Gynaecological Cancers

Mr Moiad Alazzam was among the first surgeons to apply robotic and laparoscopic surgery techniques to the treatment of gynecological malignancies in UK & Ireland. He demonstrated safety and efficacy of these techniques. He is frequently invited to national and international congresses, speaking about and demonstrating surgical techniques for treating gynecological cancer.

Mr Moiad Alazzam private practice clinic offers a surgical referral centre welcoming women from across the UK and abroad for consultations in Oxford UK with officces at the Manor Hospital Oxford.

To request an appoinment with Mr Alazzam please click here

Uterine Cancer Q & A

What is uterine cancer?

Uterine cancer is divided broadly into two types; caner that originates in the uterine (womb) lining (endometrium) is referred to as carcinoma. Cancer that originates in the uterine muscle is referred to as sarcoma. Sarcomas are rare, much less common than carcinomas, representing 8% of uterine cancers.

Uterine cancer is the most common gynecologic malignancy in the UK and western world.

The chance of being diagnosed with endometrial cancer increases with age. More then half of women with endometrial cancer are diagnosed after age 55.

What are the symptoms of uterine cancer?

  • Postmenopausal bleeding (spotting or heavy)

  • Irregular or heavy menses

  • Pelvic pain

  • Bloating

  • Cramping

  • Postmenopausal abnormal vaginal discharge

What are the risk factors for endometrial cancer?

The cause of uterine cancer is not known and there is no way to predict who will get it, but there are certain factors which make a woman more likely to develop it.

  • Women between the ages of 50 and 70 are at increased risk

  • Being overweight or obese

  • Unopposed estrogen therapy (taking estrogen without balancing it with progesterone)

  • Taking tamoxifen (non-hormonal medication used to treat breast cancer)

  • Atypical hyperplasia (abnormal tissue in the lining of the womb which may develop into cancer)

  • Beginning menstruation early, before age 12 (this increases lifetime exposure to estrogen)

  • Undergoing menopause after age 50

  • History of infertility

  • Having infrequent periods

  • Having never been pregnant

  • Polycystic ovarian syndrome (PCOS)

  • Diabetes

  • Hypertension

  • Having colon cancer before age 50

  • Inheriting a gene at birth that increases risk (such as Lynch II syndrome, known as non-polyposis colorectal cancer, or HNPCC)

What treatment options does Mr Alazzam offer for uterine cancer?

Mr Alazzam specialises in the application of minimally invasive surgical techniques to treat uterine cancer. He performs all the standard procedures through small key hole surgery; historically these procedures were performed via open surgery.

Surgey for uterine cancer frequently includes hysterectomy, removal of fallopian tubes and possibly ovaries, removal of the lymphnodes (lymph node dissection), omentectomy (removal of fatty tissue attached to the stomach and colon), pelvic washing (irrigation of the pelvic cavity to wash away cancerous cells), cancer debulking, and collection of biopsies (called staging).

Sometimes open surgery is required, but the ultimate goal is to utilise the smallest incisions to remove all visible signs of disease and optimise outcome.

Ovarian Cancer Q & A

What is ovarian cancer?

Ovarian cancer is a cancer that originates in the ovaries, fallopian tube or peritoneal surface (primary peritoneal cancer). It is the ninth most common cancer in women and the fifth most deadly.

It is the second most common gynecologic malignancy in developed countries.

The lifetime risk is 1:70 and the average age at diagnosis in the UK is 63 years old.

What are the symptoms of ovarian cancer?

Ovarian cancer is often diagnosed at an advanced stage after it has spread to distant areas, making it more difficult to treat. Even when the cancer has spread, its symptoms are often mistaken for other health conditions.

  • Abdominal bloating

  • Pelvic pain

  • Loss of appetite

  • Weight loss

  • Feeling full quickly upon eating

  • Frequent urination

  • Changes in bowel habits (constipation, for example)

  • Nausea and vomiting

  • Fatigue

  • Lower back pain

What are the risk factors for ovarian cancer?

The cause of ovarian cancer is not known and there is no way to predict who will get it, but there are certain factors which make a woman more likely to develop it.

  • Certain genetic mutations (such as BRCA1, BRCA2 and Lynch syndrome)

  • Family history of breast or ovarian cancer

  • Personal history of breast cancer

  • Estrogen replacement therapy without progesterone for more than five years

  • Personal history of endometriosis

  • Pregnancy and childbirth later in life

  • Risk increases with age

  • Obesity

What treatment options does Mr Alazzam offer for ovarian cancer?

Mr Alazzam specialises in the surgical management of ovarian cancer. He is an expert in the surgical techniques including peritoneal surface and upper abdominal surgery in order to completely remove the cancer.

These procedures include hysterectomy, removal of ovaries and tumours, lymph node dissection, omentectomy (removal of fatty tissue attached to the stomach and colon), pelvic washing (irrigation of the pelvic cavity to wash away cancerous cells), cancer debulking, peritoneal and diaphragmatic stripping, liver mobilisaiton.

Mr Alazzam performs advanced ovarian cancer surgery through open technique, however, in certain cases and when it is safe for the patients, he performs the surgery using minimal invasive technique (key hole).

Vulvar Cancer Q & A

What is vulvar cancer?

