Are There Any Survivors in the Room? A Story for Gynecological Cancer Awareness Month

female-dr-comforting-patient“Are there any survivors in the room?”

I don’t remember why I was there, but it was a discussion of cancer. I looked around at the people who had raised their hands. It wasn’t until the speaker moved on that I realized I was a cancer survivor, too.

Does that seem strange? But my first cancer in 2004 was so ambiguous. I had had a routine Pap test, and was referred to a gynecologist. I had had problematic Pap tests before, and it had usually meant I had a uterine polyp or a vaginal infection. This time it was not simple dysplasia. It seems I had precancerous cells, and the recommended treatment was a hysterectomy. I thought about it, and my sister discussed it with a friend who was also a gynecologist, and reported back that surgery was indeed the treatment of choice.

How was I supposed to relate to a cancer diagnosis that was made only after the cancer was out of my body?

I was over 50, and had pretty much gone through menopause, though once or twice a year I would have some bleeding. Everything about my reproductive system was ambiguous. I had started menstruating at age 9, along with the body changes of puberty, but seldom had my periods. When I was 18 and starting to move beyond my circumscribed Jewish Bronx upbringing, I was diagnosed with Stein-Leventhal syndrome. Great, I thought, I finally get a diagnosis, and it’s Jewish! Since that time, the condition has been renamed polycystic ovary syndrome, or PCOS. PCOS is a risk factor for many other diseases, including endometrial cancer.

But let’s get back to the hysterectomy. I had already decided that I would have the surgery when my sister got back to me. What had my uterus done for me lately, anyway? I had the doctors make the arrangements, met with the surgeon, and went through all the pre-surgery rigmarole. I made plans to stay with a friend for about a week after surgery, and checked into the hospital. When I woke up afterward, I was told that the biopsy that was done during surgery had been negative. Continue reading

STD Awareness: “Can STDs Lead to Infertility?”

Being diagnosed with a sexually transmitted disease (STD) can be upsetting. Some take it as evidence that they’ve been cheated on; others wonder if they can ever have sex again. Some people who have long dreamed of having children might worry about what impact, if any, their STD could have on future fertility. The bad news is that certain STDs can make it difficult or impossible to have children. But the good news is that STDs are avoidable — and regular STD screening can ensure that infections are caught and treated before they have time to do damage.

It’s common for STDs not to have symptoms, and infections can cause tissue damage — unbeknownst to you!

Fertility can be impacted in several ways. The ability to become pregnant and bear children can be affected by a condition called pelvic inflammatory disease, which is usually caused by untreated gonorrhea or chlamydia infections. If you have a cervix, an infection with a high-risk strain of HPV can require invasive treatment, which in some cases might affect the ability to carry a pregnancy. If you have a penis, an untreated STD might lead to epididymitis, which in extreme cases can cause infertility.

Pelvic Inflammatory Disease (PID)

Many sexually transmitted infections are localized; for example, the bacteria that cause gonorrhea usually just hang out on the cervix. But untreated infections can spread on their own, and bacteria can also hitch a ride on sperm or the upward flow of a douche, which can take them into the cervix, through the uterus, down the fallopian tubes, and to the ovaries. At any of these locations, microbes can stake claim on your reproductive real estate, establishing colonies deep in your reproductive system. As these colonies grow, the bacterial infections become more widespread, and can cause scarring and other tissue damage. To keep these interlopers from getting through the front door, sexually active people can use barrier methods, such as latex condoms — especially with spermicides. There’s no need to host an open house for sexually transmitted bacteria in your uterus. Continue reading

Diagnosing Endometriosis

If you missed it, you can read the previous post explaining the basics of endometriosis here. In this post, we’ll look a little more at how endometriosis is diagnosed as well as some current barriers to diagnosis.

Wait. So you’re telling me that killer cramps of doom aren’t normal? If I did suspect I had endo, how would I go about getting diagnosed?

Endometriosis diagnosis is a tricky thing in that there’s no in-office procedure that can definitively determine whether someone has the condition or not. However, because the “gold standard” test is laparoscopy with biopsy — a surgical procedure — many health care providers prefer to do some in-office tests before recommending laparoscopy. The most common such procedures are pelvic exams and ultrasounds, which may allow a provider to see or feel if the endometrial lesions have formed cysts (known as “endometriomas”), but won’t pick up on smaller lesions.

Another complicating factor is that endometriosis isn’t the only cause of either dysmenorrhea or chronic pelvic pain. Other causes can include uterine fibroids, pelvic floor dysfunction, pelvic inflammatory disease, irritable bowel syndrome, and interstitial cystitis.

Even with laparoscopy, diagnosis isn’t necessarily straightforward. Not only is it a surgical procedure, which carries with it extra expense and risk, but even then, presence of the disease is often missed or underestimated. Seeking out a doctor who specializes in endometriosis can minimize this, but of course, due to geographic, cost, or other access issues, this isn’t always possible. Continue reading

Interpreting Abnormal Pap Tests

Because a Pap test screens for abnormal cervical cells and because those cell changes can be associated with cervical cancer, being on the receiving end of an abnormal Pap test result can be frightening, intimidating, and confusing.

On the “frightening” aspect: Some people assume that an abnormal Pap means that cervical cancer is imminent. On the contrary, the National Cancer Institute not only states that cervical cancer, when it develops, takes “many years” to do so, but also that “[t]he majority of infections with high-risk HPVs [human papillomaviruses] clear up on their own.” This is not to suggest that regular screenings aren’t important — but rather, that they do their job and detect cervical changes in plenty of time to prevent cancer from developing in the first place.

Remember that if you’re confused about your Pap test results, part of your health care provider’s job is to answer your questions and keep you informed.

On the “confusing”: It’s true. There are a lot of different letter codes. Though some of them look awfully similar, they each mean a different thing. Moreover, the clinical recommendations for how to follow up with an abnormal Pap can depend not only on the code — in other words, the specific abnormal result — but also on one’s age and medical history.

Ready to sort them out?

Most labs in the United States use a classification system called the Bethesda System in order to have some standard terminology when reporting results. The Bethesda System uses the term squamous intraepithelial lesion to describe changes on the surface of the cervix. It categorizes those changes in these ways: Continue reading