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What caused my cancer?
My pap smear didn't detect my cancer.
Why?
My pap smear came back a little abnormal.
Now what?
What is the difference between the stage
and the grade of a cancer?
Now that I have a cancer I want to start
eating right. Any suggestions?
I've heard a lot about a new "alternative"
treatment. What do you think?
I saw a report of a new cancer treatment.
What do you think about it?
Why is my cancer being treated differently
than my fathers cancer?
What is the difference between a "tumor"
and a "mass"?
What tests do you perform to follow the progress
of my treatment?
Have you billed my insurance company?
Are the doctors Medicare providers?
What is CA-125?
Do you see a lot of my kind of cancer?
I'm on my menstrual period. Should
I reschedule my appointment?
What are the different types of hysterectomies?
How long will it take to get an appointment?
What is a consultation appointment?
If I need surgery, how long will it
take to schedule?
Q: What caused my cancer?
A: Risk factors for development of only a few cancers are well understood.
With only one exception, however, the actual cause of cancers at a molecular
level is not known. The single exception involves squamous cancers
of the cervix. It is now known that several genotypes of Human Papillomavirus
(HPV) can induce a sequence of events in the nucleus of cells covering
the cervix which lead to development of an invasive cancer. 
Q: My pap smear didn't detect
my cancer. Why?
A: Believe it or not, the pap
smear is not meant to detect any cancer! It is actually
a tool designed to detect pre-cancerous changes of the cervix only.
This is the beauty of a pap smear. After all, it is much more important
to prevent the development of a cancer by treating the changes
that immediately precede its appearance than to wait for a cancer to show
up first. A single pap smear determination is not nearly as effective
as multiple pap smears obtained at regular intervals over time.
This is why the American College of Obstetrics and Gynecology suggests
that the majority of women should receive this test at a yearly interval.
Q: My pap smear came back a
little abnormal. Now what?
A: Three different techniques are used to fully evaluate the cervix -
cytology (pap
smear), colposcopy, and histology (biopsy). The pap smear evaluates
cells that have already sloughed off of the surface of the cervix.
A pathologist looks at these cells under a microscope and makes an educated
"guess" about the environment of the cervix. If a pre-cancerous
change is suspected the next step is to inspect the surface of the cervix
with a magnifying instrument called a colposcope. This technique
allows identification of minute abnormal areas that cannot be seen with
the naked eye. If such an area is seen then a histologic sample
is removed by performing a biopsy.
Q: What is the difference between
the stage and the grade of a cancer?
A: Most cancers can be subdivided by their "stage" and "grade".
Stage basically describes the location of the tumor at the time of diagnosis.
Gynecologic cancers typically have four stages - early cancers with no
gross evidence of metastases are classified as stage I, very advanced
cancers with extensive metastases are classified as stage IV. Grade
is a description of what the individual cancer cells look like under a
microscope. Gynecologic cancers usually have 3 grades - grade I
cancers vary little from the tissue of origin, whereas grade III cancers
bear little resemblance to the originating tissue.
Q: Now that I have a cancer I want to start eating right. Any suggestions?
A: It is always a good idea to pay close attention to what you put in
your mouth. Most Americans could certainly improve their diet by
minimizing saturated fats, red meats, cholesterol, salt and alcohol while
increasing fresh fruits and vegetables. It's probably a good idea
to take a multi-vitamin every day, too. Radical changes in your
diet or any other bad habits you may have (such as cigarette smoking)
should be made after you have completed treatment for your cancer.
After all, you are under enough physical and emotional stress just dealing
with your cancer - there is no need to compound this by adding further
stress in your life right now.
Q: I've heard a lot about a
new "alternative" treatment. What do you think?
A: The National Institute of Health's (NIH) Office of Alternative Medicine
(OAM) provides perspective on Complementary and Alternative Medicine (CAM).
CAM practices can be divided into a number of categories:
| CAM Classification | |
| Alternative systems of medical practice | Acupuncture, Ayurveda, Homeopathy, Naturopathy, Shamanism, etc |
| Bioelectromagnetic applications | Blue light, Electromagnetic fields, Magnetoresonance spectroscopy, etc |
| Diet, nutrition, and lifestyle changes | Gerson therapy, Macrobiotics, Megavitamins, etc |
| Herbal medicine | Echinacea, Ginger rhizome, Gingko biloba abstract, Yellowdock, etc |
| Manual healing | Acupressure, Alexander technique, Chiropractic, Osteopathy, massage, Rolfing, etc |
| Mind-body control | Art therapy, Biofeedback, Meditation, Prayer, Yoga, etc |
| Pharmacologic and biologic treatments | Antioxidants, Chelation therapy, Oxidizing agents, etc |
Most CAM therapies are unlikely
to adversely affect your cancer treatment. There are exceptions,
however. Garlic, for instance, can have beneficial therapeutic effects
on blood pressure and cholesterol levels. It inhibits platelet aggregation
and may have an adverse reaction in individuals on chemotherapy or aspirin
therapy. Colonic therapies administered inappropriately may significantly
decrease serum potassium levels. Some herbal products contain large
amounts of estrogen and may have an unwanted stimulatory effect on the
lining of the uterus. If you have more questions regarding CAM ask
your doctor or nurse or visit the website of the OAM
Q: I saw a report of a new cancer
treatment. What do you think of it?
