General FAQ


What caused my cancer?

My pap smear didn’t detect my cancer. Why?

My pap smear came back a little abnormal. Now what?

What is the difference between the stage and the grade of a cancer?

Now that I have a cancer I want to start eating right. Any suggestions?

I’ve heard a lot about a new “alternative” treatment. What do you think?

I saw a report of a new cancer treatment. What do you think of it?

Why is my cancer being treated differently than my father’s cancer?

What is the difference between a tumor and a mass?

What tests do you perform to follow the progress of my treatment?

Have you billed my insurance company?

Are the doctors Medicare providers?

What is CA-125?

Do you see a lot of my kind of cancer?

I’m on my menstrual period. Should I reschedule my appointment?

What are the different types of hysterectomies?

How long will it take to get an appointment?

What is a consultation appointment?

If I need surgery, how long will it take to schedule?

What caused my cancer?
Risk factors for development of only a few cancers are well understood. With only one exception, however, the actual cause of cancers at a molecular level is not known. The single exception involves squamous cancers of the cervix. It is now known that several genotypes of Human Papillomavirus (HPV) can induce a sequence of events in the nucleus of cells covering the cervix which lead to development of an invasive cancer. [back to top]
My pap smear didn’t detect my cancer. Why?
Believe it or not, the pap smear is not meant to detect any cancer! It is actually a tool designed to detect pre-cancerous changes of the cervix only. This is the beauty of a pap smear. After all, it is much more important to prevent the development of a cancer by treating the changes that immediately precede its appearance than to wait for a cancer to show up first. A single pap smear determination is not nearly as effective as multiple pap smears obtained at regular intervals over time. This is why the American College of Obstetrics and Gynecology suggests that the majority of women should receive this test at a yearly interval. [back to top]
My pap smear came back a little abnormal. Now what?
Three different techniques are used to fully evaluate the cervix – cytology (pap smear), colposcopy, and histology (biopsy). The pap smear evaluates cells that have already sloughed off of the surface of the cervix. A pathologist looks at these cells under a microscope and makes an educated “guess” about the environment of the cervix. If a pre-cancerous change is suspected the next step is to inspect the surface of the cervix with a magnifying instrument called a colposcope. This technique allows identification of minute abnormal areas that cannot be seen with the naked eye. If such an area is seen then a histologic sample is removed by performing a biopsy. [back to top]
What is the difference between the stage and the grade of a cancer?
Most cancers can be subdivided by their “stage” and “grade“. Stage basically describes the location of the tumor at the time of diagnosis. Gynecologic cancers typically have four stages – early cancers with no gross evidence of metastases are classified as stage I, very advanced cancers with extensive metastases are classified as stage IV. Grade is a description of what the individual cancer cells look like under a microscope. Gynecologic cancers usually have 3 grades – grade I cancers vary little from the tissue of origin, whereas grade III cancers bear little resemblance to the originating tissue. [back to top]
Now that I have a cancer I want to start eating right. Any suggestions?
It is always a good idea to pay close attention to what you put in your mouth. Most Americans could certainly improve their diet by minimizing saturated fats, red meats, cholesterol, salt and alcohol while increasing fresh fruits and vegetables. It’s probably a good idea to take a multi-vitamin every day, too. Radical changes in your diet or any other bad habits you may have (such as cigarette smoking) should be made after you have completed treatment for your cancer. After all, you are under enough physical and emotional stress just dealing with your cancer – there is no need to compound this by adding further stress in your life right now. [back to top]
I’ve heard a lot about a new “alternative” treatment. What do you think?
The National Institute of Health’s (NIH) Office of Alternative Medicine (OAM) provides perspective on Complementary and Alternative Medicine (CAM). CAM practices can be divided into a number of categories:CAM Classification Alternative systems of medical practice – Acupuncture, Ayurveda, Homeopathy, Naturopathy, Shamanism, etcBioelectromagnetic applications – Blue light, Electromagnetic fields, Magnetoresonance spectroscopy, etcDiet, nutrition, and lifestyle changes – Gerson therapy, Macrobiotics, Megavitamins, etcHerbal medicine – Echinacea, Ginger rhizome, Gingko biloba abstract, Yellowdock, etc

Manual healing – Acupressure, Alexander technique, Chiropractic, Osteopathy, massage, Rolfing, etc

Mind-body control – Art therapy, Biofeedback, Meditation, Prayer, Yoga, etc

Pharmacologic and biologic treatments – Antioxidants, Chelation therapy, Oxidizing agents, etc

Most CAM therapies are unlikely to adversely affect your cancer treatment. There are exceptions, however. Garlic, for instance, can have beneficial therapeutic effects on blood pressure and cholesterol levels. It inhibits platelet aggregation and may have an adverse reaction in individuals on chemotherapy or aspirin therapy. Colonic therapies administered inappropriately may significantly decrease serum potassium levels. Some herbal products contain large amounts of estrogen and may have an unwanted stimulatory effect on the lining of the uterus. If you have more questions regarding CAM ask your doctor or nurse or visit the website of the OAM. [back to top]

