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Introduction

Our 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 in the hospital.

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 multidisciplinary team of doctors plans and provides the cancer care, and surgery is performed at the hospital. Some of the treatments such as chemotherapy can be given in other local regional hospitals. Radiotherapy treatment is given at St Luke’s Hospital (in St James's Hospital 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.

  • Cancer is caused by the uncontrolled division of abnormal cells in a part of the body. Not all growths are cancerous, so biopsy (removing a small sample of tissue to examine cells under a microscope) is important in making a cancer diagnosis.

    All genital tract cancers (womb, cervix, tube and ovary, vulva and vagina) are treated at the Trinity St James’s Cancer Institute.

    Endometrial Cancer (Cancer of the Womb)

    Ovarian/Fallopian Tube

    Cancer Cervical Cancer

    Vulval Cancer

    Vaginal Cancer

  • Our Gynaecological Cancer Centre is the largest in Ireland and sees over 300 cases per year. We work closely with scientists and doctors from Trinity College Dublin to advance the understanding of cancer and its complications. Ovarian cancers, in particular, are usually diagnosed at a late stage and therefore are more difficult to treat. Much of our research has focused on trying to develop tests that will pick up this cancer early. We are also involved in large studies with other centres in Ireland and abroad to try to find new and better ways to treat gynaecological cancers and to minimise the side effects of treatment.

    Development of Biomarkers for Early Diagnosis and Treatment Response

    Early detection of gynaecological cancers is important for effective treatment. St James’s Hospital, in collaboration with Trinity College Dublin and the DISCOVARY Consortium, has identified a number of potential markers for ovarian cancer that can be detected in a blood test. We are currently validating these biomarkers and hope that they can be used in the clinic. We are also looking at markers that might reveal how the cancer will respond to treatment. The research is conducted at the Trinity Centre for Health Sciences on the St James’s Hospital site.

    Prevention of Blood Clots

    Gynaecological cancers are associated with a high risk of blood clots, which can be fatal if left untreated. Trinity College Dublin research groups are working with gynaecologists in the hospital to develop a risk score to determine which patients are likely to get blood clots, particularly after cancer surgery. These patients can then be given a preventative medication that can reduce their risk.

    Understanding How Ovarian Cancer Spreads

    Ovarian cancer is a metastatic disease, meaning that it can spread throughout the body.  It does this by avoiding the body’s natural defences, which usually destroy abnormal cells as they pass through the bloodstream. Scientists in Trinity College Dublin, as well as a group in Dublin City University, are working to understand this process and to develop a device that can detect cancer cells as they circulate in the blood.

    How Do I Get Involved?

    When you are patient in St James’s Hospital, you may be approached by a member of a research team who will explain the details of the studies and ask whether you wish to participate. Your doctor will provide you with an information sheet, and you will be asked to sign a consent form. If you agree, a small sample of blood is taken at the same time as the other blood samples required for your treatment. A small piece of tumor tissue may also be taken. Participation is optional, and your treatment will not be affected if you decide not to take part. 

  • There are different treatment options that may be available once you are diagnosed with gynaecological cancer. These include surgery, radiotherapy, chemotherapy and hormonal treatment. The choice of treatment will depend on the type and stage of your cancer. A multidisciplinary team will decide on the best treatment plan for you.

    • Surgery: The type and extent of surgery will depend on the site and stage of the cancer.
    • Radiotherapy: X-ray beams are directed at your cancer to destroy cancer cells and prevent them from growing. Radiotherapy can be given before surgery (neoadjuvant) to shrink the tumor and after surgery (adjuvant) to destroy any remaining cancer cells. Radiotherapy can be also used to relieve symptoms if the cancer is very advanced or recurrent.
    • Chemotherapy: This is treatment with anti-cancer drugs. It is given through the veins and travels through the bloodstream to almost every part of your body. Chemotherapy can be given before surgery (neoadjuvant) to shrink a tumor and after surgery (adjuvant) to destroy any remaining cancer cells. A combination of agents (called a regimen) is usually recommended. This typically consists of two drugs, carboplatin and paclitaxel.
    • Hormonal and Other Treatment: Some cancers are sensitive to certain hormonal treatment.

    Endometrial Cancer (Cancer of the Womb)

    Ovarian/Fallopian Tube Cancer

    Cervical Cancer

    Vulval Cancer

    Vaginal Cancer

  • 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