What can every woman do to avoid gynecological cancer – cervical, endometrial, ovarian? Why is sometimes an operation not needed, as it will harm, and how to correctly explain this to the patient?
Why does a surgeon need to read clinical studies and scientific articles, and how has working in oncology affected her attitude towards his life?
“I became less receptive to routine difficulties.” On the impact of work on personal life”
When I was still a schoolboy, I read a book where the hero had such a habit: when some problem arose in his life, he opened a history book, started reading it from any page, and understood that the events in the past were much harder than those with which he is now confronted. And this brought him relief and helped him find new ways to solve his problems because it became obvious that many of them were far-fetched.
So I am now – working as an oncogynecologist, and I have become less susceptible to some routine difficulties that arise in my personal life. They are not comparable to the problems that my patients face and endure them with great courage, and bravery, without losing faith in life.
“The gynecological oncology surgeries have impressed me a lot.” About choosing a specialty
I did not immediately come to oncogynecology. In the first years of the Omsk Medical University, where I studied, I generally thought that I would never be able to work as an obstetrician-gynecologist or oncologist.
I believed that oncology is associated with great grief for patients – and it is obvious that this is so. But what depends on the doctor in some cases helps a person cope with the disease, and now I understand this. And then he imagined the oncology dispensary as a very depressing place.
Soon one of my classmates had an internship there and said, “Nothing like that.” I started going there, and assisted surgeons – I was very impressed with oncogynecological operations, they seemed much more elegant than those that I had seen in gynecological departments. I was allowed to do the stages of operations, and in the 6th year, under the supervision of an experienced doctor, I operated to remove the uterus.
Then I decided to become an obstetrician-gynecologist, for some time I was on duty in the maternity hospital, I won a grant for residency training in this specialty and went to study in Moscow, but I realized that after all this is not what I would like to do all my life. In obstetrics, everything happens suddenly, it is difficult to plan something, plus an exhausting schedule with regular night shifts. I understood that in this mode, burnout would happen quickly enough for me.
At that moment, I accidentally found out about the Higher School of Oncology (a grant program of the “Not in vain” Foundation), applied, passed the selection, and moved to St. Petersburg for two years to study oncology at the N.N. N.N. Petrov. Every day I learned something new and gained tremendous experience and friends. I still remember the years of residency at the Petrov Institute with warmth.
You can never be categorical – this is one of the lessons that I learned from this story. Everything changes, and what seemed unacceptable before may be very acceptable at another time.
“We need to understand what we can influence and what we can’t.” About the prevention of gynecological cancer
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Each of us will die for some reason, and being afraid that one day we will develop, for example, ovarian cancer is not the right way to spend your free time. Therefore, it seems to me that we need to understand what we can influence and what we cannot.
For example, we cannot influence the fact that KAMAZ does not fly into the oncoming lane, but we can be fastened in the car, turn on the headlights, change tires in time – that is, do everything to reduce the likelihood of an accident. This also applies to cancer prevention.
As for gynecological, there are several effective measures for the prevention of cervical cancer. The main ones are human papillomavirus vaccination and screening. This is very important because this type of cancer is completely preventable, unlike endometrial (uterine) or ovarian cancer, for which there are no effective screening methods. It is also important to influence risk factors, in particular, to use barrier contraception – this will reduce the risk of contracting HPV.
When it comes to cancer of the uterine body (endometrium), the main thing is to monitor the body mass index, because being overweight is one of the main risk factors for endometrial cancer and associated type 2 diabetes.
As for ovarian cancer, up to 25% of cases have a family history, so if there are cases of breast cancer or ovarian cancer in close relatives, then it is worth getting advice from a medical geneticist to determine if there are hereditary mutations.
I would like to say to young, sexually active patients: undergo regular examinations by a gynecologist – at least once every three years – and take a cytological examination of the cervix.
For patients who have children, I would like to recommend that they be vaccinated against HPV.
Do not be afraid to consult a doctor if there is bleeding when it should not, or if the stomach has “grown”, the stomach has increased in size. Medicine is designed to help patients, and the longer a person suffers, the worse the result of treatment can be.
Yes, in many cases the tumor is so aggressive and growing rapidly that metastases are already detected at the first symptoms, and it is very difficult to influence the prognosis by early treatment. In particular, this applies to ovarian cancer: 70% of cases are detected at stages 3-4 when there are already metastases in the abdominal region.
Annual ultrasound and tumor markers as a screening for ovarian cancer have shown not only inefficiency but even danger: if regular ultrasound is done, then a large number of women will be operated on for benign ovarian formations that are in no way associated with cancer and will not degenerate into it. Any operation that is performed for a problem that does not require an operation is in any case a risk. In addition, the situation causes concern for the patient and her relatives.
“Gynecological cancers in young women – except cervical cancer – are rare stories.” About patients
Cases of illness in young patients are usually remembered. This is probably how our memory works because gynecological cancers in young women – except cervical cancer – are rare stories.
We operated on one of these patients on the eve of the last New Year. To be honest, I thought that the treatment would end much earlier and the result would be much sadder. And then somehow I go from one building to another, I see her and don’t recognize her: she looks much better, “came to life”. I began to find out what the reasons are.
It turned out that the patient began to participate in a clinical trial and receive new drugs that target the tumor – and the tumor responded well to treatment, it was taken under control.
