Sarah Burton. Lead Gynae Oncology Nurse Specialist Cancer Care Cymru

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1 Sarah Burton Lead Gynae Oncology Nurse Specialist Cancer Care Cymru

2 Gynaecological Cancers

3 Cervical Cancers Risk factors Presentation Early sexual activity Multiple sexual partners Smoking Human Papiloma Virus Low socio-economic status Immunocompromise Asymptomatic Screening program Post coital bleeding Postmenopausal bleeding Vaginal discharge (blood stained/offensive) Later weight loss, backache, leg pain, haematuria

4 Cervical Cancer

5 Diagnosis History Smear test Colposcopy Biopsy Histology Staging EUA Cystoscopy CXR MRI

6 Histology Squamous 80-85% 85% Adeno 10% Squamous-adeno adeno 5% Rarely clear cell, small cell, sarcomas, lymphomas

7 Staging and treatment Staging is performed using the FIGO staging system Treatment will vary depending on the stage/features of the cancer

8 Ovarian Cancer Risk factors Age rare -30 peak incidence Nulliparous Genetic predisposition (10%) associated with breast cancer.brca1/brca2 gene those with BRCA1 have 50% lifetime risk HNPCC (Hereditary non-polyposis colorectal cancer) life time risk of %

9 A CT scan showing a large ovarian cancer

10 Ovarian Cancer Vague Symptomology Abdominal distension Pressure effects on bladder and rectum Dyspnoea Indigestion Presentation Post menopausal bleeding

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12 On average a GP will only see one case of ovarian cancer in 5 years!!!!!

13 Ovarian Cancer - Diagnosis USS of Pelvis CA 125 level CXR CT/MRI U and Es, LFTs, FBCs

14 Ovarian Cancer - Histology Cystadenocarcinomas 50% Mucinous 10-15% 15% Clear cell 5% Undifferentiated tumours 5%

15 Staging and treatment Staging is performed using the FIGO staging system Treatment will vary depending on the stage/features of the cancer

16 Staging Process of finding out how widespread a cancer is Most ovarian cancers are staged at the time of surgery Staging is very important because ovarian cancers have a different prognosis at different stages and are treated differently

17 FIGO classification stage 1 Stage 1a Stage 1b Stage 1c Growth limited to one ovary, capsule intact Growth limited to both ovaries, capsules intact 1a or 1b, capsule ruptured. Ascites present containing cells

18 FIGO classification stage 2 Stage 2a Stage 2b Stage 2c Extension / metastases to uterus and / or tubes Extension to other pelvic tissues (such as bladder, colon) 2a or 2b, capsule ruptured. Ascites present containing cells

19 FIGO classification stage 3 Stage 3a Stage 3b Stage 3c Microscopic seeding of abdominal peritoneal surfaces Confirmed abdominal implants < 2cm Abdominal implants > 2cm and / or positive nodes

20 FIGO classification stage 4 Stage 4 Distant metastases (liver, lungs)

21 Endometrial Cancer Risk Factors Age Over 40 (only 5-10% 5 under 40yrs) Late menopause Nulliparous Obesity Unopposed Oestrogen therapy and Tamoxifen Smoking and progesterone containing pill reduce risk

22 Endometrial Cancer - Presentation Abnormal bleeding menorrhagia Post Menopausal bleeding Granular abnormal cells on smear test Persistent intermenstrual bleeding Pelvic pain In advance stage, ascites,, pleural effusion, weight loss etc.

23 Endometrial Cancer - Diagnosis Endometrial biopsy, Pipelle,, D&C, Hysteroscopy MRI (can predict myometrial invasion and measure lymph nodes) CXR

24 Endometrial Cancer Histology Endometrioid adenocarcinoma 75-80% Papillary serous 10% Clear cell 4%

25 Staging and treatment Staging is performed using the FIGO staging system Treatment will vary depending on the stage/features of the cancer

26 Vulval Cancer Rare condition Usually disease of elderly woman May be a long history of vulval problems In younger women often seen in association with other cancers/precancers of genital tract Other conditions thought to be precursers including squamous vulval intraepithelial neoplasia,, the maturation disorders and Paget s disease

27 Vulval Cancer - Presentation Irritation and vulval pruritis of long duration May be asymptomatic Those affected may notice a lump or pain Bleeding or discharge can be present Strong indicators also include an irregular fungating mass, a malignant ulcer or enlarged groin nodes

28 Vulval Cancer - Histology Most squamous cell 85% Malignant melanomas 5% BCC, Invasion adenocarcinoma,, adenoid cystic carcinoma, sarcoma and others make up 10%

29 Vulval Cancer Diagnosis Physical Examination Vulvoscopy Biopsy Histology

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