Robotic Surgery for Gynecologic Cancer: Transforming Patient Care

Transcript

00:00 --> 00:01Funding for Yale Cancer Answers
00:01 --> 00:03is provided by Smilow Cancer
00:03 --> 00:04Hospital.
00:05 --> 00:07Welcome to Yale Cancer Answers
00:07 --> 00:08with the director of the
00:08 --> 00:10Yale Cancer Center, doctor Eric
00:10 --> 00:11Winer.
00:11 --> 00:13Yale Cancer Answers features conversations
00:14 --> 00:16oncologists and specialists who are
00:16 --> 00:17on the forefront of the
00:17 --> 00:18battle to fight cancer.
00:19 --> 00:20This week, it's a conversation
00:20 --> 00:22about gynecologic cancers with doctor
00:22 --> 00:23Elena Ratner.
00:24 --> 00:25Doctor Ratner is a professor
00:25 --> 00:28of obstetrics, gynecology, and reproductive
00:28 --> 00:29sciences and co chief of
00:29 --> 00:32the section of gynecologic oncology
00:32 --> 00:33at the Yale School of
00:33 --> 00:33Medicine.
00:34 --> 00:35Here's doctor Winer.
00:36 --> 00:37Before we get into talking
00:37 --> 00:38about
00:39 --> 00:40exactly what you do, tell
00:40 --> 00:41us a little bit about yourself.
00:42 --> 00:43How did you get interested
00:44 --> 00:45in OB GYN to begin
00:45 --> 00:46with and
00:46 --> 00:48when did you you know you were
00:48 --> 00:49interested in OB GYN, did
00:49 --> 00:50you always know you wanted
00:50 --> 00:51to be
00:52 --> 00:53a cancer doctor that is
00:53 --> 00:55specialized in gynecologic
00:55 --> 00:56cancers?
00:57 --> 00:59I always knew that I
00:59 --> 01:01wanted to take care of
01:01 --> 01:01women.
01:02 --> 01:03That was always my passion.
01:04 --> 01:06My dad died from cancer
01:06 --> 01:07when I was little, so
01:07 --> 01:09my life has always been
01:09 --> 01:11somewhat marked by that.
01:11 --> 01:13So I also always knew
01:13 --> 01:14I was gonna take care of
01:16 --> 01:17women with cancer.
01:18 --> 01:19Women survivors,
01:19 --> 01:20women previvors,
01:21 --> 01:22that has been my passion.
01:23 --> 01:24That is certainly what is
01:24 --> 01:25driving me.
01:27 --> 01:29And I will share with the
01:29 --> 01:31audience that you are someone
01:31 --> 01:31who
01:32 --> 01:33works more than
01:34 --> 01:36almost anyone I know and
01:36 --> 01:38yet maintains a very busy
01:38 --> 01:40life outside of work somehow with
01:42 --> 01:43if I can share, with
01:43 --> 01:45four children.
01:53 --> 01:55Tell us a
01:55 --> 01:56little bit about the cancers
01:56 --> 01:58that you treat.
01:58 --> 02:00There's certainly more than one.
02:00 --> 02:01I mentioned a few
02:01 --> 02:02of them earlier.
02:06 --> 02:07We take care of women
02:08 --> 02:09with ovarian cancer,
02:10 --> 02:11uterine cancer,
02:11 --> 02:12cervical cancer,
02:13 --> 02:15cancer of the vulva, cancer
02:15 --> 02:16of primary peritoneum.
02:18 --> 02:18We are also
02:19 --> 02:20very fortunate
02:20 --> 02:22and very blessed to take
02:22 --> 02:24care of women who don't
02:24 --> 02:26have cancer and who are
02:26 --> 02:28previvors, who are women that
02:28 --> 02:30for whatever reason are at
02:30 --> 02:32higher risk for these cancers.
02:32 --> 02:34And we also incredibly honored
02:34 --> 02:35to take
02:35 --> 02:36care of women who are
02:36 --> 02:37survivors.
02:38 --> 02:39Who have had cancer a
02:39 --> 02:41long time ago. And now we
02:42 --> 02:43take care of them and
02:43 --> 02:45their quality of life for
02:45 --> 02:47such things as menopause and
02:47 --> 02:47sexuality.
02:48 --> 02:50And we'll talk
02:50 --> 02:52more specifically about sexuality and
02:52 --> 02:52sexuality
02:53 --> 02:54during and after cancer
02:55 --> 02:56a little later.
02:58 --> 03:00So for a woman who
03:00 --> 03:01is listening,
03:01 --> 03:02what are
03:02 --> 03:04the symptoms that
03:04 --> 03:06she should watch out
03:06 --> 03:07for in terms of gynecologic
03:08 --> 03:08cancers?
03:09 --> 03:11There aren't really good screening
03:12 --> 03:12tests,
03:13 --> 03:16for anything beyond really cervical
03:16 --> 03:17cancer. We don't have screening
03:17 --> 03:20tests that are terribly reliable
03:20 --> 03:21for ovarian cancer.
03:23 --> 03:24But of course, people should be
03:24 --> 03:26aware of changes that
03:26 --> 03:27occur with them
03:27 --> 03:28that
03:28 --> 03:29they should go seek medical
03:29 --> 03:30attention for.
03:31 --> 03:32Yeah. So you are absolutely
03:32 --> 03:33correct.
03:35 --> 03:35We do have
03:36 --> 03:36excellent
03:37 --> 03:38screening
03:38 --> 03:40and even preventative
03:40 --> 03:42methods for cervical cancer.
03:44 --> 03:45Talk just a bit about
03:45 --> 03:46that because, I mean many
03:46 --> 03:48people, of course, feel that
03:48 --> 03:50cervical cancer in two thousand
03:50 --> 03:50twenty five
03:51 --> 03:53should almost never be something
03:53 --> 03:55that threatens someone's life.
03:55 --> 03:56Hundred percent.
