Ovarian and Endometrial Cancer Using risk factors to help triage Adam Rosenthal PhD MRCOG Consultant Gynaecologist and Gynaecological Oncologist

Ovarian Cancer

CR UK Ovarian Cancer Stats for UK and world  5th commonest women’s cancer in UK (2 nd after uterine)  7,116 cases in women / day  4,271 deaths in women / day – most lethal gynae cancer  Increasing incidence with age - 75% new cases aged > 54 yr  In Europe - 65,600 cases (estimated) in 2012  Worldwide - 238,000 cases (estimate) in 2012

Number of New Cases per Year and Age-Specific Incidence Rates per 100,000 Population, UK,

Most cases occur in postmenopausal women

Ovarian Cancer Risk Factors  Family history (and Ashkenazi Jewish heritage)  Ovarian (any age but epithelial tumours only)  Breast (esp below 50 yr)  Endometrial, colorectal (esp young ages) – Lynch Syndrome  Age – 75% postmenopausal  Gynae history  Never used hormonal contraception  Nulliparous  Never breast fed  Early menarche/late menopause  Used HRT  Endometriosis  No tubal ligation/salpingectomy/hysterectomy Stronger Weaker Lifetime ovulations & hormones

Symptoms (NICE Clinical Guideline 122) New onset, persistent (esp if >x12/month)  Bloating/distension  Pelvic/abdominal pain  Feeling full quickly after eating/loss of appetite  Increased urinary urgency/frequency NB bowel dysfunction not in guideline but if primary bowel pathology excluded please consider ovarian cancer

Investigation (NICE Clinical Guideline 122) No mass/ascites CA125 >=35 u/ml<35 u/ml TVS Re-assess / re-attend if symptoms persist Abnormal Normal Refer if suspicious

Endometrial Cancer

CR UK Uterine Cancer Stats for UK and world  4th commonest women’s cancer in UK (commonest gynae cancer)  8,475 cases in women / day  2,025 deaths in 2012  78% 5 yr survival  Increasing incidence with age – vast majority aged > 40 yr  In Europe – 100,000 cases (estimated) in 2012  Worldwide - 319,000 cases (estimate) in 2012  50% increase in UK rate since 1990s

Uterine cancer Number of New Cases Per Year and Age-Specific Incidence Rates per 100,000 Population, UK

Most cases occur in postmenopausal women

 Family History – Endometrial, colorectal (esp young ages) – Lynch Syndrome  Obesity  Age  Tamoxifen  Endometrial hyperplasia (esp atypical)  Gynae/medical history  Never used hormonal contraception  Nulliparous/early menarche/late menopause  Any HRT other than continuous combined  PCOS or ovarian granulosa cell tumour  Prior breast cancer  Pelvic radiotherapy Endometrial Cancer Risk Factors Lifetime estrogens

Symptoms Postmenopausal bleeding Intermenstrual bleeding (age > 40 yr)

Two Week Wait Referral Form  Ascites/pelvic mass on examination/ultrasound (not obviously fibroids/urological/GI)  Raised CA 125 and strong clinical suspicion of ovarian cancer (with USS if available)  Persistent intermenstrual bleeding > 45 years of with normal vaginal examination (lasting > 6 weeks after stopping HRT/COCP if taken)  Postmenopausal Bleeding  HRT: Unexpected or prolonged bleeding for >6 weeks after stopping HRT  Any other relevant symptoms or signs not covered by the guidelines

Two Week Wait Referral Form  Lesion suspicious of cancer on cervix or vagina on speculum, or smear suggestive of cancer – refer urgently to colposcopy  Lesion suspicious of cancer on clinical examination of vulva or vagina

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