A: Now that you have been diagnosed with a cancer it will seem like every
time you turn on the television or pick up a magazine or newspaper you
will see something about a "new and amazing" advance in the
treatment of cancer. Just remember that media outlets are in the
business of making money and they understand that "cancer sells"
air time, newspapers, etc,. "Advances" in cancer treatment
are well known to the medical community and either incorporated into or
discarded from clinical practice years before being reported to the general
public by television and print reporters. Even in the most respected medical
journals there is a lag time of up to 18 months between submission of
an article by an investigator and its publication. Because of this,
physicians acquire new information most rapidly and efficiently through
attendance at Society and sub-specialty meetings. By the time this information
filters down to traditional media outlets it simply "ain't news".
When you have questions about something you see on television or read
in a magazine your best bet is to check it out with us and get the "real
story".
Q:Why is my cancer being treated
differently than my fathers cancer?
A: There is a tendency to think of cancer as one disease that just starts
in different parts of the body. Actually every cancer is a unique
disease process. As an analogy, you can easily understand that there
is a different cause and treatment of a viral sore throat as compared
to appendicitis (yet both are "infections"). Your
fathers cancer was certainly not gynecologic in origin and
would not be treated in the same way as your malignancy. Finally,
the advances in cancer treatment appear so rapidly that it is unlikely
that any particular cancer is treated today in the same way it was treated
several years ago.
Q: What is the difference between
a tumor and a mass?
A: Medical terminology can sometimes be confusing. Here's a little
primer on terms you will hear when we discuss your cancer:
Cancer = Malignancy = Invasive
Benign = not Cancer
"Tumor" comes from the Latin word for "Swelling" (so,
technically, something like a pimple could be described as a "tumor")
Tumor = Mass
Not all Cancers are Tumors (e.g. leukemia)
Not all Tumors are Cancers (e.g. ovarian cystadenoma)
Q: What tests do you perform to follow the progress of my treatment?
A: You will be followed very closely during and for many years after treatment
of your cancer. Each time you come to the office a pelvic and abdominal
exam are performed
and blood
tests (e.g. CBC, CA-125, Squamous Cell Antigen, etc.,) are drawn.
You will also have imaging studies (CAT
scans, X-rays, Ultrasound, etc.,) performed at various intervals.
Initially you will need to be seen every month during your initial treatment.
After this period you will need to be seen in the office every 2-4 months
for 2-3 years. After 2-3 years you will be examined every 6 months.
Q: Have you billed my insurance
company?
A: We will submit claims to the primary and secondary insurance company.
The monthly statement indicates the date of service and the insurance
company to which your claim was submitted.
Q: Are the doctors Medicare
providers?
A: Yes, we accept Medicare assignment, which means Medicare will pay 80%
of the Medicare allowance and the secondary insurance, if any, will pay
for the additional 20% of the allowance.
Q: What is CA-125?
A: CA-125 is a blood test that measures the amount of a substance secreted
by many cancers and non-cancerous conditions. It is a helpful way
to follow the progress of your treatment for ovarian cancer and, to a
lesser extent, other cancers. It is not useful in diagnosing a cancer
since too many unrelated conditions can cause false elevations of CA-125.
You may have this tumor marker or other similar tests performed on a regular
basis. (For a more in depth discussion of the statistical value of CA-125
determinations written by Dr. William Rich click
here.)
Q: Do you see a lot of my kind
of cancer?
A: Yes. Gynecologic Oncologists treat only cancers of the female
pelvis. There will never be more than a few hundred board certified
Gynecologic Oncologist in the United States. This means that every
Gynecologic Oncologist has extensive experience in treating any kind of
female pelvic cancer.
Q: I'm on my menstrual period.
Should I reschedule my appointment?
A: No. Your menstrual period does not make interpretation of a pelvic
exam or performance of a pap smear any more difficult.
Q: What are the different types
of hysterectomies?
A: A hysterectomy is the removal of the uterus and cervix. Removal
of the ovaries is referred to as a bilateral salpingoophorectomy.
The common lay terms "partial hysterectomy" and "complete
hysterectomy" really do not have any medical meaning.
| Type of Hysterectomy | Reason for Performing | What is Done |
| Abdominal | Benign conditions, early uterine cancers | Removal of the uterus and cervix, with/without removal of the ovaries and fallopian tubes |
| Supracervical | Benign conditions | Removal of the uterus, with/without removal of the ovaries and fallopian tubes |
| Vaginal | Benign conditions, early uterine cancers | Removal of the uterus and cervix, with/without removal of the ovaries and fallopian tubes. |
| Radical | Cancers of the cervix and uterus. Some cancers of the ovary. | Removal of the uterus, cervix, upper vagina, parametria, with/without removal of lymph nodes, ovaries and fallopian tubes |
Q: How long will it take to
get an appointment?
A: If you have a newly diagnosed cancer you will usually be scheduled
for an initial appointment within one week.
Q: What is a consultation appointment?
A: The doctor will examine you and review any records you have.
You, your family and the doctor will then discuss the best treatment for
your problem.
Q: If I need surgery,
how long will it take to schedule?
A: Surgery is usually scheduled within 1 - 2 weeks from initial
consultation if your situation is not an emergency,.