Below you will find some highlights for each topic question. Resources can be found at the end of the post.
T1: Most gyn cancers are treated with surgery. What types of surgeries can women diagnosed with, or at high risk for, the different gynecologic cancers expect?
- T1: For cervical cancer or pre-cancer, there are many types of procedures and it can get confusing. @StopHPVCancer just shared this resource from @AmericanCancer today that gives an overview: #gyncsm Surgery for Cervical Cancer https://www.cancer.org/cancer/cervical-cancer/treating/surgery.html
- A1: Surgery for gyn cancer usually involve removal of some part of the female reproductive tract. The ovaries, uterus, cervix, vagina or vulva. And may involve removal of more than one of these organs as well as lymph nodes and other biopsies.
- A1: #Previvors may consider a risk-reducing salpingo-oophorectomy--the removal of (healthy) ovaries & fallopian tubes to reduce the risk of ovarian cancer. A helpful resource for more info: https://www.facingourrisk.org/understanding-brca-and-hboc/information/risk-management/oophorectomy/ #gyncsm #HealthComm #HereditaryCancer #GeneticRisk
- T1: Although rare, #sarcoma can arise anywhere in the body, including a woman's reproductive tract. Surgery is standard. But some women may get radiation or chemo beforehand in hopes of reducing a large tumor that affects other organs. #gyncsm
- t1 as per @CancerDotNet Tumor removal, Debunking, Palliation Surgery, Laparoscopy surgery, laser surgery, /cryosurgery, Different cancer types-ovarian cancer, uterus cancer just naming a few.
- @StopHPVCancer @AmericanCancer #gyncsm agree good resource! . Can be confusing especially in #cervicalcancer but have your md review types and indications; many different options depending on fertility preferences, invasive vs. precancer(severe dysplasia); age;
T2: What are the differences between Minimally Invasive Surgery (MIS) and Open surgery? How does the type of surgery impact outcomes and side effects?
- Minimally invasive surgery is either laparoscopic or robotic surgery. It means small incisions, less blood loss and fewer complications. But this has to be balanced with long term oncologic outcomes. We still want patients to get the best possible cancer surgery. #gyncsm
- Yes patient factors must be considered as well - prior surgery, location and size of the tumor. Surgical plans should be individualized. #gyncsm.
- There is now a lot of data supporting that for most women with #cervicalcancer minimally invasive surgery leads to worse survival - the evidence is from many sources including clinical trials and population data. #gyncsm.
- Some surgeons are still advocating for MIS for cervical cancer and in certain cases this might still be an appropriate decision. But this requires shared decision-making. And of course if your surgeons recommendations don't sound right get a second opinion! #gyncsm
- T2 balancing long term goals of surgery
- T2: There are no foolproof tests to detect uterine #leiomyosarcoma before surgery. Women face greater risk of metastasis & death if they have MIS with power morcellation. Less research on tumors cut by hand. #gyncsm
T3: What are some important things for women to consider before surgery?
- T3 personal risk. Recovery time. Medications
- risks/benefits, advance directives, durable power of attorney, and support systems.
- Those at risk for #HereditaryCancer may consider fertility preservation and assisted reproductive technologies (aka ART). Here's another helpful resource, which provides an overview: https://www.facingourrisk.org/understanding-brca-and-hboc/information/fertility-parenting/fertility-preservation/index.php #GeneticRisk #FamilyPlanning #HealthComm
- The research on outcomes point to involving a gyn-oncologist in the surgery. @ocrahope has a good overview - Why should a woman who has indications of ovarian cancer seek referral to a gynecologic oncologist as soon as possible? https://ocrahope.org/patients/about-ovarian-cancer/symptoms-and-detection/about-gynecologic-oncologists/ #gyncsm
- T3: Here's a more scholarly article re: The Relevance of Gynecologic Oncologists to Provide High-Quality of Care to Women with Gynecological Cancer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712269/
- T3 - before surgery things for women to consider are goals for treatment, personal goals, quality of life, what is she willing to live with, long term side effects, risk of recurrence, subsequent tx..
- It may also be helpful to talk to your partner WITH your healthcare provider to discuss each other's goals, desires, needs, etc.
- Yes for woman with #ovariancancer outcomes are improved if they see a gynecologic oncologist with their initial diagnosis. Yet nationally, fewer than half of ovarian cancer patients ever see a gynecologic oncologist. #gyncsm
T4: Many women experience early menopause after having their ovaries removed during surgery. What are ways to manage menopause symptoms?
- I've heard too many stories of women who were completely unprepared for surgical menopause and their care team hadn't really covered it. Really important also in previvor care and decision making.
- T4. Ice packs & a sense of humor #gyncsm
- Some women may still be candidates for menopausal hormone therapy even after a gyn cancer diagnosis if their ovaries have been removed. It's worth discussing with your doctor.
- surgical menopause- very critical/should be a very important part of consent process; address what to expect and how you could address specific symptoms ex. sexual function; vasomotor/hot flashes; etc; medical vs non medical interventions depending on surgery indication
- T4: Some women may be able to take hormones, for those whom hormones are not safe management can be difficult. Some antidepressants can help, accupuncture may be worth a try and no one ever likes this answer but... exercise may be helpful. #gyncsm
- elimination of foods. Having a fan bedside to help with hot flashes. Air conditioning. Layered clothes. Acupuncture possibly.
