for joining us today. Please come back anytime.
And I know our viewers really appreciate you taking the time to help educate them.
[00:20:36] Speaker B: Thank you.
[00:20:37] Speaker A: So thank you again.
Thank you for listening to this episode of Healthy Youth. 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.
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