Healing the Woman
The three most common cancers among women, according to the Centers for Disease Control and Prevention, are breast, lung, and colorectal. Locally, more of these women are taking advantage of the improved technology and research around screening, treatment, and post-cancer care. While cancer treatment can be effective in eradicating the disease from the body or preventing it from spreading, it can also leave patients with side effects like immobility, changes in appearance, and even send some women into premature menopause. Local doctors and specialists weigh in on aspects of women’s health care and the challenges various treatments present.
Attacking the colon or rectum, colon cancer occurs at the lower end of the digestive tract. “Colon cancer can happen to anyone,” says Dr. Casandra Anderson, surgical oncologist at Virginia Piper Cancer Institute and Abbot Northwestern. “Patients should not wait to be screened until they’re symptomatic. This is a disease that can be prevented with regular screenings.” When symptoms are noticeable—such as anemia, dark stools, vague abdominal pain, constipation, fatigue or weight loss—colon polyps are likely already cancerous.
Medical research has made drastic improvements in the outlook of colon cancer patients. “Colorectal cancer treatment continues to evolve,” says Anderson. “Chemotherapy has become more effective, newer drugs are being tested, more aggressive surgical treatment is used for patients with limited metastatic disease.” When regular screenings based on risk are performed, cancer can be prevented or found at early enough stages that treatment may not be as invasive, and survival rates increase. According to Anderson, the overall five-year survival rate for colorectal cancer patients is 65 percent, a significant improvement since 1975, when the five-year survival rate was 48 percent. Patients with early staged tumors have a survival rate of 90 percent, while patients with metastatic disease are at 14 percent. “The key to improving survival is preventing it in the first place or detecting it in early stages,” says Anderson.
In addition to a colonoscopy, there are at-home tests like Cologuard, which skips the bowel prep but still offers colon testing.
“There is a decrease in younger women dying of [lung cancer], which is attributed to smoking control measures.”
—Dr. Matthew Graczyk, Virginia Piper Cancer Institute
Each year lung cancer claims more lives than any other form of cancer, according to the American Cancer Society. “Lung cancer has become increasingly common in women,” says Dr. Matthew Graczyk, co-director of the Allina Lung Program, Virginia Piper Cancer Institute, Allina Health. “It’s the leading cause of cancer death among women, and the second most common form of cancer in women.” While the disease is common, it does have a pattern. “Two out of three people diagnosed with lung cancer are age 65 and older. Less than 2 percent are younger than 45,” he adds.
That percentage also impacts mortality rates. Globally, the number of women aged 50-74 succumbing to the disease is rising, but for women aged 30-49, death rates are stable or decreasing. “There is a decrease in younger women dying of the disease, which is attributed to smoking control measures—education of smoking risks and tobacco tax,” says Graczyk. Even though tobacco is the leading cause of lung cancer, other factors such as family history, chronic lung disease, cancer that’s spread to the lungs, and exposure to toxins like radon and asbestos also contribute a greater risk of disease development.
If lung cancer is detected, treatment plans are similar to other cancers: surgery, chemotherapy, radiation, or a combination. If surgery is required, the amount of lung removed depends on the tumor size, stage, and location, as well as condition of the lungs, risk of surgery, and patient wishes. “Side effects from lung surgery are pain, numbness of chest wall, shortness of breath, decreased ability to exercise, scars, and general surgery risks,” says Graczyk. To reduce chances of getting lung cancer, the Centers for Disease Control and Prevention advises people test homes for radon, follow health and safety guidelines at work, avoid secondhand smoke, and quit smoking.
Technology in breast cancer detection continues to evolve. “3D mammography is the biggest news in breast cancer detection today,” says Dr. Don R. Schroeder, radiologist at Jane Brattain Breast Center. “It’s essentially the same experience for the patient, but [3D mammograms] use the acquired data to create a 3D rendering of the breast that can be viewed in thin sections by a radiologist—increasing cancer detection and decreasing patient recalls for additional testing.” The American Cancer Society estimates that mammography reduces mortality rates in breast cancer by nearly 20 percent. Early detection with annual mammograms generally means more treatment options for early-stage cancer, including less-extensive surgery and lower chemotherapy doses, which can reduce side effects.
Doctors recommend women with a higher-than-average breast cancer risk get screened sooner than the recommended age of 40. As breast cancer rates rise in younger women, doctors have created different treatment approaches for these patients. “Depending on the cancer, young women have been counseled for fertility preservation,” says Dr. Donna Block, physician at Clinic Sofia. “We would discuss the practicalities of fertility preservation prior to treatment . . . donor egg or a gestational carrier if she wishes to preserve her ability to have children.” Younger women diagnosed with cancer should bring up any fertility questions and concerns with a doctor before treatment, as chemotherapy or ovary removal surgeries can send women into early menopause.
