Gynecologic oncology
Gynecologic oncology is a specialized field within obstetrics and gynecology focused on diagnosing and treating cancers that originate from the female reproductive system, including cancers of the vulva, vagina, cervix, endometrium, fallopian tubes, and ovaries. Practitioners in this field employ a combination of surgical, chemotherapeutic, and emerging technological methods to address these cancers, often collaborating with other oncologic specialties such as radiation oncology to provide comprehensive care. Gynecologic oncologists undergo extensive training that includes a residency in obstetrics and gynecology followed by a fellowship dedicated to the subspecialty, where they gain both surgical skills and research experience.
The treatment process generally begins with thorough evaluations and diagnostic tests to determine cancer type and stage, which are crucial for planning effective interventions. Common procedures include surgical staging and various cancer surgeries, such as hysterectomies and tumor excisions. These oncologists also provide palliative care for patients with advanced conditions, aiming to relieve symptoms and enhance quality of life. The collaborative nature of gynecologic oncology involves working closely with medical oncologists, radiation oncologists, and specialized oncology nurses to tailor treatment plans, ensuring holistic care for patients facing the challenges of gynecologic cancers.
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Gynecologic oncology
ALSO KNOWN AS: Gynecology oncology
DEFINITION: Gynecologic oncology refers to a subspecialty of obstetrics and gynecology that deals with the diagnosis and comprehensive surgical and chemotherapeutic treatment of cancers originating from the female reproductive system and the complications thereof. Gynecologic oncology utilizes traditional surgical as well as chemotherapeutic and technological innovations to accomplish this. Additional (adjuvant) treatment before or after surgery is carried out as needed with other oncologic specialties such as radiotherapy oncology.
Cancers treated: All cancers of female reproductive system origin, including vulvar, vaginal, cervical, endometrial, tubal, and ovarian cancers; hydatidiform moles (gestational trophoblastic disease)
Training and certification: To be recognized and certified as a gynecologic oncologist, a candidate (fellow) must first finish an accredited four-year postgraduate residency training program in obstetrics and gynecology. An aspiring candidate must demonstrate excellent surgical technique and skill in carrying out procedures and have extensive knowledge of cancer's clinical and cellular behavior. The candidate must carry out clinical and laboratory research during the fellowship, which requires a comprehensive understanding of research designs and biostatistics and how to evaluate research articles, conduct original research, and write reports.
The American Board of Obstetrics and Gynecology (ABOG) is the regulatory organization responsible for graduate medical education programs for gynecologic oncology. The board requires training programs to be at least thirty-six months in duration and cover knowledge and skills the board deems essential for providing the most effective care for patients. Education is accomplished through formal subspecialty teaching conferences, seminars, didactics, teaching rounds, supervised management of patients in both inpatient and outpatient settings, and performance of subspecialty-specific procedures. Clinical or laboratory research projects are also a part of the curriculum, and time is allotted for this during training. For certification, the board evaluates candidates’ knowledge base through written and oral examinations and skills through case lists and experience logs kept by the candidate. Certifications in gynecologic oncology are renewed every six years.
Services and procedures performed: Gynecologic oncologists evaluate patients and conduct the diagnostic tests necessary to ascertain the type and stage of cancer, aiming to implement a definitive intervention. These tests may include a pregnancy test in women of reproductive age, chest X-rays, an intravenous pyelogram when kidney involvement is suspected, computed tomography (CT) scans, or magnetic resonance imaging (MRI) of the pelvis and other areas where cancer is clinically suspected to have spread, tumor marker tests, a colposcopy, and biopsies of suspicious lesions that do not require major surgery. The intervention, based on the initial diagnostic findings, may consist primarily of a surgical procedure with the intent to assess the spread of the cancer, remove as much tumor as possible, and repair any damage caused by the spread. Sometimes, a combination of chemotherapy and radiation therapy before or after surgery may be used, with radiotherapy coordinated with the radiation oncologist. A female patient suspected to have cancer of the reproductive organs is referred to a gynecologic oncologist by her primary care physician. The gynecologic oncologist focuses on the management of cancer.
Gynecologic oncologists must recognize cancer and derive the most effective treatment plan for the patient while minimizing unnecessary harm that can lower the quality of life. An essential part of treatment planning is the surgical staging of the cancer. This is generally an extension of the diagnostic plan but is also therapeutic in removing as much tumor as possible. The prognosis must be known so the most appropriate, research-based intervention can be determined based on the cancer stage.
The most common major surgical procedure performed by gynecologic oncologists is a hysterectomy, often with a salpingo-oophorectomyremoval of ovaries and Fallopian tubes. Women with preinvasive and less extensive disease who wish to bear children may elect to have only the diseased cervix or adnexa (ovary and Fallopian tube) removed. Other procedures include biopsies of small masses and wide excision of the external genitalia (vulva) and the surrounding skin and tissue in extensive tumors suspected of spreading microscopically, often through lymph drainage. These are often complex and complicated surgeries. Removing tumors arising from these organs can be challenging, especially with bulky tumors and those that have spread outside the reproductive system. A part of staging is the excision of specific groups of that drain the affected organs, as they can serve as accumulation points for cancer cells. Lymph node involvement often signifies a poorer prognosis, which means radiation, chemotherapy, or both may have to be instituted postoperatively.
Complications can arise from encroachment into nearby organs such as the bowel, urinary bladder, and urethra. These are an inevitable part of practice, and gynecologic oncologists are competent in surgical repair of these organs as well as reconstructive surgery of the external genitalia and vagina, as necessary. Reconstructive surgery seeks to preserve as much functionality as possible. Serious psychological effects on the patient’s self-image can result in disfigurement of the genitalia if left untreated.
Another part of a gynecologic oncologist’s experience is the palliative care of women with terminal conditions. Palliative treatments include surgery to remove as much tumor as possible, followed by radiation therapy to kill off remaining tumor cells and to alleviate pain.
Related specialties and subspecialties: Although the gynecologic oncologist is involved in specialized treatment, other specialists such as medical oncologists, radiation oncologists, gynecologic pathologists, and oncology nurses collaborate with the gynecologic oncologist in formulating an individualized treatment plan for the patient. Oncology nurses are specialized registered nurses who care for the patient as well as prepare and administer chemotherapy or biotherapy (for example, antibodies) to patients in as safe a manner as possible. They act as the main points of contact for the patient and family, monitor the patient’s progress during therapy, and educate the patient regarding their disease. Oncology nurses may be oncology-certified nurses (O.C.N.s).
Bibliography
Likis, Frances E., and Kerri Durnell Schuiling. Gynecologic Health Care. 4th ed., Jones and Bartlett, 2022.
Null, Gary. Women’s Health Solutions. Seven Stories Press, 2002. Berek, Jonathan S., and Neville F. Hacker. Berek & Hacker's Gynecologic Oncology. 7th ed., Lippincott Williams & Wilkins, 2021.
"Obstetrics and Gynecology." Mayo Clinic, 19 June 2024, www.mayoclinic.org/departments-centers/gynecologic-oncology/overview/ovc-20424080. Accessed 20 July 2024.
Tollefson, Michelle, et al. Improving Women’s Health Across the Lifespan. CRC Press, 2022.
"What is a Gynecologic Oncologist?" WebMD, 2 Mar. 2023, www.webmd.com/cancer/what-is-gynecologic-oncologist. Accessed 20 July 2024.