Search for tag: "ovarian"

Dr. Jones: Let's talk about ovarian cancer awareness. Let's talk about what you can do to decrease your risk of ovarian cancer. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and this is The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Ovarian cancer is one of the deadliest of gynecologic cancers. We don't have an early detection test like the Pap smear, which is very good at early detection of cervical cancer. Ovarian cancer doesn't have an early warning sign like abnormal bleeding, which gives us a heads-up about early uterine cancer. Ovarian cancer is sneaky. The symptoms of ovarian cancer, bloating, abdominal fullness with eating, pelvic discomfort, all come when the cancer has spread at least a little bit. And these symptoms are pretty common in women so that makes it difficult to know exactly who you should work up.

We've talked before about the fact that cancers, in general, are about one-third genes, one-third environment and behavior, and one-third bad luck. We know we cannot change our genes and changing our luck is sort of a cosmic thing, but what can you do to decrease your risk of ovarian cancer? The most common kinds of ovarian cancers arise from the cells on the surface of the ovary. Some of these might actually be coming from the fallopian tubes with some types of ovarian cancers that just seem to arise from the uterine lining cells that find themselves in the pelvis.

A jillion years ago when I was on a GYN cancer service in Boston, we used to say that ovarian cancer was a nun's cancer. Boston had a lot of nuns and it seemed as if these lovely women had ovarian cancer more often than we would expect. Well, we do know that nuns have a slightly increased risk of ovarian cancer, compared to women in the general population.

What is true is that there's an increased risk of ovarian cancer in women who have never had children. This has been looked at a number of ways. First, there's a decrease in the risk of ovarian cancer by 50% in women who have had their tubes tied. Women who have had their tubes tied usually have had a bunch of kids. Two, there's an increase in ovarian cancer in women who are infertile. Is it being pregnant and having kids that protects you? Is it infertility treatment, all of those hormones and things that put you at risk? Is it the cause of infertility, like endometriosis, that both makes women infertile and puts them at risk? It might be all of these.

Having said all that, I don't want women to rush out and have a bunch of kids that they might not be prepared for just to decrease their risk of ovarian cancer. It turns out that the Centers for Disease Control did a big study on contraception, and hormones, and gynecologic cancers and lo and behold, taking birth control pills lowers the risk of cancer by as much as 50%. It even lowers the risk of ovarian cancer if you have the family genes like the BRCA mutations that put you at risk for ovarian cancer. How do hormonal birth control pills do that? We don't exactly know, but it could be that ovulation, which disrupts the surface of the ovary each month, is a little bit risky with respect to ovarian cancer.

So how do you decrease your risk of ovarian cancer? If you're thinking about contraception, you may want to consider birth control pills. We don't seem to find the same protection with IUDs or implants, at least not yet as implants haven't been around that long yet for us to really know.

Another ovarian cancer prevention strategy, because there's some suggestion, and it's controversial, but that cells from the fallopian tubes may play a role in ovarian cancer. There's some suggestion that women who have their fallopian tubes removed, not their ovaries, just their tubes, have a decreased risk of ovarian cancer. So if you're thinking about having an operation to have your tubes tied, either immediately after a baby is born or later with the laparoscopy, maybe you should talk to your gynecologist of having your tubes removed. Importantly, if you have a BRCA mutation in your family and you have that mutation that is one of the genetic causes of an increased risk in ovarian cancer, you may choose to have your ovaries removed.

Now, there are some other things that may have an association with an increased risk of ovarian cancer. We don't know if these are a cause, but it seems to be an increased risk. There's a slight increased risk of ovarian cancer in women who take hormone replacement therapy after menopause. The risk is small and we don't understand the cause, but it's there to think about. And there seems to be a small increased risk of ovarian cancer in women who use talcum powder down there, on their perineum, on their lady parts. Even if the risk is low, it probably isn't necessary and we don't suggest it.