- 4: Women with low-grade endometrial stromal #sarcoma may go on Megace or other drugs to control their hormones.
- T4: #gyncsm ; great info for women and cancer ;menopause ; sex and cancer; and much more @drmonicaxmas @WomanLab_ @stacylindau ; love these resources , MDs and team! https://womanlab.org/menopause-can-be-complicated-non-hormonal-treatments-shouldnt-be/
- T4: A lot of women who have radical hysterectomies will need to use dilators to keep their vaginas from shrinking. Don't have sex if it's painful (unless you're into that). Lubricant is your friend. #gyncsm
T5: What are some of the physical side effects, both short-term and long-term, from surgery related to gyn cancers? What methods and therapies are recommended for dealing with these side effects?
- #gyncsm numbness, bleeding, infection, lymph edema, bowel obstruction, dietary concerns, One can recommend Palliative Care, medication, nutritional consult, spiritual, and find a social worker to navigate, facilitate and organize.
- Yes, palliative care really important. These are just the surgery side effects... also can be dealing with chemo, radiation, and more...
- There are some pelvic Physical therapy exercises that can help . I had GI issues for a long time after my surgery. Diet changes ( higher fiber) helped me with that. #gyncsm
- T5: Incontinence is my very least favorite side effect.
- Lymphedema can be quite difficult to manage and is typically worse for women who have had pelvic surgery and radiation. physical therapy can help but is a commitment
- T5. INSOMNIA also #gyncsm
- many patients have sexual side effects (low libido, painful intercourse) but patients often feel uncomfortable discussing this with their physicians. a physical therapy referral for this can be very helpful. #gyncsm
- T5. I like https://lmsdr.org/ for info on #leiomyosarcoma, including gyn primaries. I think it's harder to get info on other gyn sarcomas. But women can turn to peer support programs such as @fflcancersprt, @ImermanAngels & @MDAndersonNews' MyCancerConnection.
- T5: For those of us who had vaginal cancers and were single, the thought of dating can be daunting. Now that I'm 61, however, I find men are less picky.
T6: What are some of the emotional side effects from surgery related to gyn cancers? What are some helpful resources and tips for these?
- #gyncsm depression, feeling not whole. Anxiety.
- T6 Emotional side effects can include, depression, anxiety about sex, anxiety about scarring, etc. #gyncsm
- Article via @cure_magazine - Patients Speak Up About Gynecologic Cancer Side Effects https://www.curetoday.com/publications/cure/2019/womens-cancers/under-the-spotlight-patients-speak-up-about-gynecologic-cancer-side-effects #gyncsm
T7: Have there been impacts from COVID-19 on surgeries - timing, type recommended, length of surgery, special precautions, other impacts?
- I know that a lot of prophylactic surgeries were either cancelled or delayed. #gyncsm
- T1 In Maryland, many surgeries were delayed or postponed due to the crisis. #gyncsm
- A7: I have not personally been affected but know some who have had their preventive surgeries (i.e., BSO) delayed. Also, others have told me their fertility preservation has been delayed/postponed due to COVID-19. #gyncsm #ayacsm #familyplanning #HealthComm
We end all our chats with TIL - Today I Learned. Here are a few from tonight.
- TIL: About lymphedema after GYN cancer surgery, the long term physical and emotional side effects of surgery, and once again the lack of communication with some about early menopause. I appreciated all of your thoughts so much tonight! #GYNCSM
- TIL that we as health professionals have some work to do to make sure that women are fully aware of the long lasting effects surgeries (and other treatments) may have. #gyncsm
There will be no #gyncsm chat in June. Save the date for our next chat Wednesday July 8, 2020 at 9pm ET. We also invite you to check out these other great healthcare conversations happening on twitter: http://gyncsm.blogspot.com/2019/01/looking-for-cancersocialmedia-chat.html #bcsm #btsm #lcsm #mmsm #ayacsm #PANCChat #hpm #hcldr #cureconnect #wegohealthchat #patientchat
Wishing wellness and safety for all!
Dee and Christina
RESOURCES
Foundation for Women’s Cancer @GYNcancer Postoperative pain management https://www.foundationforwomenscancer.org/wp-content/uploads/2019-FWC-Patient-Education-Handout-Postoperative-Pain-Management-10.21.19.pdf
@BasserBRCA preparing for surgical menopause. https://www.basser.org/news-and-media/blog/2019/23/what-you-need-know-about-surgical-menopause
"Racism in Healthcare Is Putting Black Women's Lives at Risk" https://www.oprahmag.com/life/health/a23100351/racial-bias-in-healthcare-black-women/
@CancerDotNet - cancer surgery side effects https://www.cancer.net/navigating-cancer-care/how-cancer-treated/surgery/side-effects-surgery
Post hysterectomy exercise https://www.livestrong.com/article/396141-what-exercise-can-you-do-after-hysterectomy/ @livestrong
Patients Speak Up About Gynecologic Cancer Side Effects https://www.curetoday.com/publications/cure/2019/womens-cancers/under-the-spotlight-patients-speak-up-about-gynecologic-cancer-side-effects
