Advanced Treatments in Gynaecologic Oncology

Gynaecologic cancer surgery has moved through three distinct eras in the space of two decades: open surgery, then laparoscopic surgery, and now robotic surgery. This guide draws on a Jivo Masterclass by Dr. Archit Pandit, Director of Surgical Oncology at Fortis Escorts, New Delhi, who trained at the All India Institute of Medical Sciences and has led robotic and laparoscopic cancer surgery programmes treating patients from India and several African countries.

What this series covers

This series follows Dr. Pandit's own masterclass: the four gynaecologic cancers a general practitioner needs to recognise, the shift from open to robotic surgery, HIPEC and why it changed outcomes in advanced ovarian cancer, HPV vaccination and cervical cancer prevention, the diagnostic tests now used to stage and screen for cancer, targeted therapy and immunotherapy, the four red flags that should prompt a referral, the real cost of surgery and treatment, a set of complex international cases, and the referral pathway available to doctors outside India.

Four cancers, one specialty

Gynaecologic oncology treats four principal cancers: cervical cancer, which arises just below the uterus; ovarian cancer, which is frequently diagnosed late because the ovary has ample room in the abdomen to grow before producing symptoms; endometrial cancer, whose incidence is rising alongside childhood obesity and reduced physical activity; and vulval and vaginal cancers, which are rarer but closely linked to sexually transmitted infection.

From open surgery to the robotic console

India has performed laparoscopic gynaecologic cancer surgery for roughly two decades and robotic surgery since 2021, a period in which Dr. Pandit's own team has completed 100 to 200 robotic gynaecologic cancer cases. Fertility-sparing surgery, which preserves the uterus or ovaries in early-stage cancer, and sentinel lymph node dissection using ICG dye, which removes only the lymph node the tumour actually drains to rather than the full nodal chain, have both reduced morbidity and shortened hospital stays without compromising outcomes.

HIPEC: the advance that changed late-stage ovarian cancer

Hyperthermic intraperitoneal chemotherapy, HIPEC, circulates chemotherapy heated to 41 to 43 degrees Celsius through the abdominal cavity for 60 to 90 minutes, immediately after a surgeon has removed every piece of visible tumour. It targets the microscopic disease left behind that the eye cannot see. Fortis has performed cytoreductive surgery with HIPEC for 15 to 20 years, and over the last decade the therapy has become central to treating ovarian cancer diagnosed at stage 3C or 4, improving both progression-free and overall survival. Of the six cancers where HIPEC applies, colon, rectal, stomach, peritoneal and appendiceal cancers alongside ovarian cancer, only ovarian and endometrial cancer fall within gynaecologic oncology. It has no role in cervical cancer.

Prevention and early referral do more than any single surgery

Cervical cancer is the one gynaecologic cancer that is genuinely preventable, through HPV vaccination given between the ages of 9 and 26, and through regular pap smear and HPV screening. Four findings should prompt an oncology referral in general practice: bleeding after menopause, any palpable pelvic mass, an abnormal pap smear or HPV positivity that isn't followed up, and a family history of ovarian, breast or endometrial cancer. On the diagnostic side, PET-CT, BRCA and HRD genetic testing, MSI testing and next-generation sequencing are now available at several centres in India, alongside targeted therapy and immunotherapy drugs that act only on tumour cells.

A referral pathway between India and Africa

Dr. Pandit's hospital runs a structured referral and second-opinion programme for doctors and patients outside India: reports are shared in advance, and either a virtual consult is arranged or the referring doctor joins by video call while the patient is physically present at their own clinic. General physicians can also join as observers to see how a tumour board, a multidisciplinary meeting that reviews each case against current world literature, actually operates. Looking for a second opinion or referral pathway in gynaecologic oncology? Get in touch with the Jivo team.