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The Familial Cancer Clinic for gynaecological malignancies

The Familial Cancer Clinic moved to UCLH in April 2004. Previously, it was located at St. Bartholomew's Hospital. The service provides risk assessment, counselling, screening and prophylactic surgery to women at high risk of ovarian, tubal, peritoneal and/or endometrial cancers due to a family history of the disease.

In the UK, there are approximately 6600 new cases of ovarian cancer and 7000 cases of endometrial cancer diagnosed annually. Of them, an estimated 5-10% may be the result of a familial predisposition.

Families at high risk of gynaecological cancers belong broadly to two groups:

  1. those with a family history of a) breast or b) breast and ovarian or c) ovarian cancer alone who are at risk of carrying a BRCA 1 or 2 gene mutation
  2. those with a family history of colorectal, endometrial, small bowel, ovarian, ureteric and renal pelvic cancers suggestive of Lynch Syndrome or hereditary nonpolyposis colorectal cancer (HNPCC) who may have a gene mutation in MLH1, MSH2, MSH6 and PMS2. In such families, cancers occur in more than one family member and usually through several generations.

Women from these families who are first degree relatives of those affected with cancers have a 10% or greater life time risk of ovarian cancer. In addition, Lynch syndrome women have a 25-60% lifetime risk of endometrial cancer.

The referral criteria for woman at risk of ovarian and endometrial cancer who are seen at the Familial Cancer Clinic are summarised below.

In the clinic, all women undergo comprehensive risk assessment and counselling. Women confirmed to be at 'high risk' are offered a variety of risk management options which include:

  • risk reducing laparoscopic surgery to remove the ovaries and tubes after a woman has completed her family. Usually such surgery is undertaken in the forties. In Lynch syndrome women with a significant risk of endometrial cancer, the uterus is also removed screening for ovarian and endometrial cancer (as appropriate)
  • life style and contraceptive advice
  • referral for breast or bowel screening as appropriate
  • referral to clinical genetics (for assessment and genetic testing if appropriate)

It is not yet known whether gynaecological screening is effective and will save lives. Eligible women opting for screening are recruited into the NCRN UK Familial Ovarian Cancer Screening Study (UKFOCSS). This involves annual transvaginal ultrasound and 4 monthly serum CA125 testing. In addition, endometrial cancer screening using yearly transvaginal ultrasound scans and outpatient hysteroscopy & endometrial sampling is also available for Lynch Syndrome women.

For further information about the Familial Cancer Clinic (gynae-onc), please contact the Clinical Nurse Specialist, Michelle Johnson, at 0207 380 6912 or michelle.johnson@uclh.nhs.uk. Women can be referred to Professor Usha Menon or Professor Ian Jacobs.

Click here for information about referral criteria to the familial cancer clinic

The Familial Cancer Clinic Team:

Dr Elizabeth Benjamin  more
Dr Carol Brunell  more
Ms Sarah Chamberlain  more
Dr Sue Gessler  more
Prof Ian Jacobs  more
Michelle Johnson  more
Dr Ranjit Manchandra  more
Prof Usha Menon  more
Mr Adam Rosenthal  more
Dr Lucy Side  more

UCL Hospitals is an NHS Foundation Trust incorporating the Eastman Dental Hospital, Elizabeth Garrett Anderson & Obstetric Hospital, The Heart Hospital, Hospital for Tropical Diseases, National Hospital for Neurology & Neurosurgery, The Royal London Homoeopathic Hospital and University College Hospital.

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