So I'm not suggesting that nuns should take birth control pills, although that has been suggested by some. And I'm not suggesting that women have more children that they're unprepared for. But there are some other health benefits of birth control pills: lighter periods, lower risk of uterine cancer, and if you're having your tubes tied or operated on to end your fertility, maybe taking the tubes out isn't a bad idea. And talcum powder on your lady parts isn't a good idea.

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My patients tell me that they've had an ovarian cyst. "What kind?" I ask. "I don't remember," is the common answer. Well, that's not a helpful answer.

Ovarian cyst comes in two flavors, functional cysts and nonfunctional cysts. Functional cysts are usually the good kind. They arise from the function of the ovary. A woman who ovulates makes a cyst about one inch in diameter every month. And there are a lot of smaller cysts every month that go along for the ride. These functional cysts come in two types. Follicular cysts that have the eggs and corpus luteum cysts that the follicular cyst turns into after ovulation.

Now the Follicular cyst is filled with clear fluid, doesn't have much of a blood supply, and occasionally can get pretty big, as big as four inches. Getting that big isn't common, but it happens. And unless there's a lot of pain with this big cyst, the important thing is to leave it alone. These cysts go away after a few weeks. How do you know if you have one? Well, every woman with functional cysts has these, and they usually don't know about them unless they're getting an ultrasound for some reason.

We watch these cysts grow with great interest and hope in infertility therapy and in vitro fertilization. Sometimes a woman can learn she has one because it becomes bigger and causes pain. Follicular cysts can look a certain way on ultrasound, clear fluid, with a very thin cyst wall. So we know for pretty sure that these are good cysts, and we try to wait and let them go away.

After ovulation, the follicular cyst becomes a corpus luteum cyst. This is a progesterone factory whose job it is to make the hormones to prepare the uterus for pregnancy. If no pregnancy occurs with the ovulation, then these cysts go away in about two weeks. These cysts are very active making hormones, and they have a rich blood supply. If they get bumped, and you can figure out ways that they could get bumped, they can bleed and grow rapidly with blood and can hurt.

Women who have a corpus luteum cyst that bleeds a lot can come to the doctor or the emergency room and an ultrasound can usually make the diagnosis because they look like a cyst with new blood in it. We try not to operate and let the cyst go away on its own, which may take a month or so. Sometimes there's so much bleeding into the abdomen that it requires surgery, but we try not to operate and leave scars on the ovary if possible. So when a woman can tell me that she had a functional cyst or a corpus luteum cyst that required surgery or a follow-up, I know I don't have to worry because these are the good cysts.

Now, the bad cysts. There are nonfunctional cysts or neoplastic new tissue cysts new tissue cysts. Any of the tissues in the ovary can grow to make a cyst and some of these cysts can get big, really, really, really big. The biggest neoplastic cyst in recorded history was 328 pounds. That is really big. These cysts come in different types, depending on the kind of cells that made these cysts. Serous cysts, mucinous cysts, dermoid cysts, I could go on.

We usually operate to remove these cysts when they get bigger than two inches because they can grow and it's much easier to remove a cyst when it's two inches than when it's 20 inches or bigger, bigger, bigger. We cannot tell exactly what kind of cyst it is some of the time just by looking at an ultrasound, but we do know what it is when the pathologist looks at it. Some cysts are made out of egg tissue make hair and teeth and other kinds of tissues, and they look a certain way on ultrasound. But usually, we give them to the pathologist and let them figure it out. Why should you know what kind of cyst you had removed? Because some cysts tend to predict that you'll get another one.

Now, for the ugly. Some nonfunctional cysts are ovarian cancer. This is another reason that we remove nonfunctional cysts when they grow and look different on ultrasound than functional cysts. Ovarian cancer is not terribly common. About 10 per 100,000 women per year or a little more than 1% risk in a woman's lifetime.

