53 Dr. Valena Wright Its Time You Knew.mp3: Audio automatically transcribed by Sonix
53 Dr. Valena Wright Its Time You Knew.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Speaker1:
Hi and welcome to the Cancer Secrets podcast. I am your host and guide, Dr. Jonathan Stegall. Cancer is like a thief who has come to steal, kill and destroy. I have personally seen it wreak havoc on patients, friends and even my own family. But I am on a mission to change the cancer paradigm. Who? The practice of integrative oncology cancer treatment that integrates the best of conventional medicine with the best of alternative therapies backed by science and personalized to each patient. You need a positive voice you can trust. This podcast will share valuable information to give you practical hope for a better outcome. So I invite you to join me on this journey as we seek to change the cancer paradigm together. Hello and welcome back to the Cancer Secrets podcast. I'm your host, Doctor Jonathan Seagal. This is season four and episode number 53. In today's episode, I have a very special guest joining me, Dr. Evelina Wright. Dr. Wright is a board certified gynecologic oncologist with more than 25 years of clinical experience dedicated to improving women's health. She believes in making preventable women's cancer history. In addition to her highly respected clinical career, Dr. Wright is the author of the new book It's Time You Knew. Dr. Wright, welcome to the show.
Speaker2:
Thank you, Dr. Stegall. So it's my pleasure to be here.
Speaker1:
Well, it's an honor to have you. And I know this is going to be a great episode that our listeners will really enjoy. I look forward to to letting you share your expertise with with all of us. So I guess I'd like to first begin by by asking you what made you decide to become a physician?
Speaker2:
I think being a physician is such a privilege, really. We get to have such an impact on people's lives and specifically choosing gynecologic oncology. I think it allows me to provide care for women over the lifespan and it's really fascinating work. Gynecologic oncology in the variety of pathology or disease processes we see. And having the skills, both technically and understanding the disease processes, can have a huge impact on people's lives.
Speaker1:
Excellent. And just for our listeners who may not know exactly what gynecologic oncologists treat, you're dealing with cancer in the different female organs. So uterus, ovaries, fallopian tubes, cervix, those kinds of things.
Speaker2:
Exactly. So the diseases I treat involve the female reproductive tract. And unfortunately, many women are uncomfortable, not just women and men are uncomfortable having discussions about these topics. So the cancers that I treat most common is uterine cancer, depending on the geographic area of the world, cervix, cancers. And then we also treat vulvar and vaginal cancers as well as ovarian cancers, fallopian tube cancers, and something called peritoneal cancer, which is very similar to ovarian and fallopian tube. Those three clustered together.
Speaker1:
Excellent. So I certainly want to touch on on the importance of of regular physical exams for women. If we could just kind of deviate a little bit from our from our conversation and talk about sort of just basic stuff. When do you recommend women start to to see an ob gyn for their care?
Speaker2:
So that's that's a great question. It used to be it was recommended young women transitioned care at age 18 to, you know, gynecologic care or their primary care start to screen for gynecologic specific diseases. New guidelines suggest that screening for cervical cancer can be delayed up until age 21 now, not age 18, because it's so rare to see invasive cervix cancer before that. And so often, you know, reproductive issues start to arise in the late teens and early twenties. And whether it's primary care or gynecologist, the important thing is to be upfront and ask questions about your sexual health and not ignore them. So it's all it's all about making sure you understand what's going on with your own body and that you have the knowledge you need to make the best decisions for yourself.
Speaker1:
Excellent. So I'd like to talk a little bit about cancer screening. You know, there's a lot of information out there, and I would I would say also some misinformation out there in terms of of cancer screening when it comes to to women's health. And I know some of my listeners out there are probably thinking, you know, I really don't like the idea of mammograms or pap smears and all that kind of stuff. And there's different myths out there about, you know, the potential harms from from those interventions and those those screening tests. But what do you generally recommend in terms of screening? Because I always like to say, you know, an ounce of prevention is worth a pound of cure. We've all heard that that statement. So so what is your recommendation as a gynecologic oncologist, knowing the type of cancers that you see and and how how bad they can be if they're not detected early?
