Issue link: https://read.dmtmag.com/i/251527
48 BRAVA MAGAZINE | FEBRUARY 2014 removal of the cervix, as well as nerve damage and lymph node dissection. In addition, the radiation therapy can cause scarring of tissue and tightening of the vaginal wall." For treatment, Suzanne underwent ROUNDSOFEXTERNˬLRˬDIˬTIONǠVEIN- ternal radiation treatments known as brachytherapy, where small radioactive capsules are placed inside the vagina near the cervix; and four rounds of chemo. ŀETREˬTMENTSWEREHˬRSHˬNDTHESIDE effects wiped Suzanne out physically and emotionally. nŀE RˬDIˬTION FORCED ME INTO EˬRLY menopause, but luckily, my symptoms have not been too severe. I use a vaginal dilator daily to stretch the tissue that had shrunk and narrowed after radiation. It took a little bit, but my skin 'down there' has recovered," says Suzanne. For Jamie, six weeks of chemotherapy and daily radiation treatments caused severe fatigue, intense intestinal issues as well as burning and scarring of her skin. ŀELIFEˬLTERINGCHˬNGESTO+ˬMIEmSNOR- mally strong body and spirit included a lack of sexual sensation or desire, the need to use a dilator daily to improve the elasticity of her vaginal skin, decreased energy levels and continual hip pain. In the end, Jamie has been cancer-free for three years, but at a cost. She had to close her insurance agency because the treatments were so severe that she could not work and struggled to regain em- ployment and her status in the insurance industry. VULVAR CANCER: HARD TO DISCUSS AND HARDER TO LIVE WITH Every year, about 4,000 women in the U.S. are diagnosed with vulvar cancer, which occurs on the inner and outer lips of the vagina, the clitoris, and the open- INGOFTHEVˬGINˬˬNDITSGLˬNDSŀEVˬST majority of those cases are also caused by unresolved high-risk HPV 16 or 18 infections. ŀE'OUNDˬTIONFOR8OMENmS$ˬNCER reports that vulvar cancer is highly curable if detected at an early stage and THˬTITSTREˬTMENTTOOCˬNHˬVESIGNIǠ- cant adverse effects on sexual function as well as on body image and bladder and rectal function. +OˬNNE1EˬRSONWˬSWHENSHEǠRST noticed that she was itchy "down there" and she went to her gynecologist right away. During her exam, the doctor no- ticed a suspicious white spot on Joanne's VULVˬ 3EǢECTING ON THE LOCˬTION SHE SˬYSn*TISDIǝCULTTOEXPLˬINTOPEOPLE where your cancer is and what you are going through." In 2008, Joanne underwent a radical vulvectomy surgery to remove the cancer. ŀEPˬINˬFTERTHESURGERYWˬSSEVERE Joanne describes it as "having acid poured on your crotch." She has "stayed on top of her cancer" with six-month follow-up visits and several repeat surgeries over the past 15 years to remove more skin lesions. "It is just something that I live with. I have even the smallest spots removed so I can keep the cancer out of me," says Joanne. Numerous surgeries over the years have caused Joanne's vaginal opening to BEVERYTIGHTn*TISSOMETIMESDIǝCULT to get the speculum inserted during an examination," she says. ŀISHˬSMˬDESEXUˬLINTERCOURSENON- existent. "You don't have sex because you can't. I am lucky to have such a wonderful spouse who is accepting of our situation," she says. Joanne still feels like a woman, but also SˬYSnŀISCˬNCERDOESCHˬNGEYOUo PREVENTION: TALK ABOUT IT AND BE VIGILANT HPV infections are transferred through skin-to-skin genital or genital-oral contact, and have been mostly unavoid- able for those who are sexually active. But the gynecological cancers—cervi- cal, vulvar and vaginal—that result from the high-risk strain HPV infections are unique because they can now be pre- vented with new HPV vaccinations or at least diagnosed and treated in a pre- cancerous stage through annual pelvic exams and consistent Pap smear tests. If a high-risk HPV infection is not cleared by one's own immune system and goes undetected, it can eventually cause cervical cell DNA to morph from normal to abnormal to precancerous to invasive cancer, and lead to metastatic cancer of THELUNGLIVERORBONESŀETˬKEHOME message: Because this cell change occurs very slowly over 10, 15, even 20 years, it can be caught before it develops into can- cer by having both annual gynecological exams and regular Pap tests. Pap smears can detect changes in the epithelial (skin) layer of the cervix, as can visual pelvic exams, which also help detect changes on the external genitalia such as suspicious vulvar lesions that may indicate the need for both HPV testing and biopsy of the questionable tissues. A Pap smear involves the gentle swab- bing of cells off the surface of the cervix, which are then processed to determine if abnormal cell growth is present. In recent years, according to Dr. Kushner, THESˬMPLECOLLECTEDFORTHEnŀIN1REPo liquid-based Pap test can also be used simultaneously to determine the pres- ENCEOFˬHIGHRISK)17INFECTIONŀIS co-testing is helping to discover the slow growing, precancerous cells on the lining of the cervix at an earlier stage. Vigilance is key. "Women need to manage their health by following the guidelines for Pap testing combined with pooled HPV testing in order to catch cer- vical cancer prior to it becoming inva- sive," says Kushner. So is talking about it—with your doctor and your girlfriends.