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76 results

Page 1 of 4

  • 14 - Uterine Sarcomas

  • Edited by Mahmood Shafi, Helen Bolton, Ketankumar Gajjar
  • Book:
    Gynaecological Oncology for the MRCOG
    Published online:
    14 April 2018
    Print publication:
    19 April 2018, pp 147-152

  • Summary

    Background

    Uterine sarcomas are uncommon gynaecological cancers. They are a small but important group of tumours because their management may require a different approach compared to some of the more common cancers of the female genital tract. Due to small numbers, there is limited evidence to guide treatments. From the patient's perspective having a rarer type of cancer may feel more challenging to cope with for several reasons, for example, they may feel more isolated; it might take longer to make a diagnosis; and it can be more difficult for them to find information about their type of tumour.

    Sarcomas can occur anywhere within the female genital tract, but the most common site is the uterus. These tumours account for <1% of all gynaecological cancers. They usually behave aggressively and are associated with a poor prognosis.

    Terminology and Pathology

    The accurate histological assessment of uncommon gynaecological tumours requires expert review by specialist pathologists at cancer centres. A correct pathological diagnosis is essential for planning appropriate management.

    The terminology of uncommon cancers can be confusing, as their nomenclature has evolved with improvements in understanding of the pathology. All cancers are classified by both the primary location of tumour (primary site) and the cell type from which the cancer originates (histological type). Carcinomas are malignant cells that arise from epithelial cells and account for the majority of gynaecological cancers. In contrast, sarcomas are malignant cells that arise from mesenchymal tissues such as smooth muscle, connective tissue, fibrous tissue, fat and endothelial cells. In addition to identifying the underlying cell type of the tumour, it is also important to grade the tumour, usually as low (G1, well differentiated) or high (G3, poorly differentiated). Grading is generally based on the degree of cellular abnormality, the presence of necrosis and the rate of cellular proliferation (the mitotic index, measured by the number of mitotic figures identified within a given magnification field). Tumour grading helps to predict how the tumour is likely to behave and respond to treatment.

    Carcinosarcoma is a term used to describe a tumour that contains a mixture of both malignant epithelial and mesenchymal cell types. These were previously referred to as malignant mixed Mullerian tumours (MMMTs).

  • Preface

  • Edited by Mahmood Shafi, Helen Bolton, Ketankumar Gajjar
  • Book:
    Gynaecological Oncology for the MRCOG
    Published online:
    14 April 2018
    Print publication:
    19 April 2018, pp xi-xii

  • Summary

    Women with gynaecological cancers are managed by multidisciplinary teams, with many professionals from different backgrounds contributing to patients’ health care. As outcomes for patients continue to improve, there has been a shift towards understanding survivorship issues and tailoring treatments to achieve the best possible outcomes while minimising the impact of treatment on quality of life. This book addresses all aspects of caring for women with gynaecological malignancy, covering general topics as well as specific issues faced by patients.

    This book is aimed at trainees in gynaecology and oncology and at consultants with a special interest in gynaecological cancers. Although this book covers the syllabus for the MRCOG examination, it is also written to provide a comprehensive foundation for all healthcare professionals caring for women with gynaecological cancers, beyond the basics. Allied medical staff, palliative care professionals and nurse specialists will also find this book a useful resource for up-to-date information on the whole range of gynaecological cancers.

    Chapters 1–9 and 16–18 cover the broad issues in gynaecological oncology whereas Chapters 10–15 cover site-specific tumours. The chapters are intended to be clinically focused and are based upon published facts. Wherever possible, the reader is directed to national guidelines and standards. Boxed information, key facts and tips are highlighted to assist the reader. Each chapter lists further reading recommendations to guide the interested reader to seek further information about the topics covered in the chapter.

    We have had the pleasure of working with experts who have kindly contributed to this book. This is always one of the nicest aspects of writing a book in that there is collaboration with colleagues and friends whom we admire and respect for their expertise.

  • Appendix

  • Edited by Mahmood Shafi, Helen Bolton, Ketankumar Gajjar
  • Book:
    Gynaecological Oncology for the MRCOG
    Published online:
    14 April 2018
    Print publication:
    19 April 2018, pp 197-206

  • Summary

    WHO Performance Status Classification

    Performance status is frequently used to quantify cancer patients’ well-being and often used to indicate whether or not a patient can tolerate certain treatment such as chemotherapy. Other uses include dose reduction, use in trial and quality of life.

    Grade Explanation of activity

    0: Able to carry out all normal activity without restriction

    1: Restricted in physically strenuous activity, but ambulatory and able to carry out light work

    2: Ambulatory and capable of all self-care, but unable to carry out work; up and about more than 50% of waking hours

    3: Capable only of limited self-care; confined to bed more than 50% of waking hours

    4: Completely disabled; cannot carry out any self-care; totally confined to bed or chair

    Criteria of chemotherapy response (WHO)

  • • Complete response (CR) – resolution of all measureable or evaluable disease

  • • Partial response (PR) – ≥50% reduction in measureable or evaluable disease in the absence of progression in any particular disease site

  • • Stable disease (SD) – <50% decrease or <25% increase in measureable or evaluable disease

  • • Progressive disease (PD) – >25% increase in measureable or evaluable disease or development of a new lesion

    • Clinical Trials and Drug Development

    Clinical trials are divided into different stages, called phases. The earliest phase trials may look at drug safety or side-effect profile and tolerability. A later phase trial aims to test whether a new treatment is better than existing treatments.

    There are three main phases of clinical trials – phases I to III. But some trials have an earlier stage called phase 0, and there are some phase IV trials done after a drug has been licensed.

    Phase 0 Trials

    Phase 0 trials are aimed to find out whether the behaviour of the drug in vivo is as expected from laboratory studies.

    Phase I

    Aim is to establish human toxicity of new drug; to establish the safe dose at which to start further trials and to measure the pharmacokinetics of the drug.

    Phase II

    Aim is to establish the anti-tumour activity of the drug against a particular tumour in patients where no curative therapy is possible; further information on toxicity is obtained. Phase II studies are usually non-randomised.

    Phase III

    Aim is to compare the new drug with the conventional best therapy. Trials are prospective, randomised and controlled. Large number of patients required to show effect.

Gynaecological Oncology for the MRCOG
  • Edited by Mahmood Shafi, Helen Bolton, Ketankumar Gajjar
  • Published online:
    14 April 2018
    Print publication:
    19 April 2018
  • Written with the MRCOG examination requirements at its core, this book offers an extensive and up-to-date review of the full range of gynaecological cancers. The principles of epidemiology, imaging and treatment modalities are presented in a succinct and clinically focused manner. Each gynaecological cancer features in a stand-alone chapter, incorporating information on clinical issues, staging and principles of management. Genetic conditions and surgical principles are analysed, as well as topics such as palliative care, holistic approaches and communication. RCOG guidelines and Scientific Advisory Committee advice feature throughout the book. While authoritative and factual, the text is concise and clear. Flow-charts and diagrams support the assimilation of complex information, while practical tips, management algorithms, and clinical images enhance each chapter. Essential for those preparing for the MRCOG examination, this book is a comprehensive resource for health professionals working with gynaecological cancers, and those who want to further understand gynaecological oncology.

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