MedStar Health Blog

Over the past 10 or 15 years, uterine cancer cases have steadily increased in the United States. This year alone, an estimated 65,620 women will be diagnosed with this condition. Average age of diagnosis is 60; it is uncommon in women under 45.

The continuing rise of this cancer is partly due to the increase in obesity, a significant risk factor for the condition. While there’s no way to prevent the disease, there are important steps all women can take to reduce their risk.

Types and Symptoms

This cancer presents as two main types: endometrial cancer, which affects the lining of the uterus (the endometrium), and uterine sarcoma, which affects the muscle wall of the uterus. Endometrial cancer is the most common, representing approximately 90% of all occurrences in the United States.

The primary symptom of uterine cancer is abnormal vaginal bleeding, which appears in 85%–90% of cases. Other symptoms include pelvic or back pain and a noticeable mass. These symptoms are slightly more common in uterine sarcoma, occurring in about 10% of cases.

Risk Factors

There are many risk factors, especially when it comes to an individual’s behavior and lifestyle. For example, approximately 70% of these cancers are linked to obesity. Maintaining a healthy weight through diet and exercise is the most important step a woman can take to reduce her risk.

Less controllable factors include:

• Age—Most cases appear in women over 50
• Race—The condition is more common in Caucasian women, however African-American women are two times more likely to die from endometrial cancer
• Genetics—Some women, including those previously diagnosed with a different form of cancer, have a greater genetic predisposition to this cancer than to others

In addition, several risk factors are linked to high estrogen levels. For example, this disease is more common in women who:

• Began menstruating before the age of 12 and/or entered menopause after the age of 55
• Have never given birth
• Have undergone estrogen-only hormone replacement therapy (HRT)

Preventing the Disease

When it comes to reducing your risk of this cancer, adopting a healthy, balanced lifestyle is key. Eating a healthy diet and exercising regularly can be challenging, but they are well worth the effort. If you are struggling with weight loss, consider seeking help from a doctor or nutritionist, who can help you stay on track and achieve your goals.

Increased estrogen levels can also contribute to the development of this cancer. If you are undergoing hormone replacement therapy to treat symptoms of perimenopause, such as hot flashes, it’s advisable to take a combination of estrogen and progesterone.

Finally, if you experience any post-menopausal vaginal bleeding, see your primary care provider or gynecologist as soon as possible. Early detection of precancerous conditions like atypical endometrial hyperplasia could prevent you from developing this cancer down the line.

Seeking Care

If you have been diagnosed with uterine cancer, the Washington Cancer Institute is here to help. As part of MedStar Washington Hospital Center, we have the strong, caring staff and resources needed to provide optimum care for our patients.

Our Women’s Oncology Center specializes in treating gynecologic cancers and breast cancers. We have a multidisciplinary team of gynecologic oncologists, radiation oncologists, and medical oncologists, and we offer other critical services, such as social work and palliative care.

No matter your concern, we are happy to work with you.

LISTEN: Dr. Hoskins discusses uterine cancer on the Medical Intel podcast.

The story of COVID-19 in the emergency department is a study in teamwork, tenacity and resourcefulness.

We knew very little about the disease when it first emerged. We knew it was a real threat, based on the experience of China, Italy and other hard-hit regions.

But MedStar Washington Hospital Center has always taken disaster preparedness very seriously, fostering a true culture of readiness where every member of the team knows what to do when it counts. In the face of this new pandemic, the entire Hospital Center went to work, quickly and efficiently.

We had to prepare for every imaginable contingency—and even for those we could not imagine. We planned for staffing, for ICU overflow, and for managing the supply of PPE, which is personal protective equipment. We put up and equipped tents to handle a potential surge. If anything, we were over-prepared. Thankfully, we never even needed to utilize the tent on our campus or alternate care site at the Walter E. Washington Convention Center.

We moved mountains to make all this happen. That level of preparedness really paid off. The team came together like clockwork, each contributing to a whole far greater than the sum of its parts. We kept at it, did what had to be done, and were never overwhelmed. Plus, all the plans are still in place, so we’ll be ready in the event of another outbreak. We continue to stay the course. That’s what I am most proud of.

