Are You at Risk for Ovarian Cancer?

Joan Cheng, M.D.

Did you know that ovarian cancer is the deadliest type of gynecologic cancer? It’s typically diagnosed at an advanced stage. You can help protect yourself by knowing if you are at risk for this cancer and the symptoms.

Know the Risk Factors

The exact causes of ovarian cancer are unknown. But the following factors can play a role:

  • Increasing Age: Being middle-aged or older increases the odds of developing ovar­ian cancer. Risk is highest after menopause. The average age at diagnosis of ovarian cancer in the S. is 63 years old.
  • Family history: A woman may be at risk if she has a first-degree relative—that is, a daughter, sister, or mother—who has had ovarian cancer. Her risk is particularly high if two or more first-degree relatives have had this cancer. A history of the disease in other close family members—such as aunts or grandmothers, on either your mother’s or father’s side—is also linked to a higher-than-average risk.

A family history of breast or colon cancer also has been associated with an increased risk of ovarian cancer. Moreover, women who have a strong family history of breast cancer sometimes opt to get checked for the BRCA1 or BRCA2 genes, which are linked to a high risk of breast cancer. Being a carrier of either one of these genes is associated with an increased risk of ovarian cancer. However, it is important to note, however, majority of women who develop ovarian cancer has no family history of ovarian cancer and no genetic mutation.

  • Personal history: Women who have had colon or breast cancer may face a higher risk for ovarian cancer than those who have not had either of these other cancers.
  • Infertility and Endometriosis: Women who have never given birth have a higher risk than women who have. In fact, the more children women have had, the less apt they are to get ovarian cancer.
  • Talcum Powder: In some studies, use of talcum powder in feminine hygiene products or contraceptives has been linked to ovarian cancer. However, the overall increase in risk is minimal. This issue is still being explored.

Factors that are associated with a decreased risk include: previous pregnancy, history of breast feeding, oral contraceptives and tubal ligation.

Warning Signs

If detected early, ovarian cancer is treatable. But symptoms often are vague and may not show up until later stages of the cancer. Easy-to-overlook warning signs may include:

  • Stomach discomfort, such as indigestion, nausea, swelling, or cramps
  • Diarrhea, constipation, or frequent urination
  • Decreased appetite
  • Feeling full after even a light meal
  • Unexplained weight gain or loss
  • Abnormal vaginal bleeding
  • Pain during intercourse
  • Fatigue
  • Backache

Its’ important to pay attention and talk to your doctor if these “vague” symptoms become persistent and/or increased in frequency, intensity and duration. A patient with ovarian cancer has the best chance of being cured when she is treated early.

Click here to learn more about Ovarian Cancer.

Cheng, JoanDr. Joan Cheng was born in Hong Kong and came to the U.S. at a young age, where she grew up in South Carolina. She attended Duke University to earn her B.S. in Biology. She then moved to New Orleans to pursue her M.D. at Tulane University School of Medicine. She left New Orleans for several years to complete her residency in Obstetrics and Gynecology at State University of New York at Stony Brook and then moved across the country to pursue her Fellowship in Gynecologic Oncology at University of Southern California in Los Angeles.

Dr. Cheng, who served as a faculty member at Tulane Medical School before joining Touro’s Crescent City Physicians group in 2007, treats gynecologic cancers such as endometrial, cervical, ovarian and vulva cancers, as well as other complex gynecologic issues that require specialized surgical skills, including robotic surgery.

Are Your Menstrual Cycles Normal?

Arelis Figueroa, MD

A lot of women wonder whether their cycle is normal and when they should make an appointment with an OB-GYN. Here’s how to tell the difference.

What’s Normal, What’s Not

You count the length of your menstrual cycle from the first day of one period to the first day of the next. An average cycle lasts 28 days. But anywhere between 21 and 35 days is considered normal for adult women. Your period should account for two to seven of those days.

When your cycle falls outside these bounds, it’s considered irregular. Watch for these symptoms:

  • Cycles that last for less than 21 days or more than 35 days
  • Cycles that suddenly start to vary widely from month to month
  • Periods that last for fewer than two day or more than seven days
  • Skipped periods when you aren’t pregnant
  • Excessively heavy flow during your periods
  • Bleeding between periods, called “spotting”

If you experience any of these symptoms, talk with your doctor. The rise and fall of your hormones control your menstrual cycles. Having irregular cycles might signal a condition affecting your hormone levels. Or it might be a sign of a structural problem with your reproductive organs.

