Clerkship: Gynecologic Oncology

  • Location: Juravinski Hospital and Cancer Centre
  • Length: 2 weeks

This is a very specialized rotation but I worked with an amazing team. Read about my typical day and some of my most memorable cases!

The goal of clerkship rotations is for students to acquire a defined body of knowledge, skills and attitudes necessary for the recognition, understanding and management of the common and unique health care problems. During each core clerkship and elective rotation, the PA student will participate, in a supervised capacity, in the care of patients presenting to the specific health care setting (Emergency department, Clinic, in-patient ward, etc).

A typical day

As with any surgical specialty, the day starts with rounding on post-op patients. After that we had either OR, Clinic or Colposcopy clinic. Unfortunately, this elective was done during the summer where hospitals usually have OR shutdowns to cut down on hospital costs. Also, the team was unusually big during these two weeks with three residents, two medical students and myself. I would round with the residents in the morning and participate in clinic or OR.

  • I love, love, love new patient clinic. To me, it is so exciting to see a referral, assess the patient and think of a management plan. In surgery, once the diagnosis is confirmed, the clinical question is usually is this patient a candidate for surgery or not. At this time of my training, I was comfortable doing dictations so I helped out by dictating for the patients I saw.
  • In the operating room, I did some assisting. All the surgeries I attended were open surgeries and the pelvic anatomy is just so amazing up-close in person! After the uterus was removed, you can really appreciate the abdominal aorta bifurcating into the iliac arteries. You can also feel the sacral bones.
  • In the colposcopy clinic, this is where women with abnormal pap tests get sent to. I found it very relevant to my learning as two years ago, I was volunteering at a medical clinic where I raised awareness about preventive health care; cervical screening being one of them (read my old post on Pap test here). Here was a great opportunity for me to see what happens for abnormal pap follow-up and to practice speculum insertions. I was pretty lucky that all the patients that day were comfortable with me doing it with my doctor supervising. My doctor said usually they do not like students.

Medical conditions I encountered during my rotation

ribbons-for-website-7-18-13

  • Ovarian Cancer
  • Endometrial Cancer
  • Cervical Dysplasia and Cancer
  • GTD

Some of my most memorable cases

gynecologic-gynecologic-oncology

  • Ascites and pig tail catheter removalpigtail-drain-small

    • This patient has ascites and requires frequent paracentesis. Instead of poking her each time she needs one, she agreed to try an indwelling pig tail catheter.However, two days after insertion, the patient did not like it. She called a friend who said that she can just pull it out herself. Unfortunately, it is not that simple. A pig-tail catheter is different when you insert it, it is straight but once the needle is withdrawn, the end curls so that it does not fall out. She presented to the clinic unsure of what to do now was the catheter is half in-half out. So, we showed her how to remove it…the secret? You have to cut the other end of the pigtail so that the end inside the abdomen can unwind!
  • Metastatic endometrial cancer
    • This is a patient with stage 4 endometrial cancer undergoing an open total hysterectomy with bilateral salpingo-oophorectomy. After the abdomen is open, the surgeon checks for signs of metastases which is in the form of nodules on other organs. The surgeon told me to put my hands over the liver and to feel the omentum, all felt very nodular. It was very interesting!
  • Delivery of ovarian mass – frozen section, nodal dissection
    • We had a patient with an ovarian tumor. She is middle aged and looks like she is pregnant due to the mass in her pelvis. This is an open surgery and once we “delivered” the tumor, it was sent off to pathology for a frozen section. Depending on what the pathologist says, node dissection might be required.
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Picture taken from Google

What I learned

In the colposcopy clinic, I saw patients who were referred after getting an abnormal pap. I was allowed to place the speculum in. Then the oncologist and I would inspect the cervix with acetic acid and/or lugol’s iodine, identifying areas of rapid cell turn over. We did endometrial biopsies if atypical endometrial cells were found on the pap (suspicious of endometrial cancer). I saw a LEEP and cone biopsy as well!

Screen Shot 2016-11-02 at 11.48.03 PM.png

The residents went over pelvic anatomy with the learners. I think it is so important to know and it helps orientate us when we are in the OR looking at the pelvis in front of us. I also found this image helpful in helping me remember what is removed in what hysterectomy:

Hysterectomy-Surgery.jpg

Overall

I came into this elective with an open mind since it was so specialized and most of my other electives were relatively broad. However, I definitely enjoyed the tasks I did and my understanding of gynecologic cancers grew. The gyne onc team and nurses were all so supportive which helped me enjoy my rotation. I know my classmates have also done an elective with them and all I heard were good things! It was just unfortunate that there were a lot of down time as only two gyne oncologists were working and there was the OR shut down…AND we had a big team.

Regardless, I had a great time learning about and the management of gynecologic cancers. It makes me even more fired up to raise awareness of preventive cancer screening! AKA -> get your PAPs done and get the HPV vaccine!

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