Approaching a New Normal

In 15 years as an emergency physician, I can honestly say I have never seen anything quite like this virus. It is strange, unpredictable, sometimes surreal. Our ER team had to learn a completely new disease process. Up for the challenge, we overcame apprehension and uncertainty, navigating a path that sometimes changed by the hour. With each case we treated, we learned from the experience and emerged even better, faster and more effective.

At the start of the pandemic, just about everyone who arrived at the ER came for coronavirus symptoms. Thankfully, we are now past that stage. As cases trend downward and society begins the reopening process, we are seeing more typical cases returning.

One of the strange things about this pandemic was the way so many formerly routine issues slowed to a trickle. Thanks to stay-at-home orders, for example, there were fewer auto accidents, and so fewer associated injuries.

But concerning to our doctors was the absence from the ER of the most potentially serious conditions, like heart attack or stroke. The worry among healthcare professionals is that some of those people chose to stay home out of fear of the disease, instead of getting the life-sustaining treatment they needed. That could lead to long-term health effects for years to come.

If you are injured or showing signs of serious illness, there is no reason to be nervous about coming to the Hospital Center. We apply every precaution, including personal protective equipment like masks for both patient and provider, restricted visitation, isolation of critical patients, minimizing both wait times and the number of providers with whom each patient comes in contact, and expanded availability of MedStar Health eVisit and Video Visit.

Don’t avoid treatment for a serious problem. With telemedicine more available than ever, make sure to reach out to us if you have any health concerns.

The Beginning: Uncertainty

Although nothing in our training or experience prepared us specifically for this virus, emergency medicine personnel excel at expecting the unexpected. After all, it’s what we do, every day.

Psychologically, those first few weeks were very challenging. The fear of the unknown was, by far, the hardest part. Could we manage the surge? Would we be overwhelmed, stressed to the breaking point—like some of our colleagues in New York?

The challenges were many. We didn’t know exactly how the disease would present or progress. Nationwide, healthcare professionals were in a steep learning curve, having zero experience with this brand-new disease state. There was no reliable test for the virus. There were no medications to combat it.

However, we did have knowledge, shared by health professionals in other parts of the world. With guidelines from the Centers for Disease Control, the American College of Emergency Physicians and others, we understood that the virus is a variation of severe acute respiratory syndrome (SARS). We knew lung health would be key to beating the disease, and we focused our efforts on oxygen.

Throwing Out the Old Playbook

Although mild cases of this new virus act like the flu, what we’ve seen in the emergency room is nothing like flu. It’s very unusual for flu victims to have severe hypoxia—low blood oxygen. At most, we see one or two cases of that each season. Yet, with this disease, it’s the norm in the sickest patients—and often presents without the usual symptoms. We were often surprised to see how low blood oxygen levels had dropped without the patient even reporting much discomfort.

COVID-19 presents a cascade of potentially life-threatening problems, like blood clots and a massive immune response. Blood oxygen is priority one, two and three. But although we quickly learned to be very aggressive with oxygen, it’s a balancing act. Too much oxygen can be harmful. So we were careful to be aggressive when needed, while also knowing when to use a lighter touch.

All Over the Map

Since we first heard about this virus, we’ve become practiced at recognizing the classic presentation—respiratory distress, elevated heart rate, low oxygen. Yet over time, we saw that it represents only a portion of those infected.

This disease can manifest very differently depending on the individual. We now know that some people can have it without a single symptom, and some simply have a mild flu-like reaction. Others become gravely ill and need the aggressive oxygen therapy and, potentially, ventilator treatment.

This was very tricky in the early days, before we had reliable testing. But we knew who was at greatest risk—the elderly and those with underlying chronic disease. Quite often, patients told us they just didn’t feel quite right. Later, when we started testing, our instincts were confirmed. Many who report such nebulous symptoms do indeed test positive.