Ovarian cancer has no symptoms when it's very small so it can be hard to catch early. When a cancerous ovarian cyst gets bigger, it can cause pain, and pressure and a feeling of abdominal fullness because we cannot always tell which cysts or cancerous on ultrasound. Although cancer cysts do tend to look quite different from functional cysts, we tend to want to remove cysts when they grow, and especially if we find them in women who are post-menopausal and shouldn't be making cysts.

So if you've had surgery or medical care for an ovarian cyst, you should keep a record of what kind of cyst it was. Get a copy of the report from your doctor and keep it in your medical records. Ovarian cysts come in different types, and we have different concerns, and different follow-up, for women with some cysts. In fact, any woman who has had surgery on her reproductive organs should have a copy of her operative report and pathology in her permanent medical records.

Maybe someday, we'll have a universal electronic medical record and all of it will be there for your doctor to help you. But until then, keep your own copies on file and thanks for joining us on The Scope.

updated: July 9, 2020
originally published: August 11, 2016

Dr. Jones: If you're having a hysterectomy for problems with your uterus, should you have your ovaries removed the same time? This is Dr. Kirtly Jones from obstetrics and gynecology at the University of Utah Healthcare, and this is The Scope.

Announcer: Covering all aspects of women's health this is the seven domains of women's health with Dr. Kirtley Jones on The Scope.

Dr. Jones: A recent study from Sweden published in the British Journal of Surgery found that women who have their ovaries removed were at higher risk of colon cancer. A more careful look at the numbers found that this was a study looking back through the Swedish Patient Registry, about 200,000 women who had their ovaries removed for one reason or another compared to thousands, hundreds of thousands of women who did not. They found that removing the ovaries increased the chance of developing colon cancer in the future by 30%.

Now, Scope listeners are smart about numbers and they should be asking themselves right now 30% of what? Although 30% increase is a scary figure, the real rate of colon cancer in women who did not have their ovaries removed, was 1.3/100. And in women who had their ovaries removed it was 1.6/100 and that was a 30% increase, but it's not so scary when you look at the real numbers.

Now this was a study looking back at health histories. And maybe women who had their ovaries removed had other health risks for colon cancer, but there is another strong set of scientific evidence that estrogen protects against colon cancer. In general, women get colon cancer later in life than men. In the women's health initiative, a prospective randomized placebo controlled trial - the gold standard of medical evidence - found that taking estrogen slightly decreased the risk of colon cancer compared to women who were taking placebo, about 30%.

Finally, in a lab, adding estrogens to colon cancer cells partly inhibits their growth. There's plausible evidence in the laboratory. There's a prospective randomized trial and there's some big data that says taking out your ovaries puts you at increased risk of colon cancer. However, women don't think of colon cancer as being a woman's problem, even though about 1 in 24 women, about 4% of women will get colon cancer in their lifetime compared to 1 in 21 men. So it isn't that uncommon.

Women think about ovarian cancer as being a woman's problem. The lifetime risk of ovarian cancer is 1 in 75, significantly less common than colon cancer in women. Of course taking the ovaries out just decreases the risk of colon cancer but taking up the ovaries mostly but not completely decreases the risk of ovarian cancer. The famous Nurses Health Study followed thousands of women for many years and looked at their health outcomes if there were other conditions that are more likely in women who have their ovaries removed. Coronary heart disease is more common in women who've had their ovaries removed and osteoporosis bone thinning is more common in women who have had their ovaries removed. Lung cancer, believe it or not, is more common in women who had their ovaries removed. Breast cancer is less common, of course, in women who've had their ovaries removed.

So your surgeon is in your tummy to perform a hysterectomy because you have too much bleeding, and you're under anesthesia and you're about 50 years old. Should you have your ovaries removed? Removing the ovaries adds very little to overall risk of the surgery and your ovaries look normal.

This is a conversation you should have had with your surgeon long before you were in the operating room. What are your risks of ovarian cancer? Do you have ovarian cancer in your immediate family? Do you carry a BRCA mutation that increases your risk of breast and ovarian cancer? Did your best friend die of ovarian cancer and it's your number one fear and you can't stop thinking about it? Then the answer is probably yes. Talk to your surgeon about removing your ovaries.

