USA Today, May 2002

5/6/2002

By Adele Slaughter, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

Best known for her no-nonsense advice as The Nanny, Fran Drescher kept things light while taking care of her TV family. In real life, she brought her shoot-from-the-hip perspective to coping with a potentially deadly health crisis — uterine cancer.

"After seeing eight doctors trying to get a diagnosis for my symptoms, my doctor finally told to me, ‘You have adenocarcinoma,'" says Drescher. "When she told me that was uterine cancer, I burst into uncontrollable tears. I was devastated."

"I thought I was going to die," adds Drescher. "I thought, ‘Okay, I have reached the height of my career, experienced things that I never thought I would and it's all neatly coming to a final chapter.'"

But Drescher decided she wasn't ready to close the book on her life. Instead, she wrote one. Available in bookstores now, Cancer Schmancer is Drescher's inspirational story about how she beat uterine cancer.

"I got a grip on the situation," she says. "I called a surgeon who was recommended to me by the gynecologist. But I had to wait until the end of the week, because Friday is when she sees new patients. The world doesn't stop revolving because you have cancer. It's just your world that stops."

The most common form of uterine cancer is called endometrial cancer because it arises from the inner lining of the uterus, the endometrium. Tumors that form there are known as adenocarcinomas. These occur when cells in the glands of the endometrium grow out of control, frequently invading the adjacent muscle of the uterus.

"Endometrial cancer is the most common form of cancer of the female reproductive system," says Dr. Karl Podratz, the Atkins professor of surgery at the Mayo Clinic.

According to Podratz, this year about 39,300 American women will be diagnosed with uterine cancer, causing approximately 6,600 deaths.

Ugly growth

Frequently after menopause the endometrium changes shape, and sometimes these cells grow out of control causing uterine cancer. Although women over age 60 are in the highest risk group of developing uterine cancer, there are other factors, which include:

• Obesity (the most significant risk factor, it increases risk by 3 to 10 times)
• Hypertension
• Diabetes
• Conditions that result in high levels of estrogen, such as inappropriate estrogen use, polycystic ovarian syndrome, late menopause, estrogen producing tumors, and nulliparity (never having given birth)

"Diabetes and obesity are prevalent in the United States, which might explain, in part, why this disease is on the rise," says Dr. Robin Farias-Eisner, researcher at the Jonsson Cancer Center at UCLA.

Drescher, however, did not fall into any of the risk groups, which is partly why she had such a hard time getting diagnosed.

"For two years I tried to get a diagnosis," says Drescher. "I had staining between periods and cramping after sex, which is actually pretty classic for uterine cancer. But every doctor I went to thought I was perimenopausal, because nothing showed up on my ultrasounds, pelvic exams or blood tests."

Drescher realized something was wrong and was tenacious about getting a diagnosis.

"Nobody knows your body better than you," says Drescher. "Remember back in the days, you know, way back in the 20th century, when you went to your doctor, listed your symptoms and let them take over from there? Well, those days are over. Now, you have to do your own research too. You have to be more of a partner when you see your physician."

Doctors agree that the most important thing about uterine cancer is to detect it early. Women are advised to pay close attention to any vaginal bleeding that might occur, particularly in post-menopausal years.

"Unlike ovarian cancer, which is generally diagnosed in advanced stages, endometrial cancer can be diagnosed when it is in an early stage," says Farias-Eisner, who is also a gynecologic oncologist at the UCLA School of Medicine. "The majority of patients will have vaginal bleeding and abdominal cramping."

"Primary therapy for uterine cancer is surgery," says Podratz. "A hysterectomy with the removal of the fallopian tubes, ovaries, pelvic and parietal lymph nodes is performed. And we attempt to determine if there is any additional spread of the disease outside the reproductive organs."

Additional treatment depends on the findings of the surgery. If the tumor is well-differentiated, located in the uterus with minimal invasion outside the uterus, and the nodes are negative, no additional therapy is indicated. If the lymph nodes are involved, radiation is the therapy of choice.

Proactive

Despite the fact that doctors had successfully removed all the cancer and her lymph nodes were not involved, Drescher's doctor recommended follow-up radiation therapy.

After all she'd been through getting diagnosed, Drescher wasn't so sure.

So she began researching on the Internet and getting second and third opinions from the top cancer centers in the nation.

"I called Sloan-Kettering, they said we would never send a woman that's stage one, grade two uterine cancer to radiate," says Drescher. "And a specialist in Wisconsin said I didn't need radiation as long as I saw my physician every three months. Radiation doesn't guarantee you're not going to have recurrence.

"Somewhere along the line, I decided not to do it and I have no regrets," says Drescher. "I'm doing great. I've been two years well. All indications are that I'm cured. I go every three months to my surgeon, because follow-up is the most important part of recovery and cure."

With uterine cancer on the rise and the fatality rate increasing, doctors stress the importance of developing new methods to detect the disease.

"For endometrial cancer we really need diagnostic and prognostic tumor markers," says Farias-Eisner. "These markers would be proteins in the blood and the tissue or genes turned on in the blood that could indicate the presence of cancer. We are just beginning this quest at UCLA, and we will be tenacious and persistent."

While medical advances may eventually help detect uterine cancer earlier, Drescher insists women listen to their bodies.

"Once you wake up and smell the coffee it's hard to go back to sleep," says Drescher. "So let me sound the alarm. Women have to know what the early warning signs of all gynecologic cancers are and what tests are available, because we cannot assume they will be offered to us."

http://www.usatoday.com/news/health/spotlight/2002/05/06-drescher.htm