03:56 --> 03:58So cervical cancer has changed
03:58 --> 03:59dramatically
04:00 --> 04:01over the past ten, twenty
04:01 --> 04:02years.
04:02 --> 04:04And cervical cancer in twenty twenty
04:04 --> 04:06five, exactly as you mentioned,
04:08 --> 04:11should really never be found
04:12 --> 04:14and never should be advanced.
04:15 --> 04:16The new
04:17 --> 04:19advances in vaccines
04:19 --> 04:21for cervical cancer against HPV
04:22 --> 04:23is what changed the nature
04:23 --> 04:24of this cancer.
04:25 --> 04:27As you know, HPV vaccines
04:27 --> 04:29have now been available for
04:29 --> 04:29a long time.
04:30 --> 04:32Initially when they became
04:32 --> 04:32available
04:33 --> 04:34it was for
04:34 --> 04:36girls and boys age nine
04:36 --> 04:37to age twenty six.
04:38 --> 04:38Subsequently,
04:39 --> 04:40the age
04:40 --> 04:42has been increased to forty-five.
04:43 --> 04:45So there's a
04:45 --> 04:47great amount of value for
04:47 --> 04:49the HPV vaccine because we
04:49 --> 04:51know the cervical cancers
04:51 --> 04:52almost
04:52 --> 04:53predominantly
04:54 --> 04:56influenced and are caused by
04:56 --> 04:57HPV virus.
04:58 --> 05:00The vaccine now has been
05:00 --> 05:02in practice for a long
05:02 --> 05:03time. It has gotten better.
05:03 --> 05:05It is now against multiple
05:05 --> 05:07different HPV strains. And it
05:07 --> 05:10really almost completely eradicates
05:10 --> 05:11those kind of HPV
05:12 --> 05:12strains
05:13 --> 05:14that are known to cause
05:14 --> 05:15cervical cancer.
05:16 --> 05:18In addition, unlike unfortunately ovarian
05:18 --> 05:20cancer, we do have great
05:20 --> 05:21screening methods for
05:22 --> 05:23cervical cancers such as Pap
05:23 --> 05:24smears.
05:24 --> 05:25So, in this day and
05:25 --> 05:27age, because the world of
05:27 --> 05:29cervical cancer is so wonderful
05:29 --> 05:30and so promising,
05:30 --> 05:31we are able to space
05:31 --> 05:33out the Pap smears and
05:33 --> 05:35we're able to add HPV
05:35 --> 05:37testing to the Pap smear.
05:38 --> 05:39Because we know the women
05:39 --> 05:40who do not have an
05:40 --> 05:42HPV virus are at very
05:42 --> 05:44low risk for cervical cancer,
05:44 --> 05:45which is wonderful. It is
05:45 --> 05:47important to remember that HPV
05:47 --> 05:49virus is super common.
05:49 --> 05:50Most people
05:51 --> 05:53have been exposed to HPV
05:53 --> 05:55virus and that actually doesn't
05:55 --> 05:57matter. The only HPV virus
05:57 --> 05:57that matters
05:58 --> 05:59is the one that persists
05:59 --> 06:01for a long period of
06:01 --> 06:01time
06:03 --> 06:04in the case of women
06:04 --> 06:06after age thirty. So before
06:06 --> 06:07age thirty, we rarely will
06:07 --> 06:09even check because we're assuming
06:09 --> 06:10that most women have been
06:10 --> 06:11exposed to it and probably
06:11 --> 06:12have it. So it's not
06:12 --> 06:14a reason for concern if
06:14 --> 06:15you have it. It is
06:15 --> 06:17the HPV that persists and
06:17 --> 06:18stays on for many decades.
06:19 --> 06:20That's the one that is
06:20 --> 06:21important for us to keep
06:21 --> 06:22checking and doing Pap smears
06:22 --> 06:24and checking what kind of
06:24 --> 06:26strains women have. But in
06:26 --> 06:27general, cervical cancer right now
06:27 --> 06:29is really in a wonderful
06:29 --> 06:31place where we're able to
06:31 --> 06:33prevent these cancers. And
06:34 --> 06:35if they do develop, to
06:35 --> 06:36catch them in the precancer
06:36 --> 06:38stage or early stage.
06:38 --> 06:41And of course, vaccines have
06:41 --> 06:42recently been very much in
06:42 --> 06:44the public eye and there's
06:44 --> 06:45some controversy.
06:45 --> 06:47Can you tell us what
06:47 --> 06:47percentage
06:48 --> 06:49of individuals
06:50 --> 06:52get vaccinated for HPV?
06:53 --> 06:54Well, I knew you're gonna
06:54 --> 06:55ask me something today that
06:55 --> 06:56I do not know, which
06:56 --> 06:57is not a common thing
06:57 --> 06:57for me.
06:58 --> 06:59You know, I don't know.
06:59 --> 07:00I know it's very
07:00 --> 07:00predominant.
07:02 --> 07:03I think it depends by
07:03 --> 07:03states.
07:09 --> 07:10There are some states that have a much lower
07:12 --> 07:12HPV
07:13 --> 07:13vaccination
07:14 --> 07:16of their children or young
07:16 --> 07:16adolescents.
07:17 --> 07:18Here in Connecticut, we are
07:18 --> 07:20great with vaccinations and a great
07:20 --> 07:20majority
07:20 --> 07:22of our women are vaccinated.
07:22 --> 07:23You know, now it's actually
07:23 --> 07:25really marvelous because
07:25 --> 07:27if women or younger
07:27 --> 07:28adolescents
07:28 --> 07:30miss their opportunity, now there's
07:30 --> 07:32no such window. Women are
07:32 --> 07:33able to get vaccinated up
07:33 --> 07:35to age forty five.
07:35 --> 07:36And let me just ask
07:36 --> 07:37you a very direct question.
07:38 --> 07:39In your mind, is there
07:39 --> 07:40any question about the risk
07:40 --> 07:42benefit ratio
07:42 --> 07:43in terms of vaccination
07:43 --> 07:44for HPV?