However, in one study, about 98% of women who had their ovaries removed at the time of the hysterectomy were not at increased risk of ovarian cancer. In the end, weighing the risks and benefits, it's a highly personal decision. Although a Mayo Clinic paper and the Nurses Health Study that looked at all causes of death found out that women who had their ovaries removed in the past for non-cancerous reasons died just a little younger than women who didn't.

This decision is one for you to make with your doctor, but you should come to your appointment prepared. You can just google, "Should I have my ovaries removed" and there lots of choices, but I would suggest the website at the University of Wisconsin as an excellent interactive tool. Google, "Should I have my ovaries removed University of Wisconsin" and it'll get you there. But it's also on our website.

Full disclosure, I am the OB/GYN editor for Healthwise, the non-profit patient education company who created this patient decision document. Get the facts, not just the fears and make the right decision for you, and thanks for joining us on The Scope.

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Interviewer: There is pain when you have sexual intercourse. Is this a normal thing or should you be concerned? That's coming up next on The Scope.

We're talking today with Dr. Kirtly Parker Jones. She's the expert in all things woman. Dr. Jones, we got an e-mail asking about pain during sexual intercourse. That doesn't sound normal, but again, I'm not an expert, so you tell me, is that normal?

Dr. Jones: Well, let's talk a little bit about pain with intercourse. It's got a fancy named called "dyspareunia." If you heard that name you wouldn't know that meant pain with sex, but that's what it means.

So first of all, one always needs a little bit more information. My guess is that every single woman on the planet has had dyspareunia, pain with sex, at least first, and that was the first time. It's not uncommon. In fact, it is common for women to have pain with sex the first time.

Now, when we think about what's normal, normal is something that happens to more than 5% of people. So when they actually asked 428 women of reproductive age, so that would be 12 to 50, if they had pain with intercourse, 75% of them responded. Now, that meant 25% weren't responding because either they didn't have sex or they didn't want to talk about it, so we don't know about that 25%. But of those that responded, 39% said they had never had pain with intercourse, and I know they're lying because they at least had pain the first time. Twenty-seven percent said they'd had pain some time in their life, and 35% had dyspareunia at the time of the survey. So that means pain with intercourse, by our definition, our medical definition of normal, it means that pain with intercourse is normal, meaning more than 5% of women have pain with intercourse.

Now, having said that it probably is normal doesn't mean that it's nice. So let's back up a little bit and talk about why women might have pain with intercourse. Other than the first time, when tissues are getting stretched with intercourse the first time, one always worries about, number one, if there's an infection. So certainly, women who have a yeast infection, some women with sexually transmitted infections like gonorrhea and chlamydia, those are situations where someone could have pain with intercourse. And if it's new pain with the same partner, then one begins to worry about, is it something in the vagina like a yeast infection, is it an infection in the pelvis like a sexually transmitted disease, or do you have an ovarian cyst or something in your pelvis that, when it gets bounced around, hurts a little.

The second concern is for women who are post-menopause or post-partum. So women who are nursing after they give birth have very low estrogens during the time that they nurse, and if they nurse for a long time, meaning more than six months, they might find their tissues get quite thin. And women who are post-menopausal, their tissues, their vaginal tissues, are quite thin, and that hurts. So if it's a post-menopausal woman, we have good reasons to understand that painful intercourse could happen, and we have good treatment.

Number three, new partners, new positions, new anxieties, is there something about this particular intercourse or this new partner that makes you uncomfortable so you're having sex when you're not actually well-lubricated? So one begins to say, "Is there something new in your life, a new partner, a new position? Are you using something different? Are you allergic to some of the sex toys or lubricants that you're using?" So we'll ask that.

