Hans Nagar

Belfast Health and Social Care Trust | BHSCT · Cancer Centre

Introduction/Background: In Northern Ireland (NI) an average of 211 women are diagnosed with ovarian cancer each year with a median age at diagnosis of 65. Ovarian cancer is not a single disease but is comprised of distinct subtypes with a considerable variation in outcomes. In 2018 a funded ovarian cancer feasibility pilot was commenced in England...

Introduction/Background: The NHS England ovarian cancer audit feasibility pilot in 2018 suggested a geographical variation of treatment of ovarian cancer in England. There are areas of significant social deprivation in Northern Ireland (NI) and the aims of this project was to determine if there was any association between deprivation and treatment...

Introduction/Background Lymphadenectomy in endometrial cancer (EC) is one of the controversial topic in gynecologic oncology. Sentinel lymph node (SLN) has become a popular option in the last few years .Belfast City Hospital – Regional Cancer Center in United Kingdom started using SLN since 2021. The aim of this study is to develop a protocol for S...

Introduction/Background Surgery for vulvar cancer (VC) is associated with high morbidity. Design of ‘care bundle’ of clinical interventions would likely improve peri-operative outcomes. Aim of the study was to identify and quantify morbidity and mortality associated with VC surgeries. These data would be taken forward, after implementation of the c...

Introduction/Background Lynch syndrome is an inherited condition increasing the likelihood of developing certain cancers. Routine testing for patients diagnosed with colorectal cancers has been recommended by NICE guidance since February 2017 and in October 2020 this guidance was updated to recommend testing for patients diagnosed with endometrial...

Aims To assess the association between social deprivation in Northern Ireland (NI) and the treatment of ovarian cancer. Background The ovarian cancer audit feasibility pilot in 2018 suggested a geographical variation of treatment of ovarian cancer in England. Methods All patients diagnosed with epithelial ovarian cancer between 2014 and 2017...

Aims To audit the ovarian cancer diagnosis and treatment of women in Northern Ireland (NI). Background Ovarian cancer is comprised of subtypes with a considerable variation in outcomes. In 2018 a funded ovarian cancer feasibility pilot was commenced in England with the aim to extend to all four UK nations. Methods All patients diagnosed with...

Background: Pelvic lymphadenectomy provides prognostic information for those diagnosed with endometrial (womb) cancer and provides information that may influence decisions regarding adjuvant treatment. However, studies have not shown a therapeutic benefit, and lymphadenectomy causes significant morbidity. The technique of sentinel lymph node biops...

The role of lymphadenectomy in endometrial carcinomas is controversial, especially in low-grade endometrioid carcinomas. In many institutions, lymphadenectomy in the latter neoplasms is undertaken only when there is deep myometrial invasion, defined as invasion involving 50% or more of the myometrium (FIGO stage IB). There has been considerable deb...

Introduction/Background Cervical cancer is one of the most commonly occurring female cancers with increasing incidence worldwide. The mainstay of treatment for locally advanced cervical cancer is primary chemoradiotherapy. Pre-operative imaging alongside laparoscopic extraperitoneal para-aortic node dissection (LEPAND) has been used in order to bes...

Introduction/Background This study aims to determine the prevalence, risk factors and outcomes of ovarian endometrioid carcinoma (EC) and clear cell carcinoma (CCC) and identify patients at risk of malignant transformation. Methodology 161 patients were identified using histopathology records from March 2011 to June 2018. Patient information was c...

Introduction/Background ESGO guidance (2016) recommends simple hysterectomy and lymphadenectomy (PLN/PALN) for stage II and III endometrial cancer. BGCS guidance (2017) also recommends simple hysterectomy in both stage II/III disease, but advises reserving lymph node dissection for stage III only. Methodology Practice in the Northern Ireland Regio...

Introduction/Background Indocyanine Green (ICG) is a fluorescent imaging agent which can be given intravenously or subcutaneously and detected using near-infrared light at laparoscopy. It can be injected para-cervically in order to identify pelvic sentinel nodes at laparoscopy. It can also be given intravenously in order to test tissue perfusion....