07:45 --> 07:47Oh, absolutely not. There's absolutely
07:47 --> 07:48unquestionable
07:49 --> 07:51benefit to HPV vaccine. You
07:51 --> 07:52know, and as a cancer
07:52 --> 07:54surgeon, I can see how
07:54 --> 07:55HPV vaccine
07:56 --> 07:58is saving women
07:58 --> 07:59every single day.
07:59 --> 08:01I certainly
08:01 --> 08:03vaccinated my girls. I vaccinated
08:03 --> 08:04my boys because this is
08:04 --> 08:05not just for the girls.
08:05 --> 08:06This is also for the
08:06 --> 08:08boys and not just for
08:08 --> 08:09the sake of the boys
08:09 --> 08:09protecting
08:10 --> 08:11the women they're going to
08:11 --> 08:12be with. It's also for
08:12 --> 08:13their benefit. It's for oral
08:13 --> 08:15cancer. It's for anal cancer.
08:15 --> 08:16And I can
08:16 --> 08:17tell you because I wasn't
08:18 --> 08:19young enough to get it
08:19 --> 08:20when I was an adolescent,
08:21 --> 08:22but I personally got a
08:22 --> 08:24vaccine in my forties when I was
08:25 --> 08:26able to do so.
08:26 --> 08:28Thank you for being so
08:28 --> 08:29very clear. Now back to
08:29 --> 08:31symptoms.
08:31 --> 08:33With ovarian cancer, more often
08:33 --> 08:35it's that people are presenting
08:35 --> 08:37with symptoms. And what are
08:37 --> 08:38the symptoms
08:38 --> 08:40that might make someone think
08:40 --> 08:41that they have ovarian cancer?
08:41 --> 08:43And in particular, what are
08:43 --> 08:45the early symptoms? Because,
08:45 --> 08:47ideally, we wanna catch these
08:47 --> 08:48cancers as early as possible.
08:49 --> 08:50Right. So I'm so glad
08:50 --> 08:52that you asked this. This
08:52 --> 08:53is really kind of the
08:53 --> 08:54most important
08:54 --> 08:56part of this conversation.
08:57 --> 08:58Ovarian cancers,
08:59 --> 08:59unfortunately,
09:00 --> 09:01continue to be diagnosed
09:02 --> 09:03at later stages.
09:04 --> 09:06And that is a big
09:06 --> 09:07failure of us as a
09:07 --> 09:09medical society and us as
09:09 --> 09:11a society. The women unfortunately
09:12 --> 09:15have these symptoms usually for
09:15 --> 09:16as long as twelve to
09:16 --> 09:17eighteen months.
09:18 --> 09:19And there's some literature that
09:19 --> 09:22women see five other providers
09:22 --> 09:24prior to finally being diagnosed.
09:25 --> 09:27That is the trouble. That
09:27 --> 09:28is the reason or that
09:28 --> 09:29is part of the reason
09:29 --> 09:31why women are diagnosed in
09:31 --> 09:32stage three and four and
09:32 --> 09:34why their battle
09:34 --> 09:36with the ovarian cancer is
09:36 --> 09:37so challenging.
09:38 --> 09:39So we need to do
09:39 --> 09:40better. We need to do
09:40 --> 09:41better as a society of
09:41 --> 09:42advocacy and we need to
09:42 --> 09:43do better as a medical
09:43 --> 09:44society.
09:44 --> 09:46So we, the women, the
09:46 --> 09:48symptoms that women feel
09:49 --> 09:50would be
09:50 --> 09:51GI symptoms.
09:51 --> 09:53You know, new onset of
09:53 --> 09:53symptoms
09:54 --> 09:55that are different.
09:56 --> 09:58Clothes not fitting well, loss
09:58 --> 09:59of appetite,
10:00 --> 10:01urinary symptoms, going to
10:01 --> 10:03the bathroom too much at
10:03 --> 10:04night, fatigue.
10:04 --> 10:06It's so hard, Doctor Winer,
10:06 --> 10:08because everybody feels those symptoms.
10:08 --> 10:09And women in particular,
10:10 --> 10:12you know, around the time
10:12 --> 10:12of menopause,
10:13 --> 10:14unquestionably
10:14 --> 10:16feel the symptoms that are
10:16 --> 10:16hormonal.
10:17 --> 10:19So what separates women who
10:19 --> 10:20actually should be seen by
10:20 --> 10:22a medical provider and should
10:22 --> 10:23be checked out from somebody
10:23 --> 10:25who is likely just having
10:25 --> 10:27hormonal changes, is that for
10:27 --> 10:29women who subsequently get diagnosed
10:29 --> 10:29with cancer,
10:30 --> 10:32they have multiple symptoms. It's
10:32 --> 10:34not just GI.
10:34 --> 10:35It's GI and their clothes are not
10:35 --> 10:36fitting well and they're not
10:36 --> 10:38hungry and their bladder doesn't
10:38 --> 10:40feel normal. And also these
10:40 --> 10:41women have these symptoms
10:41 --> 10:43every single day for two
10:43 --> 10:44weeks.
10:44 --> 10:46Versus women for whom it's
10:46 --> 10:47hormonal. Usually it comes and goes
10:50 --> 10:52That's incredibly helpful. And finally,
10:52 --> 10:53the last of the
10:55 --> 10:57most common GYN cancers, that
10:57 --> 10:59is uterine or endometrial cancer.
11:06 --> 11:07And that, for the most part, is
11:07 --> 11:09a cancer that arises in
11:09 --> 11:10women who have already gone
11:10 --> 11:11through menopause, correct?
11:12 --> 11:13That's exactly correct.
11:13 --> 11:15And what is the symptom that people should
11:15 --> 11:16watch out for?
11:16 --> 11:17The symptoms women
11:17 --> 11:18have to watch out for
11:18 --> 11:20is vaginal bleeding,
11:21 --> 11:23especially vaginal bleeding after menopause.
