1. Special Tutorial Programme Professor Deirdre J Murphy Trinity College

2. Overview Gynaecological Cancer

3. Objectives Epidemiology Gynaecological History Gynaecological examination Investigations Management

4. Patient 1 Age 70 years Lower genital tract itch Slight vaginal discharge

5. Vulval / Vaginal cancer

7. Clinical Age > 60 years No specific risk factors 95% squamous Pruritus / bleeding / discharge Ulcer / Mass / Inguinal nodes

8. Investigations Biopsy Staging – surgical / histological Pre-op work-up

9. Management Wide local excision Radical vulvectomy Bilat groin lymphadenectomy +/- radiotherapy Prognosis I >90% 5yrIII/IV 40%

10. Patient 2 Age 47 years Post-coital bleeding No smears

11. Cervical cancer

15. Clinical Age peak 45-55 CIN / Partners / HPV / HIV / Smoker Squamous 90% / Adeno 10%

16. Clinical PCB / IMB / Discharge / PMB / None Ulcer / mass visible / palpable Late stage – organ symps / mass

17. Investigations Biopsy Staging – Clinical / Histological Pre-op work-up EUA / Cystoscopy / CT / IVP

18. Management Ia 1 MicroinvasionCone biopsy I – IIa Surgery / Radiotherapy AdvancedRadiotherapy Prognosis overall 65% 5 year

19. Patient 3 Age 65 years PMB Tamoxifen

20. Uterine / Endometrial cancer

22. Clinical Age >/= 60 years Risk factors: unopposed oestrogen – exogenous / obesity / PCOS / nullip / late menopause / tamoxifen Protective:COCP / HRT combined Adenocarcinoma 85%

23. Clinical PMB / Irreg menses / IMB Normal examination

24. Investigations TVS endometrial thickness Endometrial biopsy Staging – surgical / histological / nodes Pre-op work-up CT/MRI

25. Management Controversial TAH / BSO / Vag cuff / Nodes Radiotherapy [Progestagens] Prognosis Ia >90% 5 year All 65%

26. Patient 4 Age 70 years Bloating Clothes a bit tight

27. Ovarian cancer

30. Clinical Age peak 60-70 yearsRare young Epithelial – serous / mucinous / clear Germ cell - dermoid Sex-cord stromal Secondary malig Early menarche / late menopause / nullip / ovul induction / familial 4%

31. Clinical Silent Abd distension/ Bloating / Dyspepsia Mass effects Mass / Ascites / Cachexia / Breasts

32. Investigations Ultrasound scan Ca 125 Pre-op work-up Laparotomy - Staging

33. Management Debulking surgery Chemotherapy – cisplatin / taxol Paracentesis Prognosis 25% 5 yearIII 15% IV 5% Palliative care

34. Course evaluation