The Multidisciplinary Team (MDT) Approach

Like all modern cancer care, gynaecological oncology relies on a team-based approach. The core team includes:

• Gynaecological Oncologist: The primary surgeon and often the lead coordinator of care. They perform complex surgeries like hysterectomies, debulking, and lymph node dissections.
• Medical Oncologist: Manages systemic treatments like chemotherapy, targeted therapy, and immunotherapy.
• Radiation Oncologist: Plans and delivers radiation therapy, which is crucial for cancers like cervical and vulvar cancer.
• Pathologist: Analyzes tissue samples to provide the exact diagnosis, cancer type, grade, and other key biomarkers.
• Radiologist: Interprets imaging scans (CT, MRI, PET) to determine the stage and spread of the cancer.
• Oncology Nurse Specialist/Navigator: Provides patient education, support, and coordinates care throughout the treatment journey.
• Other Support Staff: Genetic counselors, dietitians, social workers, physiotherapists, and palliative care specialists.

Diagnosis and Staging

The process begins with a suspicion of cancer, often due to symptoms, routine screening (like a Pap smear), or genetic risk.

1. Diagnosis: This almost always requires a biopsy to obtain tissue for the pathologist to examine under a microscope. The type of biopsy varies:
   • Colposcopy with biopsy (for cervical abnormalities)
   • Hysteroscopy with biopsy (for uterine bleeding)
   • CT-guided biopsy (for a suspicious mass)
   • Surgical biopsy (e.g., laparoscopy for an ovarian mass)
2. Staging: Once cancer is confirmed, determining the stage (how far it has spread) is critical. This is done through imaging (MRI, CT scan, PET scan) and, most importantly, surgical staging. The gynaecological oncologist performs surgery to:
   • Assess and remove the primary tumor.
   • Examine and remove lymph nodes.
   • Take washings and biopsies from within the abdominal cavity.
   • Remove any visible spread of disease.

Staging determines the prognosis and guides all future treatment decisions.

Treatment Modalities: The Toolbox

Treatment is highly individualized but draws from these core options, often in combination:

1. Surgery:The cornerstone of treatment for most gynaecological cancers.

• Debulking/Cytoreduction: Especially critical for ovarian cancer. The goal is to remove as much of the tumor as possible (“optimal debulking”), as this significantly improves survival.
• Radical Hysterectomy: Removal of the uterus, cervix, and surrounding tissues (parametrium), often for cervical cancer.
• Lymphadenectomy: Removal of pelvic and para-aortic lymph nodes to check for spread.
• Exenteration: An ultra-radical procedure for recurrent cancer (often cervical), involving removal of the pelvis organs (bladder, rectum, vagina).

2. Chemotherapy:The use of drugs to destroy cancer cells.

• Neoadjuvant: Given before surgery (e.g., for some advanced cervical or ovarian cancers) to shrink tumors.
• Adjuvant: Given after surgery to kill any remaining microscopic cells and reduce the risk of recurrence (standard for ovarian and high-risk uterine cancers).
• Primary Treatment: For advanced or recurrent disease that cannot be cured with surgery.

3. Radiation Therapy:Uses high-energy rays to target and kill cancer cells.

• Brachytherapy: Internal radiation where a radioactive source is placed directly inside or next to the tumor (e.g., in the vagina or cervix). This is a highly effective component of treatment for cervical and uterine cancers.
• External Beam Radiation Therapy (EBRT): Radiation directed at the pelvis from a machine outside the body.

4. Targeted Therapy & Immunotherapy:newer, more precise treatments.

• Targeted Therapy: Drugs that target specific molecules involved in cancer growth (e.g., PARP inhibitors for ovarian cancer with BRCA mutations, bevacizumab for ovarian/cervical cancer).
• Immunotherapy: Drugs that help the patient’s own immune system recognize and attack cancer cells (e.g., checkpoint inhibitors for advanced endometrial or cervical cancer with specific biomarkers).

Key Aspects by Cancer Type

The Importance of Survivorship and Palliative Care

Gynaecological oncologists manage care throughout the entire journey:

• Survivorship: Creating long-term follow-up plans to monitor for recurrence and manage long-term side effects of treatment (e.g., lymphoedema, menopause, sexual health, fertility issues).
• Palliative Care: An essential part of care focused on improving quality of life, managing symptoms (like pain or bowel obstruction), and providing psychosocial support at any stage of illness, not just at the end of life.