Causes of Irregular Cycles

Young teens and women nearing menopause often have longer periods or unpredictable cycles. Beyond that, several health issues can throw your cycles out of whack. They include:

  • Polycystic ovary syndrome (a hormonal imbalance in women)
  • Hyperprolactinemia (an abnormally high level of the hormone prolactin)
  • Eating disorders
  • Thyroid disorders
  • Uncontrolled diabetes

Having irregular periods is more than just a nuisance. If the underlying issue isn’t treated, it may lead to other health problems over time. You may also find it harder to get pregnant, if you’re trying to conceive. So, let your doctor know if your menstrual cycles seem to be off. Depending on the source of the problem, treatment options may include hormonal treatments, other medicines and surgery.

Are you at risk for endometriosis?

Women who have endometriosis experience menstrual pain and bleeding worse than other women. Talk with your doctor if your menstrual pain is extreme.

Click here to learn more about endometriosis.
Click here to learn more about menstrual disorders.

Figueroa,ArelisDr. Arelis Figueroa, a Crescent City Physicians obstetrician and gynecologist, supports her patients through pregnancy and beyond, helping new moms establish healthy practices that benefit their families. A native of Puerto Rico, she speaks Spanish and English, working with patients whose language barriers might have otherwise kept them from getting care.

Should You Get a Pap Smear?

Jamie Sias, M.D.

Pap smear is used to screen your risk of getting cervical cancer. During your exam, your physician will collect and examine cells from your cervix. It’s important to talk with your physician about when and how often you should have a pap smear because your age and risk factors can change your exam timeline. It is recommended to start pap smears at age 21.

Why is it important?

A Pap smear is an important part of your routine healthcare. It can help find abnormal cells that can lead to cancer. Regular exams can help your doctor find most cancers of the cervix early. Cancer of the cervix is more likely to be successfully treated if it is found early. Pap smears can also find cervical and vaginal problems such as precancerous cells, inflammation and human papilloma virus (HPV).

Your pap smear can diagnose the following conditions:

  • Inflammation
  • Infection
  • Abnormal cells
  • Precancerous cells
  • Cancer

What happens during a pap smear?

Pap smears are usually painless and quick. Your physician will also perform a pelvic exam during your visit as well. An instrument called a speculum will be inserted into your vagina. This will spread the walls of the vagina apart to show the cervix. A small brush, swab or spatula will be used to gently remove cells from the cervix and back of the vagina. The cells will be placed in a vial of liquid or smeared on a glass microscope slide. If you need an HPV test, your doctor will take a sample of cells for this test as well.

What happens if the pap smear is abnormal?

An abnormal pap smear does not mean you have cervical cancer. This means abnormal cells have been identified on your cervix. It can be a result of an infection or inflammation, herpes, recent sexual activity, HPV and dysplasia. Your physician may repeat the test in four to six months, depending on the type of abnormal cells found. HPV is the main risk factor for cervical cancer, which is a sexually transmitted infection. However, most women who receive treatment for HPV do not develop cervical cancer.

What kind of additional testing will I need if my cells are abnormal?

Your healthcare provider may order these tests:

  • Your cervix and vagina are looked at with a microscope called a colposcope, which magnifies any abnormal areas.
  • Endocervical curettage. Cells are taken from the opening of your cervix with a spoon-shaped tool and looked at under a microscope. This may be done during the colposcopy.
  • A small tissue sample is taken from your cervix and looked at under a microscope. This may be done during the colposcopy.

You may be nervous at your first gynecological appointment but it gets easier. It is important to ask any questions or address in concerns with your physician. Your physician is there to support you and your vaginal health. To schedule an appointment, go to

Dr. Jamie Sias is an OB/GYN with Crescent City Physicians, Inc., a subsidiary of Touro Infirmary. She received her undergraduate degree from Xavier University of Louisiana and earned her medical degree from Louisiana State University School of Medicine. Dr. Sias cares for patients at two convenient locations, Mid-City and St. Claude.

What is HPV?

Heather Razmus, APRN-CNM

The Human papillomavirus is a virus that is spread by skin-to-skin contact, including sexual intercourse. The risk of HPV exposure increases with the number of sexual partners you have and the number of partners your partner has had. The majority of individuals become infected with HPV for the first time between ages 15 and 25 years. Approximately 75-80% of sexually active adults will contract HPV before the age of 50. Most people infected with HPV never develop any signs or symptoms of infection. However, 10 to 20 percent infected with certain strains of the virus can develop cancer of the cervix, anus, throat or oral cavity.

Paper with words  HPV infection and glasses.

What diseases are related to HPV?

