About Gynaecological Cancer

Ovarian cancer

Approximately 1200 new cases of ovarian cancer, primary peritoneal cancer and fallopian tube cancer are diagnosed in Australia every year and 800 patients will die of their disease. Risk factors include genetic conditions (BRCA1, BRCA2, Lynch/HNPCC) and the oral contraceptive pill reduces the risk of ovarian cancer by 50%. Prophylactic, risk-reducing surgery (removal of ovaries and fallopian tubes) protects from ovarian cancer by 80% to 90%.

Due to the lack of early symptoms, and due to inefficiency of screening, two of three patients are diagnosed at advanced stages (stage 3 or 4). Patients with early stage disease (stage 1 or 2) require surgical removal of the tubes and the ovaries as well as a staging procedure in which the extent of cancer spread is determined. Patients with advanced stage ovarian cancer should have surgical removal of as much cancer as possible. This may include removal of uterus, tubes, ovaries, omentum, bowel, spleen, diaphragm and abdominal peritoneum. The size of the tumour left behind after surgery determines the prognosis to a large extent.  If large scale surgery is not feasible, patients will have some chemotherapy upfront, followed by delayed surgery and more chemotherapy thereafter. Virtually all patients require chemotherapy to which 85% of patients respond well.  However, the majority of patients with advanced ovarian cancer will relapse.

Current research focuses on the development of new markers indicating the earliest possible stage of ovarian cancer. Diagnosing and commencing treatment of ovarian cancer early might result in better survival outcomes. Other research addresses the selection of patients for advanced surgery as well as measures to improve recovery from treatment.

Uterine cancer

Approximately 1600 patients with uterine cancer are diagnosed every year in Australia. Due to an early warning symptom (abnormal uterine/vaginal bleeding) the vast majority of patients with uterine cancers are diagnosed at an early stage. Obesity, hypertension and older age increase the risk of uterine cancer.
Standard treatment is a full hysterectomy, removal of both fallopian tubes and the ovaries. The extent of the disease will be determined by preoperative imaging and removal of lymph nodes along the large blood vessels in the pelvis.  Most patients do not require postoperative treatment. However, patients at higher risk to relapse will be recommended, chemotherapy, radiotherapy or a combination of both, depending on the cell type and the extent of the disease.

Outcomes are generally excellent with more than 90% of patients with stage 1 disease surviving the 5 year mark. Patients with high-risk uterine cancer (e.g., uterine papillary serous carcinoma) have a worse outcome.

Current research focuses on less invasive surgical techniques, which may lead to improved recovery from surgery with equal chances for survival. For patients with high-risk uterine cancer we try to find combinations of treatment (including new biological agents) to improve survival.

Cervical cancer

Approximately 700 patients are diagnosed with cervical cancer every year in Australia. Of those, 200 patients will die of their disease. Cervical cancer develops on the basis of an infection with one or more strains of HPV (Human Papilloma Virus) through early age at intercourse, multiple sexual partners and smoking. Cervical cancer develops through pre-cancerous stages (cervical dysplasia, CIN) over many years. The introduction of the PAP smear screening has reduced the incidence of cervical cancer dramatically in countries of the developed world. While the incidence of cervical cancer in USA, Australia and Europe is low, its incidence in countries of the developing world is very high.

Treatment depends on the stage of disease. Very early cervical cancer (microinvasive) can be treated by a cone biopsy or a simple hysterectomy. Patients with cervical cancer limited to the uterine cervix require a radical hysterectomy at which a safety margin around the cancer is taken. These patients also require removal of lymph nodes along the large blood vessels in the pelvis. Patients with advanced disease (stage 2+) require a combination of chemotherapy (weekly) plus radiotherapy (daily) for 4 to 6 weeks.
Survival depends on the stage of disease with more than 75% of patients surviving stage 1.

Current research includes a prospective randomised clinical trial comparing open with laparoscopic surgery for patients with early cervical cancer. This trial is organised through our centre and hopes to enrol 100 patients world-wide within 3 years.

Vulval cancer

Approximately 150 women are diagnosed with vulval cancer every year in Australia. Elderly patients with a history of other vulval skin disorders or younger patients exposed to the Human Papilloma Virus (HPV) are at risk of developing vulval cancer.

Treatment includes surgical removal of the involved vulval skin sometimes requiring plastic surgery to cover the skin defects. Vulval cancer may spread to the lymph nodes in the groins and therefore they need surgical exploration as well. Selected patients require radiotherapy to the vulva, the groins or both. Survival of vulval cancer is generally good but the side effects from treatment are significant (wound break down, lymphoedema).

Current research focuses on new techniques with which we aim to diagnose lymphoedema earlier. The earlier lymphoedema is diagnosed, the more successful treatment will be.

Vaginal cancer

Vaginal Cancer is rare. We would see less than 20 patients with vaginal cancer every year in Australia. Due to its rareness, knowledge about risk factors is sparse. While most cancer would be of “skin”-type (squamous cell carcinoma, melanoma), some cancers would be very aggressive arising from stromal tissue (sarcomas) or from glandular tissue (adneocarcinomas). Treatment is surgical excision for very early cancers and radiotherapy, chemotherapy or a combination of both for more advanced cancers.