RAISING THE AWARENESS OF GYNAECOLOGICAL CANCER. Penny Bognuda CNS Gynaecologic Oncology ADHB. June 2015.

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1 RAISING THE AWARENESS OF GYNAECOLOGICAL CANCER Penny Bognuda CNS Gynaecologic Oncology ADHB. June 2015.

2 AIMS AND OBJECTIVES OF THE NEXT ½ HOUR. Brief overview of the different types of gynaecological cancers Bingo Lingo - The language of cancer Presenting symptoms and what to look out for Vulval Cancer not just an old ladies disease The silent symptoms of ovarian cancer Don t ignore postmenopausal bleeding or any abnormal vaginal bleeding Effects of lifestyle on gynae cancer Vulnerable women Engaging women in their care and working together to make the journey better for our patients Side effects of treatment

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4 BINGO LINGO /THE LANGUAGE OF CANCER Malignant vs benign Carcinoma Tumour /mass Cancer Histology Grade and stage Diagnosis Treatment Assessments and follow-up Palliative care

5 GYNAECOLOGICAL CANCERS Cervix Uterus/Endometrial Ovary Fallopian Tube Vagina Vulval

6 EFFECT OF LIFESTYLE ON GYNAE CANCER BMI/OBESITY DIETARY FACTORS PHYSICAL ACTIVITY HORMONAL CONTRACEPTION REPRODUCTIVE FACTORS SEX + GYNAE CANCERS IMMUNOSUPPRESSION SMOKING

7 GENETIC SUSCEPTIBILITY Familial breast and ovarian cancer (BRCA 1 + 2) Hereditary non-polyposis colorectal cancer HNPCC (mismatch repair genes) Endometrial cancer as feature of HNPCC

8 CERVICAL CANCER Squamous cell carcinoma Adenocarcioma Patterns of spread

9 CERVICAL CANCER: RISK FACTORS HPV infection Early age at first sexual intercourse Multiple sexual partners Male sexual partners who have had multiple sexual partners Lower socieo-economic status, migrant groups Smoking Immunosuppression

10 VIEW OF NORMAL CERVIX

11 ABNORMAL CERVIX

12 PREVENTION + SCREENING + BARRIERS Smears Organised Approach Who should be screened? Barriers HPV testing Vaccination

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14 ABNORMAL VAGINAL BLEEDING/DISCHARGE Abnormal vaginal bleeding When to seek medical advice Other causes of abnormal bleeding Vaginal discharge Diagnostic tests

15 VULVA CANCER Not just an old ladies disease Risk factors Signs and symptoms Diagnosis and treatment

16 GUIDE TO VULVAL SELF-EXAMINATION

17 OVARIAN/FALLOPIAN TUBE CANCER Awareness of ovarian cancer Silent behavior No effective screening test for ovarian cancer Risk factors Fallopian tube/peritoneal cancer Diagnosis Treatment

18 SYMPTOMS OF OVARIAN CANCER Abdominal dyspepsia Early satiety Bloating Pressure on bladder urinary frequency/nocturia Pressure on bowel/change in bowel habits General malaise and fatigue Loss of appetite Nausea/vomiting Pelvic pain Abdominal pain Dysparenunia Irregular or heavy periods Vaginal bleeding Weight loss or gain Breathlessness Difficulty sleeping and lying down Difficulty drinking and eating due to pressure on abdominal organs Malnutrition Incidental finding!

19 Patients over 65 THE ELDERLY PATIENT Issues that arise in practice Demographics of aging in NZ Age alone is not a contraindication to potentially curative treatment

20 Cancer risk THE OBESE PATIENT Treatment complications Quality of life Factors influencing delay in seeking cancer screening Health care providers

21 SIDE EFFECTS OF TREATMENT Lymphoedema Loss of fertility Altered body image Altered sexual function loss of libido Premature menopause Vaginal stenosis /vaginal atrophy/decreasing or non existent vaginal lubrication Loss of tissue elasticity Cystitis Proctitis Fatigue Vaginal discharge Abnormal vaginal bleeding Diarrhoea Post coital bleeding and pain Resentment Guilt Insecurity about appearance

22 WORKING TOGETHER Reduce patient anxiety Co-ordinate care Supportive care Improve patient outcomes

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