Gynecologic Oncology

The treatment of cancers of the ovary, vagina, uterus, cervix, and vulva is the focus of the specialist medical discipline known as gynecological oncology. A gynecological oncologist is a medical professional with initial training as a gynecologist. Completing an OB/GYN residency is often part of additional training for a gynecological oncologist. After that, they receive more specialized training to gain a better understanding of the management of gynecological cancers.

A gynecological oncologist makes the best therapy recommendations and diagnoses patients with cancers of the ovaries, vagina, uterus, cervix, and vulva. Gynecological oncologists examine a patient's reproductive organs for tumors to see if the disease has migrated to other body parts.

In order to provide integrated care, gynecological oncologists frequently collaborate with other medical professionals. They discuss with patients the cancer treatment options that are available and which ones could be appropriate for their specific condition.  (1)

Definition and Overview

Gynecological oncology defines and treats cancers and precancers of the vulva, vagina, cervix, ovaries and endometrium (intrauterine) of gynecological oncology.

The multidisciplinary team (MDT) for gynecologic oncology is a team of clinical nurse specialists and research nurses, as well as professionals such as oncologic surgeons, medical and clinical oncologists, radiologists, and pathologists. The professionals in gynecologic oncology collaborate with those in urology, colorectal surgery, and anesthesia. They offer the patient the opportunity to take part in current clinical trials - screening for cervical, womb, and ovarian cancers and treatment for ovarian cancers. (2,3)

Procedures

There are various treatment procedures involved in the field of gynecologic oncology. Here are some commonly performed procedures:

• Surgery

Surgery is sometimes used as a part of the treatment plan to remove as much of the tumor as possible. Since there will be fewer cancers to treat, minimizing the tumor improves the effectiveness of chemotherapy or radiation therapy.

Gynecological cancer specialists are experts in minimally invasive procedures like robot-assisted surgery and advanced laparoscopic surgery that can help patients heal more quickly and resume their normal lives.

Surgery usually involves removing the tumor. However, in some cases, the doctor may also choose to surgically remove the cervix, uterus, ovaries, or other pelvic organs.

Gynecologic cancer surgical treatments include:

• Debulking surgery
• Total hysterectomy
• Radical hysterectomy
• Unilateral salpingo-oophorectomy
• Bilateral salpingo-oophorectomy
• Omentectomy
• Lymph node removal
• Radical vulvectomy
• Fertility-preserving surgery for cervical cancer

The specific surgery performed may vary depending on the type and stage of the gynecological cancer the patient has.

• Medicine

For some women with gynecological cancer, cancer treatments with drugs are applied, depending on the type and stage of the cancer. Gynecological oncologists may administer some medication treatments.

• Chemotherapy: It uses drugs that are usually injected into a vein or given by mouth
• Immunotherapy: It involves strengthening the immune system to help the body better fight gynecological cancer.
• Hormone therapy: t is the use of hormones to treat and prevent the recurrence of certain types of gynecological cancers.
• Intraperitoneal chemotherapy: It is a treatment that delivers chemotherapy drugs directly into the abdominal cavity through a catheter.
• Radiation

For most gynecological cancers, radiation therapy is used as primary therapy, whether administered as primary or curative therapy or as adjuvant therapy following surgery. This method uses high-energy X-rays or other forms of radiation to target and destroy cancer cells. Depending on the patient's specific needs, it may be applied internally (brachytherapy) or externally (external beam radiation). (4)

Candidates

Patients with the following symptoms should contact a gynecological oncologist immediately. If patients with symptoms are diagnosed, they are treated with a personalized treatment plan. These symptoms include

• A non-healing wound in the vaginal area,
• Unusual amounts of vaginal discharge or bleeding, especially after starting menopause,
• Persistent bloating or indigestion,
• Changes in the pattern of bladder or bowel movements,
• Pain in the pelvic area,
• A lump that can be seen and felt or is painful.

Depending on the symptoms, a gynecological oncologist will usually examine the reproductive organs. The doctors may order follow-up tests or imaging to confirm a diagnosis. They generally work with other healthcare providers, such as hematologists/oncologists and radiation oncologists who specialize in cancer treatment. (5)

Risks and Side Effects

Before having any surgery, it's crucial to go through potential risks with a healthcare professional. The following are some widespread risks and side effects associated with gynecologic oncology procedures:

• hemorrhage,
• infection, 
• thromboembolism, 
•  poor sexual functioning,
• damage the vaginal tissues, nerves, or blood vessels
• visceral damage. (6,7)

Post-Procedure and Follow-up

In the treatment of gynecological oncology, the post-procedure and follow-up process are of great importance for the management of possible complications, long-term care and monitoring of the healing process. Post-procedure care and follow-up may differ depending on the type of treatment and the specific needs of the patient. Following surgery, the patient is monitored in the hospital for a while to ensure stable vital signs, effective pain treatment, and proper wound healing.

The size and complexity of the procedure will determine how long the patient has to stay in the hospital. A follow-up appointment will be set up by the healthcare provider to evaluate the patient's progress and recuperation. The frequency and duration of these appointments will depend on the specific treatment and individual needs. These appointments allow the healthcare team to monitor healing, address any concerns or complications, and provide guidance for further treatment or management.

Recovery

Depending on the type of surgery done and the patient's unique conditions, the recovery period may differ. Depending on the type of treatment, the physical recovery process may take many weeks or even months. It is important for patients to follow their healthcare provider's instructions regarding rest, wound care, and activity restrictions, and gradually resume normal activities.

Results

The recovery process may also involve addressing the emotional and psychological aspects of cancer treatment. Counseling, support groups, or other forms of supportive care may be helpful to patients in coping with the emotional effects of diagnosis and therapy.

Gynecological oncology treatments are primarily intended to produce the greatest results and enhance the patient's quality of life.

For each patient, this can imply something different, from managing the illness as a chronic condition to achieving total remission.

The healthcare team will collaborate closely with the patient to create a detailed treatment plan that takes into account all of the patient's objectives and worries.