11:23 --> 11:26But even after age thirty
11:26 --> 11:27five, age forty,
11:27 --> 11:29bleeding that is new. You
11:29 --> 11:30know, bleeding that is heavy,
11:30 --> 11:32bleeding that is intermittent,
11:32 --> 11:34bleeding that happens at a
11:34 --> 11:35much shorter intervals.
11:35 --> 11:37But most importantly, because you're
11:37 --> 11:38exactly correct, it
11:39 --> 11:41is usually cancer of women
11:42 --> 11:43who have gone through menopause
11:43 --> 11:45already. It is so important
11:45 --> 11:47for women to remember that
11:47 --> 11:48once you've gone through menopause,
11:48 --> 11:50it's never normal
11:50 --> 11:52to get your period or
11:52 --> 11:53get vaginal bleeding after.
11:53 --> 11:55It, of course, doesn't mean
11:55 --> 11:56that you have endometrial
11:56 --> 11:58cancer. A great majority of women
11:58 --> 11:59will not. The great majority
11:59 --> 12:00of women will just have
12:00 --> 12:01a polyp or atrophy.
12:02 --> 12:03But some women might. And
12:03 --> 12:05it's a reason to go
12:05 --> 12:06see a doctor or a
12:06 --> 12:07nurse practitioner or some
12:07 --> 12:10medical provider.
12:10 --> 12:12Exactly, those cancers are completely curable and
12:12 --> 12:13very, very mild if you
12:13 --> 12:15catch them early. That's why
12:15 --> 12:16it's so important that you
12:16 --> 12:17would catch them early.
12:17 --> 12:19And back to ovarian cancer
12:19 --> 12:20for a minute.
12:21 --> 12:22We think of ovarian cancer
12:22 --> 12:23as a cancer that arises in
12:24 --> 12:26women in their
12:26 --> 12:28middle years and older, but
12:28 --> 12:30there are also younger women
12:30 --> 12:31with ovarian cancer too.
12:32 --> 12:33Yeah. So there's different kinds
12:33 --> 12:35of ovarian cancers. There's some
12:35 --> 12:36ovarian cancers indeed that happen
12:36 --> 12:38in younger women. But the
12:38 --> 12:39ovarian cancer that we all
12:39 --> 12:40talk about, which is epithelial
12:41 --> 12:43ovarian cancer, even those, unfortunately,
12:43 --> 12:45are happening younger. And you
12:45 --> 12:46can have cancer in your
12:46 --> 12:47forties.
12:47 --> 12:49Fifties is not uncommon. You
12:49 --> 12:50know, a lot of this
12:50 --> 12:51has to do with genetic
12:51 --> 12:52predisposition.
12:52 --> 12:54Women who have, and I
12:54 --> 12:55know we'll talk about this
12:55 --> 12:55in a little bit, who
12:55 --> 12:56have familial
12:57 --> 12:59predisposition to cancer certainly can
12:59 --> 13:00get these cancers younger in
13:00 --> 13:01life.
13:02 --> 13:03Alright. Well,
13:03 --> 13:05that is really helpful.
13:05 --> 13:06I think we're gonna take
13:06 --> 13:07a break now.
13:07 --> 13:09And when we come back,
13:09 --> 13:11we'll talk about
13:12 --> 13:14sexual health during and after
13:14 --> 13:17treatment. We will talk about
13:19 --> 13:20inherited predispositions
13:20 --> 13:22to cancers and maybe
13:23 --> 13:24some new treatment
13:24 --> 13:25approaches, particularly
13:26 --> 13:27for ovarian cancer.
13:28 --> 13:30Funding for Yale Cancer Answers
13:30 --> 13:31comes from Smilow Cancer Hospital,
13:32 --> 13:33where their hematology
13:33 --> 13:36program offers comprehensive diagnosis and
13:36 --> 13:38treatment of blood cancers including
13:38 --> 13:40lymphoma, leukemia, and myeloma.
13:40 --> 13:41Smilowcancer
13:41 --> 13:43hospital dot org.
13:44 --> 13:46Breast cancer is one of
13:46 --> 13:47the most common cancers in
13:47 --> 13:49women. In Connecticut alone, approximately
13:50 --> 13:51thirty five hundred women will
13:51 --> 13:53be diagnosed with breast cancer
13:53 --> 13:54this year, but there is
13:54 --> 13:56hope thanks to earlier detection,
13:57 --> 13:58non invasive treatments, and the
13:58 --> 14:00development of novel therapies to
14:00 --> 14:01fight breast cancer.
14:02 --> 14:03Women should schedule a baseline
14:03 --> 14:05mammogram beginning at age forty
14:05 --> 14:06or earlier if they have
14:06 --> 14:08risk factors associated with the
14:08 --> 14:09disease.
14:09 --> 14:11With screening, early detection, and
14:11 --> 14:13a healthy lifestyle, breast cancer
14:13 --> 14:14can be defeated.
14:15 --> 14:16Clinical trials are currently underway
14:16 --> 14:19at federally designated comprehensive cancer
14:19 --> 14:21centers, such as Yale Cancer
14:21 --> 14:22Center and at Smilow Cancer
14:22 --> 14:23Hospital,
14:23 --> 14:25to make innovative new treatments
14:25 --> 14:26available to patients.
14:27 --> 14:28Digital breast tomosynthesis
14:29 --> 14:30or three d mammography is
14:30 --> 14:33also transforming breast cancer screening
14:33 --> 14:36by significantly reducing unnecessary procedures
14:36 --> 14:38while picking up more cancers.
14:38 --> 14:40More information is available at
14:40 --> 14:42yale cancer center dot org.
14:42 --> 14:44You're listening to Connecticut Public
14:44 --> 14:44Radio.
