We all know there the stereotype of the medical oncologist, staring a cachectic cancer patient with stage 4 disease in the face, saying that there's one more clinical trial drug that can be tried. Are gyn oncs like this too?
are gyn oncs as "aggressive" in treatment as med oncs?
- Thread starter SandP
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Are you kidding? Gyn-oncs are known for being cowboys/girls, giving chemo with less training then medoncs, doing urologic surgery like urinary diversions with less training then urologists, etc. etc. They usually have a rep of being extremely surgically aggressive, debulking and operating on often fatal disease often with a very high complication rate.
That said, I get it. Gynecologic malignancies are often horrible, often advanced/aggressive on presentation, and often occur in younger patients. It's hard to tell that population that you're not going to try to help, even if odds of success are low.
That said, I get it. Gynecologic malignancies are often horrible, often advanced/aggressive on presentation, and often occur in younger patients. It's hard to tell that population that you're not going to try to help, even if odds of success are low.
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Strong disagree with above . On average Gyn oncs are appropriately aggressive for the diseases they treat. There will be variations with some being overly aggressive and some just saying we will give neoadjuvant chemo and see how it goes. They get more than sufficient training in surgical oncology, chemo (for gyn cancers only, a med onc fellowship is three years and they learn all of heme and all of onc, gyn onc does very limited chemo and learns everything about it in the same amount of time) and pelvic anatomy. I have never seen a gyn onc do a urinary diversion , but the ones that do probably got as many cases in fellowship as a general urologist does in residency often in much more hostile abdomens. I say this as a urogyn from a urology based fellowship program trained on diversions, reimplants, and bladder neck closures (which I could do competently but turf out cause they are not worth the trouble). They may seem aggressive because they disease they take care of is aggressive (ovary, appendiceal, peritoneal and cervical) and they are usually called upon to do the heavy lifting even in benign diseases (cesarean hysterectomies, stage IV endo etc). But the patient is the driver of the Hail Mary treatment in every field, including gyn onc. Just look at pancreatic cancer, it’s all basically futile with few exceptions but everyone does crazy 💩 to try to save all of them.
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This stereotype is about as accurate as the Ortho resident that doesn’t know what “A-sis-stoley” is…
IMO Gyn Onc is still a really cool field but I’d call it surgery first and chemo second. I could be wrong but I imagine if the chemo was as complicated as say, Breast Onc, then a lot of Gyn Oncs would start wanting us to manage it.
But that territory would be theirs to lose they have complete ownership of their patients unlike any other field of Oncology which is pretty cool. They don’t do the XRT but otherwise they’re a pretty one stop shop.
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Gyn-oncs tend to be more passionate and generally are more aggressive (not a ton, but willing to push patients) than medical oncologists, but your perception of medical oncology is dead wrong. No one does that ****.
The difference is patient population though. Gyn-onc patients can tolerate being pushed far more than a 70-80 y/o with advanced GI malignancy or metastatic lung cancer.
This minutiae here though is irrelevant. I am the most aggressive. Surg onc go yeet. And nowadays half of our pancreas cancer patients are alive at 2-5 years that we operate on up from 10% so... medium win?
The difference is patient population though. Gyn-onc patients can tolerate being pushed far more than a 70-80 y/o with advanced GI malignancy or metastatic lung cancer.
This minutiae here though is irrelevant. I am the most aggressive. Surg onc go yeet. And nowadays half of our pancreas cancer patients are alive at 2-5 years that we operate on up from 10% so... medium win?
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You're not doing your patient justice if you don't bring up the option of clinical trials. You offer it and let them choose whether to enroll or not. Being cognizant of all the available trials to put patients on is why we have such good results with PARPs and immunotherapy now vs. plain old carbo/taxol
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I find these generalized questions silly.
I have worked with 2 gyn oncs. One believed in directing the patient to die peacefully when it was apparent that further measures would in all reasonable likelihood only prolong a miserable existence a short while. The other hated the idea of “failure” and at all costs continued to discuss options and treatments over palliative care when at deaths door.
It’s more about the person than the field. FWIW I resonated with the logic and practice of the first.
I have worked with 2 gyn oncs. One believed in directing the patient to die peacefully when it was apparent that further measures would in all reasonable likelihood only prolong a miserable existence a short while. The other hated the idea of “failure” and at all costs continued to discuss options and treatments over palliative care when at deaths door.
It’s more about the person than the field. FWIW I resonated with the logic and practice of the first.
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