Speaker2:
Sure, that's a good question. I think it's really important for your listeners to understand the difference between a screening test and a diagnostic test. So screening really is meant for asymptomatic women trying to prevent a disease process. And to do that, there has to be a recognized time interval when a patient has no symptoms. But by doing it test, you can diagnose a precursor lesion to cancer. So unfortunately for gynecologic cancers, the only cancer we have a valid screening test for is cervix cancer. And so there's a lot of focus on I think most of your listeners would know what a pap smear is. And now new guidelines are changing for screening for cervix cancer, recognizing that most cervix cancers are associated with human papillomavirus or HPV. So HPV is really common. It's the most common sexually transmitted infection in the US, in the world. And many people will develop an HPV infection but not necessarily develop cancer. It's only about 2%. But as screening strategies, strategies change, it's important to speak to your provider so that you do get the screening test that's most effective and relevant to your age group and to your other risk factors as well. So depending on your age, those guidelines are changing. But many countries, Britain, Australia, have switched over to primary HPV testing rather than a pap test.
Speaker2:
In the United States, we generally still are doing cotesting or a combination of which means a combination of both a PAP and and HPV test. But the American Cancer Society did come out with a new guideline this past summer to implement primary HPV screening. So it's important to know about that change in screening and to talk to your provider when you go in for your annual well woman visit. So when you go for your doctor's annual well, women visit, you know, that's not just screening. It's also meant to answer questions you have about your health and to evaluate any symptoms. And the next thing I want point I want to make, when you do have symptoms, it's important not to ignore them. The symptoms are important to the symptoms are the clue to your diagnosis. And so there's many different things that could cause a symptom. So by speaking up and discussing those with your doctor, that can sometimes be the difference between a diagnosis that is made early on versus something that's made much later. And we know in general, for most cancers, the earlier you are able to diagnose something, the better your prognosis. So speaking up when you have symptoms, getting them checked out, it's really important part of maintaining your your health.
Speaker1:
Right. Excellent. And I would just to add on to that, you know, you mentioned earlier women being in tune with their bodies. You know, that's things like obviously for breast health, doing a regular breast self-exam, you know, in addition to obviously doing a, you know, a well woman visit and mammograms and things like that. But, you know, even with, you know, lower down women's health kind of thing, you know, I think just any abnormal bleeding. I mean, you know, my training and I'm sure yours as well, if a woman is post-menopausal and she has any vaginal bleeding, you know, that's that's endometrial cancer until proven otherwise. And it needs to be checked out immediately.
Speaker2:
Right. I think, you know, most uterine cancer, it's the most common gynecologic malignancy that we treat and it usually occurs after menopause. And menopause, by definition, is one year with no menstrual bleeding. So if a woman is post-menopausal and. Develop bleeding, even if it's spotting for a day, that's a reason to go and see your physician. In only about 10% of the time does it turn out to be uterine cancer, but you don't want to delay. There could be other reasons, such as polyps or fibroids, but after menopause, the other causes of bleeding. And so people recognize it as abnormal. Where it becomes more difficult sometimes is in women in reproductive years. And unfortunately, women between the age of 25 and 40 is the cohort of women or the group of women with the biggest increase in incidence of uterine cancer, which partly relates to the rise in obesity in the United States, because uterine cancer, many there's many there's different types of uterine cancer, but the majority of uterine cancer links to obesity.
Speaker1:
And that's a great segway into my next question. You know, you talk a lot about the importance of maintaining a healthy body weight and the sort of the risks associated with being overweight or obese. And I believe the last statistic is that about two thirds of the population in America is either overweight or obese. Is there anything else you wanted to kind of add to the discussion of of body weight?