Testing: The Game Changer

Testing has made all the difference. As testing protocols have advanced, accuracy and speed have improved. In the ED, we have several versions of the test available and can get results within a few hours. That’s a positive development, but more widespread testing and a reliable supply of reagents and other supplies will be key to battling the virus successfully.

Along with testing, experience has driven clear protocols for the disease and strict PPE requirements. The masks, gowns and gloves can be challenging, but we have all become very adept at getting the gear on quickly when seconds count.

A Cloud With a Silver Lining

Working in emergency medicine these past few months has been stressful and sometimes frightening. But the crisis has also brought out the best in both the healthcare system and the communities we serve.

I can’t emphasize enough the importance of the team. The doctor is only one part. We evaluate, test and make a treatment plan. Others put the plan into action, and they are the true heroes in this pandemic. Everyone stepped up: nurses, techs, EMTs, radiology technicians, respiratory therapists, infection control, security and environmental services, to name a few. Our hospital leadership also worked tirelessly to make sure we had the resources we needed to provide life-saving care for these patients.

The community has shown an unprecedented outpouring of warmth and support—even those who have lost loved ones. It’s gratifying to see people acknowledge the hard work of first responders.

The ER is a very social atmosphere—one of the many things I love about the job. Even with all the challenges, we are privileged to be working, compared to many who have been forced to isolate themselves. I feel it on my days off as well. Front-line workers must take care to stay safely distant from others, so I am grateful for my cats, dog, and Zoom meetings with my extended family.

At MedStar Washington Hospital Center, I am surrounded by caring, smart, resourceful and exemplary professionals in every discipline.

That keeps us going, every day. It is a true inspiration.

In 2015, then 69-year-old Willie M. Smith was diagnosed with breast cancer. A simple lumpectomy removed her tumor and a five-year dose of the oral medication, Anastrozole, was prescribed. The retired licensed practical nurse was in familiar territory. She spent 45 years working at the Hospital Center and much of that time at the Washington Cancer Institute.

Then last year, Ms. Smith’s oncologist, Christopher Gallagher, MD, told her he heard a heart murmur during a routine check-up and ordered an echocardiogram. What the test indicated prompted a referral to Ian Chang, MD, a MedStar Heart & Vascular Institute cardio-oncologist specializing in heart disease in cancer patients.

“It showed that the valve in my heart wasn’t opening and closing correctly,” Ms. Smith says. “It was a shock and very surprising. I did have leg swelling and felt out of breath just walking from the parking garage to the hospital, though.”

Treatment was fairly simple: compression stockings and medication to reduce the swelling.

But the valve deformity suggested that she might have some type of systemic disease, prompting a chest CT and an MRI of the abdomen and pelvis. The tests led to a rare diagnosis: carcinoid tumors.

“It’s a slow growing cancer that was probably there for the last 15 years,” Ms. Smith explains. “And if I hadn’t seen Dr. Gallagher and Dr. Chang, it would not have been diagnosed because I had no symptoms.”

Now under treatment with the Cancer Institute’s David Perry, MD, Ms. Smith marvels at this turn of events. “I have got to call it divine intervention!”

It’s a sensitive subject. For some, uncomfortable. Most guys don’t want to talk about it.

But most men will experience erectile dysfunction, or ED, at some point in their lifes—as many as 80 percent, by some estimates. Regardless of the cause, it’s always a good idea to talk to your doctor about it. It’s a common problem that’s often very treatable.

But staying silent can be dangerous, because this dysfunction may be a warning sign of cardiovascular disease. And a delay in reporting it might put your heart and blood vessels at risk.

When everything works normally, an intricate blend of psychology and physiology sends blood where it needs to go and keeps it there for a while. So, it makes perfect sense that trouble with an erection might be a sign of problems in the circulatory system, especially in men over 40.

Many long-term studies associate ED with both silent cardiovascular disease and silent peripheral vascular disease. It’s also been associated with disease in the aorta. Any disease that negatively impacts the smallest blood vessels—the microvasculature—can cause a host of problems, including stroke and heart attack. Because sexual performance is made possible by small blood vessels, dysfunction may serve as a warning of these potentially bigger problems.