For women in menopause—whether by breast cancer or life stage—the Twin Cities has many clinics devoted to menopause care for hormone replacement therapy, treatment for side effects, and lifestyle improvement. “The type of cancer [a woman] has experienced or is experiencing will affect the plan in terms of whether or not she can be prescribed any type of hormone, or other aspects of care,” says Rebecca Mendoza, women’s health nurse practitioner at Menopause Center of Minnesota. It’s important to consult with a physician or oncologist after cancer treatment, Medoza explains to ensure the patient is getting the correct treatment to ward off menopause effects like hot flashes, vaginal dryness, and changes in mood.
“Patients should not wait to be screened until they’re symptomatic. This is a disease that can be prevented with regular screenings.”
—Dr. Casandra Anderson, Virginia Piper Cancer Institute
Advancements in screening, technology, and attention to care continue to emerge. More women are able to function while undergoing treamtnet and have longer lives after cancer. Just as research and technologies are catching cancer sooner, even more is being done after treatment to heal the whole woman so she is able to enjoy her life to the fullest.
Local specialists address 10 common concerns among women with cancer and offer tips for curbing side effects.
1. When to get screened.
In 2015, the American College of Physicians advised women 21 and older who were at average risk for cervical cancer be screened once every three years. Since then, the American Cancer Society has also agreed, but many physicians disagree. Dr. Wesley Grootwassink at OBGYN West prefers to give annual pap smears to his patients. “I still do pap smears every year, I have not adopted the three-year recommendation. Some argue you can’t go from a normal pap smear to a high-grade lesion in three years, but then you hear of those unusual cases,” he says. “I will always do what I think is best for the patient.”
Last October, the American Cancer Society issued a recommendation that women ages 40 to 44 could opt for annual mammograms, but the recommended age to start mammograms for those with an average risk was pushed back to 45. Not all doctors agree with this philosophy either. “In the younger age group—40-50—your chance of cancer is probably not that high but for the people who do get it, that cancer is usually more aggressive than someone who’s 65 or 70,” Grootwassink says. “So that year or two difference between mammograms at that stage can mean life or death.” Consider family history, consult a doctor about any concerns, and weigh the risks and benefits to earlier screening.
“[A colorectal cancer] screening can not only detect cancer, but if done routinely it can prevent cancer by removing polyps before they become malignant,” says Dr. Casandra Anderson. General guidelines for colon cancer screening for a person with no risk factors is age 50, but for those with first-degree relatives under 60 or second-degree relatives of any age who’ve had colon cancer, screening should start at age 40 or 10 years prior to the earliest known familial colon cancer case.
Lung cancer isn’t detectable until symptoms are present, such as unexplained weight loss, persistent cough, fever, chills, night sweats, and chest pain. “The only way to effectively check for lung cancer is to have symptoms, or to ask for a CT screening as part of an annual wellness visit,” says Dr. Matthew Graczyk. If symptoms or risk factors are present, patients may be advised to be screened once per year. The takeaway is to discuss risks with a doctor to determine screenings.
2. Combatting nausea and drowsiness.
Chemotherapy has evolved so much that it’s now administered in different doses depending on the kind of cancer and stage, and tailored to each person. While chemotherapy may be effective in eradicating cancer, it can leave some women with constant nausea and drowsiness, which make eating or going back to work difficult. “If you don’t feel good because the treatment is destroying your quality of life, you have to be able to communicate that to your doctor and advocate for your quality of life,” says Grootwassink. Just as technology has evolved chemotherapy, it’s also created a variety of anti-nausea medication to help cancer patients with their treatment—all of which can be prescribed by a doctor. “[Doctors] can be so focused on the disease that the person becomes almost secondary—but you’re treating the person, not the disease,” says Grootwassink. “So advocate for yourself if you’re not feeling well. Anti-nausea medications have completely changed chemotherapy in general—it’s just night and day from when I trained.” While undergoing treatment, maintaining a positive quality of life is possible with side effect management.
3. Easing Vaginal Dryness and Discomfort.
Typically, menopause causes vaginal dryness and discomfort, but chemotherapy and other cancer treatment can do the same as well. “There are non-estrogen drugs, or others that activate an estrogen receptor but won’t have an impact on a woman’s cancer,” says Grootwassink. “Drugs like Osphena—and there are others—can give you a positive effect in the vagina, for painful intercourse or vaginal dryness—and it won’t have an impact on the breast cancer.” Physicians can recommend the appropriate approach to medication to ease vaginal discomfort—and getting more than one opinion is important to ensure patients get the help they need.
4. Soothing Dry Skin and Burns.
While radiation therapy lasers are effective in targeting specific areas under the skin to ensure cancer has been eradicated, repeated laser exposure can cause skin burns and dry patches. “Radiation can have profound detrimental effects to skin: hardening and fibrosis, increased fragility, increased red blood vessels, pain, discomfort, and itching,” says Dr. Charles E. Crutchfield III, MD of Crutchfield Dermatology and clinical professor of dermatology at University of Minnesota Medical School. “Using a combination of multiple treatments that work together synergistically gives the best results.” Crutchfield’s specialized treatment plan for radiation burns includes topical emollient cream, specialized silicone scar preparation, and multiple ablative laser treatments—which are less harsh than radiation treatments, and improve surface skin layers and simulate collagen production to promote skin growth—for a period of four to 12 months.