Speaker2:
Yes. So, you know, body weight is something that's very objective because you get on a scale and you have an objective measurement, you can incorporate your height. And often doctors do calculate what we've referred to as body mass index. Body mass index alone is defining with other risk factors, what medical services you qualify for. So obesity is really a disease, and often people are reluctant to address that because there's a lot of stigma around obesity and it can be difficult conversation. And yes, there are many people who are obese or overweight and, you know, very healthy. So it's not a straightforward decision. But in general, if you're overweight, it affects your entire body in many different ways. And I guess the best example that I can give you is from my own specialty and uterine cancer. You know, over time, obesity just puts a stress on the body and in different ways. And some of the same diseases associated with obesity increase your risk of cardiovascular disease. And in the United States, the most common cause of death still for women is not cancer, but cardiovascular disease. And the excess weight. It can put a stress on your heart, on your lungs. It can cause fat deposition sometimes in the liver and cirrhosis due to fatty liver is now surpassing that from alcohol. In addition, the extra weight over time can cause osteoarthritis of the knees. So many of the patients that I'm operating on later in life and you don't really see the impact of some of these risk factors until later in life, because when we're younger, our bodies are very forgiving.
Speaker2:
But our daily habits over a lifetime really do add up. And I like to have patients think about the fact that what they're doing every day with in respects to modifiable risk factors has a bigger impact than seeing their doctor once or twice a year. Both are really important, but the power of the choices people are making in their everyday lives for risk factors that we know modify both cardiovascular, cardiovascular risk and cancer risk can have a big impact, kind of like interest in the bank. And so I think it's really important for women to understand that many times women, when they're diagnosed with uterine cancer, are unaware that obesity is a risk factor for uterine cancer. Would it have changed their behavior? You know, I'm not sure. We really want people to move towards positive things and our tendency is to ignore or try and deny the difficult things sometimes in our our life. But our health is really important. And by being physically active, by trying to maintain a healthy lifestyle through exercise, nutrition, avoiding smoking and alcohol, it can really increase the pleasure in your life. And I think that's what the message of my book really is about, is understanding what your personal risk factors for different diseases. Is and or cancer are. And then knowing that having the self determination, I guess, to make choices that improve your health and your joy of life.
Speaker1:
Absolutely. And I'm sure you see a lot of patients every day who probably could have prevented their cancer if we could go back in time and maybe change some things. And so that's why I'm so thankful that you're sort of leading the charge on on on awareness of this topic, because it is just so important to to really do all we can to to prevent it, if possible.
Speaker2:
Yeah. You know, the Hippocratic Oath it has. Part of it is preventing decease and they, quote, like, prevention is better than cure. Meaning cure obviously is really important. But if there are a way, if there's if there are things we can do both as physicians and as patients, it's so much better to not have to deal with a cancer diagnosis and treatments and sequelae potentially of cancer treatments. If we knew how our daily choices potentially could could prevent or not necessarily prevent in all cases, because some people do everything right and still develop cancer, unfortunately. But knowing how we can modify our risk is really important.
Speaker1:
Excellent. We've talked about the importance of maintaining a healthy body weight and how that can can make a significant difference in reducing the risk of of many types of cancer, including the types that you treat. But I'd also like to talk some about exercise. You talk a lot about exercise and how it relates to reducing the risk of cancer. So could you talk a little more about that for us?
Speaker2:
Exercise definitely decreases the risk of uterine cancer. It's a linear correlation between increasing body mass index and your risk of developing cancer. Even a £5 change in weight has an impact on your relative risk. So that's that's important to know as far as your BMI, it's impacted by many things, by your nutrition, but also by your level of activity, which is basically exercise. So many physicians are now writing exercise prescriptions. And, you know, people always want the magic pill, but there's benefits that you get from exercise that can have a more dramatic effect than some medications. We know that sitting for prolonged period of time, more than 6 hours independent of your body weight, actually increases your cancer risk, which is why we've seen a movement towards stand up desks in the workplace, a variety of apps that will track your exercise. The American Cancer Society guidelines for exercise are only met by 17% of the US population, and so as a society we really have had behavioral changes that don't support our health and there's multitude of reasons for that. Sometime when I speak to my patients about becoming physically more active, time is often a big factor for, you know, women. Often they're working childcare and whatnot, but it's about making your health a priority and finding a few minutes. So it's recommended that you exercise 150 minutes, which is two and one half hours per week, which isn't that much time.
