Who Might Benefit from Consultation with a Gynecologic Oncologist?

Gynecologic Oncologists are most experienced in the diagnosis and management of reproductive tract cancer. In 2000, guidelines for referral to a Gynecologic Oncologist were developed, and published in the journal Gynecologic Oncology. These guidelines are summarized below for common gynecologic conditions.
 
Endometrial Cancer
Patients with a diagnosis of endometrial cancer could benefit from pre-surgery referral to a gynecologic oncologist. The most appropriate surgical approach, extent of surgery, and possible need for treatment after surgery can be discussed. Removal of lymph nodes at the time of surgery may provide a treatment benefit, and will guide subsequent treatment (radiation, chemotherapy) in a most accurate fashion. A review of the experience at Florida Gynecologic Oncology suggests that patients receiving care by a gynecologic oncologist were more likely to obtain complete staging information at the time of their operation, and less likely to require radiation therapy afterwards.

Pelvic Mass

Patients with masses that are suspicious for malignancy may benefit from pre-operative referral to a gynecologic oncologist. Findings that suggest an increased risk for cancer include:

 

  • Large pelvic mass (size > 10 cm)

  • Postmenopausal women with suspicious masses 

  • Postmenopausal women with abnormal tumor marker blood tests (CA-125) 

  • Young women with a pelvic mass and elevated tumor markers (CA-125, AFP, hCG) 

  • Masses with suspicious findings on ultrasound or CT scan (solid areas, surface excrescences) 

  • Suspicious masses in women with a family or personal history, of ovarian or breast cancer Ovarian Cancer 

 

Gynecologic oncologists receiving extensive training in all aspects of ovarian cancer care including surgical removal of cancer, and administration of chemotherapy after the operation. A recent NIH Consensus Panel opinion states "Adequate and complete surgical intervention is mandatory primary therapy for ovarian carcinoma, permitting precise staging, accurate diagnosis, and optimal cytoreduction. This report indicates that all women with a suspected ovarian cancer should be offered a preoperative consultation with a gynecologic oncologist."

Cervical Cancer

The optimal treatment of cervical cancer begins with obtaining an accurate diagnosis of the presence, and extent, of malignant cells on the cervix. Very early cancer can often be treated with limited surgery, preserving fertility in select patients. Localized and advanced cervical cancers benefit from the appropriate use of treatments including radical surgery, staging, chemotherapy, and radiation. Gynecologic oncologists provide expertise in the optimal management of cervical malignancy. Women likely to benefit from pre-treatment consultation with a gynecologic oncologist include:

 

  • Cases with a visible growth, or tumor, on the cervix 

  • A Pap test suggesting invasive cancer 

  • A cervix biopsy showing invasive cervix cancer

Vaginal Cancer
Cancer of the vagina is the least common reproductive tract malignancy, representing 1 to 2% of all gynecologic cancers. Women that may benefit from pre-treatment consultation with a gynecologic oncologist include:

 

  • Women with abnormal vaginal Pap smears, who are at increased risk for gynecologic cancer (DES-exposure, immunosuppression, history of lower genital tract disorders) 

  • Unexplained abnormal vaginal cancer screening tests (Pap tests) 

  • High grade abnormal vaginal lesions (vaginal dysplasia) requiring vaginectomy 

  • All women with invasive vaginal cancer

Vulvar Cancer

Early diagnosis of vulvar cancer increases the chance for cure. Important treatment decisions include the extent of surgery to remove the cancer, and management of groin lymph nodes that are at risk for cancer spread. Patients that may benefit from consultation with a gynecologic oncologist include:

 

  • Suspicious vulvar growths, tumors, and ulcers 

  • Complex precancers (dysplasia) of the vulva 

  • Cases of Paget's disease of the vulva 

  • Women with invasive vulvar cancer

References

Guidelines for referral to a gynecologic oncologist: Rationale and benefits. Gynecologic Oncology. Volume78, Number 3, September 2000.

 

NIH Consensus Conference: Ovarian cancer: screening, treatment, and follow-up. JAMA 6:491-497, 1995.

 

PY Roland, FJ Kelly, et al. The benefits of a gynecologic oncologist: A pattern of care study for endometrial cancer treatment. Gynecologic Oncology. Volume 93, 2004, pages 125-130.