The following
program presents principles
00:00:01.98\00:00:02.95
designed to
promote good health and
00:00:02.96\00:00:04.41
is not intended
to take the place of
00:00:04.44\00:00:05.98
personalized professional care.
00:00:06.08\00:00:07.96
The opinions and
ideas expressed are those
00:00:08.50\00:00:10.69
of the speaker.
Viewers are encouraged
00:00:10.72\00:00:12.90
to draw their own conclusions
00:00:12.98\00:00:14.41
about the information presented.
00:00:14.56\00:00:16.09
Hello, my name is Stoy Proctor,
00:00:37.92\00:00:39.50
I'm here today
hosting 'Wonderfully Made.'
00:00:40.13\00:00:42.45
We have wonderful
bodies. Today we're
00:00:43.40\00:00:45.86
gonna talk about a
part of a woman's body
00:00:45.89\00:00:48.29
the uterus and what
can go wrong sometimes
00:00:48.45\00:00:52.28
with a uterus.
Uterus is a cavity that,
00:00:52.38\00:00:54.94
that sort of
nurtures the fetus while it's
00:00:55.36\00:00:57.93
growing and
eventually it propels the fetus,
00:00:58.03\00:01:00.91
what is known as
Child birth. Today we are
00:01:01.55\00:01:04.32
very fortunate to
have Dr. Allan Handysides,
00:01:04.42\00:01:06.44
And welcome Dr.
Handysides, it's good
00:01:06.47\00:01:07.96
to be over here,
to our program today.
00:01:07.99\00:01:09.81
Dr. Handysides is a
Gynecologist and he has
00:01:10.29\00:01:12.54
been so for about
40 years, so he's had
00:01:12.57\00:01:15.67
much experience in this area.
00:01:16.14\00:01:17.97
Would you explain a
little bit about the
00:01:19.22\00:01:21.72
uterus and the
function of the uterus and
00:01:21.75\00:01:25.49
well, the anatomy of the uterus?
00:01:26.02\00:01:27.55
Stoy, the uterus
as you have already
00:01:27.65\00:01:29.94
mentioned is that
container in which a baby
00:01:30.06\00:01:33.07
grows and develops,
it's a very specific
00:01:33.50\00:01:36.98
and very highly
specialized organ,
00:01:37.10\00:01:39.62
it provides for the
nutrition the correct
00:01:40.06\00:01:42.67
implanting of
the developing fetus,
00:01:42.83\00:01:45.07
it has a lining
which forms the interface
00:01:45.59\00:01:48.51
between one life and another.
00:01:48.66\00:01:50.92
In order to
perhaps illustrate this for
00:01:52.05\00:01:54.41
our viewers
because it sometimes is
00:01:54.44\00:01:56.23
difficult to
illustrate for over viewers.
00:01:56.27\00:01:58.54
What I did was I
took a papaya often
00:01:58.72\00:02:02.77
known as paw paw in
certain parts of the
00:02:02.85\00:02:04.65
world and I used
that, I cut it half to show
00:02:04.70\00:02:10.27
the various parts
and anatomical parts of
00:02:10.31\00:02:14.20
the uterus. Of course
a papaya is not a uterus.
00:02:14.80\00:02:18.27
It is a seed
bearing structure so it's a
00:02:18.33\00:02:20.99
plant's uterus if
you want to think of it
00:02:21.24\00:02:22.61
like that, but in
terms of human it is just
00:02:22.64\00:02:26.12
an example, but I
did do that and I think
00:02:26.15\00:02:29.07
our viewers can
see the papaya now.
00:02:29.26\00:02:31.89
Here you see
there is this papaya,
00:02:34.07\00:02:36.23
I'm touching the
cervix portion which
00:02:36.27\00:02:38.96
would be the neck of the uterus,
00:02:38.99\00:02:41.93
the top part would
be the fundus and I'm
00:02:42.32\00:02:44.98
going to cut it and
open it up so that we
00:02:45.01\00:02:47.91
can see what the
inside of the uterus might
00:02:47.97\00:02:52.31
be looking like or
at least have an idea
00:02:52.34\00:02:55.20
as to the
structure of what is going on
00:02:55.34\00:02:58.43
in the uterus. Now,
here you see the seeds,
00:02:58.49\00:03:01.10
these would
represent the baby and a
00:03:01.13\00:03:02.87
normal uterus but
the red flesh would
00:03:02.90\00:03:05.90
represent the
muscle and the green
00:03:05.93\00:03:09.10
portion would
represent the outside,
00:03:09.38\00:03:12.01
the inner portion
that I am there marking
00:03:12.07\00:03:14.82
with the knife
represents what's called the
00:03:14.89\00:03:17.31
endometrium and the
lower portion is the
00:03:17.34\00:03:20.02
cervix. Now I'm
taking the knife and
00:03:20.18\00:03:22.21
cutting off the
cervix so that you see that
00:03:22.30\00:03:25.29
portion that I have
cut off would be called
00:03:25.44\00:03:27.96
the cervix and when
we talk about cervical
00:03:27.99\00:03:30.87
cancer. We're
talking about cancer in this
00:03:31.21\00:03:33.62
part and if we were
to talk about the part
00:03:33.71\00:03:37.82
that's protruding
into the vagina that's
00:03:37.91\00:03:39.69
the cervix that
we can see, the upper
00:03:39.79\00:03:41.88
part is the body of
the uterus and cancer
00:03:41.99\00:03:45.49
if it's going to
start in the body of the
00:03:45.64\00:03:47.29
uterus would start
in the endometerium
00:03:47.32\00:03:49.62
the part that I'm
there touching with a
00:03:49.67\00:03:51.73
knife blade. Now,
as I scrape that off
00:03:51.78\00:03:54.71
from the meaty
portion of the papaya there,
00:03:54.97\00:03:59.51
but if it were
the uterus, that part,
00:03:59.54\00:04:01.59
that yellowish
part that we would be
00:04:01.66\00:04:03.19
cutting off would
be endometerium and
00:04:03.22\00:04:06.25
the endometerium
is the part where
00:04:06.28\00:04:09.13
cancer commonly
begins in cancer of the
00:04:09.23\00:04:12.43
body of the
uterus, and so if we talk
00:04:12.46\00:04:15.66
about endometrial
cancer now I have an
00:04:15.69\00:04:17.50
idea. Sometime
cancer is just in there
00:04:17.53\00:04:20.58
but it may extend
into the muscle of
00:04:20.61\00:04:23.89
the uterus and
that is called invasion.
