Treatment of Gynaecological Cancers Flashcards
Overall treatment of different gynaecological cancers?
Uterine cancers - HYSTERECTOMY/BSO/PLND
Cervical cancers - LLETZ/Simple or radical hysterectomy/trachelectomy
Vulval cancers - WLE/Groin nodes dissection
Ovarian cancers - Optimal Debulking
What is optimal debulking in ovarian cancer?
very important when ovarian cancer has already spread throughout the abdomen at the time of surgery.
The aim of debulking surgery is to leave behind no visible cancer or no tumors larger than 1 cm (less than 1/2 an inch). This is called optimally debulked.
Can be followed up by chemotherapy if required as an adjuvant in order to kill any remaining cancer cells and reduce chances of recurrence.
What is a hysterectomy BSO?
Bilateral salpingo-oophorectomy (BSO) is surgery to remove both of your ovaries and fallopian tubes.
The hysterectomy and bilateral salpingo-oophorectomy will both be done during one procedure. This surgery will remove the uterus, cervix, ovaries, and fallopian tubes.
What is hysterectomy with PLND?
lymph node dissection when most or all of the lymph nodes in the area are removed.
This is usually done at the same time as the operation to remove the uterus (hysterectomy).
What is radiotherapy?
The delivery of ionising radiation to treat cancer
Types of radiotherapy?
External Beam
- Radiation is delivered from the outside, into the patient’s tumour.
• Radiation beams can be directed from different directions to avoid critical normal organs
• Brachytherapy
- Means ‘near therapy’
• Can be intercavity or interstitial
When would radiotherapy be used?
Radical
• Primary treatment
Adjuvant
• Along with surgery
Neoadjuvant
• Given before surgery (uncommon in avnae cancers)
Palliative
• Symptom control
What is radical radiotherapy and indications?
Primary curative treatment given at a sufficient dose to treat macroscopic disease
Indications:
* Cervical Cancer:
* Stage I if medically unfit for surgery
* Stage II, III, IV
- Endometrial cancer if medically inoperable
* Some vulval cancers
What is adjuvant radiotherapy and indications?
Following surgery to treat microscopic disease and reduce the risk of disease recurrence.
Indications:
• Cervical cancers with large tumour diameter, positive margins on resection, positive lymph nodes
- Endometrial cancer - grade ll depending on histological results, grade Ill and grade
• Vulval cancer depending on histological results
What is palliative radiotherapy and indications?
Relieve symptoms without necessarily affecting the long term outcome
• Indications:
• Pain
• Bleeding
• Spinal cord compression from spinal metastasis
• Skin metastasis
Side-effects of radiotherapy?
• Fatigue
• Nausea/vomiting
• Diarrhoea
• Vaginal discharge/dryness
• Vaginal stenosis
• Rectal stenosis
• Radiation cystitis
How does chemotherapy work?
Works by killing rapidly dividing cells
Side-effects of chemotherapy?
Fatigue
Nausea/vomiting
Diarrhoea/constipation
Mucositis
Alopecia
Peripheral neuropathy
When may chemotherapy be given?
Adjuvant
• Following surgery, if high risk of recurrence
Neoadjuvant
• Before surgery
• May have interval debulking surgery
Palliative
• Symptom control
What cervical cancer treatment can be used in the earlier stages?
LLETZ (large loop excision of the transformation zone)
LLETZ is a procedure to remove abnormal cervical cells, diagnose cervical cancer and treat it in its early stages.
This treatment has a success rate of over 90%
