Gynecological Oncology (Surgery) (ROG_009)
About Study Course
Objective
To provide the trainee with knowledge and competence in the etiology, pathogenesis, diagnosis, treatment of precancerous diseases and oncological conditions, dynamic monitoring and prevention of gynecological oncological diseases.
Learning outcomes
1.Ovarian cancer.
Comprehensive knowledge of aetiology and clinical manifestations. Diagnostics of ovarian cancer (imaging, ultrasound guided biopsy, tumour markers, histological verification and cytological examination). Surgical management: indications, techniques (primary debulking surgery, interval debulking surgery, secondary cytoreductive surgery, fertility spearing surgery), complications. The role of laparoscopy in clinical assessment. Adjuvant and Neo-adjuvant chemotherapy. Multidisciplinary approach to cancer care. Management of ascites, hydrothorax, bowel obstruction. Palliative care.
Endometrial cancer.
Comprehensive knowledge of aetiology and risk factors including obesity, hyperestrogenemia and genetic predisposition. Histological types and prognosis of endometrial cancer. Preoperative work-up, including imaging, assessment of appropriate surgery plan. The role of radiation therapy in endometrial cancer treatment. Clinical trials in gynaecological oncology clinic, patient involvement. Endometrial cancer recurrence risk factors, treatment options. Rare uterine tumours: sarcomas.
Cervical cancer.
Comprehensive knowledge of epidemiology and aetiology. Pathophysiology, diagnostics, treatment, follow-up of cervical intraepithelial neoplasia (CIN). The role of HPV in CIN and cervical cancer development. Clinical manifestations, diagnostics and work - up and principles of treatment of cervical cancer, including surgical treatment, radiation and chemotherapy. Short-term and long-term side effects of treatment. Management of cervical cancer recurrence.
Vulvar cancer.
Comprehensive knowledge of epidemiology and aetiology, diagnostics techniques and staging. Comprehensive knowledge and skill in vulvar cancer treatment according to stage of disease, in complication detection and management. Relapse of disease - management. Long term complications after surgical treatment: lymphocysts, lymphostasis, neuralgia.
Gestational trofoblastic disease.
Classification, aetiology, epidemiology, histopathology and clinical manifestations of gestational trofoblastic disease. Progression of disease according to different forms of disease. Treatment options and complication. Interpretation of HCG levels. Surgery, radiation therapy, chemotherapy, resistance to chemotherapeutic agents, relapse of the disease, tactics, genetic and molecular markers of the disease.
Vaginal cancer.
Aetiology of vaginal cancer including botryoid sarcoma of vagina and metastatic tumours. Benign abnormalities of vagina, VAIN, multifocal malignancy, clinical features, investigation, FIGO stage detection and treatment.
Fallopian tube cancer.
Epidemiology, histopathology, clinical manifestations, diagnostics, staging and treatment.
Pre / peri / post / operative patient care.
Detailed knowledge of planning surgery, preoperative assessment including risk of anaesthesia and preparation for surgery. Peri-operative complications - prevention and management. Risk factors for major surgeries (surgical and anaesthetic risk). Post-operative care.
1.History taking: symptoms and concomitant diseases, family history, genetic predisposition. General examination of patient. Counselling patient with oncological diagnosis by informing and explaining investigation plan and possible treatment options including prognosis and possible complication and their impact to the quality of life. Clarification of examination results to the patient. Interpretation of screening results to the patient.
Recognition and management of intra-operative difficulties (bleeding, intestinal resection, an unexpected findings during surgery, non-operative tumour) and postoperative complications (intestinal obstruction, thrombosis, infection), prevention of complications. Assessment of fluid balance. Comprehensive skill in all surgical procedures used in gynaecological oncology. Surgical treatment of ovarian, endometrial, cervix, vaginal, vulvar, fallopian tubes cancer. Counselling patients and their relatives about the diagnosis, surgical treatment, possible complications, prognosis and further treatment options. Discharge letters for primary health physician. Providing optimal surgical treatment according to histopathological form and stage of the disease. Management of the relapse of disease. Discharge from the hospital and preparation a plan for further observation. Detection and treatment of physical and psychosexual illnesses.
Endometrial cancer.
Histological verification of endometrial cancer. Interpretation the results of examinations, including interpretation of MRI scan data, assessment of appropriate surgery plan.
Surgery for endometrial cancer including abdominal or laparascopical hysterectomy, bilateral salpingo-oophorectomy, iliac and paraaortic lymph node biopsy or dissection, omentectomy, explorative laparoscopy. FIGO staging system for endometrial cancer. Clarification of examination and treatment results to the patient. Indications for adjuvant therapy. Management of the relapse of disease.
Cervical cancer.
Performing colposcopy, cervical punch biopsy, LLETZ. Clinical staging for invasive cervical cancer. Surgical management of cervical cancer according to disease stage and risk factors: extrafascial hysterectomy, modified radical trachelectomy, or hysterectomy with pelvic node dissection, radical trachelectomy or radical hysterectomy with bilateral pelvic lymph node dissection, paraaortic lymph node biopsy. Interpretation of imagine examinations data. Assistance in treatment using radiation and chemotherapy. Recognition and management of side effects after treatment.
Assisting chemotherapy and radiation therapy for the treatment side-effect detection and treatment. Relapse treatment options. Management of the relapse of disease.
Gestational trofoblastic disease / chorioncarcinoma.
Vacuum aspiration to remove molar pregnancy. Staging, treatment plan, observation.
Vulvar cancer.
Examination of vulva, vulvoscopy, punch biopsy of vulva, partial vulvectomy, radical vulvectomy, deep inguinal lymph node dissection, vulvar wound closure principles, sentinel lymph node dissection, reconstructive vulvar surgical procedures in collaboration with plastic surgeons. Post-operative care.
Vaginal cancer.
History collection and examination of vaginal lesions. Vaginoscpy and vaginal biopsies. Ability to detect the stage. Interpretation imaging examination results. Treatment planning including radiation and chemotherapy. Informing patient about surgical treatment options (partial or radical vulvectomy), possible complications and influence to the quality of life
1.Comprehensive, evidence - based, knowledge of diagnostic, examination and staging of gynaecological tumours. Detailed knowledge and skill in preparing treatment plan according to diseases’ stage and histopathological type. Comprehensive knowledge, skill and experience in all surgical procedures used in gynaecological oncology. Knowledge and experience in preoperative assessment, preparation for surgery, detection and management of complications, providing post-operative care. Detailed knowledge of all imaging techniques used in gynaecological oncology including indications and interpretation