Speaker2:
And we need to better support our patients in becoming physically more active. It doesn't mean you have to spend a lot of money and join a fancy gym, but just by making time for yourself and going for a walk outside is a start, and even a small amount of exercise has a benefit over no exercise, and meeting the guideline is ideal, but an exercise of moderate activity that increases your heart rate. So you can still talk, but you may feel a little bit winded, can really make a lot of positive changes in your quality of life. I think the easiest one that people see when they start to exercise and they've made it a habit, not, you know, something that you do intermittently, but as a scheduled event in your week is improvement in sleep. Often when you're exercising, if you do it for a prolonged period time, obviously you will have fatigue. But people's sleep dramatically improves once they start to exercise. When people exercise and they get off, you know, they overcome the initial fatigue that people have. If they haven't done exercise and have been inactive, your energy level will often increase and your muscle mass will increase and then your metabolic rate can increase and all of those things can improve your quality of life.
Speaker2:
When you ask men versus women reasons, you know why they exercise. Men usually tell you that they exercise because it makes them feel better. Women have kind of been socialized differently, and often the answer is something like they have a wedding or an event and they're trying to lose weight. But the focus really shouldn't be on the weight because that's extrinsic. The focus has to shift to intrinsic and the intrinsic intrinsic motivation comes from the fact that you actually do just feel better. You can sleep better. It often is a great way to relieve stress and anxiety. For many women, it can be more effective than antidepressants. But obviously if you're if it's recommended, you're on an antidepressant, there's good reason for that. And you should you should incorporate this as integrative health, not like one versus the other, but they're very simple things that can have a big impact on on your health even. You know, when we look at children and exercise, there's an impact on IQ in children who exercise who relative to those who don't. And for children, it's critically important that they exercise the guidelines, recommend an hour a day more exercise is needed than for adults. So I think all of those factors are important for patients to know and understand.
Speaker1:
Excellent. Thank you so much for that. And I just want to add to that know, we know obviously about the research showing exercises ability to reduce cancer risk. But even for our listeners who who have cancer and who are battling cancer, I mean, we have multiple studies showing a significant benefit from exercise once you're diagnosed with cancer as well, for many of the reasons you just mentioned. Never too late to get started.
Speaker2:
Right. I agree with you. I yeah, I really agree with you on that fact. We know that recurrence rates are less in people who exercise relative to those that don't. So there's lots of lots of benefits.
Speaker1:
And Dr. Wright, I'd also like to discuss vaccinations, which vaccinations are associated with a decreased risk of cancer development.
Speaker2:
So vaccinations, you know, the first vaccine proven as a way to prevent cancer, was approved in 1981. It was hepatitis B vaccine. And so it prevented chronic hepatitis, cirrhosis and hepatocellular or liver cancers. And that vaccine didn't have any gender bias because obviously men and women both have livers. And it was introduced pretty easily into vaccination regimens. And I think most of us probably are vaccinated. All health care workers are required to show hepatitis B vaccine for gynecologic cancers. Were so fortunate that we have an FDA approved vaccine called Gardasil. Initially, when it was introduced, it was targeted to her, despite the fact that we know that HPV related cancers affect both men and women. And most recently in the US, HPV vaccine guidelines were changed and extend up until age 45 because right now the most common related, the most common HPV related cancer in the United States is oropharyngeal cancer, which affects men more than women. So now there's you'll see on TV, new convert, new new commercials with patients, you know, with men running, jogging outside and the HPV vaccine. So HPV vaccine prevents cervical cancer in women, but also vulvar cancer, vaginal cancers, anal cancers, and then oral pharyngeal ent cancers and in men penile cancers. So there's five different cancers in women that can be decreased by HPV vaccination. And many people were reluctant to do HPV vaccination, thinking that their sons didn't need it with the initial introduction. And then there were always parental concerns that their children were going to be at risk, that there were concerns that sexual promiscuity would increase, but there's no data to support that. And ideally, these vaccines are given in the pediatric age group before people become sexually active, usually 11 to 12, but as young as nine up until age 26. After that 26 to 45, you should discuss your risk with your physician, but FDA has approved it up until age 45.
