Director, Surgical Oncology, Fortis Escorts, Okhla, New Delhi
Part 6 of 11 in Advanced Treatments in Gynaec Oncology
Four Red Flags That Should Prompt a Gynaecologic Oncology Referral
Dr. Pandit's masterclass deliberately narrows the list of warning signs a general practitioner needs to memorise to four, arguing that a shorter list a doctor can actually recall in clinic is more useful than an exhaustive one nobody remembers.
Bleeding after menopause
Any woman who has reached menopause and then experiences bleeding should be tested, since this can be a sign of endometrial, that is uterine, cancer. This is the finding Dr. Pandit places first.
A pelvic mass found on examination or ultrasound
Any pelvic mass detected on a physical examination or an ultrasound scan should be investigated rather than watched, regardless of how the patient otherwise feels.
An abnormal pap smear or HPV positivity
An abnormal pap result or a positive HPV test should always be followed by a repeat pap or HPV test, to confirm the cervical changes are regressing rather than progressing. Leaving an abnormal result unaddressed is where early cervical disease is most often missed.
Family history of ovarian, breast or endometrial cancer
A family history of ovarian, breast or endometrial cancer, in a woman or a man, should prompt a referral to an oncologist, since these three cancers share overlapping genetic risk.
A deliberately short list
Dr. Pandit could have listed dozens of early signs and symptoms. He chose these four specifically because they are the ones a general practitioner is most likely to actually remember and act on in a routine consultation, rather than a comprehensive list that becomes easy to set aside.
This guide is based on a live Jivo Masterclass — Dr. Archit Pandit taught doctors across Africa on June 22, 2025.
FROM THE LIVE Q&A
Dr. William Gadaga (Zimbabwe)
How can general practitioners from Africa access surgical training courses at Fortis?
Dr. Archit Pandit
After clarifying the question was about medicine-side doctors rather than surgeons, Dr. Pandit said they can join as observers, since hands-on training in India is reserved for foreign doctors who are themselves surgeons or gynaecologists. Observers get an overview of cancer care spanning preventive health checkups, medical oncology and surgical oncology, and can join the hospital's tumour board, the round-table meeting where the full team reviews each case against the current world literature.
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Frequently Asked Questions
What can be done to improve overall healthcare delivery to doctors and patients across Africa?▼
Varun, the session host, said this reflects the underlying model of the collaboration: connecting Indian specialists using current-day technology and treatment processes with doctors across Africa to help achieve better medical outcomes, and offered to continue the conversation with Dr. Sunday directly after the session.
What is the cost range for laparoscopic surgeries for gynaecologic oncology cases, and does the hospital offer chemoradiotherapy, IMRT and VMAT?▼
Dr. Pandit said laparoscopic cancer surgery, including radical hysterectomy and hysterectomy, typically costs between $5,000 and $5,500, while procedures for endometriosis such as myomectomy range from $5,000 to $6,500. Fortis offers the full range of radiation oncology, including 3D-CRT, IMRT, IGRT, 3D-ARC, CyberKnife and tomotherapy, as well as brachytherapy, and has access to targeted therapy, immunotherapy and, at one centre in India, CAR-T cell therapy.
What is the utility of high-intensity focused ultrasound (HIFU) therapy for gynaecologic malignancies, is it available at your institution, and what does it cost?▼
Dr. Pandit said focused high-frequency ultrasound therapy is generally used for small fibroids rather than malignancy, which is his own area of focus, but confirmed Fortis does perform it, at a cost of $4,500 to $6,500.
What advancements has Fortis made for African patients with gynaecologic malignancies, and what are the most recent and frequent surgical treatments and their estimated costs?▼
Dr. Pandit said no treatment is specific to African patients as such, but pointed to cancer vaccination, for cervical, genital, vaginal and vulval cancers, as an area worth spreading in Africa. On surgery, he named HIPEC as the most significant advancement, now used for ovarian cancer along with peritoneal, appendiceal, colon, rectal and some stomach cancers, transforming outcomes over the last 10 to 15 years for patients previously diagnosed too late for treatment. He also pointed to robotic and laparoscopic surgery for retroperitoneal lymph node dissection, endometriosis and radical hysterectomy, and to sentinel lymph node dissection, which avoids removing the full set of pelvic lymph nodes. Surgical costs range from $5,000 to $7,000, and HIPEC surgery costs $11,000 to $12,000.
Since HIPEC is used from stage three onward, is it possible to use HIPEC or another technology to operate on a stage two cervical cancer patient?▼
Dr. Pandit said no, HIPEC is not used for cervical cancer at all. It is limited to six cancers: peritoneal, appendiceal, ovarian, colon, rectal and some stomach cancers, and of the gynaecologic cancers, only ovarian and endometrial cancer qualify. Cervical cancer is treated with surgery in its early stages, and with chemotherapy, radiation and sometimes immunotherapy from stage 2B onward.
In This Series: Advanced Treatments in Gynaec Oncology
- 1.Advanced Treatments in Gynaecologic Oncology
- 2.HIPEC: How Heated Chemotherapy Is Changing Outcomes in Advanced Ovarian Cancer
- 3.From Open Surgery to Robotics: The Shift in Gynaecologic Cancer Surgery
- 4.The Four Gynaecologic Cancers Every General Practitioner Should Know
- 5.HPV Vaccination and the Prevention of Cervical Cancer
- 6.Four Red Flags That Should Prompt a Gynaecologic Oncology Referral
- 7.Diagnostic Advances in Gynaecologic Oncology: Genetic Testing, PET-CT and AI
- 8.Targeted Therapy and Immunotherapy in Gynaecologic Cancers
- 9.Cost of Gynaecologic Cancer Surgery and Treatment in India
- 10.Complex International Cases in Gynaecologic and Surgical Oncology
- 11.Cross-Border Referral: How African Doctors Can Collaborate with Indian Gynaecologic Oncology Centres