Oncological Gynaecology

Research profile

Our aim is to offer every patient participation in at least one study.

On-going or upcoming participation in national and international studies

  1. OVHIPEC-2: Phase III randomized clinical trial for stage III epithelial ovarian cancer randomizing between primary cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy
    (Ole Mogensen and Mette Mikkelsen, regional PI)
  2. RACC trial: Robot-assisted Approach to Cervical Cancer (RACC) – an international multicenter, open-label randomized controlled trial
    (Pernille Jensen, national PI)
  3. An international field study for the reliability and validity of the EORTC Vulva Cancer Questionnaire (EORTC VU34) module
    (Pernille Jensen PI)
  4. Optic-guided Sentinel Node Mapping in patients with vulva cancer
  5. Danish national study on risk-stratification using patient reported outcome measures (PROs), molecular biomarkers and detection of circulating tumor DNA for early detection of recurrence in women with vulva cancer
    (Pernille Jensen PI, Katrine Fuglsang post doc)

Researchers

Clinical profile

The Onco-gynecological team at Aarhus university Hospital undertakes diagnosing of all gynecological cancers; ovarian, endometrial, cervical, and vulval cancer, besides trophoblastic disease and related cancers. Further, women with suspicion of recurrent disease of gynecological cancer undergo imaging and multidisciplinary assessment of recurrence and treatment options.

Women with findings suspicious of gynecological cancer are referred from tertiary gynecological departments, general practitioners, specialists in Gynecology, or other departments in case of suspicious findings on imaging undertaken as part diagnostic for other diseases. The patients are booked for supplementary imaging (PET CT scan and/or MRI scan) and all histological specimens undergo pathology revision by pathologists specially educated in oncological gynecology.

All referrals with imaging and pathology are discussed at a multidisciplinary team conference with a dedicated team of specialists in onco-gynecology, clinical oncology, pathology, nuclear-medicine, and radiology.

The Onco-gynecological team undertakes the surgical treatment of all gynecological cancers from the central region of Denmark, besides from the Northern part regarding Cervical and vulva cancer and from the Southern part regarding vulva cancer:

  • Ovarian cancer (approx 100-120/year): Ultraradical primary debulking surgery for ovarian cancer supplemented by HIPEC in a randomized controlled setting. Interval debulking surgery after neoadjuvant chemotherapy. Further, diagnostic laparoscopy to assess operability and secondary (and tertiary) debulking surgery for recurrent disease are undertaken according to pre-set criteria.
  • Early stage low-intermediate risk endometrial cancer (approx 150-170/year): Robotic assisted laparoscopy including sentinel node mapping.
  • High risk endometrial cancer (approx 30/year) Robotic assisted laparoscopy including sentinel node mapping and radical pelvic and paraaortic lymfadenectomy.
  • Open extensive surgery for advanced endometrial cancer (aprox 10/year)
  • Early stage cervical cancer (approx 30/year): Robotic assisted laparoscopic simple or radical hysterectomy including sentinel node mapping and radical pelvic lymfadenectomy. In larger tumors open procedures are performed.
  • Vulva cancer (approx 50/year primary; 25 recurrences) Anterior, posterior, hemi- and total vulvectomy with sentinel node mapping or radical inguinal lymfadenectomy.

The Onco-gynecological team undertakes exenterative procedures (including anterior, posterior or total exenteration) for recurrent cervical and vulva cancer in close collaboration with the department of abdominal surgery.

All members of the team are certified onco-gynecologists or have been accepted for or applied for the expert certification program (ESGO and/or The Danish EXPO program).

