Health & Fitness

What you need to know about gynecological cancers

Dr. John Diaz visits with his patient Anelisa Perez on June 16. Perez is undergoing treatment at South Miami Hospital for Stage 2 endometrial cancer.
Dr. John Diaz visits with his patient Anelisa Perez on June 16. Perez is undergoing treatment at South Miami Hospital for Stage 2 endometrial cancer. pfarrell@miamiherald.com

Like many women, Deerfield Beach resident Karen Barback-Pristera always put herself on the back burner.

Her husband was diagnosed with prostate cancer the year before they were married. A nurse by training, Barback-Pristera spent the next two decades nursing her husband, until his recent death. She neglected going for any medical checkups herself.

That mistake would turn out to be potentially deadly. After bleeding internally for four weeks, Barback-Pristera was diagnosed with uterine cancer in 2010.

“Being a long-time nurse and caregiver, I suspected what was going on,” said Barback-Pristera, 64. “My mother had a history of cervical cancer in the 1980s so I said, I might as well address this. I called a friend and I said, “I need a surgeon as of yesterday.”

She wound up having a complete hysterectomy, done where the couple was then living in Albany, N.Y. The disease was caught early, and the surgery was a success. But her surgeon, Dr. Thomas Morrissey, was transferring to the Cleveland Clinic Florida in Weston. She and her husband followed him, moving to South Florida for follow-up care.

Six years cancer-free at this point, Barback-Pristera, whose husband recently died, doesn’t regret the decision to move.

“My husband always wanted me to have the best care,” she said. “The doctor I had was a stranger to me. This was complete blind faith. I put my life in someone’s hands. I thank God every day I did.’’

Barback is one of the lucky ones. Hundreds of thousands of American women are diagnosed with a form of gynecological cancer every year, and, since there is no simple and reliable way to screen for any gynecological cancer except cervical, it is especially important to have an annual checkup and Pap smear.

The five main types of “female cancer” are ovarian, cervical, vulvar, uterine, and endometrial, plus the very rare fallopian tube cancer.

All women are at risk for gynecological cancers, and that risk increases with age, as well as obesity and lack of exercise. There is also a strong genetic link. As in all cancers, when found early, treatment — usually radiation or chemotherapy — is most effective.

Endometrial cancer is the most common form of gynecological cancer, with 60,000 American women diagnosed a year and 10,000 deaths annually. However, it is also the most curable form because menopausal vaginal bleeding is an early sign that usually catapults patients to their doctors’ offices. At that point, the disease is detected through a biopsy, not a Pap smear, or swab of the vaginal wall.

“These cancers are often caught at an early stage when in uterus, at an early stage, and can usually be cured by hysterectomy,” said Morrissey. “Often, the hysterectomy can be performed vaginally or through laproscopy with a quick recovery period. It’s usually performed by a robotic assistant. It can be an outpatient treatment or an overnight stay in the hospital, and the incision is just one centimeter wide.”

I put my life in someone’s hands. I thank God every day I did.

Karen Barback-Pristera, who was diagnosed with uterine cancer in 2010 and underwent a successful surgery, performed by Dr. Thomas Morrissey, now with Cleveland Clinic Florida

Ten years ago, Dr. John Diaz of Baptist Hospital in Miami, while he was a fellow at Memorial Sloan Kettering Cancer Center in New York, pioneered a new procedure to make sure the disease had not spread, or metastasized. It is now used relatively universally.

Previously, doctors, not wanting to take any chances in determining whether the cancer had spread, would remove all the surrounding lymph nodes. That meant a much more invasive surgery, a hospital stay of at least three days and a greater risk of bleeding, lymph injury and lymphedema, or swelling caused by the accumulation of lymph in soft tissue.

“Most women — say 90 percent — were undergoing the procedure without deriving any benefit from it,” Diaz said.

Now, thanks to Diaz’s innovation, doctors use a special fluorescent yellow light to search out that one potential deadly lymph node — called a sentinel lymph node — and remove it, leaving the others intact. The procedure began with breast cancer.

“The thought was, ‘How can we do better?” said Diaz. “They used to remove all of the lymph nodes in the armpit. This can be very traumatic for women. It was very uncomfortable, and they had to wear special wraps.”

The procedure was being used in cases of melanoma, before Diaz began using it with gynecological cancers. It is now standard care, with a detection rate of 80 to 85 percent.

“We actually find additional metasisies that would have been missed with the traditional method,” said Diaz, whose original published paper led the way for the adoption of the practice.

However, the procedure was not without controversy, with some doctors clinging to the old guidelines of removing all surrounding lymph nodes. The Mayo Clinic waded into the controversy, offering up its own databases to do a comparison study. That study essentially backed up Diaz’s work, finding that removal of simply the “sentinel lymph node” was indeed sufficient.

AnelisaPerez is a patient of Diaz’s who benefited from the new procedure.

Perez, a Miami divorcée with two sons, was diagnosed with Stage 2 endometrial cancer in 2015, after visiting the emergency room at South Miami Hospital following four weeks of bleeding. Doctors found Perez had a fibroma, or tumor, and referred her to Diaz, who decided to do a hysterectomy based on her strong family history of cancers. Perez’s mother, sister, two aunts and two cousins had all been struck down by the disease, primarily colon cancer.

Due to her young age — she is 43 — Diaz decided to be extremely aggressive in treating Perez, prescribing both chemotherapy and radiation. She finished the radiation and is in the middle of her chemotherapy.

Perez says the treatments were not as bad as she expected. The key to keeping her family stable has been to maintain their normal routine.

“I haven’t mentioned the word cancer to them,” said Perez, an event planner on leave. “I just said mommy has stomach pain but she’ll be fine. I put on make-up, we go grocery shopping, I take them to school every day. The key is to keep up your attitude, and having the support of friends and family.”

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