So are you normal to have pain with sex? And the answer is, yes. Is it nice? And the answer is, no. Can we do something about it? And the answer is, most of the time we can. Talk to your clinician. We can usually make it better.

updated: May 13, 2021
originally published: November 5, 2015

Dr. Jones: The number one cause of cancer deaths in women? Most women would say breast cancer, but its lung cancer, and although the rate of lung cancer in men is falling, lung cancer deaths in women is rising. This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care and November is Lung Cancer Awareness Month. Lung cancer in women, today on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Jones: The white ribbon. We see pink ribbons everywhere for breast cancer, teal ribbons for ovarian cancer, but where are the white ribbons for lung cancer? The CDC reports that more women die of lung cancer than breast, uterine, and ovarian cancers combined. Twenty-seven percent of all cancer deaths in the US are caused by lung cancer. The five year survival rate for those diagnosed with lung cancer is 16%, which makes it a particularly deadly cancer. Now, the lung cancer rate has fallen 21% among men, but for reasons that remain unclear, the rates have risen 116% among women. Of course, we all know that smoking is the major risk factor. Since 1960, the rate of smoking in men has gone down, but for women, not so much.

Lung cancer develops differently in women than men. Women who have never smoked have a greater risk of developing lung cancer than men who've never smoked. Go figure. Worldwide, 53% of women with lung cancer were never smokers. They could have been exposed to more indoor air pollution related to cooking and heating, and that may be the risk factor for women in Asia and in China and somewhat in the United States. Women tend to develop lung cancer at a younger age than men, too. The good news is women are more likely than men to be diagnosed in early stages of lung cancer, because women probably get more health care, and women tend to live longer than men after treatment for lung cancer. So, that's the good news.

Well, I'm thrilled to live in Utah where smoking is so uncommon, and where it's against the law to smoke in enclosed public places. However, a notable trend in the increase in lung cancer among healthy non-smokers is known primarily in women. If lung cancers in non-smokers were its own category, it would rank among the top 10 of fatal cancers in the US. Lung cancer can result from factors other than smoking. Genetic mutations, as well as exposure to radon gas, secondhand smoke, air pollution and asbestos, among some other things. In Utah, we have particular geographic risks related to radon and air pollution.

So, what to do for this largely preventable, common cancer? If you're a smoker, you should stop smoking. Ten years after quitting, your risk of lung cancer is half of what it would have been if you didn't quit. If you're a heavy smoker over 50, talk to your doctor about the pros and cons of low dose CT scans for screening. If you aren't a smoker, don't start. If you're an adolescent or the parents of one, starting smoking is especially bad, as you're more likely to be addicted to nicotine, and have your developing brain wired for risky behavior, like alcohol.

Lowering your risk of secondhand smoke. If someone in your family smokes, no smoking in the house or in the car. Check your home for radon. Now, radon is a naturally occurring radioactive gas that results from the breakdown of uranium and soil and rocks. It cannot be seen, tasted, or smelled, and according to the EPA, radon is the second leading cause of lung cancer in this country, and it's the leading cause among non-smokers. Outdoors, there's so little radon that it's not likely to be dangerous, but indoors, radon can be more concentrated. When it's breathed in, it enters the lungs and exposes them to radiation. Homes in some parts of the US, like Utah, which are built on soil with natural uranium deposits can have high indoor radon levels, especially in basements. My basement is ventilated and has a fan in it specifically for that reason, and I live here in Salt Lake City.

If you are concerned about radon exposure, you can use a radon detection kit. State and local offices of the EPA can give you the names of reliable companies who can test your home. So get it checked and get it fixed. Limit your time on the freeway and be an advocate for clean air. Eat your fruits and vegetables. Antioxidants in your diet is associated with lower risk of lung cancer. Vitamin pills won't do the trick. So, ladies and gentlemen, put on your white ribbons this month. Lung cancer is largely a preventable disease. Think about the air you breathe and what's in it. Protect yourself and the people around you. This is Dr. Kirtly Jones and thank you for joining us on The Scope.

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