1. Gynecologic Oncology New or Old subspecialty Samir Fouad Khalaf Professor OBGYN Al-Azhar University President www.ArabicOBGYN.net

2. Gynecologic Oncology A field of medical sub specialization that deals with the study and treatment of malignancies arising in the female reproductive tract, ovary, cervix, endometrium, vagina, vulva and trophoblstic diseases

3. During the second half of the 20 th. Century enormous progress has been made in the use of surgery, radiation therapy, chemotherapy and other treatment modalities for gynecologic cancers During the second half of the 20 th. Century enormous progress has been made in the use of surgery, radiation therapy, chemotherapy and other treatment modalities for gynecologic cancers Meanwhile, the field of obstetrics and gynecology grew into such an enormous field, clinically and scientifically, that it became impossible for one doctor to master both complicated obstetrics, infertility, surgery for benign conditions and the treatment of cancer Meanwhile, the field of obstetrics and gynecology grew into such an enormous field, clinically and scientifically, that it became impossible for one doctor to master both complicated obstetrics, infertility, surgery for benign conditions and the treatment of cancer

4. Gynecologic Oncology The field started in 1960s in the USA and the first certificate started to be given in 1974 The field started in 1960s in the USA and the first certificate started to be given in 1974 The field grows rapidly and many gynecologic Oncology Societies established. The field grows rapidly and many gynecologic Oncology Societies established. SGO was founded in 1969 SGO was founded in 1969 GOG founded in 1970 sponsored by the NCI and now have 50 centers and 160 affiliated institutes GOG founded in 1970 sponsored by the NCI and now have 50 centers and 160 affiliated institutes IGCS was founded in 1986 IGCS was founded in 1986 AGOS May 2006 AGOS May 2006

5. What is gynecologic Oncologist? What is gynecologic Oncologist?

6. Is a specialized obstetrician/gynecologist Therefore, gynecologic oncologists have had extensive training in providing care for women with and without cancer

7. Gynecologic oncologists are trained in providing comprehensive, multi-disciplinary care They are skilled surgical oncologists who also are trained in administering chemotherapy Therefore, they are able to provide an outstanding degree of continuity of care for their patients

8. Gynecologic oncologist is prepared to provide supportive services: - Pain management - Management of medical or surgical complications from treatment, - Management of complications of the cancer - Hospice referral

9. Gynecologic Cancers Gynecologic cancers represent 14% of all solid tumors in women and 11% of deaths from them. Gynecologic cancers represent 14% of all solid tumors in women and 11% of deaths from them. Cervical, uterine and ovarian cancer represent 95% of gynecologic cancers and collectively rank the fourth in both incidence and mortality among cancers that affect women in developed countries. Worldwide, these tumors account for even larger share of cancer mortality in women

10. Cervical Cancer Worldwide, it is the second most common cancer in women: Worldwide, it is the second most common cancer in women: 493,000 cases of cancer cervix compared to 1.15million cancer breast (2002) In developing countries cancer cervix account of 15% of all new female cancer compared to 3.5% in developed countries due to: - Socioeconomic differences - Behavioral differences - Presence of screening programs

11. Number of Cases of Cancer Cervix in Egypt, Jordan, USA USA1999-2001Jordan1996-2001Egypt1999-2001 5,28419496TotalPer100,000 Age distribution 48.4%44.3% 36.5% 36.5%30-49 30.2%41.8%52.1%50-69 15.0%11.9%9.4%70+

12. Endometrial Carcinoma Worldwide it represents 3.9% of female cancer Worldwide it represents 3.9% of female cancer It is more common in developed countries : 18/100,000 in USA & Canada compared to 6/100,000 in Africa and is related to: It is more common in developed countries : 18/100,000 in USA & Canada compared to 6/100,000 in Africa and is related to: - Prolonged high estrogen levels - Few number of children - Use of HRT

13. Number of cases of Endometrial Carcinoma in Egypt, Jordan, USA USA1999-2001Jordan1996-2001Egypt1999-2001 14,129405124Total/100,000 Age distribution 15.5%26.4%33.1% <50 <50 24.4%28.9%27.4%50-59 25.5%31.6%29.0%60-70 34.6%13.1%10.5%70+

14. Ovarian Carcinoma Epithelial ovarian carcinoma account for 90% of cases and is the leading cause of death in women with pelvic malignancies Epithelial ovarian carcinoma account for 90% of cases and is the leading cause of death in women with pelvic malignancies The incidence is higher in industrial countries of the world The incidence is higher in industrial countries of the world Women who are single and have low parity and a history of breast cancer are at risk Women who are single and have low parity and a history of breast cancer are at risk

15. Age-standard incidence rate of Ovarian Carcinoma in Egypt,Jordan,USA USA1999-2001Jordan1996-2001Egypt1999-201 10.04.65.4Total/100,000 3.22.12.5<50 33.514.117.750-69 52.717.314.970+

16. Women Knowledge about gynecologic Cancer Women Knowledge about gynecologic Cancer

17. Concerning about developing gynecologic cancer 87% concerned about developing cancer 52% very concerned 70% concerned about developing ovarian cancer 68% concerned about cervical cancer 66% concerned about uterine cancer

18. Knowledge about gynecologic cancer Despite their concern about developing gynecologic cancer - 30% feel they are not knowledgeable - 30% feel they are not knowledgeable - 55% feel they are only somewhat knowledgeable - 55% feel they are only somewhat knowledgeable - 14% say they are very knowledgeable - 14% say they are very knowledgeable

19. Information about Risk Factors 54% believe they are at risk in their lifetime 43% do not feel they are at risk Women aged 35-44 are most likely to report felling that they are at risk

20. 60%29%15%13%13%6%4%4%3%1%1%0% Not aware of any risk Hereditary/geneticSmoking Exposure to STD Multiple sex partners ObesityHormonesDiet Birth control pills Infertility Unsafe sex Tamoxifen

21. Factors decreasing risk 72%19%11%11%4%4%3%1%26% Not aware Healthy lifestyle/diet Regular check-up Pap smear Birth control pills Lack of family history CondomsPregnancyOthers

22. Awareness of Symptoms 47%31%20%9%5%1%4%25% Do not know Abnormal bleeding Pelvic pain Vaginal discharge Bloating No symptoms Painful intercourse Others

23. Women are uncertain of what type of specialist they would see if they were diagnosed with gynecologic cancer: - 41% say they would need to see a gynecologist - 31% would need to see an oncologist - 11% mention that they would see gynecologic oncologist - 13% do not know what type of specialist they should see

24. conclusion The field of gynecologic Oncology is not well understood in many countries and the specialty is still far from being established in Arab countries. The field of gynecologic Oncology is not well understood in many countries and the specialty is still far from being established in Arab countries. Doctors need to know more about this specialty in order to increase patient ’ s knowledge and guide patients to the proper management by referring them to the Gynecologic oncologist Doctors need to know more about this specialty in order to increase patient ’ s knowledge and guide patients to the proper management by referring them to the Gynecologic oncologist