00:04:24.20\00:04:27.18
If cancer is
spreading into the muscle
00:04:27.80\00:04:29.86
particularly if it
goes right through we
00:04:30.19\00:04:32.08
have a fairly
extensive invasion of that
00:04:32.12\00:04:35.79
cancer. Obliviously
we would like the cancer
00:04:35.82\00:04:38.36
not to invade all
the way through but
00:04:38.53\00:04:40.67
to be restrained to
the lining portion of
00:04:40.77\00:04:44.69
the uterus. So, I
hope by looking at this
00:04:44.79\00:04:47.00
paw paw we'd been able to get an
00:04:47.05\00:04:48.23
understanding of
what we're going to be
00:04:48.29\00:04:49.75
talking about in
the rest of the program.
00:04:49.81\00:04:52.58
Now, in your
illustration there you
00:04:54.04\00:04:57.09
mentioned
endometrial and cervical cancer,
00:04:57.14\00:05:00.54
may be first for our
viewers you would explain
00:05:01.68\00:05:03.76
a little bit about
the cancer itself and
00:05:03.79\00:05:06.64
what really takes
place. Cancer is an
00:05:06.96\00:05:10.15
unrestrained,
uncontrolled division of cells.
00:05:10.40\00:05:14.74
The cellular
mechanisms of division are
00:05:15.68\00:05:19.07
regulated through
the nucleus and in many
00:05:19.11\00:05:22.37
ways cancer is a
disease that starts in the
00:05:22.45\00:05:25.97
nucleus the nucleus
of each cell and every
00:05:26.00\00:05:29.05
cell if our viewers
would remember, has a
00:05:29.21\00:05:31.70
nucleus that
contains the chromosomes,
00:05:31.73\00:05:34.08
the genetic
material of that individual.
00:05:34.13\00:05:35.90
If that nucleus
becomes damaged either
00:05:36.37\00:05:39.60
by infection
possibly by toxin, possibly by
00:05:39.72\00:05:43.79
hormonal influence or
stimulation, possibly by
00:05:43.85\00:05:47.74
degenerative
processes, possibly by inherent
00:05:47.87\00:05:50.77
weakness but whatever
cause that the nucleus
00:05:50.80\00:05:53.36
becomes damaged
then the regulation of
00:05:53.44\00:05:56.38
cell division may
go away, and so cells
00:05:56.41\00:05:59.64
begin to divide in
an uncontrolled fashion
00:05:59.67\00:06:02.22
another factor in
cancer that's very important
00:06:02.86\00:06:05.27
is that the
stickiness or adhesiveness with
00:06:05.31\00:06:07.98
which cells stick to
each together is lost in
00:06:08.01\00:06:11.45
these rapidly dividing
cells, which means that
00:06:11.48\00:06:14.16
they can break off,
get into the lymphatics or
00:06:14.24\00:06:16.80
into the bloodstream and spread.
00:06:16.83\00:06:18.99
So, there are
two ways of spread,
00:06:19.02\00:06:20.88
either by direct
extension growing into
00:06:20.95\00:06:24.54
the local tissues or
cells breaking off and
00:06:24.57\00:06:28.08
being transported
in either the lymphatic
00:06:28.11\00:06:30.35
which is the
drainage of the liquids of the
00:06:30.42\00:06:33.11
tissue or in the
bloodstream to distant
00:06:33.14\00:06:35.78
sites, where they
can set up and we call
00:06:35.95\00:06:38.21
that metastatic
spread, those are secondaries
00:06:38.24\00:06:42.72
that have come from
the original cancer.
00:06:42.95\00:06:45.58
We have in the uterus
two predominant forms,
00:06:46.02\00:06:48.82
although there are
several forms of cancer,
00:06:48.85\00:06:51.11
two predominant
forms one we call cervical
00:06:51.34\00:06:54.18
cancer which
seems to have its own
00:06:54.21\00:06:56.12
particular predisposing
factor and the other
00:06:56.15\00:06:58.89
endometrial cancer
which also has its own set
00:06:59.16\00:07:02.70
of factors and as I
explained with the paw
00:07:02.81\00:07:04.90
paw, these
anatomical sites differ and so
00:07:05.08\00:07:09.44
does the progress and the actual
00:07:09.53\00:07:11.65
characteristics
of those cancers.
00:07:11.73\00:07:13.36
Now, you mentioned
preexisting conditions
00:07:13.59\00:07:15.65
are maybe causes or
what are some of the
00:07:15.68\00:07:18.75
factors that,
that might precipitate
00:07:18.86\00:07:21.48
endometrial or
cervical cancer. Well they are
00:07:21.98\00:07:24.38
different for each
of the cancers may be
00:07:24.41\00:07:25.76
we should start with
one cancer and go with
00:07:25.79\00:07:28.35
that and then we
could explain the other one.
00:07:28.43\00:07:29.94
Which would you
like me to do first?
00:07:30.28\00:07:31.55
Endometrial, endometrial
cancer alright, okay.
