Sean Kehoe

University of Oxford | OX

Objective To investigate psychological correlates in women referred with suspected ovarian cancer via the fast‐track pathway, explore how anxiety and distress levels change at 12 months post‐testing, and report cancer conversion rates by age and referral pathway. Design Single‐arm prospective cohort study. Setting Multicentre. Secondary care incl...

Introduction/Background Grade 1 (G1) endometrial cancer (EC) are well differentiated cells which at diagnosis, most are confined to the uterine corpus and ovary (stage 1), hence mainly treated with surgery alone and often in benign gynaecology service.The aim of this study is to evaluate the independent risk factors for recurrence and mortality and...

Introduction/Background Vulval cancer is a rare gynaecological malignancy. HPV infection and lichen sclerosis are responsible for premalignant lesions. Recurrence occurs in 12–37% of cases. Around 40–80% of recurrences occur within the first two years.We aimed to examine the recurrence patterns and survival outcomes of vulval SCC in our cancer cent...

Introduction/Background Although grade is a well-recognised prognostic factor for endometrioid endometrial cancer, in more studies grade I (G1EEC) and grade II (G2EEC) endometrioid endometrial carcinomas are combined and compared together with grade III (G3EEC) tumours. The aim of our study is to investigate separately the outcomes of grade II endo...

Introduction/Background Primary surgery by total hysterectomy and bilateral oophorectomy is the widely accepted treatment for low grade (Grade 1; G1) low stage endometrial cancer (EC) worldwide.Although surgical lymph node staging is unanimously agreed for higher risk ECs for targeted therapy, there is no universal protocol regarding lymph node dis...

Introduction/Background ROCkeTS investigated accuracy of risk prediction models for diagnosing ovarian cancer (OC); no previous studies investigate all tests as head-to-head comparisons. Methodology Recruitment: ROCkeTS recruited newly presenting women with non-specific symptoms and raised CA125 and/or abnormal imaging to donate blood and undergo...

Objectives: To investigate psychological correlates in women referred with suspected ovarian cancer via the fast-track pathway, explore how anxiety and distress levels change 12 months post-testing and report cancer conversion rates by age and referral pathway. Design: Single arm prospective cohort study Setting: Multicentre. Secondary care includi...

Mixed endometrial carcinoma (MEEC) refers to rare endometrial tumours that are composed of two or more distinct histotypes, at least one of which is serous or clear cell. The aim of this study was to evaluate the epidemiology, treatment outcomes and survival rates of patients with mixed endometrial carcinoma. The medical records of 34 patients diag...

Background: Mucinous ovarian carcinomas (MOCs) are rare ovarian tumours accounting for 3% ofall epithelial ovarian carcinomas (EOCs). They are either expansile or infiltrative, based on the tumour’shistological pattern of invasion. MOCs have a distinct molecular profile, natural history, chemo-sensitivity,and prognosis compared to other EOCs. The a...

Introduction/Background High grade endometrioid endometrial cancer (HGEEC) is a heterogeneous group of tumors with unclear prognostic features. The aim of the present study is to evaluate the independent risk factors for recurrence and mortality and to describe the recurrence patterns of HGEEC. Methodology Ninety-six consecutive cases of HGEEC tre...

Introduction/Background Mixed endometrial carcinoma refers to rare endometrial tumours that are comprised of two or more distinct histotypes, at least one of which is serous or clear cell. Limited data is available on the recurrence rates for mixed epithelial endometrial carcinoma, as it comrises a relatively understudied subtype of endometrial can...

Introduction/Background NETs are rare tumours most commonly occurring in the pancreas, and represent about 2% of female genital cancers. The cervix and ovaries are the most common locations. They can vary in their behaviour though many require surgery/chemotherapy. Encountering 4 cases in a year is unusual and we present them here: Methodology Cas...

Introduction: Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the...

Highlighting over 50 hot topics where controversy exist in management of patients with gynecologic malignancy, this book presents expertly argued opinions for and against, incorporating current evidence and clinical trials outcomes. A diverse range of topics are included that pertain to several disciplines in gynecologic oncology, including surgica...