Speaker1:
So it's really going to do its work as a prevention, not after someone's probably been exposed to HPV. Is that accurate?
Speaker2:
That's accurate. Although, you know, you may be exposed. So it's not one strain of the virus. There's many different strains of the virus. And so it vaccinates against nine different strains. So by having vaccination later in life, maybe you were exposed to 16 or 18, which are the most common strains, but you're still covered from those other strains. So it's it's really a low risk vaccine. I know there's people that are anti vaccine, but there's really some local discomfort from the vaccine and very few side effects.
Speaker1:
Well, thank you for mentioning that, because, you know, there's a lot of chatter out there is, as I know you're aware, on Gardasil and especially in the alternative medicine community, there's a lot of discussion about how it's not a good vaccine, it's unsafe and it's causing all this harm. But, you know, I just want our listeners to know that that that's really not the case. I mean, it's a lot of fake news, so to speak. It is a good vaccine and it has been shown to significantly reduce cancer risk.
Speaker2:
Yeah. And not only cancer risk, it also reduces the risk of just HPV infection. So, you know, I see many women and, you know, many men as well more commonly will just develop benign genital warts that cause local discomfort, like with itching, burning, irritation, cosmetic. So it also the vaccine protects against the strains that are most commonly associated with genital warts as well.
Speaker1:
Thank you. And I'd like to also discuss genetic testing. It's become a significant aspect of health care today. Are there any genetic tests which you recommend for your patients?
Speaker2:
So genetic testing is a little more controversial for ovarian and breast cancer and some types of uterine cancer. There are families that will have germline mutations, meaning a hereditary risk for developing these cancers. And so it's critically important for families to talk about their ancestry and know and cancers, because usually a hereditary cancer affects multiple generations and you do a pedigree analysis, but that can sometimes be limited because family size can be small. And in addition, some people are adopted. Some people don't know their family history or talk about these things. So in ovarian cancer, ovarian fallopian tube, primary peritoneal, those three cancers, we're so grateful for the work of Mary-Claire King, who discovered the BRCA one and B BRCA two genes that identified hereditary breast and ovarian cancer. And so national guidelines, there's a consensus independent of society that if you have a personal history of ovarian cancer, genetic testing is indicated for that. When you go beyond that, it's important to know history of breast cancer, ovarian cancer or colon cancer in your family members. And it depends. It's a series of there's survey questions that you can do that will quantify your risk. And based on the risk assessment from different APS can do it. There's online surveys that can do it. You would then be referred to a genetic counselor for testing. That's certainly been the traditional pathway. Now with online platforms, there's a lot of testing that you can do yourself even without consulting a medical provider.