The average age of my patients is 60-70 years. Yes, sometimes they have a question for me: “Doctor, you look too young, have you already done such operations?”. And I answer what I did – this is a frequent operation, standard, safe. And if I didn’t, then I honestly say that so far I haven’t had such an experience, but I will operate under the supervision of a senior colleague, or he will do it, and I will help. Any operation is not carried out by one person – there is always the opportunity to call someone who is more experienced in this.
“Find a treatment that will help a particular patient.” About the main skills of an oncologist
To operate – if without pathos – you can teach almost anyone. No matter how much some surgeons would like to say that this is something exclusive and extremely complex, globally, this is a skill that anyone can master with due perseverance.
There are types of tumors where surgery becomes the final treatment, but sometimes it can do very little for the patient – not bring any benefit and even worsen the quality of life. Therefore, the main task of an oncologist is to find a treatment method that will help a particular patient.
That is why it is necessary to read and analyze medical literature and studies – to find reasoned answers, and not just say: “Someone helped, some did not”, otherwise some patients will be retreated, while others will not receive the treatment they need. . In this analysis, in my opinion, the main interest of oncology.
For example, the most common situation we encounter is stage IIB cervical cancer, when the tumor has already spread beyond the organ. Even though this is the second stage, which is treated surgically for most types of cancer, it is pointless to perform surgery for cervical cancer – it will not benefit the patient, on the contrary, it will worsen the quality of life, and radiation therapy will still be required.
We are often asked: “Doctor, why don’t you do the operation?”. It is necessary at this moment to resort to the knowledge of research to explain that radiation therapy before surgery is preferable and more effective. Although it seems that removing the cancer is more effective than irradiating it.
Or another example: cancer metastasizes to the lymph nodes, and it seems that if they are removed, the result of the treatment will be better. But studies show that this logic does not work in real life and that the removal of lymph nodes in many diseases does not affect overall survival. At the same time, this is a traumatic operation: in particular, the removal of lymph nodes in the small pelvis can lead to lymphatic edema of the legs.
A method was invented for the biopsy of the sentinel (signal) lymph node. Its idea is that a dye is injected into the tumor or into the tissues next to it, which accumulates in only those lymph nodes where the tumor can metastasize.
This technique allows you to remove one or more lymph nodes in which metastases are most likely, and not all the lymph nodes in this area – and this is a great benefit for the patient.
Analyzing medical literature, writing scientific articles, and communicating with patients – are the skills I learned in the classes at the Higher School of Economics.
“I must do everything so that a person receives answers to his questions.” About communicating with patients
It’s hard to leave the hospital when you haven’t given the person the attention they need. After all, most likely, he is facing an oncological disease for the first time, and by the scale of the importance of this event, I understand that I must do everything so that the patient receives answers to all his questions.
If I don’t have time at a particular moment, I ask you to postpone the conversation until tomorrow and prepare for it – for this, I ask the patient to write down all the questions that concern her so as not to forget anything during the conversation. We have a room in the department where you can retire with the patient and discuss everything in private, without outsiders – this is very important.
It is always uncomfortable to tell bad news, and it is very difficult to stop treatment, but such fateful decisions are made only by a council of doctors to avoid subjectivity. The doctor is afraid that in the eyes of the patient he will look guilty in this situation, although, of course, this is not so. But there are certain protocols for talking on uncomfortable topics – with the knowledge of these algorithms, it becomes much easier.
It is important to present this information not as “We will not treat you”, but to explain that our possibilities are limited and treatment will only worsen the quality of life, but at the same time prolong it slightly. Therefore, it may make sense to consider the option of symptomatic therapy, which will make you feel much better and prolong your life due to this.
“What analysis may be required and what questions to ask the doctor.” About the “Just Ask” Help Desk
Also, for two years now, I have been consulting in the Just Ask online reference and explaining which doctor to contact, what analysis may be required, how to be observed after treatment, and what questions to ask the oncologist.
Unfortunately, our recommendations are not always easy to implement: it will most likely be difficult for a patient from a small city to undergo genetic sequencing for a BRCA mutation to detect hereditary breast and ovarian cancer syndrome. Not everywhere may have the necessary equipment for genetic sequencing, plus not all analyzes can be done for free – some of them are quite expensive. But I hope my help is helpful.
Of course, like any person, I get tired. The only thing that allows you to maintain good spirits after a busy working week is two days off ahead. But I was lucky in my profession. When you are a 17-18-year-old young man, and you have to choose what to do in life, it is difficult to make an adequate choice – I see this in many people who have chosen their specialty not because they have a soul for it.
And now I am very happy that, firstly, what I do gives me sincere pleasure, and, secondly, when I wake up, I have no idea that I need to go to work again – to that place where I work now, I go with pleasure. And this feeling, in my opinion, is experienced by few people. I’m lucky.
Useful materials about diseases of the cervix:
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The Good, the Bad, the Ugly: Benign Cervical Diseases
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The Good, the Bad, the Ugly: What is Cervical Cancer?
Why does cervical cancer (CC) develop, how and when to be examined so as not to miss it, and how can cervical cancer screening harm? More
The Good, the Bad, the Ugly: Which Vaccinations Will Protect Against Cervical Cancer
The main cause of cervical cancer is the human papillomavirus (HPV), which most people have experienced. The good news is that there are vaccines that protect against oncogenic strains of HPV. What are these vaccines? Who needs them and when should they be vaccinated? More
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