What is a Gynecologic Oncologist?

A gynecologic oncologist is an obstetrician/gynecologist who specializes in the diagnosis and treatment of women with cancer of the reproductive organs. After completing a four-year residency in obstetrics and gynecology, gynecologic oncologists complete an additional three-year fellowship specializing in cancerous conditions of the GYN tract. Surgical skills required to properly stage and remove the majority of the tumor, as well as chemotherapy and radiation therapy techniques are learned and practiced at the highest skill level. This training uniquely qualifies gynecologic oncologists to care for women with cancer of the reproductive tract.

• Link to Minnesota Gynecologic Oncologists and Specialists in the Treatment of Gynecologic Cancers

Gynecologic Oncologists Provide Optimal Surgical Care  

The preeminent standard of care for women with ovarian cancer includes definitive surgical staging and optimal tumor removal.¹

• Studies conducted over the past decade have documented the superiority of surgical staging and overall survival in early and advanced stages of ovarian cancer when the surgery was performed by a gynecologic oncologist.¹
• A March 2002 study affirmed that extended formal training of gynecologic oncologists translates into optimal resection rates that are 50 percent to 60 percent higher than in other specialties. ²

Gynecologists and cancer experts both agree that when ovarian cancer is suspected surgery should be performed by a gynecologic oncologist. ³

• A recent opinion from the American College of Obstetricians and Gynecologists Committee and the Society of Gynecologic Oncologists recommends that when a woman presents with a suspicious or persistent complex adnexal mass, a physician trained to appropriately stage and debulk ovarian cancer, such as a gynecologic oncologist, should perform the operation.³
• The National Cancer Institute’s support is even stronger, with its statement that surgical intervention is best conducted by a qualified gynecologic oncologist when there is a high probability of ovarian
  cancer. ¹

A study done on the management of ovarian cancer showed that gynecologic oncologists were almost five times more likely to completely debulk ovarian tumors than were their non-specialist counterparts.

• In fact, many general surgeons were found to have only performed a biopsy, leaving patients with a stronger likelihood of retaining residual disease of greater than two centimeters after the operation.⁴ Women whose tumors have been reduced to less than 2 cm have shown to have a better response to chemotherapy and improved survival rate. ⁵

A 1993 study showed that gynecologic oncologists were twice as likely to perform the multiple peritoneal and lymph node biopsies necessary to permit adequate surgical staging than were other surgeons. ⁶

• The absence of lymphadenectomy and assignment of histologic grade are the primary reasons up to 75% of women with stage I and II ovarian cancer do not receive proper staging and treatment.⁷

According to a study done by the American College of Surgeons, almost 80% of women with ovarian cancer are treated by a non-gynecologic oncologist surgeons who perform adequate surgical staging in only 12 to 25% of the patients they treat. ⁶

• In a review of ovarian cancer cases referred by non-oncologists, it was found that grossly inaccurate staging and information often was obtained.⁶
• The majority of women with ovarian cancer do not have surgery done by a properly trained specialist. The most recent survey of patients in Utah between 1992-1998 revealed that only 39 percent had surgery performed by a gynecologic oncologist.²

Another study published in 1992 showed older women in particular suffered when a non-specialist performed their surgery.

• Seventy-nine percent [34 of 43] of women over 65 years old operated on by gynecologic oncologists had the majority of their tumors surgically removed, compared to only 15% [9 of 60] operated on by other physicians. Gynecologic oncologists also more frequently performed procedures that were required to attain optimal tumor removal for women whose cancer has spread to their intestines or diaphram. ⁵

Improved Survival Rates with Surgery by a Gynecologic Oncologist

The improved survival of women whose surgeries are performed by gynecologic oncologists is a result of their tendency to perform more aggressive surgical techniques, and consequently realize more optimal treatment outcomes. Treatment by a physician other than a gynecologic oncologist can lead to compromises in care and survival, and increased costs due to unnecessary and inadequate procedures and treatment.

• A Meta-analysis drawing on the data from a variety of studies found that women whose surgery was performed by a gynecologic oncologist had a median survival time of 50% longer than women whose surgery was done by a general gynecologist or other surgeons inexperienced in optimal debunking procedures.²

A 1999 Scottish study showed significant benefits for women treated by gynecologic oncologists, especially for the 44% of women who present at stage III.

• This study, based on 621 deaths over seven years, showed a reduction in death rates of 25% for those women operated on by a gynecologic oncologist, and a 32% increase in death rates for women operated on by other surgeons. In addition, women treated by a gynecologic oncologist showed mean survival rates one-third longer than those treated by a OB/GYNs. The study authors suggest that the incredible success rates of gynecologic oncologists are probably due to the three factors: the extent of surgery, more success in removing the majority of tumor, and more effective chemotherapy. ⁸

This 1999 study also showed that women with Stage III cancer treated by gynecologic oncologists had a mean survival of 18 months compared with 13 months for those treated by gynecologists.

• Since 66% of ovarian cancer deaths occur in women with stage III disease, any improvement in this group makes a substantial contribution to overall improvement in survival for women with ovarian cancer, and would justify the need for gynecologic oncologists. ⁸

Five-year survival and disease-free intervals for women whose surgeon was a gynecologic oncologist far surpass the rates for women treated by a non-oncologist, OB/GYN groups.

• Women whose surgery was performed by a gynecologic oncologist had five-year survival rates after surgical treatment only, which parallel those rates found in studies of women utilizing radiation or chemotherapy in addition to their surgery. One reason behind these startling statistics is the fact that frequently, non-oncologic surgeons overlook ovarian malignancy in the preoperative clinical diagnosis of a pelvic mass. ⁹

1. Podratz, K.C., Gynecologic Oncology: On the Eve of the New Millennium, Gyec. Oncol. 74, 157-162 [1999]; Ovarian Cancer: Screening, Treatment and Follow-Up, NIH Consensus Statement. Volume 12 [3], 1-14 [1994].
2. Bristow RE, Tomacruz, RS, Armstrong DK, et al: Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: A meta analysis. Journal of Clinical Oncology 20: 1248-1259, 2002.
3. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice in conjunction with the Society of Gynecologic Oncologists. “The Role of the Generalist Obstetrician – Gynecologist in the Early Detection of Ovarian Cancer” by Gynecologic Oncology 87, 237-239 [2002].
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6. Averette, H.E., Hoskins, W., Nguyen, H.N., Boike, G., Flessa, H.C., Chmiel, J.S., Zuber, K., Karnell, L.H., Winchester, D.P. National Survey of Ovarian Carcinoma: A Patient Care Evaluation Study of the American College of Surgeons, Cancer. 71[4] 1629-1637 [1993].
7. Munoz, K.A., Harlan, L.C., Trimble, E. L. Patterns of Care for Women With Ovarian Cancer in the United States, J. of Clinical Oncol. 15 [11] 3408-3415 [1997].
8. Junor, E.J., Hole, D.J., McNulty, L., Mason, M. Young, J. Specialist Gynaecologists and Survival Outcome in Ovarian Cancer: A Scottish National Study of 1866 Patients, British Journal of Obstetrics and Gynaecology. 106, 1130-1136 [1999].
9. Mayer, A.R., Chambers, S.K., Graves, E. Holm, C., Tseng, P.C., Nelson, B.E., Schwartz, P.E. Ovarian Cancer Staging: Does it Require a Gynecologic Oncologists?, Gynec. Oncol. 47, 223-227 [1992].