HPV types 6 and 11 cause 90 percent of genital warts in both men and women.  There are over 100 identified strains of HPV and more than 40 of these are known to infect the cervix and approximately 15 can cause cervical cancer. High risk types 16 and 18 cause most cases of cervical cancer, but types 31, 33, 45, 52 and 58 are also high-risk types, which can also cause cancer. HPV has also been associated with anal cancer, cancer of the throat, tonsil and base of the tongue. Penile cancer is very rare, however over 50 percent of cases can be attributed to HPV.

How can I prevent HPV?

Condoms do not provide complete protection from HPV infection because they do not cover all exposed genital skin and infection comes from skin-to-skin contact. People cannot become infected by touching an object, such as a toilet seat. Three vaccines (Gardasil-9, Gardasil, and Cervarix) are available to prevent infection with types of high risk HPV. Research has indicated that the vaccine will significantly reduce the occurrence of women who develop precancerous cervical cells, thus decreasing the incidence of cervical cancer. Limiting the number of sexual partners and smoking cessation has also been attributed to decreasing the incidence of HPV.

Doctor vaccinating small redhead girl.

Who should get the HPV vaccine?

The vaccine will provide the greatest protection from HPV when received prior to the initation of sexual activity. It is recommended that all boys and girls be vaccinated at the age of 11 or 12. It is FDA approved to vaccinate girls ages 9 to 26 years and boys ages 9 to 21 years.

There are currently three FDA approved vaccines available. You should talk to your health care provider to determine which vaccine is best for you. The three vaccines protect against different types of HPV. Dosing depends on the age of administration, but is at least two injections six months apart.

Are there any side-effects to the HPV vaccine?

The HPV vaccine may cause mild redness, tenderness or swelling near the injection site. There is no thimerosal (a mercury derivative used as a preservative) in the HPV vaccine. Large studies have not demonstrated any evidence of severe health risk associated with this vaccine. Most healthcare experts believe that health benefits of the vaccine outweigh any potential risk.

heather-razmus-aprn-webHeather Razmus, APRN-CNM, is a Certified Nurse-Midwife with Crescent City Physicians Inc., a subsidiary of Touro Infirmary. Heather received her Bachelor of Science in Nursing from William Carey College and received her Master of Science with Midwifery focus from the University of Minnesota. After graduation she practiced in Michigan for thirteen years. Heather is a New Orleans Native whose goal was to return home and bring more birth options to the women of New Orleans and she is thrilled to be achieving that dream.  Her interests include waterbirth, Polycystic Ovarian Syndrome and she is committed to helping woman achieve their birth goals. As a certified-nurse midwife, Heather can care for women of all ages, at every stage of life

Cervical Cancer Risks

Gynecologic Oncologist Joan Cheng, M.D.

Who’s at Risk for Cervical Cancer?

Risk factors are anything that may increase your chances of having a disease.  Cervical cancer is the third most common gynecologic cancer in the United States.  The mean age at diagnosis of cervical cancer is 48 years. It is extremely rare for a woman younger than 20 years to be diagnosed with this cancer.  Human papillomavirus (HPV) is key to the development of cervical cancer and can be detected in 99.7% of cases.  Most of the risk factors for cervical cancer are associated with an increased risk of acquiring or having weakened immune response to infection with HPV.  Knowing these risk factors can help you make choices that might lower your risk.  These include:


HPV infection is extremely common but only a small number of infected women will develop cervical cancer.  For most women, the infection is temporary and harmless.  A woman becomes infected through intimate contact with a partner who has the infection.  There are over 150 subtypes of HPV and approximately 15 subtypes are known to lead to cervical cancer if they don’t go away on their own.  Over the recent years, the development of HPV testing and HPV vaccination are expected to help prevent women from getting cervical cancer.

Sex at young age or multiple sexual partners

Compared with women who has first intercourse at 21 years or older, women who begin intercourse younger than 18 years are twice as likely to get cervical cancer.  Also, compared with women who have one partner, women with six or more partners are three times more likely to get cervical cancer.  Having sex with a high risk sexual partner, such as a partner with multiple sexual partners or with known HPV infection, puts you at higher risk of getting HPV infection. The only sure way to protect yourself is to not have sex, or to have sex only with a partner you know doesn’t have HPV.  Also, you can lower your risk by getting the HPV vaccine before becoming sexually active and getting regular Pap screening and/or HPV testing.



If you smoke, you are twice as likely to get cervical cancer as women who do not smoke.  Chemicals in cigarettes get into your bloodstream and in the cervical mucus which make it more likely for HPV infection to persist rather than go away.  Also smoking weakens the immune system, making you less able to fight HPV infections.

