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Gynaecological Oncology Services

by

Thomas Ind

Consultant Gynaecological Surgeon

St George's & Royal Marsden Hospitals

 

Introduction

Gynaecological Oncology services in the UK are provided by primary health care teams, Cancer Units, Cancer Centres, and other health care providers. To fully understand how a patient's pathway is organised it is important to understand the cancer network and the professionals that work within each aspect of the network.

 

Primary Health Care Teams

Most patients present to their general practitioner. However, they may be seen by the practice nurse or another health care professional. For example, most smear tests are now performed by nurses.

 

When a general practitioner or a member of the primary health care team queries a possible gynaecological cancer the patient is referred to the local gynaecological cancer unit for assessment. This referral is normally done through the 'Two Week Rule' where the referral letter is faxed to the hospital which has an obligation to see the patient with two weeks of referral. A more recent method is by direct booking into consultants clinics via a computer network.

 

The department of health have issued guidelines as to what cases should be seen urgently. These are detailed below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Cancer Unit

The cancer unit normally sees patients and makes the  diagnosis. About 1 in 10 women referred to a hospital through the two week rule will actually have cancer. Some will have precancerous conditions such as atypical endometrial hyperplasia. The cancer unit will treat some of the cancers diagnosed and organise continuing care for those who do not have cancer if required.

 

In each cancer unit there is a lead clinician responsible for these patients. He/she liaises with the primary health care teams and the cancer centre. The cancer unit lead will normally have a colleague who assists during annual leave and a specialist nurse who also assists. There is a core team that usually meets at least fortnightly to discuss cases and consists of the gynaecologist, the nurse, radiologists, and pathologists.

 

The Cancer Centre

The cancer centre manages most (but not all) gynaecological cancers. The national guidelines recommend the following patients should be managed in the gynaecological cancer centre.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The cancer centre's team consists of a variety of people who work in a multidisciplinary group. The core team consists of the following;

• Gynaecological Oncology Surgeons

• Medical Oncologists

• Clinical Oncologists

• Palliative care physicians

• Clinical Nurse Specialists

• Histopathologists

• Radiologists

The extended team consists of

• Urological surgeons

• Colorectal surgeons

• Plastic surgeons

• Vascular surgeons

• Stoma therapists

• Counsellors

• Physiotherapists

• And others

In the cancer centre, the multidisciplinary team meets weekly and discusses every new patient.

 

The MDT

The MDT (Multidisciplinary Team Meeting) occurs weekly in the cancer centre. At this meeting all new cases are discussed. The aim of the meeting is to ensure that each patient is channelled through the correct speciality for their treatment (e.g. radiotherapy, chemotherapy, or surgery). Other aspects of care such as psychosocial support are also discussed.

 

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