The prognostic characteristics and recurrence patterns of High Grade Endometrioid Endometrial Cancer: A retrospective analysis of 96 consecutive cases sharing the experience of a large tertiary Center over 10 years.

Introduction: Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the...

RCOG world congress 2023 12-14 June Poster presentation session

To our knowledge, this is the first reported case of synchronous ovarian and vulva (Bartholin gland) cancer. A postmenopausal woman presented with a complex multiloculated left adnexal mass and 2-cm right Bartholin gland mass. CA 125 was 59 IU/mL. Computed tomography of chest, abdomen, and pelvis showed a very large (32 × 13.5 × 22.5 cm) complex ma...

High grade endometrioid endometrial cancer (HGEEC) is a heterogeneous group of tumors with unclear prognostic features. The aim of the present study is to evaluate the independent risk factors for recurrence and mortality and to describe the recurrence patterns of HGEEC. Ninety-six consecutive cases of HGEEC treated with primary surgery in a single...

A retrospective study including 49 women with ovarian clear cell carcinoma between January 2009 and December 2021 at Oxford cancer centre was done. The mean age was 63 years, with 78% post-menopausal. All women underwent cytoreductive surgery with no residual disease (R0) in 39 women. The follow-up time ranged between 12-144 months, with mean of 10...

Background: A recent randomized trial showed that laparoscopy had poorer outcomes compared with open surgery for early-stage cervical cancer. Whether this is of concern in endometrial cancer, when the cervix is involved has received little attention. This study aimed to investigate whether there is any difference on overall and cancer specific sur...

Background: This study aimed to assess the impact of multiple COVID-19 waves on UK gynaecological-oncology services. Methods: An online survey was distributed to all UK-British-Gynaecological-Cancer-Society members during three COVID-19 waves from 2020 to2022. Results: In total, 51 hospitals (including 32 cancer centres) responded to Survey 1,...

Objectives: Concerns were raised by clinicians at the Oxford Gynaecological Cancer MDT that there was an increasing number of women presenting with large cervical tumours requiring chemo-radiotherapy, possibly due to delays associated with the COVID pandemic. This audit was undertaken to assess whether this was a real event. Study design: This r...

During the COVID-19 pandemic, reports of delays and alterations in cancer treatment pathways have emerged. We aim to evaluate the proportional impact of the pandemic over time on standard care delivery in a large tertiary gynaecological cancer centre. Consecutive patient records from weekly multidisciplinary team meetings were collected prospective...

To revise the FIGO staging for carcinoma of the vulva using a new approach that involves analyses of prospectively collected data. The FIGO Committee for Gynecologic Oncology reviewed the recent literature to gain an insight into the impact of the 2009 vulvar cancer staging revision. The Committee resolved to revise the staging with a goal of simpl...

In 2020, more than 600 000 women were diagnosed with cervical cancer and 342 000 women died worldwide. Without comprehensive control, rates of cervical cancer incidence and mortality are expected to worsen. In 2020, the World Health Organization adopted the global strategy to eliminate cervical cancer to the threshold of four cases per 100 000 wome...

In 2014, FIGO's Committee for Gynecologic Oncology revised the staging of ovarian cancer, incorporating ovarian, fallopian tube, and peritoneal cancer into the same system. Most of these malignancies are high-grade serous carcinomas (HGSC). Stage IC is now divided into three categories: IC1 (surgical spill); IC2 (capsule ruptured before surgery or...

In a previous study, we showed that the Hedgehog (Hh) signalling pathway is aberrantly activated in vulval squamous cell carcinoma (VSCC). In this study, we further validated our findings on a prospective cohort of primary VSCC cases, where immunohistochemical staining confirmed that key Hh pathway components were overexpressed in VSCC compared to...