00:07:31.68\00:07:33.81
If we look at a
group of women who had
00:07:34.68\00:07:36.15
endometrial cancer,
we can actually predict
00:07:36.18\00:07:40.36
that there are
certain groups who are more
00:07:40.46\00:07:42.68
prone to endometrial
cancer. So, for instance
00:07:42.76\00:07:45.69
if we see a woman
who is overweight we
00:07:45.72\00:07:47.71
know that she has a
risk, an increased risk
00:07:47.75\00:07:50.18
in the endometrial
cancer. If she is diabetic
00:07:50.22\00:07:53.50
we know she has
an increased risk of
00:07:53.92\00:07:56.55
endometrial cancer,
another factor that may
00:07:56.58\00:07:59.66
predispose very
much has to do with the
00:07:59.70\00:08:02.74
regularity of
ovulation and if a woman has
00:08:02.79\00:08:07.08
a regular menstrual
cycles she is not ovulating
00:08:07.13\00:08:10.32
regularly, she is
going to be more prone
00:08:10.45\00:08:14.09
to have
endometrial cancer. So, when we
00:08:14.61\00:08:17.37
look at that we say
well those women will
00:08:17.40\00:08:19.38
probably have
fewer babies, so we see
00:08:19.48\00:08:21.81
people who don't
have children. People who
00:08:21.85\00:08:24.33
are overweight,
people who are diabetic,
00:08:24.36\00:08:27.41
people who have
irregular or erratic ovulation
00:08:28.00\00:08:32.37
or no menses, this
group of women are at
00:08:32.43\00:08:35.63
an increased risk
for endometrial cancer.
00:08:35.66\00:08:38.89
Now, what can a
women do something
00:08:39.88\00:08:41.81
about like say her
diabetes, can she control
00:08:41.91\00:08:44.20
it, will that help
any, well, what about the
00:08:44.31\00:08:46.29
regularity of her
period, can she control that,
00:08:46.35\00:08:48.50
is there is any
ways of, you see,
00:08:48.69\00:08:50.62
reducing this risk.
We might need to ask
00:08:50.80\00:08:53.08
ourselves what could
be the common pathway
00:08:53.11\00:08:56.69
in all these people
that is predisposing to her
00:08:57.15\00:09:02.21
having
endometrial cancer. And the
00:09:02.27\00:09:04.93
current thinking
is that women who are
00:09:05.00\00:09:07.98
not ovulating
regularly, women who are obese,
00:09:08.04\00:09:10.91
the fat tissue
actually produces estrogenic
00:09:11.46\00:09:14.66
component, women
who don't menstruate
00:09:14.74\00:09:17.30
regularly don't
have progesterone,
00:09:17.34\00:09:18.66
so it looks that the
effect of an unopposed
00:09:18.74\00:09:23.30
presence of
estrogen, in other words,
00:09:24.06\00:09:26.26
not a cyclical
estrogen, but a continuous
00:09:26.98\00:09:29.50
estrogen may be
playing a factor in
00:09:29.56\00:09:32.35
developing
cancer. So, what we need
00:09:32.38\00:09:34.49
to do in that
situation in a younger
00:09:34.57\00:09:36.40
woman is we need to
do everything possible
00:09:36.43\00:09:39.24
to reduce this
single hormone stimulation
00:09:39.78\00:09:44.62
and to get them into
the situation that they
00:09:45.03\00:09:46.61
have a cyclical reaction.
So, a consultation with
00:09:46.70\00:09:50.87
one's doctor may be
a good idea because the
00:09:50.96\00:09:55.48
doctor convince like
look we can do certain
00:09:55.51\00:09:57.86
things to induce
regularity, of course
00:09:58.00\00:10:01.04
losing weight
maybe one of those very
00:10:01.15\00:10:02.97
important things,
good control of the
00:10:03.00\00:10:04.97
diabetes maybe
one of those things.
00:10:05.00\00:10:06.66
So, there are
things that can be done.
00:10:07.36\00:10:09.30
What can a woman
do to maybe detect the
00:10:09.93\00:10:13.14
cancer early? Endometrial cancer
00:10:13.26\00:10:15.97
usually comes later
in life, and the cardinal
00:10:16.11\00:10:21.63
feature in
endometrial cancer is a change
00:10:21.66\00:10:24.02
in bleeding
patterns. So, a woman,
00:10:24.06\00:10:26.64
at menstrual cycle
maybe, menstrual cycle,
00:10:26.72\00:10:28.68
in other words it's
really not menstrual cycle
00:10:28.79\00:10:31.52
it's bleeding that
may be mistaken for a
00:10:31.98\00:10:34.83
menstrual cycle,
but is actually bleeding
00:10:34.86\00:10:37.84
from the cancer that
is in the endomentrium.
00:10:38.12\00:10:41.31
Typically a woman
who has reached post
00:10:41.79\00:10:44.62
menopausal years
lets say we have a post
00:10:44.72\00:10:47.23
menopausal woman
she stopped menstruating
00:10:47.69\00:10:51.06
and out of the
blue there appears to be
00:10:51.62\00:10:54.93
bleeding, that is
a, oh I'm getting young
00:10:54.96\00:10:57.80
again, very
significant. She is not getting
00:10:57.96\00:11:01.11
young again, she
has got to take that
00:11:01.23\00:11:03.22
seriously and she
has to got to go for an
00:11:03.25\00:11:05.78
immediate
consultation with a doctor.
00:11:05.81\00:11:07.47
A younger woman may
find that she starts
00:11:08.05\00:11:10.74
to have bleeding
irregularly between her
00:11:10.77\00:11:14.36
periods at a
time when she wouldn't
00:11:14.44\00:11:16.72
suspect that she
should be bleeding and
00:11:16.89\00:11:19.07
so should that happen
that again is indicative
00:11:19.22\00:11:23.17
that she needs to
go and see the doctor.
