Gynae Ca Flashcards
Most common gynaecological cancer
High grade serous ovarian cancer (cancer starts in the fallopian tube and drops into ovary)
When are PARP inhibitors used?
Palliative high grade serous or endometriod ovarian cancer, stage 3-4, BRCA positive
Started on olaparib after deep PR or CR to “induction” platinum doublet chemotherapy
General approach to treatment of gynae cancer
Resect –> platinum doublet
Except germ cell tumours - resect and treat like testicular tumour, consider high dose chemo or TIP up front
Mucinous ovarian cancer tumour markers
Tumour marker CEA, Ca19-9
Lower response to platinum doublet chemotherapy
Endometrial cancer risk factors
Unopposed estrogen
Nulliparity, early menarche, late menopause
Obesity and metabolic syndrome (excess peripheral conversion of androgen to estrogen)
PCOS (anovulatory)
Tamoxifen
Age
MSH6 germline mutation
Lynch syndrome
OCP and increased parity are protective
2 main histopathological groups of endometrial ca
Type 1: Endometrioid (80%)
- estrogen dependent, arises from endometrial hyperplasia, good prognosis
Type 2: Non-endometrioid
- high grade endometrioid, serous, clear cell - poor prognosis, less chemosensitive, estrogen independent
Treatment early stage endometrial ca
Total hysterectomy + bilateral salphingo-oopherectomy +/- sentinal lymph node biopsy
+/- adjuvant radio, chemo, immunotherapy if MSI-high (depends on FIGO stage, histologic subtype and grade, lymphovascular invasion, depth of myometrial invasion, age) *rather controversial
In early endometrial cancer or atypical hyperplasia (pre-cancer), can attempt oral progestin or progestin IUD
Treatment advanced endometrial ca
Cytoreductive surgery (remove all visible disease in the abdominal cavity) + adjuvant chemoradiotherapy
+/- hormonal therapy as long-term control for those with type 1 endometrial ca
+/- palliative radiation for symptomatic disease
+/- PD1 inhibitor e.g. durvalumab if MSI-high
Who should get BRCA1/2 testing in ovarian, fallopian tube or primary peritoneal cancer?
All women diagnosed at age <70 with high grade, non-mucinous epithelial ovarian, fallopian tube, primary peritoneal cancer should get BRCA1/2 testing
Has implications for treatment and families
Should we use CA125 to monitor for recurrent ovarian ca?
No
No difference in survival when we treated those with just a rising CA125 so no point doing this.
Risk of recurrence in ovarian cancer
80%
Treatment of ovarian cancer
1) General approach
2) If suboptimally debulked
3) BRCA1/2 mutation
Debulking surgery PLUS chemotherapy (carboplatin and paclitaxel)
If suboptimally debulked/stage 4: add bevacizumab (anti-angiogenesis)
If BRCA 1/2 mutation: use maintenance therapy with olaparib (PARPi) after chemo
When might you consider neoadjuvant chemo in ovarian ca?
Makes no difference in PFS and OS
But can consider in those with very bulky/symptomatic disease and ascites. Goal is try to improve symptoms and performance status quickly before debulking surgery.
When might you consider intraperitoneal chemo in ovarian ca?
Improved PFS and OS in stage 3 optimally debulked ovarian ca
However toxicity +++ and benefit is only seen in those who can get through all 6 cycles of it
What’s bevacizumab and when is it used?
Anti-angiogenesis agent
Used in suboptimally debulked ovarian ca/stage 4, together with cisplatin/paclitaxel