PhD students

  • Ina Marie Hjort Dueholm
    Improved Diagnosis of Ovarian Cancer (Ole Mogensen main supervisor) Aarhus University
  • Sara Maria Bjørnholdt
    Sentinel Node Mapping with Robotic Assisted Near Infra-Red Fluorescent Imaging in Women with Endometrial Cancer (Pernille Jensen main supervisor) Aarhus University
  • Dina Overgaard
    Active surveillance of cervical intraepithelial neoplasia grade 2 and risk of hpv-related cancer (Pernille Jensen, co-supervisor) Aarhus University
  • Helle Joon Christiansen
    Painless Surgeons (Ole Mogensen main supervisor) Aarhus University
  • Louise Krog
    The value of patient reported outcome measure (PROM) assessment and circulating tumor DNA (ctDNA) to detect early relapse during surveillance in women with vulva cancer (Pernille Jensen, main supervisor) Aarhus University
  • Anne Katrine Leonhard
    School-based HPV-counselling and -vaccination (Lene Seibæk, main supervisor) Aarhus University

PhD projects

School-based HPV-counselling and -vaccination. User centered cancer prevention targeting children and parents with ethnic minority background

Participation to HPV-vaccination in Denmark is significantly lower among children with ethnic minority background compared to native Danish children. Complex reasons for not attending are among others a lack of awareness regarding HPV, insecurity, fear, and cultural taboos. This project has developed and tests school-based HPV-counselling to children and parents at schools in the municipality of Aarhus, followed by school-based HPV-vaccination. The research-group cooperates with local Neighbourhood Mothers, the Municipality of Aarhus and school nurses and has developed material, including an animation, suitable for national implementation. With the combination of targeted information and accessible vaccination, we expect to increase participation to HPV-vaccination and hereby contribute to equalize the social inequality in prevention of cancer.

PhD Student Anne Katrine Leonhardt. Main supervisor Lene Seibæk.

Improved diagnosis of ovarian cancer

PhD-project June 2021-May 2024.

How do we identify patients with ovarian cancer among the many patients with benign ovarian cysts? Can we optimize the way we use our tools for clinical decision making?

Our currently used model for prediction of malignancy fails to catch 25-30 % of patients with cancer. This can lead to uncertainty for patients and doctors.

We hope to contribute by:

-Implementing systematic description of ultrasonography and Magnetic Resonance Imaging findings of ovarian masses in hospitals in the Central Denmark Region. This may support quality in the diagnostic process. Moreover, the efficiencies of new prediction models based on imaging by different observers can be compared.

-Exploring if circulating tumour DNA can be used as a biomarker for differentiation between benign and malignant ovarian masses, and how this method may supplement the imaging modalities.

 

PhD student, MD, Ina Marie Dueholm Hjorth1,2 (+45 26192456, inahjo@rm.dk)

Main supervisor: Professor, Consultant, Dr. med., Ole Mogensen1,2.

Co-supervisors: Consultant, PhD, Charlotte Møller2; Professor, Consultant, Dr. Med., Thierry van Den Bosch3.

1. Department of Clinical Medicine, Aarhus University

2. Department of Gynaecology and Obstetrics, Aarhus University Hospital

3. Universitair Ziekenhuis Leuven, Leuven, Belgium

Active surveillance of cervical intraepithelial neoplasia grade 2 and risk of HPV-related cancer

PhD period: 01.02.2022-31.01.2025.

Human papillomavirus (HPV) is a highly contagious sexually transmitted virus that can cause both malignant and benign diseases. Approximately 800 new cases of HPV-related cancer are diagnosed each year in Denmark, and the incidence of several HPV-related diseases has increased in recent decades. We aim to improve our understanding of HPV-related disease, and to identify those most at risk of developing HPV-related precancers and cancers.

In this PhD project we are investigating the long-term risk of developing HPV-related disease in women with moderate cell changes of the cervix using nationwide registries. We are comparing women who are treated with active surveillance with women who have undergone surgical excision. Furthermore, we will investigate the risk of HPV-related cancer in the women’s male partners.

PhD student, MD, Dina Overgaard Eriksen: dinaoeriksen@clin.au.dk

Main Supervisor: Anne Hammer, Dept. of Obstetrics and Gynaecology, Gødstrup.
Co-supervisors: Pernille T Jensen and Eva Bjerre Ostenfeld, Dept. of Obstetrics and Gynaecology, Aarhus Universuity Hospital
 

Painless Surgeons

The PhD project started in June 2022 and will finish by May 2025.