00:11:23.28\00:11:24.84
What the risk
for a younger woman,
00:11:24.93\00:11:26.18
you mentioned
earlier that it was the
00:11:26.21\00:11:27.51
older woman who
usually got the endometrial
00:11:27.54\00:11:29.88
cancer, but and you
now say that younger
00:11:29.91\00:11:32.87
women may also
get it, is it rare or?
00:11:32.91\00:11:35.39
It's much less
common in a younger woman,
00:11:35.89\00:11:38.72
but a younger
woman who is obese,
00:11:39.14\00:11:41.26
who is diabetic,
who has irregular menses
00:11:41.95\00:11:44.91
has not had
children, who begins to find
00:11:45.08\00:11:47.45
abnormal
bleeding, she needs to pay
00:11:47.88\00:11:50.71
particular attention
to this and seek some
00:11:50.81\00:11:53.72
advise from her
medical professions.
00:11:53.84\00:11:55.35
Is there any test
that one can get for
00:11:55.38\00:11:56.67
endometrial
symptoms or like cancers?
00:11:56.74\00:11:58.94
As with all types
of cancers we do really
00:11:58.97\00:12:02.31
need to be
definitive about the diagnosis.
00:12:02.63\00:12:07.15
So, yes, a history
is taken and a physical
00:12:07.75\00:12:10.30
examination is
taken, we might examine the
00:12:10.33\00:12:12.61
lady if she finds
huge fibroids. We may know
00:12:12.64\00:12:16.70
to find out on the
history that she's been
00:12:16.88\00:12:18.58
taking some
hormonal preparations or some
00:12:18.61\00:12:21.53
type of alternative
therapies that have a
00:12:21.64\00:12:25.24
hormonal like
activity, so depending on
00:12:25.27\00:12:27.98
what she's been
doing well there may be
00:12:28.01\00:12:29.84
an answer for the
abnormal bleeding on
00:12:29.87\00:12:32.11
the other hand in
the absence of clear cut
00:12:32.14\00:12:35.76
factors we may need
to say what is going on.
00:12:35.89\00:12:38.61
The examination
may not be very helpful
00:12:39.58\00:12:42.14
and in that
situation sometimes an
00:12:42.77\00:12:45.30
ultrasound
examination will show us the
00:12:45.33\00:12:48.48
thickness of the
endometrium, that lining
00:12:48.51\00:12:50.85
that I showed
you in the paw paw,
00:12:50.89\00:12:52.24
that can be
thickened and enlarged and will
00:12:52.75\00:12:54.63
be shown on ultrasound to be so.
00:12:54.67\00:12:56.90
But the most
definitive way would be to
00:12:57.56\00:13:00.20
actually obtain
some tissue from the
00:13:00.23\00:13:03.33
endometrium and a
gynecologist will possibly
00:13:03.36\00:13:06.45
even in the office
do what is called an
00:13:06.50\00:13:08.77
endometrial biopsy.
Now an endometrial biopsy,
00:13:08.80\00:13:11.42
you take a little
cannula, a little plastic
00:13:11.65\00:13:13.84
canola its
inserted, is like a tube,
00:13:13.96\00:13:16.98
a little tube okay,
it's inserted into the
00:13:17.17\00:13:19.84
cavity of the
uterus. So it would be put
00:13:19.95\00:13:22.00
where you saw the
seeds all that there
00:13:22.17\00:13:23.80
are not seeds in
usually, but we put it
00:13:23.83\00:13:25.44
through the cervix
into that cavity and a
00:13:25.67\00:13:28.36
little syringe on the
end and with the syringe
00:13:28.39\00:13:30.73
you can create a
vacuum, a little suction
00:13:30.91\00:13:34.86
and then you
manipulate that little cannula
00:13:35.92\00:13:39.20
up and down and it
sucks cells into that
00:13:39.25\00:13:44.89
cannula, those
cells are then placed in a
00:13:44.94\00:13:47.37
little jaw of
fomblin and sent to the
00:13:47.63\00:13:50.04
pathologist,
hopefully the pathologist is
00:13:50.08\00:13:53.16
gonna give us a
good diagnosis. Now, in a
00:13:53.19\00:13:56.12
woman who is post
menopausal she may
00:13:56.15\00:13:58.65
be bleeding because
her hormones are so low,
00:13:58.68\00:14:00.93
she has a low grade
infection something like
00:14:01.01\00:14:03.13
that and you do that
procedure and you get
00:14:03.16\00:14:05.06
very, very few
cells, the pathologist says
00:14:05.20\00:14:07.78
atrophic that
means lacking of hormone,
00:14:07.85\00:14:10.55
atrophic thin endometrium, no
00:14:10.96\00:14:13.34
evidence of any
malignancy. So that you
00:14:13.49\00:14:15.66
say well this is
probably because we just
00:14:15.69\00:14:17.98
having a very,
very low hormone or
00:14:18.09\00:14:20.40
inflammation or
something like that,
00:14:20.43\00:14:22.20
but we may also
find cells that are
00:14:22.49\00:14:25.66
inductive of
cancerous or precancerous
00:14:25.72\00:14:29.44
change and that
would be very good,
00:14:29.47\00:14:31.72
we'd like to see
precancerous rather than
00:14:31.75\00:14:33.45
cancerous,
because that means the
00:14:33.51\00:14:34.99
treatment that
we're going to do, can be
00:14:35.21\00:14:37.60
done in such a
way that we treat this
00:14:37.68\00:14:39.74
very early and the
prognosis or the outcome
00:14:39.90\00:14:43.52
for somebody that
has an early diagnosed
00:14:43.99\00:14:48.34
endometrial cancer
is really excellent,
00:14:48.37\00:14:50.69
just very, very
good. But there is really
00:14:50.75\00:14:53.11
then, are you saying
that there is really no
00:14:53.22\00:14:54.68
test, there is no
blood test, there is no
00:14:54.75\00:14:56.41
hormone test, the
doctors can do on a
00:14:56.60\00:14:59.05
regular basis than
that's what we like to
00:14:59.13\00:15:00.84
talk about, how
often should a woman go
00:15:00.87\00:15:03.80
to her gynecologist.