Background: Epithelial ovarian cancer presents at an advanced stage in the majority of women. These women require a combination of surgery and chemotherapy for optimal treatment. Conventional treatment has been to perform surgery first and then give chemotherapy. However, there may be advantages to using chemotherapy before surgery. Objectives:...

www.PosterPresentations.com ❖ Epithelial ovarian cancers (EOCs) are the most common and most lethal of all gynaecological malignancies. ❖ High-grade serous ovarian cancer (HGSOC) is the most common EOC and the fifth leading cause of cancer-related deaths in females worldwide. (1) ❖ Despite advances in our understanding of the molecular pathology of...

Significance The optimal timing of surgery/chemotherapy and the benefits of earlier diagnosis of HGSC remain controversial. We developed a mathematical framework of tumor dynamics, populated the model with primary clinical data, and reliably recapitulated clinical observations. Our model predicts that 1) PDS is superior to NACT with relatively smal...

Cancer stage at diagnosis is important information for management and treatment of individual patients as well as in epidemiological studies to evaluate effectiveness of health care system in managing cancer patients. Population‐based studies to examine international disparities on cancer survival by stage, however, has been challenging due to the...

Epigallocatechin-3-gallate (EGCG), the primary bioactive polyphenol in green tea, has been shown to inhibit the growth of human papilloma virus (HPV)-transformed keratinocytes. Here, we set out to examine the consequences of EGCG treatment on the growth of HPV18-immortalised foreskin keratinocytes (HFK-HPV18) and an authentic HPV18-positive vulvar...

Background: Epithelial ovarian cancer presents at an advanced stage in the majority of women. These women require surgery and chemotherapy for optimal treatment. Conventional treatment has been to perform surgery first and then give chemotherapy. However, there may be advantages to using chemotherapy before surgery. Objectives: To assess whether...

Introduction/Background Sentinel lymph node (SLN) mapping is established as the standard of care for staging in selected cases of melanoma, breast and vulval cancer amongst other malignancies. Nonetheless, adapting its use in endometrial cancer (EC) and cervical cancer (CC) has been challenging. There is currently growing evidence to support its ac...

Background Surgery is the cornerstone of gynecological cancer management, but inpatient treatment may expose both patients and healthcare staff to COVID-19 infections. Plans to mitigate the impact of the COVID-19 pandemic have been implemented widely, but few studies have evaluated the effectiveness of these plans in maintaining safe surgical care...

Objective To investigate the impact of serum albumin (at diagnosis and pre-operatively) on survival in patients undergoing cytoreductive surgery for advanced ovarian cancer(AOC) and whether improvement in albumin achieved following neoadjuvant chemotherapy (NACT) affects overall survival (OS). Methods Outcomes of 441 patients who underwent cytor...

Ureteric injury during radical hysterectomies for cervical cancer is a well-known complication requiring some form of intervention to redress the damage. The incidence is reported at approximately 2%. Direct ureteric injuries may be recognised and repaired at surgery, but if not, generally present within a week of surgery. Indirect injuries, consid...

Introduction The current standard of care for advanced high grade serous ovarian cancer (HGSC) comprises a combination of debulking surgery and platinum-based chemotherapy given in the neoadjuvant or adjuvant setting. In the neoadjuvant setting, patients usually undergo 3 cycles of chemotherapy followed by interval cytoreductive surgery (ICS), then...

Introduction: Vulvar squamous cell carcinoma (VSCC) commonly metastasises through groin lymphatics. However, the use of pre-operative imaging in detecting inguinal nodal metastasis before staging surgery or to triage patients for sentinel node biopsy remains unclear. Here, we investigated if pre-operative CT scan, the imaging choice in our cancer...

Outcomes of secondary cytoreduction surgery (SCS) were evaluated for morbidity, progression free survival (PFS) and overall survival (OS) and factors influencing results were explored. Retrospective analysis of all cases of SCS for epithelial ovarian cancer (EOC) was performed from October 2010 to December 2017. 62 patients were prospectively ident...

