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Comprehensive Overview of Gynaecological Cancer Management by Professor Deirdre J. Murphy

This tutorial program led by Professor Deirdre J. Murphy at Trinity College provides an in-depth overview of gynaecological cancers, focusing on epidemiology, history, and patient management. It covers clinical case studies of four patients with varying ages and symptoms, illustrating the diagnostic processes, staging methods, and treatment options such as surgery, radiotherapy, and chemotherapy. The course aims to enhance the understanding of gynaecological malignancies, their management, and patient prognosis, fostering a comprehensive approach to women's health.

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Comprehensive Overview of Gynaecological Cancer Management by Professor Deirdre J. Murphy

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Presentation Transcript

  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

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