Gynaecological malignancies

Marfu’ah Nik Eezamuddeen

Clinical Oncologist, HCTM
 Aims
• Ovarian cancer
• Endometrial cancer
• Cervical cancer
• (Vaginal + vulva cancer)
Women reproductive system
OVARIAN CANCER
Women reproductive system
 Epidemiology
• Most common cause of death from gynae
malignancies
• Peaks at 50-55
• 2/3 presents with locally advanced disease
 Aetiology/risk factors
• Infertility
• Long term HRT
• Fx of breast/ovarian ca (2x risk)
• BRCA1 BRCA2
• HNPCC
– Colon, endometrial, ovarian
 Clinical presentation
• Absence of symptoms
• Local
– Fallopian tubes, uterus, vagina, bowel, bladder,
pelvic side wall
• Peritoneal
– Ascites, pleural effusion
• Distant metastases
– Liver, bone, lung
Presentation
 Investigations
• Tumour markers
– Ca125
– AFP
– Beta HCG
• Imaging
– transvaginal ultrasound
– CT TAP
• Cytology from ascitic fluid/pleural fluid
 Histopathology
• Epithelial ovarian cancer
– Serous
– Mucinous
– Endometroid
– Clear cell
• Sex cord tumours
• Germ cell tumours
• Metastases from other cancer
– Breast, GI
Staging – stage I
Stage II
Stage III
Stage IV
 Treatment overview
• Surgery
– Accurate staging
– Optimal debulking : TAHBSO, peritoneal washings
• Followed by chemotherapy in all cases
– Except FIGO 1A
• If very extensive, neoadjuvant chemotherapy
then surgery
Surgery in stage IV
Post-surgical treatment
 Role of RT
• Rarely given
• Traditionally whole abdominal RT
ENDOMETRIAL CANCER
Women reproductive system
 Epidemiology
• 4% of female cancers
• Post menopausal women (> 60)
• Mostly stage 1
 Aetiology/risk factors
• Family history
– HNPCC
• Unopposed oestrogen stimulation
– Obesity
– Old age
– Exogenous oestrogen: HRT, tamoxifen in breast
cancer
– Nulliparity
 Clinical presentation
• Primary
– Postmenopausal bleeding
– PV discharge
– Pelvic mass
• Regional
– Back pain from
para-aortic nodes
• Distant metastases
– Jaundice
– Bone pain
– Pleural effusion
 Investigations
• Imaging
– TVS: thickened endometrium
– CT TAP
• Invasive procedure:
– Hysteroscopy + pipelle biopsy
 Histopathology
• Adenocarcinoma (90%) • Others
– Uterine sarcomas
• Mucinous carcinoma
– Lymphomas
• Clear cell carcinoma
– Metastases
• Serous carcinoma
• Ovary
• Mixed cell carcinoma
• Rectum
• Bladder
• cervix
Staging
 Treatment overview
stage Intent RX

I Early Curative Surgery + RT (high

risk)

II Early Curative Surgery + RT

III to IVA Locally advanced Curative Surgery + RT +

chemo

IVB Metastatic Palliative Palliative

chemotherapy
Palliative RT
Surgery
 Role of radiotherapy
• Adjuvant
– Vaginal brachytherapy
– External beam RT + VBT
• Palliative
– For bleeding
– Bone metastases
CERVICAL CANCER
Women reproductive system
 Epidemiology
• 12th most common cancer
• 2% of female cancers
• Peaks at 40-45 years old
• Decline over 10 years due to screening
 Aetiology/risk factors
• HPV infection
• Others
– Early age at first pregnancy
– Multiparity
– Multiple sexual partners
– Smoking
 Clinical presentation
• Asymptomatic • Distant metastases
• Primary – Jaundice
– Abnormal bleeding – Bone pain
– PV discharge – Pleural effusion
– Dyspareunia
• Regional
– Urinary symptoms
– Changes in bowel habit
 Investigations
• Imaging
– CT TAP
– MRI abdomen pelvis

• Invasive procedure:
– Pap smear
– Examination under
anaesthesia + BX
 Histopathology
• Squamous cell carcinoma
• Adenocarcinoma
Staging
 Treatment overview
stage Intent RX

IA Early Curative Surgery

IB1 and IIA Early Curative Surgery or RT

IIB to IVA Locally advanced Curative Definitive CCRT

IVB Metastatic Palliative Palliative

chemotherapy
Palliative RT
THANK YOU