Q&A: Gynaecological cancers

The questions below were raised - and answered by our expert consultants - at one of our regular GP Education Days

18 October 2017

Dr Susie Banerjee, Dr Susan Lalondrelle and Dr Alex Taylor, consultants at The Royal Marsden’s Gynaecology Unit

10,000

new cases of uterine, or endometrial cancer diagnosed each year in the UK

How common is uterine cancer with other female cancers?

Uterine, or endometrial cancer is the most common gynaecological cancer with around 10,000 new cases diagnosed each year in the UK.

A woman's lifetime risk is 1 in 41.

It is the fourth most common cancer in women after breast (55,000 diagnoses a year), lung (22,000), and bowel (18,000). Its incidence has increased by over 50% since the early 1990s mainly due to increasing obesity rates and an ageing population.

Incidence rates increase from the age of 40 and peak in those aged 70-74.

What are the main risk factors?

The main risk factors for uterine cancer are:

Increasing age
Early menarche (first menstruation) and late menopause
Obesity
Family history of ovarian cancer including Lynch Syndrome
Infertility particularly in the presence of Polycystic Ovarian Syndrome
Unopposed oestrogens
Radiation exposure
Endometrial Hyperplasia

What are survival rates for ovarian cancer in different countries?

Although 5 year net survival in the UK has increased from 32.8% for those diagnosed 1995-9 to 36.4% for those diagnosed from 2005-9, this is still lower than comparable countries in Europe and around the world.

Ovarian Cancer, Age-Standardised, Five-Year Relative Survival, Females (Aged 15+), European Countries, 2000-2007 (Cancer Research UK)

Why do UK survival rates for ovarian cancer lag behind other Western countries?

This is multifactorial but the major factors are probably:

Access to optimal treatment
Diagnostic delay and late presentation
Patient co-morbidity

What are three top tips for GP’s to pick up more gynae cancers early?

Examine the lower genital tract and pelvis if there are any new gynaecological symptoms
Encourage patients to attend for regular cervical screening
Have a low threshold for CA125 tests and pelvic/abdominal ultrasound for patients with non-specific pelvic and abdominal symptoms

What are the up-to-date survival statistics for main gynaecological cancers?

Cancer (years of diagnosis)	1 year (%)	5 year (%)	10 year (%)
Ovary (2010-11)	72.4	46.2	34.5
Uterine (2010-11)	90.3	79.0	77.7
Cervix (2010-11)	82.8	67.4	63.0
Vulva and vagina (2009-13)	82.0	64.0	53.0

Data from Cancer Research UK

Surgery, chemotherapy and radiotherapy

A summary of the roles surgery, chemotherapy and radiotherapy play in treating the main gynae cancers:

Cancer	Surgery	Chemotherapy	Radiotherapy
Ovary	For most patients unless very advanced unresectable disease. Complete cytoreduction is the main predictor of survival for those with advanced disease.	All but the most early stage patients or those for palliation will be recommended chemotherapy. Recurrent disease is often sensitive to chemotherapy and novel agents are being used with good effect.	Rarely used
Uterine	For most patients and this is usually performed with minimally invasive techniques.	For some high risk patients and for those with recurrent or very advanced disease.	For some high risk patients and some with recurrent disease
Cervix	For early stage patients and fertility preserving options may be possible.	For some high risk patients and for those with recurrent or very advanced disease.	For locally advanced disease often with chemotherapy
Vulva	For most patients	Rarely	For locally advanced patients
Vagina	Sometimes – either early stage or very radical resection	Sometimes in conjunction with radiotherapy	For most patients

PHT after breast cancer

There is concern about women who have had breast cancer using post-menopausal hormone therapy (PHT), or otherwise known as hormone replacement therapy (HRT), because of the known link between oestrogen levels and breast cancer growth.

Previously, PHT has been offered after breast cancer treatment to women suffering from severe symptoms because no harm has been shown. But more recent clinical trials have found that breast cancer survivors taking PHT were much more likely to develop a new or recurrent breast cancer than women who were not taking the drugs. Most doctors now feel that if a woman was previously treated for breast cancer, taking PHT would be unwise.

Diagnosing malignant fibroids

There is no one test that is particularly good at diagnosing malignant fibroids in the context of specificity and sensitivity but Magnetic Resonance Imaging (MRI), Ultrasound imaging (USS) and Doppler, CA125, trucut biopsy, dilation and curettage (D&C) and lactate dehydrogenase (LDH) are commonly used tests; rather clinical diagnosis with age, with particular attention being given to fibroids that rapidly increase in size, is advised