The cost can vary significantly based on the type of cancer, stage, hospital choice, city, and the treatment plan (surgery, chemotherapy, radiation, etc.).

Overall Cost Range

For a comprehensive treatment package that may include surgery, chemotherapy, and/or radiation, the total cost can range widely:

• Approximate Range: ₹ 4,00,000 to ₹ 15,00,000+ (USD ~$5,000 to $18,000+)
• This is a broad estimate. Complex cases (like advanced ovarian cancer requiring major debulking surgery and targeted therapy) can exceed this range.

Cost Breakdown by Treatment Type

Here’s a more detailed look at the costs of individual components:

1. Surgery (Often the biggest cost component)

The type of surgery (open, laparoscopic, or robotic) greatly influences the price.

• Radical Hysterectomy (for Cervical/Endometrial Cancer):
  • Open Surgery: ₹ 2,50,000 – ₹ 4,50,000
  • Laparoscopic Surgery: ₹ 3,50,000 – ₹ 5,50,000
  • Robotic Surgery (Da Vinci System): ₹ 5,00,000 – ₹ 7,50,000+ (More precise, faster recovery, but most expensive)
• Debulking Surgery (for Ovarian Cancer):
  • This is often a major and complex operation.
  • Cost: ₹ 4,00,000 – ₹ 8,00,000+ (Highly dependent on the extent of surgery and operating time).
• Pelvic Exenteration (Ultra-radical for recurrent cancer):
  • Cost: ₹ 7,00,000 – ₹ 12,00,000+ (Due to extreme complexity and longer hospital stay).

2. Chemotherapy

Costs are calculated per cycle. A typical treatment may require 6 cycles.

• Standard Chemotherapy Drugs (per cycle): ₹ 15,000 – ₹ 40,000
• Targeted Therapy Drugs (e.g., Bevacizumab/Avastin – per cycle): ₹ 50,000 – ₹ 1,00,000+
• PARP Inhibitors (e.g., Olaparib for Ovarian Cancer – monthly): ₹ 1,00,000 – ₹ 2,50,000+ (These are oral medications taken over a long period)

3. Radiation Therapy

Cost depends on the technology used and the number of sessions (fractions).

• External Beam Radiation (EBRT):
  • 3D-CRT/IMRT: ₹ 1,50,000 – ₹ 3,00,000 (for full course)
  • IGRT/VMAT: ₹ 2,50,000 – ₹ 4,50,000 (for full course) – More precise, better side-effect profile.
• Brachytherapy (Internal Radiation):
  • Cost per session: ₹ 50,000 – ₹ 1,20,000
  • A full course typically requires 3-5 sessions.

4. Diagnostic and Workup Costs

• PET-CT Scan: ₹ 15,000 – ₹ 25,000
• MRI Scan: ₹ 8,000 – ₹ 20,000
• Biomarker and Genetic Testing (e.g., for BRCA mutation): ₹ 15,000 – ₹ 30,000

Factors Dramatically Influencing Cost

1. Type and Stage of Cancer: Early-stage cancer might only require surgery, while advanced-stage cancer needs a multi-modal approach (surgery + chemo + radiation), drastically increasing the cost.
2. Hospital Category:
   • Public Government Hospitals: Highly subsidized, almost free, but with long waiting times.
   • Private Hospitals: Higher cost but offer faster service, modern technology, and often international standards of care. Top corporate chains (e.g., Apollo, Fortis, Max, Medanta) are at the premium end.
3. City: Treatment in metros like Delhi, Mumbai, Bangalore, Chennai is generally more expensive than in tier-2 cities.
4. Doctor’s Expertise: The fee of a senior, renowned Gynaecological Oncologist will be higher.
5. Hospital Stay & Complications: Longer ICU stays, blood transfusions, or post-surgery complications can add significantly to the bill.
6. Medicines: The choice between generic drugs and branded imported drugs can cause a 2x-3x difference in pharmacy costs.

In summary, Gynaecological Oncology is a holistic and highly specialized field that integrates complex surgery, chemotherapy, radiation, and newer precision medicines to provide comprehensive care for women with cancers of the reproductive tract.