I am doing a gynecology oncology rotation right now.
Thus, I am doing a lot of operating room time and a lot of pelvic exams.
You are probably thinking… Ew.
I am thinking you’ve seen one, you’ve seen them all… Sort of.
The thing with the pelvic exam is that sometimes you uncover things.
In many areas of medicine, the physical exam is extremely important. But, you don’t necessarily stumble upon a finding that can change someone’s prognosis. If someone comes in with a history of lung cancer, they are often short of breath before you hear a wheeze. The lymphoma patient points out the lump. And sometimes the gyne patient says there is bleeding.
But, sometimes, things seem to be going along swimmingly. Then, you take a look. And there, right before your eyes is a surprise no one in the room expected and no one in the room wants. A bit of something in the vaginal vault.
Vault recurrences are one of the most common sites of recurrence in gynecologic cancer. That is why we make all of these women have speculum exams with every visit, even though nobody likes them. You know going in it is a possibility. But, when you see one, it crushes you a little.
Sometimes visit is going so well, and things are going great and then you see something red and fleshy and you know it is bad. You have to break the news and take biopsies and all that icky stuff. Plus, this is probably one of the worst positions to get bad news in. At least in my opinion. So vulnerable.
This rotation is one of the ones that remind me of the sad truth about some gyne cancers. That many can be prevented or at least caught early. And others are nearly impossible to catch at all until it is too late.
It is a funny dichotomy.
It often seems unfair. The young women who could have prevented or minimized their disease and morbidity by getting a simple pap smear, the middle-aged women who, if they had maintained a healthy body weight could have avoided an endometrial cancer and if they saw the doctor about the bleeding sooner may have avoided the chemo and then there are the ladies that were perfect and took good care of themselves until they had some bloating and constipation only to learn they have an advanced ovarian cancer that probably couldn’t have been detected any earlier.
I know you can’t catch everything and you can’t fix anything. But, when I see young women dying in their thirties and forties of something that would have been prevented with some basic screening that takes only a few extra minutes of your day, it disturbs me. It upsets me that physicians don’t push the issue. It bothers me that people don’t know how much grief they can save just by going for a test that some call “embarrassing.”
It makes me crazy that we talk about healthy lifestyle and such, but it is rare that we warn women that obesity increases their risk of endometrial cancer. Sure we do heart disease and such, but do we really discuss all the risks honestly. Then, do we really take post-menopausal bleeding seriously? I know so many women who were brushed off or made to wait for imaging instead of going directly for biopsy. Time is tumor growth. Any bleeding after menopause is abnormal. Irregular and constant bleeding before menopause should be investigated. So many women have endometrial cancer. It is curable. But, we have to find it at a point where it can be cured.
Ovarian cancer is the one that is tricky. You can’t screen for it. It has few symptoms. It scares me the most because it is the sneakiest. Awareness campaigns are helping to make women know symptoms to look out for. Unlike some other diseases, it is often not apparent until it is too late. Other times it can be found by accident. But the other two, they can be found early or before they happen more often than not. I wish people would just heed that, for the sake of those who don’t have that opportunity.
When you palliate someone your own age for a cancer that could have been prevented with simple screening, you realize these things are serious. When you find a recurrence after a seemingly excellent office visit, you realize these things are serious. When someone you know or love has one of these diagnoses, you realize these things are serious.
Why can’t we just do the right screening when it is available? Why can’t people report abnormal symptoms and get them tested in a timely manner? It only seems fair, especially for those who would not be able to find things sooner.
Everyone says “if only,” but the best way to avoid the “if only” is to get checked for what you can when you should. Cervical cancer is preventable. Endometrial cancer is both preventable and detectable in some (though not all) cases. If ovarian cancer could be reliably found earlier, I am sure people who have ovarian cancer would want people to get screened. At least people can be aware of possible symptoms.
So, stop saying maybe later. We can’t prevent everything. We can’t live in a bubble. But, sometimes a simple test can save lives. A lifestyle change can reduce risks you may not realize are there. Being aware of your body can save you later.
I know screening, appropriate physician visits and self-awareness won’t prevent all illness. But, I do know that some cancers can be avoided or their burden can be lessened. That beats finding surprise recurrences or dying young or dealing with nasty side effects that could otherwise have been avoided.
I get that it is scary. The mystery is scary. Potentially finding out you have a cancer is scary. But, knowledge is power. And prevention/risk-reduction is everything and fortunately in the world of gynecologic cancer, it works in many cases. If only people would take advantage of what is potentially available to them. It could save so much grief in the long run.
So, next time you question whether you need that pap smear or wonder why things haven’t been feeling right, remember you may be saving yourself a lifetime of pain and fear that could have otherwise been prevented. And that there are many women out there who wish they would have just done it when they had the chance.