Ob/Gyn-Oncology: Gynecologic Cancer Specialists – Training, Scope & Treatments

What Is Gynecologic Oncology?

Gynecologic oncology is a subspecialty of obstetrics and gynecology focused on the diagnosis, treatment, and research of cancers affecting the female reproductive system: uterus (endometrium), cervix, ovaries, fallopian tubes, vagina, and vulva.

Scope of Practice

Gyn oncologists manage:

• Malignant conditions: Endometrial, ovarian, cervical, vulvar, vaginal cancers; gestational trophoblastic disease; uterine sarcoma.
• Premalignant/complex benign: High-grade CIN/AIS, complex atypical endometrial hyperplasia, ovarian tumors of low malignant potential.
• Related symptoms: Abnormal uterine bleeding, pelvic masses, postmenopausal bleeding, genetic risk (BRCA, Lynch syndrome).

Training Pathway (US)

1. Medical School: 4 years (MD/DO)
2. Ob/Gyn Residency: 4 years (ACGME-accredited)
3. Gyn Oncology Fellowship: 3 years (ACGME-accredited) – includes surgical oncology, chemotherapy management, radiation oncology, palliative care, research.
4. Board Certification: ABOG written & oral exams in Gynecologic Oncology.

Total: 11+ years post-undergraduate.

Diagnostic Modalities

• Pelvic exam, colposcopy, cervical biopsy/LEEP/cone
• Imaging: Transvaginal US, CT/MRI/PET-CT, diagnostic laparoscopy
• Biomarkers: CA-125, HE4, CEA, CA 19-9, β-hCG, AFP
• Genetic testing: Germline & tumor molecular profiling

Treatment Modalities

Surgery (Core Competency)

• Radical hysterectomy (open, laparoscopic, robotic), pelvic/para-aortic lymphadenectomy
• Omentectomy, bowel resection, splenectomy, diaphragmatic stripping (advanced cytoreduction for ovarian cancer)
• Sentinel lymph node mapping (SLN) for endometrial/cervical cancer
• Vulvectomy, vaginectomy, pelvic exenteration (recurrent/pelvic recurrence)

Systemic Therapy

• Chemotherapy: Platinum/taxane backbone; dose-dense regimens; IP chemotherapy (ovarian)
• Targeted: Bevacizumab (anti-VEGF), PARP inhibitors (olaparib, niraparib, rucaparib – BRCA/HRD+), Mirvetuximab (FRα+ ovarian)
• Immunotherapy: Pembrolizumab (MSI-H/dMMR, PD-L1+ cervical/endometrial)
• Hormonal: Progestins, aromatase inhibitors (low-grade endometrial, recurrent)

Radiation Therapy

• External beam (EBRT), brachytherapy (intracavitary/interstitial), SBRT for oligometastases

Research & Multidisciplinary Care

• Lead/participate in NRG/GOG clinical trials
• Tumor boards: pathology, radiology, radiation oncology, medical oncology, genetics, palliative care
• Survivorship programs: lymphedema management, sexual health, fertility preservation, psychosocial support

When to Refer

Any suspected or confirmed gyn malignancy, complex premalignant disease, hereditary cancer syndrome, or need for radical pelvic surgery.