14:45 --> 14:46Good evening again. This is
14:46 --> 14:48Eric Winer with Yale Cancer
14:48 --> 14:50Answers and returning for the
14:50 --> 14:52second half of our
14:52 --> 14:54program with
14:54 --> 14:56doctor Elena Ratner, professor of
14:56 --> 14:59obstetrics, gynecology, and reproductive sciences,
14:59 --> 15:00and the co chief of
15:00 --> 15:02the section of gynecological
15:02 --> 15:04oncology at Yale School of
15:04 --> 15:04Medicine.
15:06 --> 15:08We're gonna cover a few
15:08 --> 15:10different topics in the next
15:10 --> 15:12fourteen or fifteen minutes,
15:13 --> 15:14and we're gonna start off
15:14 --> 15:15talking about
15:16 --> 15:17sexuality and cancer.
15:18 --> 15:18And
15:21 --> 15:22this is a topic that
15:22 --> 15:23oftentimes patients
15:25 --> 15:26are reluctant to bring up
15:26 --> 15:28with their doctors,
15:28 --> 15:29maybe more so when their
15:29 --> 15:31doctors are men than women.
15:33 --> 15:34But in either case,
15:34 --> 15:35I think that
15:35 --> 15:38oftentimes, patients are worried about
15:39 --> 15:40wanting to cover all the
15:40 --> 15:42details of their medical problems
15:42 --> 15:44and are somewhat
15:45 --> 15:46hesitant to talk about
15:47 --> 15:48other issues.
15:48 --> 15:50But you've started a
15:51 --> 15:51clinic
15:52 --> 15:55that really encourages people to
15:55 --> 15:58focus on sexual health during
15:58 --> 15:59and after cancer. Can you
15:59 --> 16:00tell us a little bit
16:00 --> 16:01about that and how
16:02 --> 16:03in your view it's
16:03 --> 16:04so important?
16:05 --> 16:06Yes. Thank you for NOTE Confidence: 0.99546623
16:06 --> 16:08asking that question.
16:08 --> 16:09You already gave me a
16:09 --> 16:11wonderful opportunity to talk about
16:11 --> 16:13my very first aspect
16:13 --> 16:14that I care so deeply
16:14 --> 16:15about,
16:15 --> 16:16symptoms and advocacy
16:17 --> 16:17and
16:18 --> 16:20women who need to demand
16:21 --> 16:22the kind of care that
16:22 --> 16:23they deserve.
16:24 --> 16:25Because this is truly a
16:25 --> 16:27partnership between the medical community
16:27 --> 16:29and the women, and we
16:29 --> 16:30all just need to do
16:30 --> 16:30better.
16:31 --> 16:32So thank you now for
16:32 --> 16:33giving me an opportunity to
16:33 --> 16:34talk about survivorship, which is
16:34 --> 16:35also something that is so
16:35 --> 16:36important
16:36 --> 16:38that at times because of
16:38 --> 16:39complexity of women's cancers and
16:39 --> 16:40their battles,
16:41 --> 16:42doesn't get addressed.
16:43 --> 16:45I started this program
16:45 --> 16:47many years back when I
16:47 --> 16:49just graduated from fellowship, when
16:49 --> 16:50I realized how
16:51 --> 16:51profound
16:52 --> 16:54the need is and exactly
16:54 --> 16:55as you said,
16:55 --> 16:57how women unfortunately do not
16:57 --> 16:58talk to their providers
16:59 --> 17:00about their
17:01 --> 17:03concerns about menopause and sexuality
17:03 --> 17:04and lack of intimacy.
17:05 --> 17:06I started this program in
17:06 --> 17:08collaboration with Doctor Mary Jane
17:08 --> 17:10Minkin, who is an incredible
17:10 --> 17:12menopause specialist and OB GYN
17:13 --> 17:14and we're so blessed
17:14 --> 17:15to have her as part
17:15 --> 17:15of our community.
17:17 --> 17:18But it is so
17:18 --> 17:20essential to women's lives.
17:20 --> 17:23We as cancer surgeons, as
17:23 --> 17:24medical oncologists, we do so
17:24 --> 17:26much to treat the cancer.
17:27 --> 17:29Whether it's surgery or radiation
17:29 --> 17:30or chemotherapy,
17:31 --> 17:32it is so important to
17:32 --> 17:34remember that women have their
17:34 --> 17:35lives. And as we're treating
17:35 --> 17:36the cancer, we need to
17:36 --> 17:38do everything we can to
17:38 --> 17:39support their ability to live
17:39 --> 17:41their lives in a way
17:41 --> 17:42that's good for them.
17:43 --> 17:44So yeah, we have a
17:44 --> 17:45special program that deals with
17:45 --> 17:46sexuality,
17:46 --> 17:48intimacy and menopause
17:48 --> 17:49where we take care of
17:49 --> 17:51women actually with all cancers
17:51 --> 17:52and even women who are
17:52 --> 17:53previvors
17:54 --> 17:54to help
17:55 --> 17:57with their quality of life
17:57 --> 18:00in these aspects.
18:01 --> 18:02There's so much out there,
18:03 --> 18:05there's this very incorrect
18:05 --> 18:06thought
18:06 --> 18:08that after certain cancers, after
18:08 --> 18:10breast cancer, after ovarian cancer,
18:10 --> 18:11the urine cancers, women just
18:11 --> 18:13need to accept this new
18:13 --> 18:14reality. And they just need
18:14 --> 18:14to tolerate
18:15 --> 18:16not being able to have
18:16 --> 18:19a satisfying sexual life,
18:19 --> 18:21not being able to find
18:21 --> 18:22the intimacy that they so
18:22 --> 18:23desperately
18:23 --> 18:24seek and that is
18:24 --> 18:25not the case.
18:26 --> 18:27There's so many things out
18:27 --> 18:28there that we can do
18:28 --> 18:29for help.
18:29 --> 18:31It might be hormones and
18:31 --> 18:32for the women who are
18:32 --> 18:33not able to have hormones,
18:33 --> 18:34there's naturopathic
18:35 --> 18:36and homeopathic
18:37 --> 18:37aspects.
