THE GYNECOLOGIC ONCOLOGIST
Gynecologic Oncology Training:
With an ever increasing knowledge and treatment modalities associated with management of malignancies in female organs the specialty of gynecologic oncology was conceived and became reality over two decades ago. The American Board of Medical Specialties approved this as a specialty and set up fellowship training programs that followed strict criteria established by that Board. Training, originally, was for one year but has since been expanded to 2 - 3 years post-completion of an approved obstetrics-gynecology four year residency program.
Radical Pelvic Surgery:
Training involves extensive experience in radical pelvic surgery, including bowel resections and anastomoses, intestinal diversions, gastrogtomies, urinary diversions, ureteral implantations, urinary bladder removal, abdominal and pelvic lymphadenectomies and various other surgeries as splenectomies, pelvic reconstruction and plastic surgery.
Additional training includes comprehensive experience in administering chemotherapeutic agents and their attendant modes of delivery as well as managing severe life-threatening chemotoxicity. This latter areas requires an advanced knowledge in managing sepsis with antibiotics, fluid, electrolyte and metabolic therapy including advanced nutritional support systems. With recent advances in bone marrow support programs, a good working knowledge of chemotherapy dose intensification programs is essential so as to maximize chemotherapeutic responses with a reasonable degree of patient safety.
Training criteria include an in-depth knowledge of radiation physics, dosimetry and treatment techniques. Such training includes experience with external beam therapy, brachytherapy, radioactive needles, seeds and colloidal solutions and the specific indications for use in each of these modalities. Personal placement of these radioactive delivery systems is a part of the training experience. Training must include experience in managing radiation complications as genito-urinary and intestinal fistulae, ureteral and intestinal obstructions.
Although research is an integral part of most two-year fellowship training programs, a third year has been added to some programs specifically for advanced research opportunities.
Gynecologic oncology comprehensively includes diagnosis and management of malignancies in the vulva, vagina, cervix, uterus, tubes, ovaries and in many programs the breast.
After the required two year minimal post-obstetrical-gynecological fellowship training is completed board certification is offered via written and oral examinations. Upon successfully passing the examinations the physician is fully certified as a gynecologic oncologist who then is available for referral service.
Utilization of the Gynecologic Oncologist:
Ideally the gynecologic oncologist can be called upon to provide expert review in medical-legal issues involving gynecologic malignancy.