CANCER DETECTION AND PREVENTION

Gynecologic cancer detection and prevention has been a career-long interest of Dr. Sassone. She pursued special training in this area and accumulated considerable experience

For All Gynecological Cancers
We review the known risk factors derived from personal and family health history, hormones, interaction with sexually transmitted diseases, diet and lifestyle. This includes mental attitude and depression. Strategies for risk lowering and healthier life style are discussed. More specifically, for each of the following:

Breast
examination, demonstration of self exam technique, pros and cons of available screening methods, cyst aspiration under ultrasound guidance, referral to radiologists and surgeons, coordination of finding and BRC 1 and 2 genetic testing; alternatives to traditional hormonal therapies.

Vulva
the papsmear method that is so effective as screening for cancer of the vagina and cervix, is not useful for the vulva. To detect cancer and precancerous lesions of this area, we do: examination, cultures and immediate microscopic exam (wet mount) for infections, detailed exam with magnifying instrument (colposcope), biopsies, treatment of precancerous lesions, chronic skin irritation and follow-up of cases at risk. Most cases are treated in the office or at home. If Laser or wide excisions are indicated, Dr. Sassone performs them in the operating room, as ambulatory procedures.

Vagina
examination, papsmear, cultures and immediate microscopic exam (wet mount) for infections, detailed exam with magnifying instrument (colposcope), biopsies. If the vaginal opening is tight or tender, a thin instrument, suitable also for children, will be used instead of the classical colposcope. Treatment of precancerous lesions and vaginal infections, follow-up of cases at risk. Most cases are treated in the office or at home. If Laser is indicated, Dr. Sassone performs it in the operating room, as an ambulatory procedure.

Cervix
The cervix is the neck of the uterus: the lower part of the uterus, that closes the top of the vagina like a cork closes the bottle neck. We offer in the office: examination, papsmear, and management of abnormal papsmear. Cultures and immediate microscopic exam (wet mount) for infections, detailed exam with magnifying instrument (colposcope), biopsies. If the vaginal opening is tight or tender, a thin instrument, suitable also for children, will be used, instead of the classical colposcope. Treatment of precancerous lesions, infections of cervix and vagina, follow-up of cases at risk. Most cases are treated in the office with Loop Electrosurgical Excision. If Laser is indicated, Dr. Sassone performs it in the operating room, as an ambulatory procedure.

Endometrial Cancer
It's cancer of the lining of the upper part of the uterus. This is the most common uterine cancer and is often detectable in its precancerous stage because it tends to produce irregular bleeding. On the other hand, so far, there is no screening method, like the pap smear. For women who complain of irregular vaginal bleeding or who are at high risk, we offer the following procedures: pelvic exam, ultrasound, sonohysterogram, brush and aspiration biopsies that can be ultrasound- guided to enhance accuracy, diagnostic hysteroscopy. When operative hysteroscopy is indicated, Dr. Sassone performs it in the hospital as an ambulatory procedure. High risk cases are monitored. Treatment of precancerous lesions is generally done with medications. Whenever appropriate, we offer in-office insertion of an intrauterine device (IUD) that delivers the hormonal agent directly to the lining of the uterine cavity. This methods ensures compliance while minimizing the systemic side effects of hormonal therapy.                                                                

Uterine Sarcoma
It's a rare cancer of the wall of the uterus. No screening methods are yet available. Periodic exam of the uterus, manually and by ultrasound, and work-up of irregular vaginal bleeding are performed in the office. Magnetic resonance (MRI)  or Computerized Tomography (CT) are performed at radiologic facilities and the films are reviewed by Dr. Sassone with the patient. Except for the periodic pelvic exam, everything else is done only when deemed necessary.

Ovary
periodic pelvic ultrasound and CA 125 are indicated only for women at high risk. Both these tests are not simple, inexpensive and sensitive enough to be used like the papsmear done for cervix and vagina. In the office we perform a pelvic exam, ultrasound and aspiration of the fluid collected in the peritoneal cavity. The fluid can be studied for the presence of abnormal cells. CA 125, and other blood "markers", are sent from the office to the lab. Genetic counseling and testing is coordinated. Pelvic surgery, when indicated, is performed in the operating room as ambulatory or inpatient procedure (depending on the extent of the surgery).

Tube
This cancer is vary rare and behaves like ovarian cancer. See "Ovary" section above.

Bladder and Urethra
Examination, cultures and urine analysis, urine and urethral cytology, ultrasound, catheterization, detailed exam of the bladder with a small camera (cystoscopy) attached to a video that the patient can see with the doctor during the procedure and biopsies. Treatment of chronic and acute infections and inflammation. If cancer or precancerous lesions are detected, the patient is referred for therapy to a specialist.

Colon and Rectum
Periodic rectal examination. The test for occult blood (Guaiac) is performed in the office and patients are taught to repeat it at home for more sensitive results. Referral to gastroenterologist or colorectal surgeon for colonoscopy: a detailed endoscopy during which the physician can detect and destroy small precancerous lesions or detect cancer and plan for appropriate treatment. Genetic testing is coordinated by the office.

If you are unfamiliar with some of the terminology used in this page, please visit our glossary.