18:37 --> 18:38There's exercise,
18:39 --> 18:41there's therapy, there's all kinds
18:41 --> 18:43of different aspects of care
18:43 --> 18:44that we're able to offer
18:44 --> 18:46the women in this truly
18:46 --> 18:47personalized approach,
18:47 --> 18:49not to their cancers, but
18:49 --> 18:50to them as women.
18:51 --> 18:53And very much, it's
18:53 --> 18:55a situation where one size
18:55 --> 18:56doesn't fit all.
18:56 --> 18:58Where in fact,
18:58 --> 19:00a particular person's problem
19:00 --> 19:02may vary a great deal
19:02 --> 19:02from
19:03 --> 19:05the next person you see
19:05 --> 19:06in the next examining room.
19:07 --> 19:09So it becomes really important
19:09 --> 19:11to take a history and
19:11 --> 19:12understand really what
19:12 --> 19:13the problem is about.
19:14 --> 19:16That's exactly correct. There's a
19:16 --> 19:17lot of literature that we
19:17 --> 19:19actually published on that and the
19:19 --> 19:21reason why women don't share
19:21 --> 19:22this is because medical providers
19:22 --> 19:23don't ask.
19:23 --> 19:25And they don't ask either
19:25 --> 19:26because there's not enough time
19:26 --> 19:27or because they don't know
19:27 --> 19:29how or they don't have
19:29 --> 19:32the options of referrals
19:32 --> 19:33or centers. That was indeed
19:33 --> 19:35the reason why Smilow Cancer
19:35 --> 19:37Hospital has this amazing program
19:38 --> 19:40on sexuality, intimacy, menopause,
19:41 --> 19:42not just from hormone
19:42 --> 19:44providers, not just from OBGYNs,
19:44 --> 19:45not just from cancer,
19:46 --> 19:48doctors, but also from specialized
19:48 --> 19:49therapists
19:49 --> 19:51that help women and help
19:51 --> 19:51couples
19:52 --> 19:55and physical therapists and lymphedema
19:55 --> 19:57specialists. You are absolutely correct.
19:57 --> 19:58This is truly
19:58 --> 19:59just like everything really that
19:59 --> 20:01we do here at Smilow,
20:01 --> 20:03it's truly personalized approach specifically
20:04 --> 20:06to that woman and to
20:06 --> 20:06that couple.
20:07 --> 20:08And I think some some
20:09 --> 20:10medical providers,
20:11 --> 20:12both men and women, are
20:12 --> 20:13just
20:13 --> 20:15concerned about asking the questions.
20:16 --> 20:17And instead,
20:18 --> 20:20what I tend to tell
20:20 --> 20:21people is they just need
20:21 --> 20:22to normalize
20:22 --> 20:23the question
20:23 --> 20:24about
20:25 --> 20:26do you have any
20:26 --> 20:29concerns about your sexual health,
20:29 --> 20:31to give people an opportunity
20:31 --> 20:32to raise these issues.
20:34 --> 20:35Absolutely. And there's
20:35 --> 20:36a way to do this
20:36 --> 20:37in a way, you know,
20:37 --> 20:38like, the way we've been
20:38 --> 20:39able to incorporate it is
20:39 --> 20:41actually so comfortable and so
20:41 --> 20:43natural and very much part
20:43 --> 20:45of the history because it
20:45 --> 20:46is it so part
20:46 --> 20:48of women's lives. It cannot
20:48 --> 20:49be a part that we
20:49 --> 20:51leave undiscussed or untouched.
20:53 --> 20:55It's really great work
20:55 --> 20:56you're doing there.
20:56 --> 20:57Now we're gonna we're gonna
20:57 --> 20:59sort of take a different
20:59 --> 21:01turn and talk about inherited
21:01 --> 21:04aspects of female cancers
21:04 --> 21:06and specifically ovarian cancer.
21:07 --> 21:07And
21:08 --> 21:09many people, of course, know
21:09 --> 21:11that both breast cancer and
21:11 --> 21:13ovarian cancer have
21:13 --> 21:15an inherited component, not that
21:15 --> 21:17it always is that way.
21:17 --> 21:19But can you talk
21:20 --> 21:22about the inherited aspects of
21:22 --> 21:24of ovarian cancer. Meaning,
21:25 --> 21:27what predisposes
21:27 --> 21:28someone
21:30 --> 21:32to have ovarian cancer in
21:32 --> 21:33the setting of a family
21:33 --> 21:33history?
21:34 --> 21:36What kind of family
21:36 --> 21:38histories tip you off? NOTE Confidence: 0.9157523
21:38 --> 21:40So you and I spend
21:40 --> 21:41a little bit of time
21:41 --> 21:42in the last segment talking
21:42 --> 21:44about how unfortunately this cancer
21:44 --> 21:46is still diagnosed at later
21:46 --> 21:46stage.
21:47 --> 21:49Because unfortunately, exactly as you
21:49 --> 21:51said, we are not great,
21:51 --> 21:52not for the luck of
21:52 --> 21:53trying, but we're just not
21:53 --> 21:55great in finding these cancers
21:55 --> 21:55early.
21:56 --> 21:57We gotta do everything we
21:57 --> 21:59can to try to prevent
21:59 --> 22:00them. What's even better than
22:00 --> 22:02cure and what's even better
22:02 --> 22:04than early detection is prevention
22:04 --> 22:05and not getting cancers in
22:05 --> 22:06the first place.
22:06 --> 22:07So because of that, it
22:07 --> 22:09is so important to identify
22:09 --> 22:11what women and what families
22:11 --> 22:12are at higher risk for
22:12 --> 22:13these cancers.
22:14 --> 22:16You probably remember, you and
22:16 --> 22:17I are old enough
22:17 --> 22:19to remember when Angelina Jolie
22:19 --> 22:20published an
22:20 --> 22:22editorial in the New York Times,
22:23 --> 22:24quite a bit ago that
22:24 --> 22:26talked about know your genes.