Speaker2:
For example, 23 and me, Mary Mary-Claire King advocated in an article she wrote for the Journal of the American Medical Association that all women should consider genetic testing at age 30. And it doesn't mean that if you get genetic testing, that you have to necessarily undergo risk reducing surgery, but it allows you to be triaged into a risk category that we can then better screen you for the development of cancers because many women will have a gene mutation and there's environmental factors, you know, nutritional factors, other things. We don't fully understand that those even though you have a gene mutation, you may not develop that cancer. And so we need to really study that and better understand who should undergo risk reducing surgery. And part of that depends if there's a screening test or not, because if there's a screening test that's reliable and effective, then you can avoid surgery and be screened and have an intervention prior to the development of cancer. Unfortunately for ovarian and fallopian tube cancer, there is no effective screening test. So it's a limitation. And there's been decades of research on this using ultrasound to look at the ovaries and tubes and a tumor marker called K 125. But the false positive rate is just too high to justify that in the general population, in people who do have a documented gene mutation in the BRCA genes when they finished having their children, it's generally recommended that they consider risk reducing surgery, which removes means removal of the fallopian tubes and ovaries.
Speaker2:
So, you know, genetics is still a field that has so much potential, but we as doctors and clinicians and researchers need to figure out the ways that we best apply that to populations and not cause harm, such as excessive anxiety or worry, unnecessary testing or surgical interventions, because surgical interventions can have complications sometimes. The one thing I really wanted to mention, though, is that often what was discovered with the BRCA one gene mutations in women undergoing risk, reducing surgery, removal of the fallopian tubes and ovaries that a lot of these cancers actually started in the fallopian tube and not in the ovary. So cells in the distal end of the tube would exfoliate and land on the ovary and create a mass that would lead to the diagnosis. So knowing that fact, we often now recommend the medical term is opportunistic self inject to me meaning women have the option of having fallopian tubes removed after finishing finished after they finished having their families to decrease their cancer risk, in addition to preventing as a means of family planning and contraception as well. And if someone's having a hysterectomy now, we do not leave the fallopian tubes in place. We can leave the ovaries in place. But by removing the tubes, we decrease cancer risk, yet maintain the hormone production of the. To avoid side effects of early menopause.
Speaker1:
Excellent. Think. Thank you for that. And obviously is we can tell by the by the things we've discussed already. You're you're having some very important and detailed conversations with your patients. And I just want to kind of touch on your emphasis on good communication. I know you're you're a champion of just really good communication and open dialogue with your patients. How is that impacted your practice in your relationship with your patients?
Speaker2:
So I think it's important for doctors to think of patient centered care or patient focused care. So when I speak to my patients, I usually ask them why they're here and what is the most important thing to address at the visit. So that we're providing, we're acknowledging and making sure we address what's most important to the patient. And doing that with some open ended questions can really help things along as far as reaching for the patients, being satisfied with their visit, and also for the doctor achieving the best health care for their patient. So when we just have a checklist and we go in and we we were short on time, we sometimes miss important clues to symptoms that maybe the patient wouldn't bring up otherwise. But starting that way, I think is always very helpful. And also that patients, when they come to the doctor, if they can think in advance and write down their questions, because when they're here, sometimes, you know, they forget or they're nervous or they're anxious. So having your your top three questions or reasons, you're coming to see a doctor in your mind or written down or note it on your iPhone can really make a big difference for the limited time we have sometimes with.
Speaker1:
Patients, and I'm sure that empowers your patients to feel like they can they can be honest and ask some of those questions without fearing that you're going to get mad at them or or or think it's a stupid question or anything like that. Because I hear a lot of patients tell me that they just didn't want to ask for for fear of of it not being received well. And so I'm I'm I know they're able to discuss those those concerns with you.
Speaker2:
Right. I think, you know, patients and doctors have to have a relationship that's based on trust and mutual respect. I think that's really important for the best outcome.
Speaker1:
And if I may, I'd like to just briefly touch on surgery. I mean, obviously, you you have days every week that you're in the O.R. and you're doing surgery. And I mean, obviously, no one wants to have to have surgery. But I'd like to just briefly touch on the importance of surgery in in effective cancer care, especially as it relates to the types of cancer you see, because, you know, there's there's certainly an element of of fear when it comes to surgery and anesthesia and, you know, having having certain parts removed. But there's this belief out there that, you know, surgery spreads cancer and that it, you know, is is this bad thing and you want to avoid it. And, you know, I unfortunately see a lot of patients in my practice who have refused surgery and then they saw their cancer get worse. And then they they they come to me to establish care as a stage four patient in and we wish we could go back in time and have them do surgery. So can you just briefly kind of touch on that and just the way surgery is is so sophisticated these days and how safe it is? Because I think there are some people maybe listening who who still aren't sure about that.