Three in four surgeons experience multi-site pain that negatively affects their work, leisure and sleep. To counteract the pain, the literature highlights good ergonomics in the operating room, however, the effect is limited and surgeons report low awareness of good ergonomic practices. In contrast, evidence states that physical exercise training is essential in reducing musculoskeletal pain. Among various occupational groups, the concept Intelligent Physical Exercise Training (IPET) has improved muscular strength and endurance and demonstrated clinical relevant health effects by increased resilience. IPET tailors the exercise training to each individual’s job profile, physical capacity and health. In collaboration with Mayo Clinic, USA, the present study is the first international RCT to investigate the effects of IPET on musculoskeletal pain among surgeons. Up-to-date ergonomic recommendations will be launched 3 months ahead of study start and act as the control arm. In addition to the ergonomic recommendations, the intervention group will follow IPET that will be delivered as an app-based 60 min./per week training program that can be conducted at work or at leisure. The primary outcome is musculoskeletal pain, and secondary outcomes are general health, quality of life, work ability, productivity and sickness absence due to musculoskeletal pain.

PhD Student Helle Joon Christiansen: hjchristiansen@clin.au.dk

Main Supervisor: Ole Mogensen, Prof. Aarhus University, Dept. of Gynaecology, and Obstetrics

SENTIREC-endo, Sentinel lymph node Mapping in women with endometrial cancer

Surgical staging of endometrial cancer (EC) serves to identify women with metastatic disease and to allocate them to adjuvant therapy. Sentinel lymph node (SLN) mapping represents a sensitive and minimal invasive staging procedure that enables the identification of even very small metastases. 

For women with endometrial cancer with a histological low- intermediate risk of lymph node metastases the SENTIREC-endo study performed a national protocolled adoption of SLN mapping. The study will assess benefits and potential harms of the national adoption using validated patient reported outcome measures. 

For women with endometrial cancer with histological high risk of metastasis and recurrence, the SENTIREC-endo study will investigate if SLN mapping can safely identity lymph node metastases and replace the current full pelvic and paraaortic lymph node dissection.   

PhD student: MD, Sarah Marie Bjørnholt, samnil@rm.dk

Main Supervisor: Professor, Ph.D.  Pernille Tine Jensen, Dept. of Gynaecology, AUH

Co-supervisors: 

Professor, DMSci Ole Mogensen, Dept. of Gynaecology, AUH

Associate Professor, MD, PhD Kirsten Bouchelouche, Depth. Nuclear Medicine and PET, AUH 

The value of patient reported outcome measure (PROM) assessment and circulating tumor DNA (ctDNA) to detect early relapse during surveillance in women with vulva cancer

PhD period: 01.02.2023 – 31.01.2027

Vulva cancer is a rare disease often diagnosed in elderly, comorbid women. Treatment of vulva cancer is often mutilating, and despite a curative intent, up to 40% will experience a recurrence. Furthermore, a recurrence is often diagnosed late despite that patients treated for vulva cancer are followed thoroughly in the clinic. Today, there is only limited evidence regarding the incidence of late complications, and knowledge on intervention and prevention primarily relies on small retrospective studies. There is also a lack of valid biomarkers for risk-stratification of women with vulva cancer, but identification of circulating tumor DNA (ctDNA) may represent a novel technological advancement for personalized risk assessment and treatment allocation. Additionally, systematic assessment of patient reported outcome measures (PROMs) may represent a valid method for earlier identification of recurrence and for future implementation of individualized follow-up schedules. The overall aim of the present PhD study is to investigate different aspects of recurrence detection in women with vulva cancer to optimize the current surveillance program.

PhD student Louise Krog: LOUKRG@rm.dk

Supervisor group:

Main supervisor: Pernille Tine Jensen, MD, PhD, Professor and Consultant in Oncogynecology
Co-supervisor: Katrine Fuglsang, MD, PhD, Associate Professor and Consultant in Oncogynecology
Co-supervisor: Lars Dyrskjøt Andersen, PhD, Professor in Molecular Medicine