Gynaecological Cancer Surgery
In Australia, a gynaecological oncologist is fully trained obstetrician & gynaecologist
who completed another three years of training in pelvic surgery exclusively. This training mainly
includes surgery to the female reproductive organs, the bowels and the urinary system.
A gynaecological oncologist will perform surgery mainly for suspected or proven gynaecological cancer
if required will arrange for chemotherapy or radiotherapy.
I am a RANZCOG Certified Gynaecological Oncologist (CGO) and as such I have extensive experience
in the management of gynaecological malignancies and in performing surgical procedures for gynaecological cancer.
This includes surgery for carcinoma of the uterus, the uterine cervix and the vulva/vagina.
I also perform surgery for ovarian cancer and suspicious pelvic masses on a regular basis.
Pelvic masses are suspicious if they occur in older patients, show suspicious features on medical
imaging (ultrasound or CT scan), if patients have an elevated CA125 blood test or if patients present with
a combination of these parameters. These patients benefit from the input of a gynaecological oncologist because
only the subspecialist for gynaecological oncology is able to treat the patient according to the international
standard without unnecessary delay.
Laparoscopic Surgery for Gynaecological Cancer
I had the honor and the privilege of having been taught by a number of magnificent surgeons
introducing me not only to the conventional “open” surgery by laparotomy but also to various laparoscopic
(“key hole surgery”) techniques. Since 2003 I perform independently
and teach a wide range of laparoscopic operations including total laparoscopic hysterectomy,
laparoscopic ovarian cystectomy and oophorectomy,
laparoscopic radical hysterectomy and laparoscopic pelvic and aortic lymphadenectomy.
However, not all patients can be safely treated by
laparoscopy and it needs experience to decide the best treatment for each individual patient.
Currently,
we investigate if a laparoscopic or an open approach is the best treatment for uterine cancer.
This is done as part of a phase 3 clinical trial (www.lacetrial.com).
I believe that the best option for patients with uterine cancer is to be enrolled into this trial.
Patients enrolled in clinical trials are looked after better and their prognosis is yet better
than patients who do not have access to the facilities of a clinical trial.
For more information on this clinical trial or on clinical trials in general, pls visit www.lacetrial.com.
Familial Cancer
I am involved in counseling and research of women who have a high familial cancer risk.
While 90% of all gynaecological cancers are spontaneous and not inherited, mutations in the BRCA1,
BRCA2 or mismatch repair genes (Lynch or HNPCC) typically cause cancers of the breast, ovary, uterus,
colon, pancreas or the urogenital system. These cancers occur at a younger age and arise in family clusters.
Normally, tumour supressor genes prevent cells from turning into cancer.
If one or both of these genes is defect, members of these families are more likely
to develop breast, ovarian, colon or uterine cancer at a younger age.
Counseling is essential because the management of these genetic changes may differ strongly
in women living in different circumstances or at different stages of their life.
Chemoprevention, close surveillance or prophylactic surgery are the main options.
The best way to deal with a genetic change can be very different depending on women's
circumstances - there is not one best solution, that would fit all.
Overview of Current Research Activity
- Retrospective Clinical Studies: These studies focus on rare tumours,
where only little information is available in the literature.
Patients with rare tumours are seen more often in the Queensland Centre for Gynaecological Cancer because our centre is one of the largest centres treating women with gynaecological cancer world-wide and documents several of those rare tumours every year. The knowledge accumulated by these studies helps us to improve the treatment for women with rare cancers further.
- Prospective Clinical Trials: Decisions on cancer treatment should be based on clinical trials whenever possible. As a principle, the new (investigative) treatment is compared to the current standard treatment. Patients are allocated randomly to one of the treatment types in order to avoid a selection bias. Outside the clinical trial the new treatment is not available until the trial has demonstrated a benefit over the current standard treatment. Generally, patients treated within clinical trials have a better outcome compared to patients who are not treated in clinical trials. As the Director of Research Gynaecological Oncology I am currently involved in developing and managing clinical trials in gynaecological cancers.
- Basic and Translational Research: The focus of the basic and translational research program is the application of new technology (molecular, biochemical, imaging and surgical) to prevention, detection and therapy for gynaecological cancers. I will ask patients to participate in these trials because I expect a benefit for future generations of cancer patients. I do not expect a benefit for my actual patient. My interest focuses on factors, which mediate tumour growth and metastasis.
- Quality of Life Research: Cancer specialists are aware that not only the survival time but also the quality of life is a key factor in cancer treatment. This is especially important when two treatments are equally effective but cause different side-effects. My Quality-of-Life research focuses on ovarian, endometrial and on vulval Cancer. I wish to provide the best, most effective and modern treatment to my patients with least possible changes in quality of life.
Teaching
Together with Dr. Anusch Yazdani, I have established a workshop of teaching
laparoscopic skills to gynaecologists. These workshops are held three to four
times a year in Brisbane. More information is available on
www.qimis.com.
I am a medical advisor to charitable organisations, as the Gynaecological Cancer
Society of Australia and the Austrian Cancer Society. I help in the preparation
of information leaflets and of written information for the WebPages of the Gynaecological
Cancer Society of Australia.
I have implemented a teaching programme in gynaecological oncology for Austrian and Dutch medical
exchange students in Brisbane. I also provide continuing medical education for medical
students, nurses and medical staff (Workshop Anatomy of Complications).
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