Speaker2:
Yeah, I think for patients that are fearful of surgery, it's always important to ask the doctor if there's alternative treatments. So for some gynecologic cancers, radiation therapy is an alternative. If you're if you're really fearful and unable to go ahead or make the decision to have surgery. I also think that if surgery has been recommended, it's always a great idea to get a second opinion if you're anxious or if it's anything that's a rare tumor or out of the ordinary, because that can give you a different perspective as well. When there's alternatives to surgery that are really effective without, you know, with a risk profile or side effects of treatment that aren't, you know, aren't acceptable, you know, with surgery, it's always the acute side effects. It's always like the intraoperative blood loss or post-operative infection or unexpected injuries. But the majority of time, you know, when we make recommendations for surgery, it's based on a long history of trials that have looked at patient outcomes over years and correlate it to prognostic factors that we get from surgical pathology reports. And we can pretty, pretty much predict success based on historical controls that are being updated on a regular basis. So making decisions about surgery because of fear, I think it's important to recognize what is what is it that you're fearing and is the alternative acceptable to you? You know, some people will just not be able to have surgery because of different anxiety or beliefs that they have, which, you know, it's ultimately the patient's decision. But for a lot of gynecologic cancers by. Having surgery, it means something is early or relatively early or early stage that you're cured with surgery. It's unfortunate when we have to add radiation and chemotherapy because that's often in the setting of metastatic cancer where the cure rates aren't as high. So sometimes surgery, even though it may be scary to people, can be life saving and avoid some of the toxicities that are a no and side effect of radiation and or chemotherapy treatments.
Speaker1:
Right. And the whole idea that surgery spreads cancer, do you want to do you want to weigh in on that?
Speaker2:
Well, I don't really want to weigh in on the breast cancer because I don't treat it primarily. So it's a little outside of my expertise.
Speaker1:
No, no, I just my my question is, is the myth that surgery spreads cancer not not breast cancer specifically, but just there's there's this myth out there that that any kind of surgery to remove cancer is going to spread it and make it worse.
Speaker2:
Yeah, I'm glad you ask me that question, because my patients asked me that sometimes, too, and they'll talk about family members who had surgery and then all of a sudden it was metastatic and their loved ones passed away from cancer. And so obviously that leaves a really emotional connection and fear in some patients. The problem, especially for ovarian fallopian tube cancers, are our ability to see cancer spread is limited. So sometimes we'll do a CT scan that will look fine. And so people are told, oh, it looks like it's early, it's limited to the over. Yet when we do surgery and we actually see we can see sometimes like little grains of salt on the lining of our abdomen and pelvis, which is metastatic cancer, that it just can't be picked up by a CT scan or even a PET scan in really early diagnosis, because what we're seeing is cancer can be microscopic and obviously a surgeon doesn't have a microscopic vision. And so we miss things. And when we open the abdomen and look, it's not that it's spreading. It's just that it was there and it's gotten to the point where it's going to be clinically symptomatic. And surgical staging is a term that is used for cancers that rely on pathology to assign the final stage of disease. And so we may we may remove tissues that look normal, such as lymph nodes. And then the pathologist is the one that tells us it's metastatic cancer. So it didn't mean that it spread. It just was not well quantified where exactly the cancer was or where it spread to at the time of the initial diagnosis before surgery.