Introduction/Background To investigate the impact of serum albumin (both at diagnosis and pre-operatively) on survival in patients undergoing cytoreductive surgery for AOC and whether any change in albumin achieved following Neoadjuvant chemotherapy (NACT) affects overall survival (OS). Pre-operative albumin is known to be a marker of survival in A...

Purpose Survival difference between socioeconomic groups with ovarian cancer has persisted in the United Kingdom despite efforts to reduce disparities in care. Our aim was to delineate critical episodes in the patient journey, where deprivation has most impact on survival. Methods A retrospective review of 834 patients with advanced ovarian cancer...

Background: Epithelial ovarian cancer presents at an advanced stage in the majority of women. These women require surgery and chemotherapy for optimal treatment. Conventional treatment has been to perform surgery first and then give chemotherapy. However, there may be advantages to using chemotherapy before surgery. Objectives: To assess whether...

Background Quality of life after ovarian cancer treatment is an important goal for patients. Complex debulking surgeries and platinum based chemotherapy are often required but quality of life after surgery is rarely reported. Objectives To describe quality of life outcomes after surgery for advanced ovarian cancer in a systematic review and meta-a...

Objectives: We evaluated four different treatment regimens for advanced-stage mucinous epithelial ovarian cancer. Methods: We conducted a multicenter randomized factorial trial (UK and US). Patients were diagnosed with primary mEOC: FIGO stage II-IV or recurrence after stage I disease. Treatment arms were paclitaxel-carboplatin, oxaliplatin-cape...

(Abstracted from Lancet Oncol 2018;19:1680–1687) Most women with carcinoma of the ovary, fallopian tube, or peritoneum (tubo-ovarian cancer) present with advanced disease and have a very poor prognosis. An essential therapeutic strategy in these women has been primary debulking surgery (PDS), but no randomized controlled trials have demonstrated an...

Objective: To revise FIGO staging of carcinoma of the cervix uteri, allowing incorporation of imaging and/or pathological findings, and clinical assessment of tumor size and disease extent. Methods: Review of literature and consensus view of the FIGO Gynecologic Oncology Committee and related societies and organizations. Results: In stage I, r...

Background: Individual patient data from two randomised trials comparing neoadjuvant chemotherapy with upfront debulking surgery in advanced tubo-ovarian cancer were analysed to examine long-term outcomes for patients and to identify any preferable therapeutic approaches for subgroup populations. Methods: We did a per-protocol pooled analysis of...

Objective: Dysregulation of the Hedgehog (Hh) pathway has been described in a variety of cancers, including cervical cancer, a disease which shares a common aetiology with vulval squamous cell carcinoma (VSCC). Here, we investigate a large number of primary VSCC cases for evidence of Hedgehog pathway activation and examine the implications of path...

The Gynecologic Oncology Committee of FIGO in 2014 revised the staging of ovarian cancer, incorporating ovarian, fallopian tube, and peritoneal cancer into the same system. Most of these malignancies are high‐grade serous carcinomas (HGSC). Stage IC is now divided into three categories: IC1 (surgical spill); IC2 (capsule ruptured before surgery or...

Endometrial cancer is now the commonest gynaecological cancer. This chapter tabulates the recognized risk factors for endometrial cancer and provides some updates on the management of this disease. Endometrial cancer is categorized into type I and type II disease. Postmenopausal bleeding is the commonest presentation in endometrial cancer, and up t...

Objective: To determine which descriptors of cytoreductive surgical extent in advanced ovarian cancer(AOC) best predict post-operative morbidity. Design: Retrospective notes review. Setting: A gynaecological cancer centre in the United Kingdom. Population: 608 women operated on for AOC in 114 months at a tertiary cancer centre between 16/8/0...

To determine the pattern of disease recurrence in patients treated for advanced ovarian cancer (AOC). Materials and Methods:A retrospective review of the locations of recurrence in all patients treated for AOC between August 16, 2007 and February 3, 2014 who underwent cytoreductive surgery and platinum based chemotherapy achieving complete (R0) or...

