HISTORY OF GYNECOLOGIC ONCOLOGY SUBSPECIALTY

Gynecologic oncology, as a subspecialty within the discipline of obstetrics and gynecology, was defined 30 years ago. In 1969 the American Board of Obstetrics and Gynecology recommended the development of three specialties, which included gynecologic oncology, fetal maternal medicine, and reproductive endocrinology. Three separate divisions were therefore created; each division had a specific goal to develop a postresidency training program leading to certification. In 1972 the American Board of Obstetrics and Gynecology defined the qualification and eligibility necessary for certification of special competence in gynecologic oncology, maternal fetal medicine and reproductive endocrinology. Authorization to certify for special qualification in this field was approved by the American Board of Medical Specialties in March 1973.

In addition to the efforts made to expand the discipline of obstetrics and gynecology, there have been major developments in establishing societies that improve training and research activities. The Society of Gynecologic Oncologists was established in late 1960 and had its first scientific meeting in January 1970. The main goals of this society were advancement of research in the area of female genital neoplasm and establishment of a formal training program, leading to certification in the specialty. In 1970 the Gynecologic Oncology Group was founded, with a specific role to coordinate the research effort of various institutions in the United States. From 1970s until today, the Society of Gynecologic Oncologists and the Gynecologic Oncology Group have made major contributions in the United States in terms of establishing standard therapies, development and improvement of training programs, and coordination of research activity within the subspecialty. Similarly, following the example of the United States, many other countries have now established national gynecologic oncology societies. In particular, the International Society of Gynecologic Cancer has made many major contributions in the development of collaborative research projects and educational activities during the past few years at an international level.

Today the management of gynecologic malignant neoplasm requires a multidisciplinary approach, which includes surgery, chemotherapy, and radiotherapy. The Gynecologic Oncology fellowship is a 3-year program that involves 1 year of research and 2 clinical years. During the subspecialty training program, the physician should learn to understand and perform radical pelvic surgery, including intestinal and urology procedures, pertinent to gynecologic oncology. The gynecology oncologist is trained to:

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  Manage vaginal, intestinal, and urologic problems because they may be encountered during elective surgical procedures because of the nature of the procedure or the growth of the tumor into adjacent organ systems
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  Deliver chemotherapy and monitor patients receiving chemotherapy treatment to assess the frequency of treatment and the need for surgical intervention
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  Understand the principles of radiation therapy and work directly with the radiation oncologist who administers the treatment

For all of these reasons, it is very important that the gynecology oncologist is directly involved in the management of patients before, during, and after surgery.

This issue of the Surgical Clinics of North America describes the most common surgical procedures performed by the gynecology oncologist, including the management of intraoperative and postoperative complications related to the care of patients with gynecologic cancer. During the past 30 years, there have been several changes to the management of gynecologic cancers, which have led to improved outcomes. The main contributing factors are described here for each organ.