Speaker1:
Excellent. And just to piggyback on that, you know, I know there are also cases where a patient has imaging and then they have surgery and the surgeon couldn't visibly see anything that looked abnormal otherwise. But we know that cancer can already have spread through into the bloodstream or in the lymphatic system before surgery. And the surgery didn't spread the cancer, but it was, you know, the the train had already left the station, so to speak. And, you know, if cancer popped up later, again, that's not because of the surgery spread. It's because cancer had already escaped out of that initial area to begin with. I'd like to talk about your new book titled It's Time You Knew. Tell us more about that.
Speaker3:
So the book is meant to help people understand their risk, and no one wants to hear all the negatives. And so it's written with storytelling based on patients I've taken care of and common patterns of disease. So each chapter in the book tells the story of a patient and makes it more personal so that I hope the women and men who read the book can see someone or empathize or understand the decisions and what can happen based on the actions the different characters took and what happened. The book actually starts with a very personal story because my older sister passed away from ovarian cancer. And I think by knowing that, we automatically knew that all the women in our family were at higher risk than the general population for ovarian cancer. And not all women know that. So family history, again, it's really important. And knowing what you can do to decrease your risk can sometimes be lifesaving. My youngest sister, Shirley, had breast reducing surgery and was diagnosed with the earliest stage of fallopian tube cancer, diagnosed only by final pathology. And so when women who are at high risk for some forms of hereditary cancer undergo surgery about 5% of the time. Go find a very early cancer in the fallopian tube at a time when no further treatment is necessary, such as chemotherapy. So I wrote the book in part as a tribute to my sisters and the hope with the hopes that people can learn from it and prevent cancer by making wise choices.
Speaker1:
Well, I can say that I've read your book and it's excellent. So I definitely encourage our listeners to to obtain a copy. And where's the best place for them to do that? Dr.. Right.
Speaker3:
So. Dr.. Siegel The best place is probably the website for Lena, right, imdb.com, because it has links to where you can buy the book. And the book is sort of the website is sort of created to tell listeners a little bit about me, but also about the book. And it also has a link to a newsletter or email that has the top five ways to prevent women's cancer. So I encourage your listeners to check it out and hopefully they'll enjoy reading the book.
Speaker1:
Well, I know they will, and I'm just going to spell your website for them at Val in a w r i g h t imdb.com evelina right.
Speaker2:
Md Correct.
Speaker1:
And you also have a social media presence so they can connect with you on social media as well.
Speaker3:
Right. So I'm working on that. I really wrote the books in honor of my sisters, and so I didn't really pay enough attention to the marketing. So if they have patients, the newsletter is there and I do post on Instagram and I have one podcast published. So I'm nothing like your expertise, but it's a fascinating way to reach for people so that they understand the importance of some of this health information.
Speaker1:
Excellent. And so for those who are listening, we'll make sure to post links to to Dr. Wright's website and social media as well. So we'll make sure that they can they can find you.
Speaker3:
Well, thank you. It was really a pleasure, Dr. SIEGEL, to speak with you. And I love your podcast and your book, Cancer Secrets. And I think Integrated Health and having these conversations is so key to public health in general. So I wanted to thank you again for having me as a guest.
Speaker1:
Oh, well, it's it's been my honor. So thank you for taking time out of your really busy schedule to to be with us today.
Speaker3:
I really it's my pleasure. Thank you again so much.
Speaker1:
And just to our listeners, if you're enjoying these podcasts, please take a minute and provide a review on iTunes, Spotify or wherever you listen to podcasts. And as a reminder, please subscribe to the Cancer Secrets podcast to be notified when new episodes are released. We have some great shows planned and I can't wait to share them with you. And as always, please share this podcast with your family and friends. All previous episodes are available for free on our website at Cancer Secrets dot com. Dr. Wright thank you again. I really appreciate this.
Speaker3:
Again, thanks. Thanks for your time and I hope your listeners found this useful.
Speaker1:
Oh, I know that. I know they have. Well, thank you very much. And until next time. Bye bye.
Speaker3:
Okay, bye bye.
Speaker4:
Oh. Oh.
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