Weakened immune system or HIV infection

Women who have illnesses or take medications that weaken their immune system raises the risk of cervical cancer.  Also women with human immunodeficiency virus (HIV) are more likely to have persistent HPV infection and therefore are at higher risk of getting cervical cancer.

Oral birth control

Long term use of oral birth control pills increases the risk of cervical cancer.  The risk goes back down after you stop taking them.

Early age at first birth and 3 or more pregnancies

Women who are younger than 20 years old at first birth and who have 3 or more babies have an increased risk for cervical cancer.  These are also likely due to exposure to HPV through sexual intercourse.

Not getting regular Pap tests


Pap tests screen for abnormalities of the cervix caused by HPV infection.  If these abnormalities are diagnosed and properly treated, then progression to cancer can be prevented.  Therefore, women who get regular Pap tests are less likely to get cervical cancer.


It is not clear whether genetics play a role in cervical cancer.  There is ongoing research to identify genetic changes that may make women less likely to clear HPV infection on their own, hence making them more likely to develop cervical cancer.

Knowing these risk factors for cervical cancer give you the power to make wise and deliberate choices that will significantly impact your health. Remember to visit your gynecologist on a regular basis, get your Pap test and get your HPV vaccine.

Cheng, JoanJoan Cheng, M.D. is a Gynecologic Oncologist with Crescent City Physicians, Inc., a subsidiary of Touro infirmary. Dr. Cheng attended Tulane Medical School and completed her residency at University of New York at Stony Brook. She then served her fellowship at University of Southern California. Dr. Cheng chose the specialty of Gynecologic Oncology because it represents a subspecialty in medicine that has the perfect blend of complex surgery and medical oncology, both of which SHE find fascinating and gratifying. And as a mother, wife, daughter and sister, Dr. Cheng connects well with the women she cares for.

Early Warning Signs of Ovarian Cancer You Shouldn’t Ignore

What is ovarian cancer?

Joan Cheng, M.D.

Ovarian cancer is a disease in which cancer starts in the cells of the ovary. There are 3 types of ovarian tumors, named for the tissue in which they are found:

  • Epithelial cell – These are cells that cover the surface of the ovary. Most of these tumors are benign (noncancerous) and account for most cases of ovarian cancer.
  • Germ cell – These are cells that form the eggs in the ovary.
  • Stromal cell – These cells form the structural tissue of the ovary and produce female hormones.

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Cervical Cancer: What You Need to Know

Joan Cheng, M.D.

What is Cervical Cancer?
Cervical cancer is a type of cancer that occurs in the cells of the cervix, which is the lower part of the uterus that connects to the vagina. In the past, cervical cancer was considered one of the most serious cancers among women, but now there are ways to detect cervical pre-cancers and cancers early on thanks to effective screening tests (Pap and HPV test) and receiving a vaccine (Gardasil or Cervarix) that protects against the human cervical cancer awarenesspapillomavirus (HPV) infection.

Screening & Prevention:
A Pap test has been the traditional method to detect cervical abnormalities and allow for treatment before it develops into cancer. There is a newer test for women 30 years of age or older called the HPV test that finds the virus and helps determine if you are at higher risk for cervical cancer. The two vaccines that protect against most common strains of HPV include Gardasil and Cervarix. The vaccine is recommended for females starting at 11 – 12 years of age and up to 26 years old. Although the vaccine is expected to decrease cervical cancer rates, it is still important to get screened regularly.

Warning Signs and Symptoms:
Since most women do not experience any symptoms until the cancer has advanced, it is important to be aware of cervical cancer signs including excessive vaginal discharge, pelvic pain or bleeding during or after intercourse, after menopause or at unexpected points in the menstrual cycle. In most cases if caught early enough, treatment may only entail removing the cancer through a biopsy or surgery. However, in more extreme cases, women may need to have a hysterectomy to remove the entire uterus.

The good news is that cervical cancer is usually slow growing over the course of many years, deaths continue to decline by 2% a year and most of the more than 12,000 Americans diagnosed annually can be cured.

Cheng, JoanJoan Cheng, M.D. is a Gynecologic Oncologist with Crescent City Physicians, Inc., a subsidiary of Touro infirmary. Dr. Cheng attended Tulane Medical School and completed her residency at University of New York at Stony Brook. She then served her fellowship at University of Southern California. Dr. Cheng chose the specialty of Gynecologic Oncology because it represents a subspecialty in medicine that has the perfect blend of complex surgery and medical oncology, both of which SHE find fascinating and gratifying. And as a mother, wife, daughter and sister, Dr. Cheng connects well with the women she cares for.

>> Click here for details on Dr. Cheng’s practice.