Well, a woman should
00:15:03.86\00:15:06.35
certainly go to her
gynecologist if we're
00:15:06.50\00:15:08.20
talking
endometrial cancer, this is not
00:15:08.23\00:15:10.06
cervical, may be I'll
answer that question in
00:15:10.13\00:15:11.80
like of cervical
cancer a little differently
00:15:11.87\00:15:13.53
but certainly go if
she has any bleeding
00:15:14.10\00:15:16.43
after the
menopause. The menopause comes,
00:15:16.56\00:15:19.60
she's gone her
years, she knows she
00:15:19.63\00:15:20.87
has no further
bleeding, when bleeding
00:15:20.90\00:15:22.14
comes out of the
blue absolutely mandatory
00:15:22.22\00:15:25.54
that she should
go and seek highly
00:15:25.66\00:15:28.21
skilled professional
attention immediately,
00:15:28.31\00:15:31.26
don't delay it,
don't put it off, take no
00:15:31.60\00:15:34.97
chances because
you can be a hundred
00:15:35.25\00:15:37.36
percent killed,
of course a regular
00:15:37.39\00:15:39.43
gynecological
examination visit with
00:15:39.46\00:15:41.80
your gynecologist
during reproductive years
00:15:41.83\00:15:44.01
is advised for
most women because it's
00:15:44.22\00:15:47.80
much better to
pick something up early
00:15:47.84\00:15:49.54
and prevention is
far better than cure.
00:15:49.57\00:15:52.36
Now, suppose
unfortunately the doctor
00:15:53.01\00:15:55.17
finds that there is
cancerous cells there,
00:15:55.31\00:15:58.26
what happens then,
do they, what about,
00:15:59.43\00:16:01.73
I understand there's
something like putting
00:16:02.41\00:16:05.35
this cancer in
stages of seriousness,
00:16:06.24\00:16:08.50
well of course, as
staging, as with all
00:16:08.67\00:16:10.54
cancers we want to
stage. You know there
00:16:10.60\00:16:12.54
are different
systems of staging, one is
00:16:12.57\00:16:14.61
the tumor itself,
one ought to see if there
00:16:14.64\00:16:17.25
are lymph nodes and
other is metastasis,
00:16:17.28\00:16:18.93
so we sometimes
call it the TMX or TNX
00:16:19.04\00:16:21.94
staging system.
What really needs to be
00:16:23.18\00:16:26.90
done is to see if
there is any evidence that
00:16:26.97\00:16:30.34
this cancer has
spread, so the doctor will
00:16:30.37\00:16:32.20
order a series of
investigations, the aim
00:16:32.26\00:16:36.08
of which is to show
the extent of the cancer.
00:16:36.11\00:16:38.69
If the cancer is
spread to the pelvis,
00:16:39.04\00:16:40.88
to the lymph nodes and so forth,
00:16:40.95\00:16:42.54
then to do that he
may order a bone survey,
00:16:42.70\00:16:45.79
he may order MRIs,
ultrasound, but MRI is
00:16:46.30\00:16:49.88
probably what he's
going to want to do
00:16:49.91\00:16:51.53
to see that he may
do x-rays of the kidneys
00:16:51.67\00:16:54.28
to see that the
kidneys are draining well
00:16:54.41\00:16:56.36
and so forth but
once he has delineated
00:16:56.49\00:16:59.64
this then there are
two principle modalities.
00:17:00.07\00:17:03.38
The one for
endometrial cancer would be
00:17:03.87\00:17:05.58
a hysterectomy,
which would include the
00:17:05.61\00:17:08.03
tubes and the
ovaries, because one would
00:17:08.06\00:17:10.40
want to get a wide
scope here. If lymph
00:17:10.56\00:17:14.33
nodes are
detected by extension then
00:17:14.38\00:17:16.90
further therapy would be added.
00:17:16.98\00:17:18.78
Radiation therapy
is usually done in
00:17:19.20\00:17:22.01
conjunction with
the surgery. So, because
00:17:22.14\00:17:24.58
the surgeon says I
think we will use radiation.
00:17:24.72\00:17:27.48
Doesn't mean that
he believes that you
00:17:27.71\00:17:30.22
have a particularly
worse situation but we
00:17:30.34\00:17:32.78
know the results of
radiation combined with
00:17:32.92\00:17:34.85
surgery give better
results, some give the
00:17:34.91\00:17:37.65
radiation before,
some give the radiation
00:17:37.68\00:17:40.38
afterwards. Your
own practitioner,
00:17:40.42\00:17:42.23
your own
specialist will tell you the
00:17:42.35\00:17:44.64
gynecological
oncologist will tell you what
00:17:45.59\00:17:47.66
is the preferred
method of treating your
00:17:47.69\00:17:50.63
particular cancer.
Now, this is serious,
00:17:50.72\00:17:53.53
taking out your
ovaries and all those sexual
00:17:53.64\00:17:57.52
aspects of a
woman, should someone ever
00:17:57.85\00:18:01.03
think about
getting a second opinion.
