Radiotherapy and Chemotherapy of Gynaecological Cancers Flashcards
What is the BEAT acronym?
B-bloating that is persistent and doesn’t come and go
E- eating less and feeling fuller
A- abdominal pain
T- tell your GP
What should all women with non-mucinous ovarian or fallopian tube cancer be offered?
BRCA1 and BRCA2 mutation testing
What should women with ovarian cancer who have FHx of breast, ovarian or colon cancer have?
Genetic risk assessment
What should women with genetic mutations of BRCA1 and 2 genes be offered?
Prophylactic oophorectomy and removal of fallopian tubes at a relevant time of their life
In the RMI score, what US features constitute a score?
Multilocular cyst Solid areas Bilateral lesions Ascites Intra-abdominal mets
In the RMI score, how is the US section scored?
0=No abnormalities
1= One abnormality
2= Two or more abnormalities
In the menopausal section of the RMI, how is it scored?
Premenopausal=1
Postmenopausal=3
What RMI score constitutes referral?
> 200
What are the patterns of ovarian cancer spread?
Transcoelomic spread/peritoneal seeding within pelvis-> abdo cavity
Haematogenous spread- late and rare
Brain mets <2%
What may be appropriate in selected patients with relapsed epithelial ovarian cancer which is platinum sensitive?
2’ cytoreductive surgery- aim to completely resect all macroscopic disease
What response rate does ovarian cancer have to chemo?
60-70%
Carboplatin/paclitaxel
Relapse rates high
What chemo is used at initial presentation?
Platinum/paclitaxel
What chemo is used in the relapse stage?
Caelyx
Plat/pac
Topotecan
What chemo is used palliatively?
Carboplatin Paclitaxel Etoposide Caelyx Topotecan Gemcitabine Chlorambucil
What should all women with high grade early stage ovarian cancer be considered for?
Adjuvant chemo
Patients who are unfit for combination (chemo)therapy should be offered what?
Single agent carboplatin
Can a third cytotoxic agent be added to carboplatin and paclitaxel?
No
What should women with platinum-sensitive relapsed ovarian cancer be treated with?
Platinum based combination with paclitaxel, PLDH or gemcitabine
What can hormonal therapy with tamoxifen or an aromatase inhibitor be used for?
Women with recurrent, platinum-resistant, ovarian cancer or in those wishing to avoid or delay further chemotherapy, particularly where their original tumour is expressing the oestrogen receptor
What should patients with low-grade serous, clear cell and mucinous histological subtypes be considered for?
Chemotherapy clinical trials
What are some factors in the aetiology of cervical cancer?
HPV Smoking Age of onset of intercourse 'High risk' male OCP Multiple partners
How is cervical cancer staged?
Stage 1a – microscopic Stage 1b visible lesion Stage 2 a – vaginal involvement 2b parametrial involvement Stage 3 lower vagina or pelvic sidewall Stage 4 bladder/rectum or metastases
What are some treatments for cervical cancer?
Surgery-LLETZ, Fertility Sparing, Wertheim
Radiotherapy
Chemotherapy
Describe radiotherapy in cervical cancer
High energy x-rays
Targeted to include tumour +-nodes
External bream
Brachytherapy
What chemo drugs can be used in cervical cancer treatment?
Cisplatin- 40mg/m2 weekly
Carboplatin/paclitaxol
What is brachytherapy?
Radioactive seeds or sources are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues.
How is endometrial cancer treated?
TAH BSO Washings
Debate over lymphadenectomy
Adjuvant radiotherapy- vault brachytherapy, external bream
Adjuvant chemo- depending on grade
