Transcript Management of Gynaecological Cancers

Management of
Gynaecological Cancers
Gynaecological Cancers in
NSW
1180 new cases in 2002
 10% of all new cancer diagnoses
 Crude incidence rate 35.3 per
100,000 women
 1:38 risk of developing
gynaecological cancer
 1 case per GP every 4 years
 3 cases per gynaecologist each year

Epidemiology Of Gynaecological
Cancers in NSW (2002)
Cancer
Type
New
cases
Deaths
(% of cancer
deaths)
Incidence Rate Lifetime
Risk
(per 100,000
women)
Cervix
Uterus
Ovary
210
477
386
69 (1%)
101 (2%)
237 (4%)
6.3
14.3
11.6
1:218
1:85
1:124
Breast
3981
885(16%)
119.2
1:11
Familial cancer risk and
gynaecological cancer



Family history is a recognised risk factor
in breast, ovarian and colorectal cancer
Endometrial cancer is often associated
with non-polyposis colon cancer
syndrome
Patients identified as having a high risk of
familial gynaecological cancer may benefit
from referral to a specialised Familial
Cancer Clinic
Cervical Cancer




Cervical screening with regular,
conventional Pap smears has proven to
be an effective cancer screening
strategy
Most cervical cancers present in
unscreened women
Prognosis relates to stage at
presentation
Symptoms warrant investigation,
regardless of Pap smear result
Management of Cervical
Cancer
Depends on stage of presentation
 Treatment often involves either
surgery or (chemo)radiation or both
 The woman should be involved in
treatment decisions
 Fertility preservation feasible for
some (very) early stage disease

Management of Cervical
Cancer (I)

“Microinvasive”



Early stromal
invasion
Usually diagnosed
after abnormal Pap
smear
Needs cone biopsy
for accurate
assessment

Cone biopsy



Minor surgical
procedure
Excises area for
diagnosis
Sometimes
adequate
treatment if
minimal invasion
and clear margins
Management of Cervical
Cancer (II)

“Early” disease



Stage I or early 2A
Disease clinically
confined to cervix
No clinical
metastases

(Chemo)radiation or
surgery are options:


Radical hysterectomy
and pelvic lymph node
dissection
External beam
radiation with platinum
chemotherapy and
brachytherapy
Management of Cervical
Cancer (III)

Advanced disease

Stage 2B and
greater

(Chemo)radiation :


External beam
radiation with
platinum
chemotherapy and
brachytherapy
“Palliative”
treatment for very
advanced disease
Issues in cervical cancer
Life threatening illness
 Fertility
 Menopause
 Sexuality
 Toxicity of treatment

Follow-up after treatment
for cervical cancer
After treatment, patients are usually
followed closely as salvage
treatment for localised recurrent
disease may be beneficial
 Most recurrences occur within 2
years
 If the cervix remains in situ, followup usually involves repeat cytology.

Cancer of the Uterus
No effective screening strategy
 Early investigation of symptoms,
especially PMB
 Clinical suspicion eg. Obesity,
diabetes, chronic anovulation and
infertility
 Delay in presentation worsens stage
and prognosis

Management of
Endometrial Cancer
Attempt surgical resection (despite
medical risks)
 Assess surgico-pathological risk
factors
 Adjuvant (radiation) therapy for
high-risk

Ovarian Cancer
No effective screening test
 Symptoms often (? always) nonspecific
 Usually advanced at presentation
 Delay in diagnosis often perceived
by patient

Management of Ovarian
Cancer
Assessment of pelvic masses
 “Risk of malignancy index”
 Surgical staging and debulking
 Surgery alone for early cases
 Chemotherapy for most
 High relapse and mortality rates

Management of Early Stage
Ovarian Cancer
Meticulous surgical staging
 Prognosis dependent on
histopathologic features
 Sub-groups with high risk of
recurrence
 Fertility sparing treatment
appropriate in selected favourable
cases

Follow-up after treatment of
ovarian cancer




Following completion of treatment, followup usually involves clinical assessment
and measurement of CA-125
The prognosis of recurrent disease is very
poor, particularly if recurrence occurs
soon after completing treatment
The CA-125 is usually elevated prior to
clinical recurrence
Abnormal levels of CA-125 are a frequent
cause distress and anxiety during followup