22:27 --> 22:28Know your history, know your
22:28 --> 22:31family history, know what risk you are at.
22:34 --> 22:35And that's the key. You're
22:35 --> 22:36exactly correct. There's a lot
22:36 --> 22:38of these cancers that have
22:38 --> 22:39a genetic predisposition.
22:39 --> 22:41There's a lot of cancers
22:42 --> 22:43that are not ovarian cancer
22:43 --> 22:45necessarily, but in the same
22:45 --> 22:45family
22:48 --> 22:48for the women to be
22:48 --> 22:50at higher risk for ovarian
22:50 --> 22:51cancers, such as breast cancer,
22:52 --> 22:53such as melanoma,
22:54 --> 22:56such as prostate cancer in
22:56 --> 22:56men.
22:57 --> 22:58So the families that we
22:58 --> 22:59pay
23:00 --> 23:01a lot of attention to
23:02 --> 23:03in terms of these concerns,
23:04 --> 23:05women who had one of
23:05 --> 23:07these cancers earlier in life,
23:08 --> 23:10family history, you know, multiple
23:10 --> 23:11family members who have developed
23:12 --> 23:13one or more of these
23:13 --> 23:13cancers.
23:14 --> 23:15You know, in the older
23:15 --> 23:16days we used
23:16 --> 23:17to think that Ashkenazi Jewish
23:17 --> 23:19women were the ones that
23:19 --> 23:20were at highest risk and
23:20 --> 23:21they still are. But now
23:21 --> 23:22we have a lot of
23:22 --> 23:24literature that there's many different
23:24 --> 23:25ethnicities,
23:25 --> 23:28and geographical distribution of women
23:28 --> 23:29who are at higher risk.
23:30 --> 23:32So it's not just Jewish
23:32 --> 23:33Ashkenazi women.
23:33 --> 23:35And nowadays, also beautifully, we
23:35 --> 23:37are able to check the
23:37 --> 23:37genetic
23:38 --> 23:39makeup so much easier. You
23:39 --> 23:40know, in the older days,
23:40 --> 23:41it used to be prohibitive,
23:41 --> 23:42it used to be so
23:42 --> 23:43expensive. Now with the help
23:43 --> 23:45of genetic counselors and with
23:45 --> 23:47the help of multiple companies
23:47 --> 23:48who can run this kind
23:48 --> 23:49of genetic profiles,
23:49 --> 23:51we truly can know if
23:51 --> 23:53women are at higher risk,
23:54 --> 23:55for these cancers and then
23:55 --> 23:56prevent these cancers if that
23:56 --> 23:57was the case.
23:57 --> 23:59And in terms of ovarian
23:59 --> 24:01cancer, the way you prevent
24:02 --> 24:04ovarian cancer to a largest
24:04 --> 24:04degree
24:05 --> 24:07is removing the ovaries and
24:07 --> 24:09the fallopian tubes after a
24:09 --> 24:11woman has completed childbearing.
24:11 --> 24:13Right. So there's a lot
24:13 --> 24:14of stuff that has happened
24:14 --> 24:16in this field in the
24:16 --> 24:17past couple of decades.
24:18 --> 24:20First, the very important thing
24:20 --> 24:20I wanna bring up that
24:20 --> 24:21I try to bring up
24:21 --> 24:22at any interview I give
24:22 --> 24:23no matter what, is
24:24 --> 24:25that one of the really
24:25 --> 24:26good things
24:27 --> 24:28that we can do for
24:28 --> 24:28reduction
24:29 --> 24:30in ovarian cancer and uterine
24:30 --> 24:32cancer is birth control pills.
24:33 --> 24:35Birth control pills significantly
24:35 --> 24:36decrease
24:36 --> 24:38risk of ovarian cancer.
24:38 --> 24:40And that risk is profound.
24:40 --> 24:42For any woman that takes
24:42 --> 24:44birth control pills for five
24:44 --> 24:46years, cumulatively during her lifetime,
24:47 --> 24:48she can decrease her risk
24:48 --> 24:50of ovarian cancer by fifty
24:50 --> 24:50percent.
24:51 --> 24:52And that's true whether or
24:52 --> 24:53not she has a mutation?
24:54 --> 24:55Literally, the next thing I
24:55 --> 24:57was gonna say, doesn't matter.
24:57 --> 24:59This is like a dance.
25:00 --> 25:01It doesn't matter if she
25:01 --> 25:02has a mutation. So some
25:02 --> 25:03women
25:04 --> 25:06who have this deleterious mutation
25:06 --> 25:07and could have as high
25:07 --> 25:08as forty percent chance of
25:08 --> 25:09developing their cancers.
25:09 --> 25:11Indeed, if she was taking
25:11 --> 25:12birth control pills for five
25:12 --> 25:14years, her risk would go
25:14 --> 25:16down to twenty percent. If
25:16 --> 25:17she takes them for ten
25:17 --> 25:18years, it goes down by
25:18 --> 25:20eighty percent and so forth.
25:20 --> 25:21So you can do profound,
25:22 --> 25:22decrease.
25:23 --> 25:24Also, nowadays,
25:25 --> 25:27we do so much, again,
25:27 --> 25:28personalized medicine and personalized
25:30 --> 25:32interventions specifically to the woman's
25:32 --> 25:34life. Nowadays, there's times where
25:34 --> 25:35we can just take the
25:35 --> 25:36fallopian tubes and leave the
25:36 --> 25:38ovaries behind. Because we now
25:38 --> 25:39think that a lot of
25:39 --> 25:40these cancers actually start in
25:40 --> 25:42the fallopian tubes and not
25:42 --> 25:43in the ovaries. And then
25:43 --> 25:44we can leave the woman
25:44 --> 25:45the ovaries so she can
25:45 --> 25:47continue benefiting from her hormones,
25:47 --> 25:48but at the same time
25:48 --> 25:50significantly decrease her risk by
25:50 --> 25:51taking out the fallopian tubes.