As for dry skin patches, Crutchfield says the skin may never fully heal from radiation laser treatment, but it can certainly be improved. “[Treatment] is simple, I use a combination of a rich emollient moisturizer and a cleanser that is low in detergent so it won’t strip the natural moisturizing oils in the skin,” he says of the twice-per-day treatment.
5. Diminishing Exhaustion.
To combat fatigue and muscle weakness caused by inactivity or limited activity during cancer treatment, Annemiek Sistermans, physical therapist at Methodist Hospital, recommends getting a one-hour strength assessment by physical therapists who can customize strength training and flexibility programs to each individual. After the initial visit, follow-up appointments will include strength building. “We see patients for 60 minutes, spending up to 30 on endurance—using a treadmill, bike, NuStep, or walking on a track—strengthening with focus on weaker muscle groups and stretches for flexibility,” she says. To stave off severe muscle weakness and fatigue, Sistermans suggests walking around the house several times a day for 5- to 10-minute increments on the most severe chemotherapy days, and going longer distances for longer periods of time on the better days before the next dose of chemo. “Fatigue from chemo is different than fatigue from exercising,” says Sistermans. “Getting tired from being active will help fight the fatigue from chemo by building up or at least maintaining your endurance.” While getting up and moving may be difficult on the worst days, breaking it up into segments to meet your body’s limits is important.
6. Relieving NerveDamage.
Tingling, weakness, and numbness in the hands and feet are signs of neuropathy—a common side effect of chemotherapy that can leave patients with lifelong mobility challenges. Though neuropathy can’t be fixed with exercise, using physical therapy can help patients learn to modify their movements to tolerate the symptoms throughout their life to ease pain. “We figure out alternative ways to work on endurance instead of walking or running,” Sistermans says. “It would be using a stationary bike, NuStep, or a seated elliptical.”
But even changing footwear can help—more cushioning, wider shoes, or thicker socks may contribute to pain reduction as you move.
7. Incorporating Estrogen.
The health and strength of the skeletal system is essential to everyday life. Estrogen helps bones absorb calcium, but during menopause—or after receiving cancer treatment—incorporating estrogen can be a challenge. Rebecca Mendoza, whose patients are generally in perimenopause or menopause at Menopause Center of Minnesota, suggests supplements like magnesium D3 and calcium, or an injectable treatment, like Prolia, to support bone health if estrogen can’t be prescribed. However, she adds that women who’ve gone through cancer treatment may need to take a different approach to supplements. “Different prescriptions like Brisdelle for hot flash relief—which can’t be taken with Tamoxifen—or Effexor for mood improvement, are prescribed by a physician,” she says.
8. Reducing Surgical Scars.
Scarring can be bothersome whether it’s visible or not. Fortunately, many technologies and treatments are now available to heal the affected skin. Laser therapy treatments damage surface skin layers to stimulate collagen so new, undamaged skin grows in its place. This can decrease scarring over time, and although scars will likely always be present, there are ways to decrease the severity. “Wear meticulous sun protection, apply it 30 minutes before sun exposure, and reapply it every one to two hours—especially if the person is sweating or swimming,” says Crutchfield. Skin that’s been damaged by scarring is less resistant to ultraviolet rays and more prone to sunburn, and it can actually darken the scarring.
9. Restoring Upper-Body Movement.
Breast or lung cancer surgery can impact upper-body movement, so a physician may recommend physical therapy to keep muscles and the body flexible shortly after surgery. “In breast cancer surgery, there is significant surgical pain, which ranges from mild soreness and tenderness at the incision site to extreme pain,” says Susan E. Anderson, certified hand therapist and certified lymphedema therapist at Twin Cities Orthopedics. “As the surgical site heals, scar formation begins, which results in significant tightness in the chest, arms, and back.” While it’s important to focus on moving these areas, Susan E. Anderson stresses that relaxing and healing are also part of the process, and not everyone’s physical therapy will be the same. The recommendation is to work with a physical therapist on movements that will ease pain and discomfort and allow movement, slowly building back up to normal functioning.
10. Improving the Doctor-Patient Relationship.
The comfort between a doctor and patient is immeasurable and can shed light on potential problems or differences in personality or health that can point to underlying conditions. “As health care is evolving, you may only have seven minutes with a patient, and you may miss things,” says Grootwassink. “So if you have a good relationship with a physician that’s got your best interest at heart, you can make the most of your time with honest questions about your health.” It can make asking those tough questions easier when the patient is comfortable with their doctor. Grootwassink also goes on to note, “Asking questions and being honest goes both ways—for the doctor as well.” Think of unexplained weight gain or loss and the potential reasons behind it. A doctor who feels comfortable with the patient is going to ask about lifestyle and habits and find out what’s changed, which can detect possible underlying health issues.
“Getting tired from being active will help fight the fatigue from chemo by building up or at least maintaining your endurance.”
—Annemiek Sistermans, Physical Therapist, Methodist Hospital