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Introduction

St James’s Hospital (SJH) Gynaecological Cancer Care Centre is the largest provider in the Republic of Ireland of treatment for malignancy of the reproductive organs: cancer of the womb (uterus), cervix, ovary, vagina and vulva.  Our centre provides a regional and national service and is accredited by the NCCP (the HSE’s National Cancer Control Programme) for complex radical gynaecological surgeries. International standards of treatment apply, and the service is supported by research and teaching activities through Trinity College Dublin and the Cancer Trials Research Office at SJH.                                                

Over 300 women with gynaecological cancer are referred to the centre annually. Cancer of the endometrium (lining of the womb) is the most common cancer, followed by cancer of the ovary/fallopian tube, then cervical cancer. Cancers of the vulva and vagina are less common. Women are referred by their general practitioners or by gynaecologists at their local hospital. A Multi-Disciplinary Team of doctors plans and provides the cancer care, and surgery is performed at SJH. Some of the treatments such as chemotherapy can be given in other local regional hospitals. Radiotherapy treatment is given at St Luke’s Hospital (SJH and in Rathgar, Dublin). When treatment is completed, long-term follow-up care is often provided at the patient’s local hospital.  Follow-up visits may go on for five years or longer.

  • The womb, or uterus, is a pear-shaped organ located between the bladder and the rectum. The inside of the uterus has two layers: The thin inner layer is called the endometrium and the thick outer layer, which is composed of muscle, is called the myometrium. In women who menstruate, the endometrium thickens every month in preparation for pregnancy and the endometrial lining is shed during the menstrual period. After menopause, when menstrual periods stop, the endometrial lining normally stops growing and shedding. In women who have endometrial cancer, the uterine lining develops abnormal cells.

    Most womb cancers are slow growing, but there are cases of aggressive womb cancer. The cancer may spread to other parts of the body, particularly the lymph nodes. Cancer of the womb is often suspected when a woman has abnormal vaginal bleeding, particularly bleeding after menopause. An ultrasound scan of your abdomen (tummy) or internally (trans-vaginal) will help the doctor to decide whether you need a biopsy (a sampling of cells from the lining of the womb).  The most common tests include:

    • Endometrial Biopsy: An internal test done in the outpatient clinic.
    • Hysteroscopy: A test that is done as a day surgery, with a short anaesthetic with dilation and curettage (D&C).

    Both tests take a sample of tissue from the lining of the uterus, called the endometrial lining. A laboratory doctor will examine the tissue with a microscope to see whether there are signs of cancer.

  • Womb cancer is usually treated with surgery, which seeks to remove the cancer and determine how far the cancer has spread (staging).

    • Surgery typically includes removing the womb, cervix, ovaries and fallopian tubes. Lymph nodes may also be removed. This can be done by open or keyhole (laparoscopy) surgery.
    • Radiotherapy is given to certain patients after surgery to consolidate the treatment. If surgery is too risky, such as in elderly women and women with serious medical problems, radiation therapy alone may be recommended.
    • Chemotherapy is given in rare type womb cancer (Serous, Clear Cell) or if the cancer is advanced or recurrent.
    • Hormonal Treatment (Megace) can be used if cancer relapses or if patient is unfit for surgery or radiotherapy.  
  • We are a multidisciplinary team of surgeons, medical oncologists, radiotherapists and specialist nurses supported by experts in nutrition, physiotherapy, occupational therapy, stoma care, palliative care and pain and pastoral care. Four outpatient clinics are held weekly. Each clinic has one or more lead consultants and team doctors.

    Gynaecological Consultant Surgeons

    • Dr Noreen Gleeson is the lead gynaecology cancer surgeon and trainer. She is an associate professor at Trinity College Dublin. Her major clinical interests are gynaecological cancer and pelvic surgery and reconstruction. Her research is in surgical methods and how cancer cells grow and spread and affect other systems in the body. Her published research profile is on ResearchGate
    • Dr Tom Darcy is a gynaecology cancer surgeon and trainer. He is also a lecturer at Trinity College, Dublin. He is the director of the colposcopy pre-cancer clinic at the Coombe Women’s & Infants’ University Hospital, Dublin.
    • Dr Waseem Kamran is a gynaecology cancer surgeon and trainer. He is also the director of the Cancer Risk Reduction Clinic.
    • Dr Feras Abu Saadeh is a gynaecology cancer surgeon and the director of clinical research. His published research profile is on ResearchGate; 

    Medical Oncology Chemotherapy Consultant

    • Dr Dearbhaile O’Donnell
    • Dr Karen Cadoo

    Radiotherapy Consultant

    Cancer Nurse Specialists

    • Ms Debra McKnight
    • Ms Ciara Donohoe
    • Ms Elaine Gray

    Debra, Ciara and Elaine will coordinate all your care, from your first visit to the clinic through to your blood and X-ray tests, your admission for surgery or your appointments with other doctors.

    Research /Scientific Investigators

    • Dr Lucy Norris
    • Dr Sharon O’Toole

    Sharon and Lucy are scientific doctors who work in the research laboratory and coordinate the studies outlined. They ensure patients are informed about research studies, so you may meet them when you come to the outpatient clinic, when you come for your surgery or at other stages during your treatment. They coordinate the collection of blood and tissue samples and store them for the various studies.

    Further information on research projects is available on our Research page. Published research for Noreen Gleeson, Feras Abu Saadeh, Lucy Norris and Sharon O’Toole is available through ResearchGate.

    If you wish to support our research, please contact Debra McKnight, Gynaecological Coordinator; dmcknight@stjames.ie. You can also specify which type of gynaecological cancer you wish to support. We carry out research on ovarian, womb and cervix and vulval cancer.

  • Other Resources

    The following are websites of organisations offering information relating to the treatment and management of cancer:

    Irish Cancer Society: www.cancer.ie

    Emer Casey Foundation: www.emercaseyfoundation.com

    Ovacare: www.ovacare.com

    Supporting Ovarian Cancer Knowledge: www.sock.ie