Cardiovascular disease usually starts with damage to the endothelium, a thin layer that lines the blood vessels and vessels of the lymphatic system. In direct contact with blood, the endothelium controls blood flow and clotting. It plays a major role in regulating the immune system, combating inflammation and building new blood vessels. When the endothelium is damaged by factors such as tobacco exposure, several problems can occur—most typically, hypertension and poor circulation that can encourage life-threatening blood clots.

A Real Danger

Men who experience difficulty with an erection may be four times more likely to have cardiovascular disease and three times more likely to have carotid artery issues than men who have no difficulty. These risks are so well documented that, when erectile dysfunction is reported as part of a general workup, it often merits a cardiovascular assessment. That generally starts with a physician’s office visit and additional testing such as a stress test, EKG, or echocardiogram, depending on the individual. It’s important to identify any issues in the heart and blood vessels immediately, even before the ED itself is addressed.

Cardiovascular disease is just one potential cause. Sexual performance in men is complicated and depends on many things happening in the right sequence and at the right time. Sometimes, it’s psychological. Stress, in and out of the relationship, is a common culprit. Prescription and recreational drugs can interfere, including alcohol and tobacco. Diabetes, high blood pressure and high cholesterol play a role. Obesity is a potential cause. Low testosterone levels and other endocrine issues are contributors. Traumatic injury and some surgeries can affect it, as can problems in the brain and nervous system and even psychological trauma.

With all these potential causes, how do you figure out which one may be affecting you? Short answer: you can’t, on your own. That’s why it’s so important to talk to an expert.

Talking About It Could Save Your Life

Men experiencing performance issues should not avoid talking about it.

You could ignore it and hope for the best. You could try to treat it on your own. You could chalk it up to aging and forget about it. Or, you could do the right thing and talk to your doctor.

As a vascular surgeon, I can say without hesitation that delaying medical attention can lead to bigger issues in the future. If ED is caused by problems in the blood vessels, by the time that man comes to see me or a cardiologist, it could be too late. The damage has likely been done over years and, at that stage, there’s little any doctor can do to restore normal function. Before a patient gets to that point, there are dozens of ways we can help, including oral and injectable medications and devices to improve blood flow.

Unfortunately, the urge to keep the problem under wraps drives some men to self-medicate without a doctor’s visit. Erectile dysfunction is a big industry, with many players seeking a pathway to your wallet.

But you can also buy legitimate medications without visiting a doctor, and that’s really asking for trouble. You may try this for years before the pills stop working. Then what? If it turns out that your problems with an erection actually have cardiovascular roots, you’re much worse off than if you had sought medical attention earlier.

Don’t Go It Alone

ED can be more than a nuisance, embarrassment or source of anxiety for you and your partner. Although it can be uncomfortable to talk about, your healthcare provider can help you get the conversation started.

The issue can affect any man at any age and has many potential causes. Your doctor will work to narrow the cause, starting with a physical exam and medical history and asking key questions about your health and situation. It’s important to be honest in your answers—even the difficult ones, like any recreational drug history.

Expect questions about your general state of health and well-being. Weight, exercise and other lifestyle factors will be evaluated, as well as medication history, stress levels, relationship status, sleep patterns—things you might never consider without expert guidance.

Our multi-disciplinary approach includes urology, cardiology, vascular surgery and endocrinology, and a patient with erection issues may be referred to a specialist in one of these areas for testing. When our team has determined if the cause is psychological or physical, we can target the problem and devise a plan to improve the situation.

What You Can Do

Besides being candid with your doctor, anything that will improve your general health will also improve your blood flow, including regular exercise, good diet, avoiding tobacco and not drinking excessively. Because blood flow is key to performance, the better your cardiovascular health, the healthier your sex life can be.

In the final analysis, facing the issue is all benefit with no risk. Erectile dysfunction is more than just a physical problem. It can have a real impact on quality of life. It can make men anxious and can contribute to feelings of failure, inadequacy or letting their partner down. Those are all reasons enough to talk with your doctor.

But now you know: talking about it could also save your life and give you more years to enjoy it.