ENDOMETRIAL OVARIAN CANCER IN LYNCH SYNDROME Henny Lukman

ENDOMETRIAL &OVARIAN CANCER IN LYNCH SYNDROME Henny Lukman Consultant Obstetrician & Gynaecologist

Cancer General Syndro Mean age 10 year Populatio me Risk of onset survival n Risk (England & Wales) Endometrium 3% 40 -60% 48 -55 78% Ovarian 1. 4% 10 -20% 42 -46 35% RCOG 2015

SCREENING ? Endometrial Cancer Ovarian cancer Evidence for screening No (RCOG- part of research only) No difference in early stage pick up Symptoms Abnormal bleeding None in early stages, often vague Ultrasound Transvaginal Other tests Hysteroscopy, biopsy CA 125 How often ? ?

SYMPTOMS Endometrial cancer: abnormal bleeding Ovarian cancer : very vague in early stages pain, bloating

RISK REDUCING SURGERY • Key hole surgery • Open surgery

HORMONE REPLACEMENT THERAPY Recommended until the age of 50 Oestrogen only Most publicised risk only apply to women over 50.

THE EVIDENCE –NICE 2015 Per 1000 women <60 y. o. Baseline Coronary heart disease UK over 7. 5 years: 26. 3 per 1000 1 Current user E only --6 fewer E+P ---5 more Stroke UK over 7. 5 years: 11. 3 per 1000 E only --0 E+P ---6 more Breast cancer UK over 7. 5 years: 22. 48 per 1000 >5 years since stopping E only --6 fewer E+P ---4 more E only – 1 more E+P ---4 more E only --4 fewer E only --5 fewer E+P ---5 more E+P ---8 more Fragility fractures Baseline rate 69 per 1000 23 fewer No data Ovarian 1 more per 1000 after 5 years use Little difference between E alone or E+P No data Dementia No data

RISKS THAT CAN BE CHANGED-ENDOMETRIAL CANCER Risk Increased body weight Combined oral contraceptive pill Low of physical activities Regular exercise Red meat Eat more vegetable (HRT) Coffee, tea (especially green) Contraceptive coil Aspirin (HRT)

RISKS THAT CAN BE CHANGED-OVARIAN CANCER Risk Smoking Breastfeeding more than 6 months ? have more pregnancies? Overweight Combined oral contraceptive pill Eat more vegetable