Objectives: To establish the positive predictive values of pre-operative identification with CT imaging of metastatic diaphragm disease in surgically managed cases of advanced ovarian cancer (AOC). Additionally, we have assessed the post-operative morbidity and survival following diaphragmatic surgical intervention in a large regional cancer centr...

Objective: Inguinofemoral lymphadenectomy (IFL) is included in the standard surgical management of early-stage vulval cancer (VC) but is often accompanied by surgical complications. Efforts have been made to limit the postoperative morbidity by adopting more conservative IFL techniques without compromising the surgical outcomes. Saphenous vein (SV...

Inguinal lymphadenectomy has significant morbidity. Blue dye-guided lymph channel ligation is an effective technique for resolving lymphocele. This was a feasibility study in a preventative setting. Patients with vulval cancer requiring bilateral inguinal lymphadenectomy were recruited. After lymphadenectomy, patent blue V dye was injected and the...

Objectives To assess the impact of 5 or more cycles of neoadjuvant chemotherapy (NACT) and cytoreductive outcomes on overall survival (OS) in patients undergoing interval debulking surgery (IDS) for advanced ovarian cancer. Methods A retrospective review of patients receiving NACT followed by IDS between 2007 and 2017. Patients were analysed accord...

The quality of clinical research in surgery has long attracted criticism. High-quality randomised trials have proved difficult to undertake in surgery, and many surgical treatments have therefore been adopted without adequate supporting evidence of efficacy and safety. This evidence deficit can adversely affect research funding and reimbursement de...

Background: Lymph node status is one of the most important prognostic factors in endometrial cancer and crucial for deciding adjuvant therapy. Objective: The aim of the study was to assess the different models used to predict lymphatic nodal disease. Search strategy: A literature search was conducted to detect the relevant studies. Inclusion...

INTRODUCTION: The impact of >5 cycles of NACT on survival, especially in association with modern cytoreductive targets, is poorly described. The SGO and ASCO recommends ≤4 cycles of NACT. Increasing to 6 cycles raises theoretical concerns relating to the development of chemo-resistance. Our aim was to assess the impact of the number of NACT cycles,...

INTRODUCTION: Despite the importance of surgery, up to 44% of patients with AOC do not receive optimum therapy. Limited data for these patients is recorded in national databases. In contrast, numerous reports exist regarding the efficacy of primary debulking surgery (PDS). In this latter group however, overall survival (OS) data is often presented...

Health-centred research has changed hugely over the last ten years, from the importance of computing software to the NHS becoming more involved in research. The expectations of grant-awarding bodies, ethics committees and publishers have evolved and increased in many senses. This new edition is designed for trainee clinicians, not only those prepar...

Health-centred research has changed hugely over the last ten years, from the importance of computing software to the NHS becoming more involved in research. The expectations of grant-awarding bodies, ethics committees and publishers have evolved and increased in many senses. This new edition is designed for trainee clinicians, not only those prepar...

The aim of this study was to determine whether the age-adjusted Charlston co-morbidity index (ACCI) can predict post-operative complications, adjuvant chemotherapy usage and overall survival (OS) in patients with advanced epithelial ovarian cancer (AOC) treated with neoadjuvant chemotherapy (NACT). A review was performed of all cytoreductive surger...

In the UK, more than 3,200 new cases of cervical cancer are diagnosed each year. Early stage cervical cancer (IA2-IB1) treatment comprises central surgery mainly in the form of radical hysterectomy or fertility sparing surgery including trachelectomy as well as systematic pelvic lymphadenectomy to detect metastases and adjust treatment accordingly....

The repurposing of drugs is becoming increasingly attractive as it avoids the lengthy process and cost implications associated with bringing a novel drug to market. Itraconazole is a broad-spectrum anti-fungal agent. An emerging body of in vivo, in vitro and clinical evidence have confirmed that it also possesses antineoplastic activities and has a...

e17037 Background: Two important developments in ovarian cancer have occurred over the last decade: i) EORTC 55971 and CHORUS trials reporting neoadjuvant chemotherapy as a management strategy in advanced disease and ii) recognition of fallopian tubes as the origin of many ovarian cancers. This study examines how these have impacted on care and reg...

e17035 Background: Vulval squamous cell carcinoma (VSCC) is predominantly a disease of the elderly; with three-quarters of cases occurring in those aged over 60 years. Currently, chemotherapy is only used as an adjunct to surgery in advanced disease or for palliation. Unfortunately, the treatment response of VSCC to chemotherapies is variable, and...