00:18:01.07\00:18:02.75
I think it's very wise
to have second opinions,
00:18:03.15\00:18:05.72
second opinions are
good for the physician,
00:18:05.80\00:18:07.78
second opinions are
good for the patient,
00:18:08.01\00:18:09.60
you don't look back
and think I wish I'd done
00:18:10.17\00:18:12.74
this, I wish I had
done something else,
00:18:12.78\00:18:14.48
in a clear cut case
most cases will follow
00:18:14.88\00:18:17.58
what I have said and
it is serious to have
00:18:17.70\00:18:20.31
the uterus
removed and the ovaries,
00:18:20.34\00:18:21.75
but unfortunately
it's an older woman's
00:18:21.80\00:18:24.37
condition and by
that time many woman have
00:18:24.78\00:18:27.64
ceased to need their
uterus for child bearing
00:18:27.67\00:18:30.76
procedures and
they are post menopausal
00:18:31.21\00:18:33.42
and so the hormone
production from the
00:18:33.68\00:18:35.56
ovaries has
dropped. So, usually women do
00:18:35.64\00:18:39.15
not notice it as
being very serious as far as
00:18:39.24\00:18:43.81
hormonal
deprivation is concerned.
00:18:43.84\00:18:46.10
Now, if they have
a, if a woman has a
00:18:46.13\00:18:47.51
hysterectomy how is
that gonna effect her
00:18:47.58\00:18:49.49
sexually, the way
she feels, her energy
00:18:49.60\00:18:52.85
level, how does
that effect, any notice,
00:18:52.88\00:18:56.71
any difference? I
think some women claim
00:18:56.83\00:19:00.16
that it does make
a difference and we
00:19:00.28\00:19:02.40
would be insensitive
to their claims if we
00:19:02.43\00:19:05.31
said it didn't make
any difference, in reality,
00:19:05.34\00:19:08.20
in large studies
people who have sexual
00:19:09.28\00:19:12.36
difficulties after
hysterectomy are not
00:19:12.39\00:19:14.53
very much increased
over those who do not
00:19:14.77\00:19:17.83
have, sexual difficulties
may come from reasons
00:19:17.89\00:19:20.40
of hormonal
depletion, aging process and so
00:19:20.47\00:19:25.12
forth. We sometimes
say that a woman who
00:19:25.15\00:19:28.30
has a normal sexual
drive, normal sexual
00:19:28.33\00:19:30.63
activity before
will continue to do so
00:19:30.66\00:19:33.97
afterwards and
person who has had
00:19:34.08\00:19:35.94
problems or
difficulties will continue with
00:19:36.01\00:19:38.19
problems and
difficulties afterwards.
00:19:38.22\00:19:39.82
But of course there
may be some consequences
00:19:40.05\00:19:43.81
of surgery that
could cause for pain,
00:19:43.84\00:19:45.82
scarring and
tissue damage, and a women
00:19:46.30\00:19:49.01
needs to be upraised
of all of this by her
00:19:49.23\00:19:51.20
physician. Now,
another type you mentioned
00:19:51.37\00:19:54.23
early was cervical
cancer. What, how does
00:19:54.29\00:19:57.43
that differ from
endometrial, of course the
00:19:57.46\00:19:59.24
place is different
but, place is difference as
00:19:59.37\00:20:00.70
you've explained,
and it's a different
00:20:00.76\00:20:02.31
cellular process.
Okay, tell us about that.
00:20:02.35\00:20:04.85
With cervical
cancer we're looking at a
00:20:04.88\00:20:06.86
situation, that
the epidemiology of it,
00:20:06.96\00:20:09.76
that is studying the
population that gets it,
00:20:09.79\00:20:12.02
they found that
people who had early
00:20:12.44\00:20:15.20
sexual encounters,
multiple sexual partners
00:20:15.45\00:20:19.45
and women who had
been or had evidence
00:20:19.94\00:20:22.20
of having been
affected with the Human
00:20:22.32\00:20:24.86
Papillomavirus.
Those people have a
00:20:24.89\00:20:28.73
much greater risk
of cervical cancer.
00:20:28.78\00:20:33.14
And today we
believe that the bulk of
00:20:33.44\00:20:35.83
cervical cancer
not all, not all and I
00:20:35.90\00:20:38.17
would not want,
have used to go away with
00:20:38.28\00:20:40.38
the idea that
anybody had cervical cancer
00:20:40.44\00:20:43.16
must have had a
Human Papillomavirus
00:20:43.43\00:20:44.98
infection, but
the bulk of them are
00:20:45.13\00:20:46.79
probably related to
that. There are other
00:20:46.85\00:20:49.01
forms of cervical
cancer that are not
00:20:49.14\00:20:53.53
related to human
papillomavirus. It also
00:20:53.63\00:20:56.51
seems that
herpetic infection, herpes
00:20:56.60\00:20:59.05
plus human papillomavirus may
00:20:59.55\00:21:02.46
increase the risk.
How are these acquired?
00:21:02.84\00:21:05.31
Well these are all
sexually transmitted
00:21:05.42\00:21:07.58
and acquired
through sexual intercourse.
00:21:07.94\00:21:10.35
That's why multiple
partners and beginning
00:21:10.43\00:21:13.56
very early seem to be factors in
00:21:13.65\00:21:16.31
predicting whether
you will get a cervical
00:21:16.72\00:21:18.88
cancer. So that's
one of the different
00:21:19.01\00:21:20.65
pertaining cervical
cancer and endometrial
00:21:20.68\00:21:22.84
And endometrial cancer. Very big
00:21:23.03\00:21:24.26
differences. Early
sexual encounters has
00:21:24.32\00:21:27.09
nothing to do with
endometrial cancer.
