Chemotherapy and Radiotherapy in Gynaecological Cancers Flashcards
what other cancer can HPV commonly cause and how?
carcinoma of the nasopharynx
HPV infects cells to replicate within them and produce E6 and E7 proteins which inhibit the P53 tumour suppressor protein increasing cancer risk
which stage of cervical cancer is suitable for surgery?
stage 1 (A or B) - where the cancer is limited to the cervix
name a recognised feature of cervical cancer in Tayside?
acute renal failure
risk factors for cervical cancer?
smoking earlier age of first intercourse (earlier exposure to HPV and immature transition zones) high risk males oral contraceptive multiple partners
symptoms of cervical cancer?
abnormal bleeding (post-coital, intermenstrual, post-menopausal) acute renal failure
surgical management of cervical cancer?
surgery only done when all of it can be excised (well defined etc)
LLETZ (Large loop excision of the transformation zone)
fertility sparing treatment for young women or women who haven’t started families yet (only for cancers confined to cervix)
Wertheim hysterectomy for early/micro-invasive disease
total abdominal hysterectomy, excision of the proximal 1/3 of the vagina and lymphadectomy, (for cancers that have spread)
radiotherapy is the main treatment for what in cervical carcinoma?
main treatment for solid metastases to target the tumour cells and the lymph nodes within the pelvis (defined via CT)
how is radiotherapy delivered in cervical carcinoma?
a fraction is given each day for 5 days a week
starting with external beam therapy followed by brachytherapy which allows a very high dose of radiation to the cervix
what is brachytherapy?
internal radiation treatment
where a pellet/intrauterine tube/ovioid/ring applicator is inserted directly into the site and emits radiation
issue with brachytherapy?
everyone involved in treatment is exposed to radiation
main use of chemotherapy in cervical carcinoma?
acts as a radiation sensitizer to make the radiotherapy more effective
how can chemotherapy be used in cervical carcinoma?
can be used as a neoadjuvant (shrink tumour before other treatment)
concomitant (use of chemotherapy along with radiotherapy)
palliative
chemotherapy drugs?
cisplatin 40mg/m2 weekly which inhibits cancer replication
carboplatin + paclitaxel
how can you plan for treatment pathway?
do examination under anaesthetic and insert EUA and marker seed insertion to find the most inferior extent of the cancer
view cancer via CT
mainstay of treatment for endometrial cancer?
surgical
rarely treated with chemoradiotherapy unless patient is inoperable
risk factors for endometrial cancer?
obesity
oestrogen exposure (HRT, tamoxifen)
HNPCC (lynch syndrome)
how does endometrial cancer present?
post-menopausal bleeding
incidental finding
what surgery is used for endometrial cancer?
TAH (total abdominal hysterectomy) BSO (bilateral salpingooophrectomy) hysterectomy and salipingooophrectomy washings
how is radiotherapy used in endometrial cancer?
adjuvant treatment to reduce risk of relapse
- vaginal vault brachytherapy and external beam
how is chemotherapy used in endometrial cancer?
adjuvant therapy depending on fitness of patient to reduce relapse risk
why are ovarian cancers usually more advanced on presentation?
there is more space for them to grow in the peritoneum so they can grow very big before causing symptoms
ovarian cancer increases risk of what other cancer?
peritoneal cancer
risk factors for ovarian cancer?
age >50 (or germ cell tumours in young women)
nulliparity (or low parity)
delayed pregnancy
FH of breast/ovarian cancer (BRCA gene)
symptoms of ovarian cancer?
ascites bloating pelvic mass bladder dysfunction acute bowel obstruction pleural effusion (not always malignant fluid) SOB incidental finding
investigations in endometrial cancer?
blood tests (CA125 - not always high)
US scan (TV and TA)
cytology (pleural/ascetic fluid sample) need a CT guided biopsy if inconclusive
pathology
RMI (RMI >200 should be referred to gynaecology-oncology MDT)
why is US scan useful In endometrial cancer?
shows thickness of endometrium
how does endometrial cancer spread?
“cauliflower like metastases”
- varying elements that are cystic and others that are solid
spread to greater omentum = omental cake
2 types of spread in endometrial cancer?
peritoneal spread/seeding within the pelvis to abdominal cavity
haematogenous spread to liver and lungs and later to the brain
surgical treatment of endometrial cancer?
total abdominal hysterectomy
bilateral salpingooophrectomy
omentectomy and optimal debulking for advanced cancers
how is chemotherapy used in endometrial carcinoma?
enhances duration of response to surgery and reduces relapse risk
some people have chemo along with surgery or just chemo alone
types of chemo drugs in endometrial cancer?
carboplatin alone (palliative)
carboplatin + paclitaxel (mainstay?)
PARP inhibitors
how long are cured stage 1 patients followed up for?
5 years
