Deficiencies in gynaecological cancer treatment and what can be done about it
The Queensland Centre for Gynaecological Cancer Research (QCGC Research) is a research centre that I founded in 2002 and which is located at The University of Queensland’s Centre for Clinical Research. Our research mission has remained unchanged since then: Develop the best standard of care for women diagnosed with gynaecological cancer; Prevent gynaecological cancer from occurring; and Develop treatment solutions that are less harmful to patients but more effective.
Cancer remains a challenging disease to treat, but the treatments that are emerging are increasingly successful. I believe this is because the knowledge about cancer increases almost every day. Better than last year, we do understand how uterine cancer progresses; how certain types of ovarian cancer disseminate; how we should treat cervical cancer in the most effective way.
Our biggest limiting factor to advance gynaecological cancer research in Australia is lack of funding. Government funding is sparse with only 5% to 10% of the most valuable and promising research projects being funded.
Why is it that if our country requires submarines, tanks, or rockets, we order them. The question “How do we pay for this?”, will not come up, regardless of what government is in office. When it comes to fixing cancer (or other life-threatening health conditions) we get told there is only limited money available. “How would we pay for this?”
Lack of funding delays the development of cancer cures. Tumour streams that have received plenty of funding in recent times, have seen their cure rates rise significantly. The prognosis of breast cancer, previously a mass killer, is now over 90% at 5 years overall. The prognosis of leukaemia and lymphoma fortunately have also improved through research. Prostate cancer is the next tumour that will experience marked rises in prognosis and outcomes.
This is why organisations such as the Cherish Women’s Cancer Foundation exist—to provide funding to fast forward research towards fixing gynaecological cancer.
Listed below are some of the current deficiencies in gynaecological cancer treatment, and initiatives that QCGC Research is aiming to implement and progress, with the help of funding from Cherish Women’s Cancer Foundation.
1. Less invasive treatments are needed
We are seeing increasing rates of endometrial cancer in all ages but dramatically also in younger women who still desire fertility. The standard treatment for these young women is a hysterectomy, which removes the option for women to carry a pregnancy. This is simply not good enough. We need to find alternative, non-surgical treatments and research has commenced, but we are only halfway there. Our feMMe study treated women with early-stage endometrial cancer less-invasively through the use of a hormone-releasing Intra-Uterine Device (IUD) or Metformin, which is a widely used anti-diabetes drug, reducing the need for surgery and preserving a women’s fertility. We found promising results, but we still have a few years to go to announce breakthroughs.
2. Current treatment guidelines are not patient centric
Current treatment guidelines for endometrial cancer are more than 30 years old and do not meet modern patients’ needs. Clinical management guidelines currently mandate removal of lymph nodes but we do not know if the removal of lymph nodes is actually required. Our international ENDO-3 trial aims to find the answers to address this knowledge gap. It randomises patients to hysterectomy with or without sentinel node biopsy and compares survival and patient outcomes. This trial will provide high-level evidence informing patients of the benefits and disadvantages of sentinel node biopsy.
There is no single clinical research trial on vulvar cancer in Australia. While vulvar cancer is rare (approx. 600 new cases per year in Australia), its treatment will leave virtually all patients substantially harmed. Patients will suffer from the side effects of their treatment for years, including lymphoedema, which means that affected women find it challenging to do their daily activities, or simply earning an income. It does not need to be like this. We are ready to test new treatments by taking advantage of new technology that is available in Queensland. We have the capacity to change this so that treatment and its cure are not as morbid as they are now. To change from these currently invasive treatment options, new treatment options first need to be tested in a clinical research trial.
4. Ovarian cancer: the deadliest gynaecological cancer
Ovarian cancer is a still a mass killer in Australia and many other countries. Over 1,500 Australian women will be diagnosed with ovarian cancer each year, and of these women, over 1,000 will die from the disease. That’s unacceptably high. The five-year survival rate for women diagnosed with ovarian cancer is 48%, the lowest survival rate of the gynaecological cancers.
Ovarian cancer develops in one or both ovaries, and can spread throughout the pelvis and abdomen if not treated early. Unfortunately, the symptoms for ovarian cancer can be unspecific, similar to other common illnesses and may be more likely to present at later stages. We need to get clinical research trials underway to improve the life expectancy of those diagnosed with this killer disease and improve the diagnostic tools available, as there is currently no ovarian cancer screening program.
How you can help
As a not-for-profit organisation, fundraising provides a significant part of QCGC Research's income and we would really appreciate your help to raise much needed funds for research to change the status quo. Cherish is a charity that I founded 10 years ago to provide the financial support needed by QCGC Research to continue its important work.
Next month, I will embark on the Cherish Challenge to raise funds for research and increase awareness of gynaecological cancer. I will be joining 14 Cherish Champions who have committed to the Cherish Challenge Kimberley 2022, where we will take on a guided hike through the remote Kimberley region. 100% of funds will go towards research deficiencies outlined above.
Please consider donating to the Cherish Challenge.