Objective: Combined surgery and platinum-based chemotherapy is the internationally agreed standard therapy for advanced ovarian cancer (AOC). However international cancer registry datasets demonstrate a significant proportion of patients do not receive both or either therapies. Our objective was to evaluate the effect of total patient cohort data...

Background: Ovarian cancer is a leading cause of female gynecological cancer-related death, and there are no effective screening procedures or early diagnostic approaches. Aims: To examine risk factors and risk-reducing strategies for both sporadic and familial tumors. Materials and methods: Literature review and consensus of expert opinion....

This study examines the overall survival of primary peritoneal cancer (PPC), in those patients who had primary debulking surgery (PDS) followed by six cycles of chemotherapy versus those who had neoadjuvant chemotherapy (NACT). This was a prospective observational study performed at Oxford Gynaecological Cancer Centre, over a 5-year period. Eighty-...

Objective: Cancer initiation and progression has been linked to aberrant expression of the DNA methyltransferases (DNMT), the enzymes which establish and maintain DNA methylation patterns throughout the genome. In this study, we investigated if DNMT expression in vulvar squamous cell carcinomas (VSCC) was related to clinical outcome. Methods: DN...

Introduction Ovarian cancer (OC) is associated with non-specific symptoms such as bloating, making accurate diagnosis challenging: only 1 in 3 women with OC presents through primary care referral. National Institute for Health and Care Excellence guidelines recommends sequential testing with CA125 and routine ultrasound in primary care. However, th...

Objective: In this study, we investigated if the presence of histologically abnormal epithelium adjacent to the primary tumour influenced the frequency, timing, and topography of local vulvar recurrences (LVR) following treatment for squamous cell carcinoma of the vulva (VSCC). Methods: The study population comprised a cohort of 201 consecutive...

Objective: In early-stage cervical cancer, single modality therapy is the main objective, to minimize patient morbidity while offering equivalent cure rates. Intraoperative frozen section examination (FSE) of lymph nodes (LNs) can facilitate this aim, ensuring that radical surgery is avoided in patients requiring adjuvant therapy for metastatic LN...

Primary debulking surgery (PDS) followed by platinum-based chemotherapy has been the cornerstone of treatment for advanced ovarian cancer for decades. Primary debulking surgery has been repeatedly identified as one of the key factors in improving survival in patients with advanced ovarian cancer, especially when minimal or no residual disease is le...

The treatment of advanced ovarian cancer is a combination of surgery and platin-based chemotherapy, with surgery traditionally the first intervention. Neoadjuvant therapy was only used in women who were deemed unfit for an operation. However, in recent years, two prospective randomized studies have evaluated the concept of neoadjuvant chemotherapy,...

Primary debulking surgery (PDS) followed by platinum-based chemotherapy has been the cornerstone of treatment for advanced ovarian cancer for decades. Primary debulking surgery has been repeatedly identified as one of the key factors in improving survival in patients with advanced ovarian cancer, especially when minimal or no residual disease is le...

Background Lymphadenectomy has become a fundamental part in the surgical staging of endometrial carcinoma. However, debate continues about the indications and extent necessary in various disease stages, particularly when balancing the benefits against the associated surgical morbidity. Objectives To assess risk factors for lymph node metastasis, in...

This is the protocol for a review and there is no abstract. The objectives are as follows: To establish the accuracy of symptoms, ultrasound and biomarkers alone or in combination for the diagnosis of ovarian cancer in pre- and postmenopausal women. To compare the accuracy of different tests or test combinations. We will investigate the following s...