25:52 --> 25:53And do you ever take
25:53 --> 25:54out one ovary and leave
25:54 --> 25:55the other one? Does that
25:55 --> 25:57decrease risk to any degree?
25:57 --> 25:58You know, this comes up
25:58 --> 25:59a lot.
26:00 --> 26:01And you would think theoretically
26:01 --> 26:03that it would, but there's
26:03 --> 26:04no literature to say so.
26:06 --> 26:07So, yes. I mean, at
26:07 --> 26:08times, we end up doing
26:08 --> 26:10it for other reasons, but
26:10 --> 26:11I don't usually
26:11 --> 26:13recommend it for risk reduction
26:13 --> 26:14because you don't know.
26:14 --> 26:15And what about
26:15 --> 26:16a woman who's already gone
26:16 --> 26:18through menopause? A woman has
26:18 --> 26:19gone through menopause and she
26:19 --> 26:20has a
26:21 --> 26:23BRCA one mutation like Angelie
26:24 --> 26:25Jolie and likes
26:25 --> 26:27so many other people.
26:27 --> 26:29And she says, what can
26:29 --> 26:29I do to
26:30 --> 26:32reduce my risk of
26:32 --> 26:34ovarian cancer to the greatest
26:34 --> 26:36extent? And there, I assume
26:36 --> 26:37the answer is probably just
26:37 --> 26:38do surgery
26:38 --> 26:39at the moment in two
26:39 --> 26:41thousand twenty five.
26:43 --> 26:45You know, again, in
26:45 --> 26:46the sense of this
26:46 --> 26:47personalized medicine,
26:47 --> 26:48everything has to make sense.
26:48 --> 26:49So we know that women
26:49 --> 26:51who have a BRCA1 deleterious
26:51 --> 26:53mutation have a very significantly
26:53 --> 26:55higher risk and their cancers
26:55 --> 26:56could happen younger. So because
26:56 --> 26:58of that, we would recommend
26:58 --> 26:59this kind of surgery to
26:59 --> 27:00be done around age thirty
27:00 --> 27:01five to forty. But there's
27:01 --> 27:02different mutations
27:03 --> 27:05and there's different risks associated
27:05 --> 27:06with these mutations at different
27:06 --> 27:06ages.
27:07 --> 27:08You know, interestingly for women
27:08 --> 27:10who don't have mutations, in
27:10 --> 27:12the older days, like seven
27:12 --> 27:13years ago, we used to
27:13 --> 27:14say that there's no benefit
27:14 --> 27:16at all to the ovaries
27:16 --> 27:17after menopause.
27:17 --> 27:18We now know that's not
27:18 --> 27:19the case. There's some studies
27:19 --> 27:20that came out that show
27:20 --> 27:21that there's probably a little
27:21 --> 27:23bit of benefit to women
27:23 --> 27:24in terms of heart protection
27:24 --> 27:25and bone protection
27:25 --> 27:27up to age sixty five.
27:27 --> 27:29But again, it's this balance.
27:29 --> 27:30There are your risks of
27:30 --> 27:31developing it versus
27:31 --> 27:33your risks or benefits of
27:33 --> 27:35keeping them. And of course,
27:35 --> 27:37since many many of the
27:37 --> 27:39people who you talk to
27:39 --> 27:41about these prophylactic procedures come
27:41 --> 27:41from
27:42 --> 27:43families where
27:43 --> 27:45people have had cancer, people
27:45 --> 27:47have died of cancer. There's
27:47 --> 27:49a big emotional component as
27:49 --> 27:51well. NOTE Confidence: 0.95499206
27:51 --> 27:53Especially for women who lost
27:53 --> 27:54family members or
27:54 --> 27:55their moms. There's such a
27:55 --> 27:56difficult conversation.
27:57 --> 27:57And, you know, we're also
27:57 --> 27:59in the infancy of this
27:59 --> 27:59genetic
28:01 --> 28:02discovery. You know, hundred years
28:02 --> 28:03from now, fifty years from
28:03 --> 28:05now, we'll know everything there's
28:05 --> 28:06to know about every gene
28:06 --> 28:07and what causes what. Right
28:07 --> 28:08now, all we got is
28:08 --> 28:10what we got. And, again,
28:10 --> 28:11this is why this personalized
28:11 --> 28:12approach, which is what we
28:12 --> 28:14use for for women at
28:14 --> 28:15higher risk, what we use
28:15 --> 28:17for treatment, for chemotherapy, for
28:17 --> 28:19surgery. You know, here at
28:19 --> 28:21Smilow, we so truly believe
28:21 --> 28:22about this personalized approach and
28:22 --> 28:23understanding
28:24 --> 28:25what genes women have and
28:25 --> 28:26how we can treat them
28:26 --> 28:27best and how we can
28:27 --> 28:29prevent cancers best in them.
28:29 --> 28:31Doctor Elena Ratner is a
28:31 --> 28:33professor of obstetrics, gynecology, and
28:33 --> 28:34reproductive sciences
28:35 --> 28:36and co chief of the
28:36 --> 28:37section of gynecologic
28:37 --> 28:39oncology at the Yale School
28:39 --> 28:39of Medicine.
28:40 --> 28:41If you have questions, the
28:41 --> 28:43address is cancer answers at
28:43 --> 28:44yale dot e d u,
28:44 --> 28:46and past editions of the
28:46 --> 28:48program are available in audio
28:48 --> 28:49and written form at yale
28:49 --> 28:50cancer center dot org.
28:51 --> 28:52We hope you'll join us
28:52 --> 28:53next time to learn more
28:53 --> 28:54about the fight against cancer.
28:55 --> 28:56Funding for Yale Cancer Answers
28:56 --> 28:58is provided by Smilow Cancer
28:58 --> 28:59Hospital.

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Robotic Surgery for Gynecologic Cancer: Transforming Patient Care with guest Dr. Elena Ratner March 2, 2025

Yale Cancer Center

visit: https://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

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Dr. Elena Ratner

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