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Special Tutorial Programme

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  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

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

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

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

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

  10. Cervical cancer

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

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

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

  14. Management Ia1 Microinvasion Cone biopsy I – IIa Surgery / Radiotherapy Advanced Radiotherapy Prognosis overall 65% 5 year

  15. Patient 3 Age 65 years PMB Tamoxifen

  16. Uterine / Endometrial cancer

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

  18. Clinical PMB / Irreg menses / IMB Normal examination

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

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

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

  22. Ovarian cancer

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

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

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

  26. Management Debulking surgery Chemotherapy – cisplatin / taxol Paracentesis Prognosis 25% 5 year III 15% IV 5% Palliative care

  27. Course evaluation