Gynecologic Cancer Chart and Second Opinions

Gynecologic Cancer Chart

Cervical

Ovarian

Uterine

Vulvar

Symptoms	Abnormal vaginal bleeding; Bleeding after sex; Vaginal discharge (Note: early stages often asymptomatic)
Causes	Human Papilloma viruses (HVP)
Risk Factors	Early sexual activity; Multiple partners; High-risk sexual partner; HPV or sexually transmitted disease (e.g., Chlamydia, herpes simplex virus); Smoking; HIV; Bearing many children; Prolonged use of oral contraceptives; Poverty; History of vulvar or vaginal cancer
Detection / Prevention	Regular Pap test; HPV testing - - - Treat abnormal pre-cancer findings; Limit sexual partners; Condoms; No smoking; Partner is circumcised; HPV vaccine
Incidence	11,150 new cases / year 3670 deaths annually 50% higher in African American women, 66% higher in Hispanic women

Symptoms	Daily occurrences for several weeks of: Bloating; Increased abdominal size; Urinary urgency or frequency; Difficulty eating or feeling full; Abdominal or pelvic pain
Causes	Unknown
Risk Factors	BRCA genes; Relative with ovarian cancer; Not bearing children; Age; Endometriosis; Prolonged usage of HRT (<> 10 years); Risk lowered with pregnancy; use of oral contraceptives; tubal ligation or hysterectomy with ovaries preserved; breast-feeding
Detection / Prevention	Role of symptom recognition: New Ovasure screening test for high risk (91% early detection rate and 99% rate of ruling out ovarian cancer) - - - Vitamin D3; Prophylactic oophorectomy (ovaries removed)
Incidence	20,180 new cases / year 15,310 deaths annually Most cases diagnosed at a late stage

Symptoms	Abnormal uterine bleeding - even one drop in post-menopausal women; Endometrial cells on a Pap test; Thickening of uterine lining on ultrasound; Sarcomas: Abnormal bleeding Pelvic pressure/pain; Enlarged uterus; Rapidly growing fibroids
Causes	Prolonged unopposed estrogen exposure (e.g., late menopause, or not using progestin with HRT
Risk Factors	Estrogen replacement therapy at higher doses and prolonged usage; Tamoxifen; Chronic anovulatory cycles (polycystic ovary syndrome); Estrogen secreting tumors; Diabetes; Obesity; Alcohol; Age; Hypertension; Hereditary non-polyposis colorectal cancer; Breast cancer; BRCA1; Not bearing children; Early menarche, or late menopause; Long-term soy supplementation; Vitamin D deficiency
Detection / Prevention	Trans-vaginal ultrasound and/or endometrial biopsy: 2-4% of uterine cancers are uterine sarcomas requiring histological exam of the entire uterus (endometrial sampling alone can be negative) - - - Protective factors: ideal weight maintenance; oral contraceptives; combined hormone replacement therapy; smoking; vitamin D3
Incidence	39,000 new cases / year 7,400 deaths annually Uterine sarcomas represent 2-4% of uterine cancers. Exclusion of a uterine sarcoma requires histological exam of the entire uterus - endometrial sampling alone can be negative.

Symptoms	Broad, raised unifocal or multifocal vulvar skin growth; Ulcer, or lump (fleshy, nodular, or warty) most commonly on the labia majora; Itching or burning; Skin growth with bleeding or discharge (Note: Many growths are without symptoms)
Causes	HPV; In-utero DES exposure for vaginal cancer; Extension of other genital cancers
Risk Factors	HPV infection; Cigarette smoking; Lichen sclerosis; Vulvar in-situ cancer; Other genital cancers; HIV; Prior history of cervical cancer; Northern European ancestry
Detection / Prevention	Vulvar self exam; Annual clinical exam - - - Possibly HPV vaccine; Postponing the beginning of sexual activity; Limiting the number of sexual partners
Incidence	3,490 new cases / year 880 deaths annually Vulvar in-situ cancers have more than doubled in women < 45

Second Opinions

Though it may feel awkward between the patient and medical provider, you should feel a right to seek another perspective on your situation, disease, pathology or treatment. It has been shown that when medical providers get ill, they often seek second, third, and fourth opinions. What is best for medical providers should absolutely be your right as well.

Sometimes you'll get the same recommendations in a second opinion, and you may be in a different space to hear and understand them. Sometimes you will be heard in a different way. Cancerguide.org provides the why, when, and who of second opinions: (summarized)

WHY:

1. To get a different perspective--some doctors are conservative and others more aggressive
2. Because no doctor can know everything all the time
3. To get a general quality check

WHEN:

1. If you have been given no hope or don't feel heard
2. If there is something 'borderline' or gray about your case
3. If you live in a rural or isolated area
4. If you are an HMO member
5. If your doctor wants you in his/her clinical trial
6. If you have a rare cancer
7. If you have 'cancer of unknown primary site'
8. If your pathology report doesn't give a definite diagnosis

WHO:

1. Independent doctors
2. Tumor Boards
3. A different type of specialist
4. An expert on your cancer