Vulvar cancer is a type of cancer that occurs on the outer surface area of the female genitalia. The vulva is the area of skin that surrounds the urethra and vagina, including the clitoris and labia.

Vulvar cancer commonly forms as a lump or sore on the vulva that often causes itching. Though it can occur at any age, vulvar cancer is most commonly diagnosed in older adults.

The most common types of vulvar cancer include:

  • Vulvar squamous cell carcinoma. This cancer begins in the thin, flat cells that line the surface of the vulva. Most vulvar cancers are squamous cell carcinomas.

  • Vulvar melanoma. This cancer begins in the pigment-producing cells found in the skin of the vulva.

What are the symptoms of vulvar cancer?

Signs and symptoms of vulvar cancer may include:

  • Itching that doesn't go away

  • Pain and tenderness

  • Bleeding that isn't from menstruation

  • Skin changes, such as color changes or thickening

  • A lump, wartlike bumps or an open sore (ulcer)

What are the risk factors for vulvar cancer?

Although the exact cause of vulvar cancer isn't known, certain factors appear to increase your risk of the disease, including:

  • Increasing age. The risk of vulvar cancer increases with age, though it can occur at any age. The average age at diagnosis is 65.

  • Being exposed to human papillomavirus (HPV). HPV is a sexually transmitted infection that increases the risk of several cancers, including vulvar cancer and cervical cancer. Many young, sexually active people are exposed to HPV, but for most the infection goes away on its own. For some, the infection causes cell changes and increases the risk of cancer in the future.

  • Smoking. Smoking cigarettes increases the risk of vulvar cancer.

  • Having a weakened immune system. People who take medications to suppress the immune system, such as those who've undergone organ transplant, and those with conditions that weaken the immune system, such as human immunodeficiency virus (HIV), have an increased risk of vulvar cancer.

  • Having a history of precancerous conditions of the vulva. Vulvar intraepithelial neoplasia is a precancerous condition that increases the risk of vulvar cancer. Most cases of vulvar intraepithelial neoplasia will never develop into cancer, but a small number do go on to become invasive vulvar cancer.

  • Having a skin condition involving the vulva. Lichen sclerosus, which causes the vulvar skin to become thin and itchy, increases the risk of vulvar cancer.

What treatment options does Mr Alazzam offer for vulvar cancer?

Mr Alazzam specialises in the management and the application of microsurgical surgical techniques to treat vulvar cancer.

These procedures include wide local excision (simple and radical), vulvectomy (simple and radical), removing of the inguinofemoal lymphnodes (sentinel and comple node dissection), plastic reconstruction and rotational flaps if indicated.

Cervical Cancer Q&A

What is cervical cancer?

Cervical cancer originates in the cervix, which is the lower part of the uterus (womb) that connects to the top of the vaginal canal.

There are two types of cervical cancer; about 80% of cervical cancer is squamous cell carcinoma, which begins in the cells lining the outer par of the cervix which projects into the vagina. the remaining 20% is adenocarcinoma type which begins in the glandular cells lining the cervical canal.

Cervical cancer most often affects women between the ages of 35 and 45, but more than 15% of cases are found in women over age 65.

The cause of almost all cases of cervical cancer is known to be HPV (human papillomavirus), a persistent longstanding infection that develops into cancer.

Vaccination is available for girls and women. This reduces the risk of cervical cancer and is most effective if administered before becoming sexually active.

What are the symptoms of cervical cancer?

  • Abnormal vaginal bleeding (such as between periods, after intercourse, or after menopause)

  • Vaginal discharge that is watery, pale or bloody

  • Pain during intercourse

  • Heavy periods that may last longer than usual

  • Pelvic pain

What are the risk factors for cervical cancer?

The risk of cervical cancer is greatly reduced by using screening tests such as Pap smear and HPV testing, enabling detection of high-risk strains of HPV, early treatment and improved outcome.

  • History of abnormal cervical smears

  • Having multiple sexual partners or a partner who had multiple sexual partners (increases likelihood of exposure to HPV)

  • Sexual activity at an early age

  • Having other sexually transmitted infections (such as chlamydia, gonorrhea, syphilis and HIV/AIDS)

  • Weakened immune system

  • Smoking (associated with squamous cell cervical cancer)

What treatment options does Mr Alazzam offer for cervical cancer?

Mr Alazzam specialises in the management and the application of minimally invasive surgical techniques to treat cervical cancer when it is safe. In view of the LACC trial findings Mr Alazzam extensively counsel his patients about the surgical option; key hole vs open surgery. He is expert in performing the procedure either way.

These procedures include nerve sparing radical trachelectomy (removal of the cervix and surrounding tissues but leaving the uterus intact), simple hysterectomy (removal of the uterus and cervix without removal of additional tissue on the side of the cervix or any vaginal tissue), nerve sparing radical hysterectomy (removal of the uterus, cervix, some of the tissue surrounding the cervix and a small portion of the vagina), lymph node dissection (or sentinel node dissection), and removal of ovaries (if indicated).

For very early cancer or precancerous cervical changes; Mr Alazzam can perform cervical knife cone treatment via vaginal approach. This involves cutting a wedge from the endocervical canal while preserving the uterus and extra tissues.

Mr Alazzam is an expert in fertility preserving surgery and microsurgical techniques which he offers to his patients if appropriate.