00:21:27.12\00:21:28.87
Now another
interesting feature here is
00:21:29.34\00:21:30.99
smoking. They have
found that women who
00:21:31.02\00:21:33.69
smoke have an
increased cervical cancer
00:21:33.72\00:21:36.43
and women who take
birth control pills
00:21:36.46\00:21:38.51
seem to do, but it
is thought that it may
00:21:38.54\00:21:41.02
not actually be a
direct effect but just
00:21:41.11\00:21:44.58
an associated
effect, because women who
00:21:44.61\00:21:46.74
start on birth
control pills early may have
00:21:46.77\00:21:49.17
more sexual
partners and be more sexually
00:21:49.25\00:21:52.04
active, they're
not people who don't,
00:21:52.08\00:21:54.51
and smokers we know, women who
00:21:54.67\00:21:56.92
smoke also are
more sexually active and
00:21:57.06\00:21:59.67
may have more
sexual partners, as a
00:21:59.70\00:22:01.78
group not an
individual of course.
00:22:01.87\00:22:03.59
But as a group.
So, that shows through
00:22:03.77\00:22:06.23
when you start
looking at the epidemiology
00:22:06.53\00:22:08.19
of cervical cancer.
So, some of the things
00:22:08.46\00:22:10.84
that we can do or
may be instruct our
00:22:10.87\00:22:13.08
daughters to do
or not to do would be
00:22:13.17\00:22:15.95
not to smoke.
First of all, not to have
00:22:16.00\00:22:19.69
early sexual
partners. I think that's the
00:22:19.75\00:22:21.99
order. Not to have
multiple. Which order
00:22:22.13\00:22:24.88
would you put them
in. Well first of all
00:22:24.94\00:22:26.18
I think it's
definitely related to the
00:22:26.21\00:22:28.29
sexual activity.
Okay. See and of course
00:22:28.34\00:22:30.95
when they are
rebellious or when they
00:22:31.31\00:22:33.46
are wanting to
prove their womanhood
00:22:33.49\00:22:37.16
sometimes they
smoke and those same
00:22:37.25\00:22:39.56
motivating factors
that would lead them
00:22:39.63\00:22:41.36
to smoke.
Sometimes lead them to be
00:22:41.41\00:22:44.13
experimenting with
sexual activity and
00:22:44.22\00:22:46.58
to be more
interested in sexual activity
00:22:46.75\00:22:50.90
then would be
people who tend to take
00:22:50.98\00:22:53.19
a more measured
lifestyle and be more
00:22:53.59\00:22:56.46
controlled
themselves. I think we need to
00:22:56.50\00:22:58.32
teach our daughters
that there are dangers
00:22:58.35\00:23:00.34
in early sexual
encounters, particularly
00:23:00.75\00:23:03.88
young girls seem
to be more at risk for
00:23:04.29\00:23:06.59
Human Papillomavirus
infections. So it's
00:23:06.98\00:23:09.69
very, very important
for us to stress that,
00:23:09.72\00:23:12.23
and this is
probably related to taking
00:23:12.45\00:23:14.47
drugs or taking
alcohol, and of course that
00:23:14.56\00:23:16.90
whole scene you
see, yeah I saw sort of.
00:23:17.16\00:23:18.86
These pictures are
all tied together so,
00:23:18.89\00:23:20.39
using alcohol, using
drugs. Drugs are often
00:23:21.10\00:23:23.98
used to
heighten sexual activity.
00:23:24.19\00:23:26.00
So all of these
factors tied together,
00:23:26.16\00:23:28.11
so the lifestyle
that we choose when we
00:23:28.46\00:23:31.86
are very young,
may actually impact us
00:23:31.89\00:23:34.68
evenly. I remember
seeing a 70-year old
00:23:34.77\00:23:37.25
lady, who had
cervical cancer and it came
00:23:37.28\00:23:41.30
on, you know, at
72 I diagnosed it,
00:23:41.36\00:23:43.23
and when I took
her story, she told me,
00:23:43.33\00:23:45.57
yes when I was
young I used to be
00:23:45.60\00:23:47.76
sexually somewhat
promiscuous. And so she
00:23:47.89\00:23:51.25
had carried the
virus for many years.
00:23:51.32\00:23:53.37
The virus had got
into the nucleus of the
00:23:53.81\00:23:55.44
cells. And over the
years has caused trouble.
00:23:55.47\00:23:57.62
Now we would be
remiss, if we didn't
00:23:57.66\00:24:00.29
stress the
importance of the pap smear.
00:24:00.51\00:24:02.84
Oh yeah, that's
why it is a test we can
00:24:03.80\00:24:05.36
do for that. We
don't have that test for
00:24:05.39\00:24:07.34
endometrial, but
we do for cervical.
00:24:07.56\00:24:09.45
But for, for pap
smears have reduced
00:24:09.52\00:24:13.46
the numbers of
deaths. I remember
00:24:13.49\00:24:15.33
sitting in a clinic
in Africa. I worked with
00:24:15.36\00:24:18.25
King Edward the
VIII hospital in Durban
00:24:18.28\00:24:20.28
for a year. We
could walk in there,
00:24:20.54\00:24:23.53
there maybe 200
people in the out patient,
00:24:23.64\00:24:25.68
gynecological out
patient coming to see us.
00:24:25.75\00:24:27.37
You could walk past
and smell the two or
00:24:27.77\00:24:30.99
three women that
day would be coming
00:24:31.07\00:24:33.29
in with cancer of
the cervix. Of course
00:24:33.35\00:24:35.91
at that point it's
too far gone, because
00:24:35.94\00:24:38.95
it's invaded the
bladder, it's invaded the
00:24:38.98\00:24:40.79
rectum, maybe it's
closing off the tubes
00:24:40.88\00:24:43.39
coming from the
kidney, those women are
00:24:43.42\00:24:44.79
doomed. But, if it
can caught early, it can
00:24:44.86\00:24:48.80
be treated so
successfully so that the
00:24:48.86\00:24:50.56
pap smear has
reduced the amount of
00:24:50.62\00:24:54.42
deaths from cervical
cancer so dramatically.