I saw a report of a new cancer treatment. What do you think of it?
Now that you have been diagnosed with a cancer it will seem like every time you turn on the television or pick up a magazine or newspaper you will see something about a “new and amazing” advance in the treatment of cancer. Just remember that media outlets are in the business of making money and they understand that “cancer sells” air time, newspapers, etc,. “Advances” in cancer treatment are well known to the medical community and either incorporated into or discarded from clinical practice years before being reported to the general public by television and print reporters. Even in the most respected medical journals there is a lag time of up to 18 months between submission of an article by an investigator and its publication. Because of this, physicians acquire new information most rapidly and efficiently through attendance at Society and sub-specialty meetings. By the time this information filters down to traditional media outlets it simply “ain’t news”. When you have questions about something you see on television or read in a magazine your best bet is to check it out with us and get the “real story”. [back to top]
Why is my cancer being treated differently than my fathers cancer?
There is a tendency to think of cancer as one disease that just starts in different parts of the body. Actually every cancer is a unique disease process. As an analogy, you can easily understand that there is a different cause and treatment of a viral sore throat as compared to appendicitis (yet both are “infections”). Your fathers cancer was certainly not gynecologic in origin and would not be treated in the same way as your malignancy. Finally, the advances in cancer treatment appear so rapidly that it is unlikely that any particular cancer is treated today in the same way it was treated several years ago. [back to top]
What is the difference between a tumor and a mass?
Medical terminology can sometimes be confusing. Here’s a little primer on terms you will hear when we discuss your cancer:Cancer = Malignancy = InvasiveBenign = not Cancer”Tumor” comes from the Latin word for “Swelling” (so, technically, something like a pimple could be described as a “tumor”)Tumor = MassNot all Cancers are Tumors (e.g. leukemia)

Not all Tumors are Cancers (e.g. ovarian cystadenoma) [back to top]

What tests do you perform to follow the progress of my treatment?
You will be followed very closely during and for many years after treatment of your cancer. Each time you come to the office a pelvic and abdominal exam are performed and blood tests (e.g. CBC, CA-125, Squamous Cell Antigen, etc.,) are drawn. You will also have imaging studies (CAT scans, X-rays, Ultrasound, etc.,) performed at various intervals. Initially you will need to be seen every month during your initial treatment. After this period you will need to be seen in the office every 2-4 months for 2-3 years. After 2-3 years you will be examined every 6 months. [back to top]
Have you billed my insurance company?
We will submit claims to the primary and secondary insurance company. The monthly statement indicates the date of service and the insurance company to which your claim was submitted. [back to top]
Are the doctors Medicare providers?
Yes, we accept Medicare assignment, which means Medicare will pay 80% of the Medicare allowance and the secondary insurance, if any, will pay for the additional 20% of the allowance. [back to top]
What is CA-125?
CA-125 is a blood test that measures the amount of a substance secreted by many cancers and non-cancerous conditions. It is a helpful way to follow the progress of your treatment for ovarian cancer and, to a lesser extent, other cancers. It is not useful in diagnosing a cancer since too many unrelated conditions can cause false elevations of CA-125. You may have this tumor marker or other similar tests performed on a regular basis. (For a more in depth discussion of the statistical value of CA-125 determinations written by Dr. William Rich click here.) [back to top]
Do you see a lot of my kind of cancer?
Yes. Gynecologic Oncologists treat only cancers of the female pelvis. There will never be more than a few hundred board certified Gynecologic Oncologist in the United States. This means that every Gynecologic Oncologist has extensive experience in treating any kind of female pelvic cancer. [back to top]
I’m on my menstrual period. Should I reschedule my appointment?
No. Your menstrual period does not make interpretation of a pelvic exam or performance of a pap smear any more difficult. [back to top]
What are the different types of hysterectomies?
A hysterectomy is the removal of the uterus and cervix. Removal of the ovaries is referred to as a bilateral salpingoophorectomy. The common lay terms “partial hysterectomy” and “complete hysterectomy” really do not have any medical meaning.Type of Hysterectomy – Abdominal Reason – Benign conditions, early uterine cancersWhat is Done – Removal of the uterus and cervix, with/without removal of the ovaries and fallopian tubesType of Hysterectomy – SupracervicalReason – Benign conditions

What is Done – Removal of the uterus, with/without removal of the ovaries and fallopian tubes

Type of Hysterectomy – Vaginal

Reason – Benign conditions, early uterine cancers

What is Done – Removal of the uterus and cervix, with/without removal of the ovaries and fallopian tubes.

Type of Hysterectomy – Radical

Reason – Cancers of the cervix and uterus. Some cancers of the ovary.

What is Done – Removal of the uterus, cervix, upper vagina, parametria, with/without removal of lymph nodes, ovaries and fallopian tubes. [back to top]

How long will it take to get an appointment?
If you have a newly diagnosed cancer you will usually be scheduled for an initial appointment within one week. [back to top]
What is a consultation appointment?
The doctor will examine you and review any records you have. You, your family and the doctor will then discuss the best treatment for your problem. [back to top]
If I need surgery, how long will it take to schedule?
Surgery is usually scheduled within 1 – 2 weeks from initial consultation if your situation is not an emergency. [back to top]