After journalist Gwen Ifill died of endometrial cancer in November, many women have been asking me about this disease. And with good reason.
While endometrial cancer is the most common gynecologic cancer, it is typically the most treatable: The five-year survival rate is nearly 82%. I don't know enough about Ifill's case to say why she succumbed to the disease, but her tragic death highlights just how aggressive endometrial cancer can be if not diagnosed early enough or properly managed. For this reason, it is important to understand your risks and recognize warning signs.
Because the cancer typically starts in the cells that line the uterine cavity, vaginal bleeding between periods and after menopause is a common symptom. This abnormal bleeding prompts most women to see their doctors.
Unfortunately, I and many other oncologists have seen women in our office who either ignored the warning signs or didn't act on them quickly enough. Roughly one-third of endometrial cancer cases are aggressive, with a disproportionate number of those cases affecting African-American women. If you are experiencing bleeding, even light bleeding, after menopause, call your doctor.
Also, be mindful of your risk. Genetics play a role in a small number of endometrial cancer cases, the most common being Lynch syndrome. And hormones are another risk factor, which is why endometrial cancer occurs more often in women who have high estrogen and low progesterone levels, such as in women who don't ovulate regularly.
The No. 1 modifiable risk factor, however, is weight.
Obesity has long been linked to endometrial cancer. In fact, due to the prevalence of obesity in women, incidences of endometrial cancer are expected to increase by 55% from 2010 to 2030, according to the National Institutes of Health. Reducing your weight helps you reduce your risk.
If you do have cancer, seek out the most experienced team you can. Treatment often involves hysterectomy, a surgery to remove the uterus. In fact, in the early stage, hysterectomies often “cure” the cancer. But it is critical that this surgery be performed by a gynecologic oncologist.
Most gynecologists in Orange County refer their patients to a gynecologic oncologist if they develop cancer. Because our expertise is cancer, gynecologic oncologists have access to therapies and treatments that can translate to better outcomes and easier recoveries. For example, at Hoag we were early to adopt the procedure of sentinel lymph node removal during endometrial cancer treatment.
Rather than remove 10 to 20 lymph nodes during a hysterectomy, evidence now shows that identifying, removing and examining a patient's sentinel lymph node is just as effective in helping us to determine whether cancer cells are present. The sentinel lymph node is the first lymph node that cancer “drains” into, and it can tell us whether additional treatment, such as chemotherapy or radiation, is needed after surgery.
By identifying and removing the sentinel lymph node during a minimally invasive surgery, we are able to reduce the risk of chronic lymphedema. Over the coming years, this will become the standard of care, but right now it's available only from experienced gynecologic oncologists.
The many questions women have asked me about Gwen Ifill's death all tend to boil down to one sentiment: “How could she have died from this disease?” This “treatable” cancer, clearly, can kill.
What is important in the aftermath of this high-profile death is to remember that endometrial cancer is nearly always highly curable if caught early and treated by an experienced medical team. Be aware of your risks, work to reduce them and act quickly if you see any signs of trouble.
DR. LISA ABAID is a gynecologic oncologist on medical staff at Hoag Memorial Hospital Presbyterian.
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