00:24:55.27\00:24:58.48
And it's a simple
test. So we recommend
00:24:58.51\00:25:01.13
for most women over 21 that they
00:25:01.43\00:25:05.62
should go. Now a
virgin who has not had
00:25:05.71\00:25:08.11
any sexual activity
probably doesn't need
00:25:08.26\00:25:11.21
to be having a
pap smear. But a woman
00:25:11.61\00:25:13.98
who has been, even may be not,
00:25:14.05\00:25:15.86
is still a virgin,
but has been sexually
00:25:16.05\00:25:18.58
experimental may acquire Human
00:25:18.74\00:25:21.35
Papillomavirus, so
we do recommend that
00:25:21.40\00:25:24.29
people should be
checked and they should
00:25:24.32\00:25:26.79
take a very great
care to look after
00:25:27.52\00:25:29.87
themselves. Even if
they have had sexual
00:25:29.90\00:25:32.43
dalliances along
the way. One question,
00:25:32.56\00:25:34.56
what about personal
hygiene. Daily bathing
00:25:35.01\00:25:38.03
and things like
this, does this have
00:25:38.07\00:25:39.04
anything to do
with it? Well you know,
00:25:39.05\00:25:41.16
one's personal
hygiene is a reflection
00:25:41.25\00:25:43.84
of one's
lifestyle and people who are
00:25:43.90\00:25:45.99
clean will be
punctilious about their care,
00:25:46.02\00:25:50.68
but you can be as
clean as you like,
00:25:50.77\00:25:53.84
the Human Papillomavirus
will be transmitted
00:25:54.71\00:25:58.37
even in clean
people. So you have to
00:25:58.48\00:26:00.15
be careful about your partner.
00:26:00.18\00:26:01.56
That's why it's
important for partners
00:26:01.91\00:26:03.72
not to have many
sexual dalliances,
00:26:03.82\00:26:05.86
because they may
finally settle down
00:26:05.89\00:26:08.02
but they bring to
their marriage these
00:26:08.11\00:26:10.44
viruses that can
cause disease. Now you,
00:26:10.49\00:26:13.03
in the illustration
of the papaya, you are,
00:26:13.06\00:26:15.40
or paw paw, you cut off the end.
00:26:15.48\00:26:17.44
That's the surgery.
That would be surgery
00:26:17.61\00:26:19.03
would it not. But that
was just an illustration.
00:26:19.66\00:26:21.35
I know, but what
about surgery. Is that.
00:26:21.38\00:26:23.80
Well we have to
quickly go through the
00:26:24.23\00:26:25.33
treatment maybe
of cervical cancer,
00:26:25.43\00:26:27.05
in the very early
stages we can actually
00:26:27.65\00:26:30.06
skin the surface and
get rid of the cancer
00:26:30.19\00:26:32.46
that can be done with
Cryo freezing therapy,
00:26:32.50\00:26:34.95
can be done
with Electro therapy.
00:26:35.31\00:26:37.08
It can even
sometimes just be cut off
00:26:37.65\00:26:39.85
with a Conization.
But if the cancer starts
00:26:39.91\00:26:42.53
to extend then we
are either going to go
00:26:42.56\00:26:45.14
to radiation and
radiation therapy is very,
00:26:45.21\00:26:47.35
very useful for
the cervix, because you
00:26:47.38\00:26:49.31
can put the rod
containing radio active
00:26:49.34\00:26:52.79
material right into
the cervix and actually
00:26:52.82\00:26:55.43
radiate. The
problem with cervical cancer
00:26:55.46\00:26:57.89
is when it's
diagnosed late and is already
00:26:57.92\00:27:00.18
spread to other
organs, in that situation
00:27:00.29\00:27:03.06
we are going to
have much more difficulty
00:27:03.48\00:27:04.96
in controlling it.
Although great things
00:27:05.05\00:27:07.38
can be done and
major surgeries can be
00:27:07.44\00:27:09.95
done to clear it
out, but it's much better
00:27:09.98\00:27:12.15
to diagnose it
early. So the take away
00:27:12.22\00:27:13.87
message that I
would like to leave is
00:27:13.90\00:27:16.24
please if you're a
woman take good care
00:27:16.33\00:27:19.10
of this wonderful
body that has been
00:27:19.38\00:27:21.60
given you, and if
you feel that there may
00:27:21.63\00:27:25.56
be a problem follow
up early, don't delay.
00:27:25.59\00:27:28.72
Very good, I want to
thank you Dr. Handysides
00:27:29.34\00:27:31.38
for being with us
today, good to be,
00:27:31.41\00:27:32.97
enlightening us on
this important topic.
00:27:33.07\00:27:35.16
And to our
viewers, I want to thank you
00:27:35.86\00:27:37.23
for watching
Wonderfully Made today.
00:27:37.26\00:27:39.45
We have discussed
an important topic
00:27:40.96\00:27:43.28
about an important
body of ours. The only
00:27:43.84\00:27:45.60
one we'll ever
have. And so remember,
00:27:45.72\00:27:48.75
if you have any
irregular bleeding,
00:27:49.27\00:27:50.94
go see your
doctor. Go see your doctor
00:27:51.38\00:27:53.70
to get a pap smear
on a regular basis.
00:27:53.79\00:27:55.76
Keep faithful to
your husbands and if
00:27:57.10\00:28:00.27
you're not yet
married wait until you do
00:28:00.30\00:28:03.93
get married before
you have sexual activity,
00:28:03.96\00:28:05.91
because that's
going to protect you from
00:28:06.09\00:28:07.70
having a very
terrible disease and
00:28:07.73\00:28:10.39
remember it's
curable in most cases.
00:28:10.49\00:28:12.93