Screening Programmes
and Studies

The research programme has earned the highest grading from the Medical Research Council and Cancer Research UK. It extends out to 13 regional centres across the UK and our scientists collaborate with international teams based in Denmark.

The ten-year programme is designed to show that the number of deaths from ovarian cancer can be reduced by prevention, early detection and optimal treatment.

There are 3 key components:

Clinical Research
The largest ovarian cancer screening trial in the world is taking place right here in the UK and involves 200,000 women. It aims to find a way of diagnosing ovarian cancer at the earliest possible stage.

Laboratory Research
The laboratory team is trying to find ways to predict which women in the population are at risk of cancer because of their genetic make-up and lifestyle factors. The team is also trying to find better ways to detect, prevent and treat ovarian cancer.

Psychosocial Research

Understanding how women experience their cancer illness, and cope with their treatment and its consequences is also a part of the research programme. This provides important information to develop new and better ways of supporting women and their families.

Eight crucial areas for potential major new findings have been identified:

Understanding the causes of gynaecological cancers
Understanding the biology of cancer
Screening for cancer
Identifying women at risk
Diagnosis of cancer
Documenting the spread of cancer
Surgery for cancer
Quality of life and cancer treatment

Two major screening trials form an integral part of the ten year research programme. The first is the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and is the world’s largest ever screening trial for ovarian cancer.

The second is the United Kingdom Familial Ovarian Cancer Screening Trial (UKFOCSS), a collaborative study which aims to find out if screening is beneficial to women with an inherited risk or genetic risk of ovarian cancer.

Furthermore, a Psychosocial Research Programme runs parallel to the laboratory research and clinical trials, addressing the human needs of women with gynaecological cancer - and is part of a larger psychosocial research initiative within the Institute of Women’s Health.

Finally, the Danish Mermaid Project forms a significant part of the co-operative network, with a unique and ambitious research programme which aims to reduce the high mortality rate in women with ovarian cancer.

Understanding the causes of gynaecological cancers
The aim is to identify the abnormalities that occur in cancer and may provide new details for prevention or screening. This programme requires a laboratory team with the molecular skills to identify the genetic changes that occur in cancer cells and lead to the development of cancer. This research has already provided insights into the genetic steps, which occur when cancers of the ovary and endometrium develop.

Understanding the biology of cancer
When a woman presents with advanced cancer she may have one millions extra cells in her abdomen. Only half of these will be cancer cells, the rest will be normal cells recruited by the cancer. These normal cells provide a vital support network for the growing tumour, supplying nutrients, oxygen and growth factors. If this network of cells can be disabled the cancer will die. The cancer cells themselves are a moving target. Although they may initially respond to treatments, in their time their genes are altered again and again and they become resistant. The normal support cells do not change. The aim of the Gynaecological Cancer Research Unit is to understand how cancers develop this support network and to identify new treatments to destroy this support.

Screening for cancer (UKCTOCS)
The research programme in ovarian cancer screening is particularly well established and the Gynaecological Cancer Research Unit leads the international research. The screening methods involve a blood test for a substance called CA125 , which is released into the circulation by ovarian cancer, and ultrasound scanning to show the changes in size and texture of the ovaries caused by cancer. This study involves 200,000 women across the UK and suggests that screening can pick up cancer early and may save lives. Research is also in progress to develop new and more sensitive methods of screening for cervical cancer.

Identifying women at risk of cancer (UKFOCSS)
A proportion of cancers are known to occur because of inherited genetic abnormalities. Some of these genetic changes can be identified and are associated with a very high risk of ovarian cancer and endometrial cancer. An important aspect of the research programme is to refine methods for finding these genetic abnormalities in the hope that the cancers they cause can be prevented.

Diagnosis of cancer
The more accurately a cancer can be diagnosed and its extent assessed, the better the treatment can be planned - and more likely it will be effective. The department have placed a major emphasis on this area of research using the most sophisticated technology to detect cancer cells. The methods used range from measuring the levels of tumour markers in the circulation to scanning techniques like ultrasound and magnetic resonance imaging. These techniques will provide important information for planning and refining treatment of all gynaecological cancers.

Documenting the spread of cancer
Often the precise treatment of cancer depends upon whether or not it has spread to the lymph glands. Until recently the most sensitive way of assessing this was by looking at the lymph glands down a microscope. It is now possible to use much more sensitive molecular techniques, which will detect as few as one cancer cell amongst a million or more normal cells. This work is at an early stage but has great potential for improving the treatment of cancers, which have only just spread to the lymph glands.

Surgery for cancer
The Gynaecological Cancer Research Unit is also dedicated to contributing to new surgical methods in gynaecological cancer. This work currently has three components. First, there are efforts to decrease the side effects of surgery for gynaecological cancer. For example, performing complex keyhole surgery for cervical cancer to avoid the discomfort and scarring of a large incision - and to preserve fertility. Second, the department is using complex surgical techniques to reconstruct the bladder, bowel and vagina when these tissues need to be removed to treat cancer. Third, studies are underway to see whether extensive repeated surgery for ovarian cancer saves lives.

Quality of life and cancer treatment
A major priority is understanding how women cope with their cancer and how they feel about the care they receive. A series of studies are in progress on the tests that the department is using for screening and diagnosis, as well as the new treatments that have been introduced, to help clarify their impact on the quality of life. These studies are also designed to provide important information about the counselling, information and support needs of women with gynaecological cancer.