Week 6-radiotherapy and chemotherapy in gynaecological care

Question 1

Which virus causes 70% of cervical cancers? Which proteins are these related to?

Answer 1

HPV- specifically types 16 and 18 Related to E6 and E7 proteins

Question 2

What other risk factors are there for developing cervical cancer?

Answer 2

Smoking Early age of onset of intercourse Multiple partners High risk male Oral contraceptive pill

Question 3

How does cervical cancer present?

Answer 3

Post coital bleeding Intermenstural bleeding Post menopausal bleeding. Acute renal failure

Question 4

How is cervical cancer staged?

Answer 4

Stage 1a-microscopic 1b- visible lesion 2a- vaginal involvement 2b- parametrial involvement 3-lower vagina or pelvic side wall 4- bladder/rectum or mets.

Question 5

These are the survival rates with cervical cancer.

Question 6

How do you treat cervical cancer?

Answer 6

Surgery- Large loop excision of transformation zone (LLETZ)

• Fertility sparing- removal of cervix with sparing of the uterus.
• Wertheim- removal of uterus, vagina and all parametrial structures.

Radiotherapy and chemo

Question 7

What is radiotherapy?

Answer 7

High energy X rays. They are targeted at the tumour and nodes.

Question 8

What is brachytherapy?

Answer 8

When doctors insert radioactive material into the point that needs destroyed e.g. the tumour. Then high dose radition is given to that area.

Question 9

How do you plan radiotherapy?

Answer 9

Need to examine under anaesthetic and marker seed insertion (these improve the accuracy of the radiotherapy).

CT is planned.

Question 10

What broad categories of chemotherapy may be used?

Answer 10

Neoadjuvant- in addition to other treatments.

Concomittant

Palliative

Question 11

Which drugs are used in chemotherapy for cervical tumours?

Answer 11

Cisplatin

Carboplatin/paclitaxol

Question 12

What is the mainstay of treatment for endometrial cancer?

Answer 12

Surgical.

Question 13

How do endometrial cancers present?

Answer 13

Post menopausal bleeding.

Question 14

What surgical treatments would they use for endometrial cancer?

Answer 14

Total abdominal hysterectomy with bilateral saplingo-oophrectomy (basically removal of the uterus, fallopian tubes and ovaries) (TAH BSO)

Question 15

What is the role of radiotherapy in endometrial cancer?

Answer 15

Usually adjuvant therapy- vault brachytherapy or external beam.

Question 16

What is the role of chemotherapy in endometrial cancer?

Answer 16

Adjuvant. However depends on the grade.