The Royal Marsden

Innovative treatments

Mr John Butler and Ms Marielle Nobbenhuis, two of The Royal Marsden’s leading consultant gynaecological oncology surgeons, explain the hospital’s wide range of leading-edge treatments for gynaecological cancers
Surgeons Mr Butler (left) and Ms Nobbenhuis (right) in the operating theatre with Mr Desmond Barton (centre)

Surgeons Mr Butler (left) and Ms Nobbenhuis (right) in the operating theatre with Mr Desmond Barton (centre)


Gynaecological cancers

Can you tell us what gynaecological cancers are?

Gynaecological cancers include ovarian, cervical, uterine, vaginal and vulval tumours. Together, they represent a significant proportion of morbidity and mortality in women with cancer.

What are the latest developments in gynaecological cancer treatment?

The surgical approach to gynaecological cancer has changed over the past decade with a greater use of keyhole surgery, and in ovarian cancer, more extensive surgery that has improved outcomes. The introduction of robotic and minimally invasive surgery has resulted in less perioperative complications, shorter hospital stays and a quicker return to normal activities, all with the same oncological outcomes for our patients. State-of-the-art imaging techniques using MRI and CT scans have improved the treatment options available. The scientific advances in gynaecological cancer have increased our understanding of the subtypes of cancers, which has led to better targeted treatments. For example, 15 per cent of ovarian cancers are related to the BRCA gene mutation, and The Royal Marsden has led in the development of new drug therapies for these cancers.

What should a GP look for in diagnosing these cancers?

Gynaecological cancers can be cured if detected early, and primary care has a key role in the detection and referral of suspected cancers. For cervical cancer, regular cervical screening is essential. Any abnormal vaginal bleeding – including post-coital, between periods, or postmenopausal – should be assessed and referred to specialist centres such as The Royal Marsden for further investigation. Ovarian cancer is difficult to diagnose in primary care, but symptoms include gastrointestinal and urinary problems, bloating, or a palpable mass.

What services can you offer patients?

We offer investigation for possible gynaecological cancer, management of abnormal smears including a colposcopy, the full range of surgical assessments and leading-edge treatments, and general gynaecological review, particularly for patients with cancer.

What techniques and equipment are used to treat gynaecological cancer?

The effective management of gynaecological cancers involves surgery, radiotherapy and chemotherapy. The majority of patients will be treated with surgery. At The Royal Marsden, we offer some of the most innovative techniques available, such as identification of sentinel lymph nodes and the PlasmaJet device, which uses plasma energy to cut tissue and destroy cancer cells safely. The PlasmaJet is particularly suited to treating advanced ovarian cancer as it eliminates the need for patients to have parts of their bowel removed, helping to improve outcomes. Thanks to our robotic surgery facilities – such as the da Vinci Xi – many patients can now be treated with minimally invasive surgery. This improves recovery times, allowing patients to return to their normal activities or start the next phase of their treatment as soon as possible.