Gynaecological Oncology

Hammersmith Hospital has been designated the West London Gynaecological Cancer Centre (http://www.hhnt.org/gynaecancer/index.htm). Annually over 450 patients with gynaecological malignancy are referred from 15 hospitals for multidisciplinary treatment.  Patient management is underpinned by clinical and translational research. The existing infrastructure, including a comprehensive electronic record/database, facilitates collection of data and samples for laboratory studies as well as allowing patients the opportunity to enter national and international clinical trials such as ICON 7 and OVO5. The majority of these trials include novel targeted therapies against specific tumours.

Translational research led by Dr Sadaf Ghaem-Maghami and Professor Hani Gabra focuses on tumours to improving understanding of ovarian and endometrial tumour biology by analysis of gene, metabolite and protein expression, mechanisms of chemoresistance, tumour suppressor genes, cell signalling and immunotherapy. Combining surgical and research expertise, we plan on studying direct biological effects of targeted agents on tumour cells using minimally invasive (laparoscopic) and novel cell fluorescence capture and imaging techniques based. 

Immunological characterisation of ovarian tumours and their immune responses has identified the Wilm’s tumour 1 (WT1) gene and its protein expression as a promising target for immunotherapy. A peptide vaccination using four WT1 peptides is now planned. This will be supplemented not only with an adjuvant but also with an antibody to a co-stimulatory molecule involved in regulatory T-cell stimulation. This will be the first time a vaccine of this type is used in patients with ovarian cancer.  Further translational studies of immunological strategies with therapeutic potential in ovarian cancer patients are ongoing.

 

There have also been advances in fertility-sparing surgery in women with gynaecological cancers. Currently we are the only centre in the UK offering radical abdominal trachelectomy in invasive cervical cancer tumours too large to be considered for vaginal trachelectomy. This technique allows complete removal of the cervix with parametrial tissue and pelvic lymph nodes and provides hope for suitable women who wish to retain their fertility. Specialised contrast media that produce microbubbles in blood vessels show promise in distinguishing benign and malignant ovarian tumours. If the results of larger studies underway are as promising, the care of women with adnexal masses will change dramatically with tumours deemed benign managed laparoscopically. A large practice of women with pre-invasive disease of the cervix and vulva has shown a significant recurrence rate and progression to cancer beyond five years. As a result, the national recommendation for cytological surveillance of women with CIN has increased from five to 10 years. Similarly a randomised trial of use of needle diathermy to carry out cone biopsies has shown this to be an effective treatment with many advantages resulting in routine use of this technique in clinical practice in many hospitals.