Chapter 4: General Concepts of Surgical Management

The fact that you are reading this book is almost certainly because you or a relative have been diagnosed as having cancer. The process by which that diagnosis was made will, I know, have caused you great distress and seemed to have taken ages. For the majority of you, hopefully, it will have taken no more than a few weeks, but those few weeks will have been psychologically and/or physically painful and stressful. You will almost certainly have gone to your GP, perhaps with a swelling in your tummy or some irregularity of bleeding or perhaps with pain. Your GP will have examined you, performed tests and referred you either to a general gynaecologist or to some form of rapid assessment clinic or perhaps directly to a gynaecological cancer specialist. A gynaecological cancer specialist will be a highly trained surgeon who will have specially trained in the area and will be somebody who you can feel certain is up to date in modern management of gynaecological cancer, who understands the different types of treatment and will work within a large team of individuals. These teams meet at what are called multi-disciplinary team (MDT) meetings on a regular (weekly or fortnightly) basis. At these meetings there are usually a minimum of two or more surgeons, a radiotherapist, one or more medical oncologists who prescribe chemotherapy, a radiologist who takes and reads ultrasound scans, X-rays, computerised tomography (CT), positron emission tomography (PET)-CT, and magnetic resonance imaging (MRI) scans, specialist oncology nurses and a pathologist. All of these consultants may well have junior members in their respective teams who will also attend these meetings and who you may see during your care. These meetings ensure that the treatment that you are offered is the optimal treatment and so that no one group (e.g. the surgeon or the radiotherapist) can steer you into the wrong therapy…