Definition and Overview
A gynaecologic oncology consultation is an appointment with a gynaecologist who specializes in malignancies that originate or have spread to the female reproductive organs.
Gynaecology is the medical study of the female reproductive system, as well as the conditions or diseases that affect it, including cancers. Doctors who specialize in the field are called gynaecologists. Some of these medical professionals decide to pursue a fellowship or further training after they have completed their residency. One of these subspecialties is oncology, which refers to the diagnosis, treatment, and management of cancer.
Cancer that is detected in the female reproductive system is referred to as gynaecological cancer. Although it can affect any part of the system, it is more commonly detected in the cervix, vulva, vagina, endometrium, uterus and ovaries. In general, cancers develop due to the abnormal cellular growth and spread within the affected organ.
Who Should Undergo and Expected Results
A woman may consult a gynaecologic oncologist for the following reasons:
The gynecologist suspects or has confirmed cancer – A gynecological cancer may be detected or at least suspected following a biopsy, which refers to the collection of tissue samples for microscopic analysis of the cells. Under a microscope, these cells may appear abnormal and thus require further investigation with the help of an oncologist.
Treatment options need to be discussed – If cancer is confirmed, the next step is determining the best treatment method. Treatment options for gynaecologic cancers include surgery, chemotherapy, immune therapy, and radiation therapy. The patient may also be referred to clinical trials in case none of the standard options worked.
The patient has already been diagnosed with gynaecological cancer – At this point, the consultation focuses on the spread of the disease. For example, cancer that starts from the cervix may metastasize to the vagina. The consultation is necessary to monitor the progress of the condition.
The patient wants a second opinion – A cancer diagnosis is distressing for any patient, and thus, she may ask for another perspective from another doctor. A second opinion may also be sought in case the patient is not comfortable with the first doctor.
How Does the Procedure Work?
Before a patient sees a gynaecologic oncologist, she needs to be referred first by her gynaecologist. Prior to the referral, the patient must have completed various tests such as biopsy that suggest the presence of cancer.
During the actual consultation, the oncologist will review the results of the tests and this is typically followed by a short interview.
Some of the points discussed during the consultation include:
- Staging of the disease (more tests may be requested to determine this)
- Treatment considerations
- Risks and complications of each treatment
- Prognosis or outlook
- Management of the disease
- Complementary therapies
In cases where the cancer has reached the terminal stage, the consultation will focus on palliative care.
The oncologist may also refer the patient to other health care providers, such as surgeons and radiologists, who will then become part of her treatment team. The oncologist is also expected to coordinate closely with the gynaecologist, who is still in charge of the woman’s general reproductive health.
A typical consultation may last for at least 30 minutes. Usually, an oncologist and a nurse are present. In certain cases, a fellow or a resident may be in the room as well. The patient is encouraged to bring a companion such as a loved one or a caregiver. The patient may be scheduled for a number of consultations and these may go on until the treatment plan has been completed and the follow-up care commences.
Possible Risks and Complications
One of the possible risks and complications of this type of consultation is the non-appearance of the patient. This could be caused by many reasons including the overwhelming anxiety associated with being diagnosed and treated for cancer.
In some cases, patients are not able to continue with the other consultations due to the effects of the treatment, worsening of the disease, death, costs, and geography.
Freund K. Approach to women's health. In: Goldman L, Ausiello D, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 245.
Schrager SB, Paladine HL, Cadwallader K. Gynecology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 25.