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Ovarian and Endometrial Cancer Using risk factors to help triage Adam Rosenthal PhD MRCOG Consultant Gynaecologist and Gynaecological Oncologist
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Ovarian Cancer
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CR UK Ovarian Cancer Stats for UK and world 5th commonest women’s cancer in UK (2 nd after uterine) 7,116 cases in 2011 - 19 women / day 4,271 deaths in 2012 - 11 women / day – most lethal gynae cancer Increasing incidence with age - 75% new cases aged > 54 yr In Europe - 65,600 cases (estimated) in 2012 Worldwide - 238,000 cases (estimate) in 2012
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Number of New Cases per Year and Age-Specific Incidence Rates per 100,000 Population, UK, 2009-2011
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Most cases occur in postmenopausal women
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Ovarian Cancer Risk Factors Family history (and Ashkenazi Jewish heritage) Ovarian (any age but epithelial tumours only) Breast (esp below 50 yr) Endometrial, colorectal (esp young ages) – Lynch Syndrome Age – 75% postmenopausal Gynae history Never used hormonal contraception Nulliparous Never breast fed Early menarche/late menopause Used HRT Endometriosis No tubal ligation/salpingectomy/hysterectomy Stronger Weaker Lifetime ovulations & hormones
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Symptoms (NICE Clinical Guideline 122) New onset, persistent (esp if >x12/month) Bloating/distension Pelvic/abdominal pain Feeling full quickly after eating/loss of appetite Increased urinary urgency/frequency NB bowel dysfunction not in guideline but if primary bowel pathology excluded please consider ovarian cancer
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Investigation (NICE Clinical Guideline 122) No mass/ascites CA125 >=35 u/ml<35 u/ml TVS Re-assess / re-attend if symptoms persist Abnormal Normal Refer if suspicious
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Endometrial Cancer
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CR UK Uterine Cancer Stats for UK and world 4th commonest women’s cancer in UK (commonest gynae cancer) 8,475 cases in 2011 - 23 women / day 2,025 deaths in 2012 78% 5 yr survival Increasing incidence with age – vast majority aged > 40 yr In Europe – 100,000 cases (estimated) in 2012 Worldwide - 319,000 cases (estimate) in 2012 50% increase in UK rate since 1990s
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Uterine cancer Number of New Cases Per Year and Age-Specific Incidence Rates per 100,000 Population, UK
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Most cases occur in postmenopausal women
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Family History – Endometrial, colorectal (esp young ages) – Lynch Syndrome Obesity Age Tamoxifen Endometrial hyperplasia (esp atypical) Gynae/medical history Never used hormonal contraception Nulliparous/early menarche/late menopause Any HRT other than continuous combined PCOS or ovarian granulosa cell tumour Prior breast cancer Pelvic radiotherapy Endometrial Cancer Risk Factors Lifetime estrogens
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Symptoms Postmenopausal bleeding Intermenstrual bleeding (age > 40 yr)
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Two Week Wait Referral Form Ascites/pelvic mass on examination/ultrasound (not obviously fibroids/urological/GI) Raised CA 125 and strong clinical suspicion of ovarian cancer (with USS if available) Persistent intermenstrual bleeding > 45 years of with normal vaginal examination (lasting > 6 weeks after stopping HRT/COCP if taken) Postmenopausal Bleeding HRT: Unexpected or prolonged bleeding for >6 weeks after stopping HRT Any other relevant symptoms or signs not covered by the guidelines
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Two Week Wait Referral Form Lesion suspicious of cancer on cervix or vagina on speculum, or smear suggestive of cancer – refer urgently to colposcopy Lesion suspicious of cancer on clinical examination of vulva or vagina
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adam.rosenthal@uclh.nhs.uk 17
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