Objectives Cervical cancer is one of the most commonly occurring female cancers with increasing incidence. The mainstay of treatment for locally advanced disease is primary chemoradiotherapy. Pre-operative imaging in combination with laparoscopic extraperitoneal para-aortic node dissection (LEPAND) has been used to best target this treatment. This...

The recent publication of two papers and an editorial in the New England Journal of Medicine (NEJM) has caused consternation in the gynaecological oncology community (4, 5). Both papers demonstrate a worse outcome for patients undergoing radical hysterectomy by the minimal access route compared to open surgery and thus question the dominant paradig...

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the diagnostic accuracy of sentinel lymph node biopsy in the identification of pelvic lymph node involvement in women with apparent early stage endometrial cancer.

Evidence to support prolonged catheterisation after radical hysterectomy is lacking. We sought to assess feasibility of a new protocol of early post-operative catheter removal following laparoscopic radical hysterectomy for cervical cancer. A retrospective review of post-operative bladder care in patients who underwent laparoscopic radical hysterec...

Background: Cervical human papillomavirus (HPV) infection among young women (20-25 years of age) is common and normally transient. There are growing concerns that referral to a colposcopy clinic may lead to unnecessary treatment with an increased risk of obstetric complications. Therefore, the purpose of this study was to determine the level of in...

Early invasive squamous carcinomas of the cervix are sometimes multifocal. There are few guidelines regarding how to measure multifocal carcinomas and options include measuring from the edge of 1 invasive focus to the edge of the furthest invasive focus, adding the maximum horizontal dimension of each invasive focus together or regarding multiple f...

Laparoscopic surgery is associated with reduced levels of postoperative pain, early discharge from hospital and quick return to normal activity. Chemoradiotherapy is considered as the main treatment for advanced cervical cancers such as FIGO stage II and above. The majority of women with endometrial cancer will be cured by a total hysterectomy and...

The objectives of this study were to investigate the accuracy of magnetic resonance imaging (MRI) in predicting the depth of myometrial invasion in the preoperative assessment of women with endometrial cancer and to quantify the impact of MRI as an adjunct to predicting patients requiring full surgical staging. This was a diagnostic accuracy study...

There is a controversy regarding the optimal management of small cervical adenocarcinomas, and more radical surgery is often undertaken compared to similar size squamous carcinomas. We wished to determine the risk of parametrial involvement and metastatic disease and the outcome in International Federation of Gynecology and Obstetrics (FIGO) stage...

We report a primary vaginal angiosarcoma with widespread intra-abdominal metastasis occurring in a 73-yr-old woman 13 yr after vaginal brachytherapy for an endometrial carcinoma. This is an extremely rare phenomenon with only 7 previously reported cases of vaginal angiosarcoma, 5 of which were associated with earlier irradiation. All of the earlier...

The objective of this study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting cervical involvement by endometrial cancer. A retrospective accuracy study of 135 consecutive women who underwent preoperative MRI and surgery for endometrial cancer at a single gynaecological cancer centre between 1st February 2003...

The objective of this randomized controlled trial was to determine whether the pure cut setting results in less thermal artefact than the traditional blend setting when performing a large loop excision of the transformation zone (LLETZ). Forty-nine consenting women were randomized to undergo an LLETZ procedure using either the pure cut or the blend...

Members of the evolutionarily conserved septin family of genes are emerging as key components of several cellular processes including membrane trafficking, cytokinesis, and cell-cycle control events. SEPT9 has been shown to have a complex genomic architecture, such that up to 15 different isoforms are possible by the shuffling of five alternate ami...

The septin family of genes has been implicated in a variety of cellular processes including cytokinesis, membrane transport and fusion, exocytosis, and apoptosis. One member of the septin family maps to chromosome 17q25.3, a region commonly deleted in sporadic ovarian and breast tumours, and has also been identified as a fusion partner of MLL in ac...