Radiotherapy and Chemotherapy in Gynaecological Cancers 2

Question 1

Occurrence of cervical cancer?

Answer 1

2% of all female cancers; it is the 2nd most common cancer in women <35 years of age

Question 2

Cause of cervical cancer?

Answer 2

HPV types 16 & 18 cause 70% of cervical cancer

Can be prevented with vaccination (although this does not cover all HPV types)

Question 3

Other risk factors for cervical cancer?

Answer 3

Smoking

Age of first intercourse

High risk male

Oral contraceptive pill (long-term use) increases risk

Multiple partners

Question 4

Presentation of cervical cancer?

Answer 4

May be referred after screening

May present with:
• Post-coital bleeding
• Inter-menstrual bleeding
• Post-menopausal bleeding

ARF

Question 5

Staging of cervical cancer?

Answer 5

Stage 1:
• 1a – microscopic
• 1b visible lesion

Stage 2:
• 2a – vaginal involvement
• 2b - parametrial inv.

Stage 3 - lower vagina or pelvic sidewall

Stage 4 - bladder/rectum or metastases

Question 6

Survival with different stages of cervical cancer?

Answer 6

95% for stage 1a but this drops to 20-30% with stage 4 disease

Question 7

Treatment of cervical cancer?

Answer 7

Surgery:
• LLETZ (large loop excision of the transformation zone)
• Fertility sparing
• Wertheim

Radiotherapy

Chemotherapy

Question 8

What is radiotherapy?

Answer 8

High-energy X-rays; 2 types include:
• External beam - targeted to include tumour +/- nodes
• Bracytherapy - placing radioactive material inside the body; this is more focused to the tumour

Question 9

Planning of radiotherapy?

Answer 9

Different methods:
• EUA and marker seed insertion
• CT-planned
• Simulator

Question 10

Types of chemotherapy?

Answer 10

1. Neoadjuvant - given to shrink the tumour before the main treatment (surgery)
2. Concomitant
3. Palliative

Question 11

Drugs used for chemotherapy in gynae?

Answer 11

Cisplatin - 40mg/m2 weekly; this is good for sensitising the cancer to radiotherapy

Carboplatin / paclitaxol (ovarian cancer)

Question 12

Staging of endometrial cancer?

Answer 12

Stages 1-4

Question 13

Treatment of endometrial cancer?

Answer 13

Mainstay is surgical:
• Total abdominal hysterectomy and bilateral salpingo-oophorectomy
• Washings (for staging)

Controversy over the role of lymphadenectomy

Question 14

Risk factors for endometrial cancer?

Answer 14

Obesity

Oestrogens, e.g: HRT, Tamoxifen

Genetic, e.g: Lynch syndrome (HNPCC)

Question 15

Presentation of endometrial cancer?

Answer 15

Post-menopausal bleeding