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Fran Drescher was the star of a hit television series, The Nanny
, when she began spotting
between periods and experiencing cramping and pain after sex. The actress, then 40, paid a visit to her gyne-cologist, who dismissed the symptoms as signs of perimenopause, the stage around the onset of menopause.
More than two years later, Drescher discovered the real reason
menstrual periods, as Drescher did. Women who have gone
for her symptoms: uterine cancer. Today, Drescher is a six-year
through menopause should see a doctor if they have any spotting
cancer survivor and one of the nation’s most outspoken advocates or bleeding.
for early detection of uterine cancer, which is the most common
Don’t panic and assume you have cancer if you experience spot-
cancer of the female reproductive system.
ting, though. Uterine bleeding also can be caused by other condi-
Women need to know the signs of uterine cancer, Drescher
tions, such as polyps, fibroid tumors (noncancerous growths in the
says, and they need to be persistent in seeking answers when
uterus) and a thinning of the vaginal wal s after menopause.
Other symptoms of uterine cancer can include abdominal pain
“We need to educate ourselves about our bodies,” Drescher
and pain with sex, as Drescher had, or pain with urination.
says in Cancer Schmancer
, a book she wrote about her experi-
Is there a screening for uterine cancer?
ences. “Women need to understand gynecological cancers and
There is no screening for uterine cancer, although Dr. Scribner
says many women mistakenly think a Pap smear will detect it. A Pap smear (typically performed at a woman’s annual gyneco-
What is uterine cancer?
logical exam) is designed to detect cancer of the cervix, which
This year, 41,200 women will be diagnosed with cancer of the
is located at the opening to the uterus. Occasionally, it also will
detect uterine cancer, Dr. Scribner says.
Doctors are hoping to develop a screening test that would
pinpoint early signs of the disease. Dr. Scribner and his partner,
Natalie S. Gould, MD, are participating in a
National Cancer Institute research trial aimed at
doctor usually will order diagnostic tests.
The first may be a transvaginal ultrasound,
a test that uses sound waves to visualize
the organs in the pelvis and to determine
if the lining of the uterus is thicker than it
The older you are, the more likely you are to be
diagnosed with cancer of the uterus. Most women
are in menopause when diagnosed, although (as Drescher’s case illustrates) younger women also can
“The typical age at diagnosis is 61 to 62,” says
Dennis R. Scribner, Jr., MD, of Carilion GYN
What are the
menopause is typically the first sign of this type of cancer,” says Dr. Scribner.
should see a doctor if they have spot-ting or staining that occurs between
To determine if cancer cel s are present in the lining of the uterus, though, the doctor
must remove cel s from the uterus for examination under a microscope. This is typical y
you at done in an office procedure caled an endometrial biopsy or an outpatient procedure
cal ed a D&C (or dilation and curettage).
Drescher’s uterine cancer was found when her doctor ordered a D&C to evaluate her
risk for abnormal bleeding. Drescher urges women of al ages who have abnormal bleeding to
ask their doctors about this procedure.
How is uterine cancer treated?If the cancer is found early, a hysterectomy (removal of the uterus, Fal opian tubes
uterine and ovaries) is the treatment. Your surgeon also should remove lymph nodes and per-
You’l want to make sure you have your hysterectomy performed by a gynecologic
cancer? oncologist, a specialist who focuses on cancer in women’s reproductive organs and
has received training in the removal of lymph nodes associated with the reproductive system. These lymph nodes wil be removed and tested to see if the cancer has spread. If cancer has spread beyond the uterus, radiation and chemotherapy may be recom-
Drs. Scribner and Gould are the only board-certified gynecologic oncologists in
enced higher-than-normal estrogen levels
Southwest Virginia, so they typical y operate on area patients with reproductive cancers.
Thanks to advances in technology, they can perform a patient’s hysterectomy and
For example, you’re at higher risk if you:
remove her lymph nodes with laparoscopic surgery, which requires just a few small incisions in the patient’s abdomen and a device cal ed the daVinci Robot to extract the
n Started your menstrual period early.
n Began menopause later than average.
“This system takes a very complex surgery and makes it much more simple,” says
n Are obese (because fat cells convert other
Scarring is minimal compared to the old method, which required a long incision on
the abdomen, and patients recover more quickly and are able to go back to work much
n Have taken medicines such as tamoxifen,
Can uterine cancer be cured?
When found early, before it has spread to other organs, uterine cancer is highly
curable. The five-year survival rate for women with cancer confined to the uterus is
be taking estrogen alone,” warns Dennis
“We pick up about 75 percent of uterine cancers in the first stage,” says Dr. Scribner.
R. Scribner, MD, a gynecologic oncologist
The survival rate is lower for the remaining 25 percent whose cancer has spread.
That’s why early detection is so important. Drescher, who had symptoms for
Roanoke. “You need progesterone with it
two years before her eighth doctor finally diagnosed cancer, shudders to think of
to counteract the effects of estrogen and
what could have happened. She urges women to be vigilant in observing their
own bodies, persistent in seeking help for symptoms and knowledgeable about
tests such as the transvaginal ultrasound and the D&C, which can help detect
diabetes or suffer from hypertension also
are at increased risk. And if there’s a history
“Once you wake up and smell the coffee, it’s hard to go back to sleep,” she notes
of uterine or colon cancer in your family,
in Cancer Schmancer
. “Let me sound the alarm … never be passive when it comes
position to uterine cancer. Your doctor can
For more information, visit www.carilion.com.
perform tests to determine if you have this susceptibility.
If you don’t fall into any of those cat-
Numbers to know on uterine cancer
egories, that doesn’t mean you’ve won a free pass around this disease. About half of
Number of women who will be diagnosed in 2006 with uterine cancer: 41,200
those diagnosed with uterine cancer have
Number of women expected to die from uterine cancer in 2006: 7,350
no known risk factors, Dr. Scribner notes.
Survival rate of women diagnosed with uterine cancer: 96 percent
confined to uterus); 66 percent
(when it has spread regionally); 25 percent
(when it has spread to distant places)
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C1-inhibitor concentrate home therapy for hereditary angioedema: a viable, effective treatment option H. J. Longhurst,* S. Carr† and K. Khair‡ *Barts and The London NHS Trust, Department Economic and political factors have led to the increased use of home therapy of Immunopathology, London, UK, †Barts and The London NHS Trust, Department of programmes for patients who have tradi