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Division of Gynaecologic Oncology

Executive Summary

The Division of Gynaecologic Oncology continues to provide gynaecologic cancer consultation services and treatment to the women of British Columbia. Leadership in cervical cancer screening, as well as diagnosis and treatment of pre-invasive gynecologic cancer is an important part of our mandate.

Divisional activities occur at the Vancouver General Hospital and at the BC Cancer Agency, where it is the policy of the Gynecology Tumour Group to try and have all new patients discussed at a Gynecologic Oncology Disposition Clinic. The Friday Disposition Clinic is video linked with the Vancouver Cancer Centre, Fraser Valley Cancer Centre, Vancouver Island Cancer Centre and the Cancer Centre of the Southern Interior. This facilitates patient consultation and discussion of difficult clinical problems by this multidisciplinary group. At this clinic, the patient's history, physical findings, laboratory reports and pathology slides are reviewed and discussed by members of the group. A treatment decision is arrived at and recommendations made to the patient and the referring physician. Those patients requiring surgery other than radical surgery are referred back to their attending physician unless it is the physician's desire that the surgery be performed by the Agency consulting staff. A Gynecologic Oncology opinion is available and is recommended even if it is anticipated that treatment is to be given entirely in the patient's own community in order to ensure uniform standards and quality throughout the province. This would also help to avoid undesirable delays in patient treatment because of failure to appreciate the "high risk" nature of lesions based on their histology.

The Department does conduct Tumour Conferences for the discussion of unusual or difficult management problems. This Conference is available for a more formal review of a patient management problem at the request of any physician.

Mandate

• To provide excellence in gynaecologic cancer care for the women of British Columbia
• To provide a provincial resource for clinical and educational aspects of the specialty
• To respond to the needs of the patients and the practicing community
• To foster a multidisciplinary, evidence-based approach to the practice of oncology
• To encourage research in the basic sciences related to the subspecialty

The Team

• Lori Brotto, Clinical Pyschologist
  
• Tom Ehlen, Gynaecologic Oncologist;
  • Head, Provincial Colposcopy Program
    
• Sarah Finlayson, Gynaecologic Oncologist
  
• Mark Heywood, Gynaecologic Oncologist; Site Head, Vancouver Acute
  
• Janice Kwon, Gynaecologic Oncologist
  
• Jessica McAlpine, Gynaecologic Oncologist
  
• Dianne Miller, Gynaecologic Oncologist;
  • Division Head;
  • Provincial Tumor Group Head;
  • Acting Chair of Surgical Oncology Network;
  • Acting Provincial Program Leader, BC Cancer Agency
    
• Gavin Stuart, Gynaecologic Oncologist;
  • Dean, Faculty of Medicine, University of BC
    
• Leslie Sadownik, Gynaecologist with a special interest in lower genital tract neoplasia
  
• Sydney Thomson, Gynaecologist with a special interest in Sexual Medicine

Education

Members of the Division are active participants in teaching at all levels of education. The Gynaecologic Oncology Fellowship Program is Royal College accredited. The program is a two-year funded Clinical Fellowship, with the option of a third research year (which can be funded through various mechanisms, such as the UBC Clinical Investigator Program).

Senior residents in Obstetrics and Gynaecology each spend three months on the gynecologic oncology service. Chief residents also have the opportunity to be further trained in colposcopy and laser treatment of the lower genital tract.

Dr. Sydney Thomson is the Reproduction Block Chair, as well as Week 2 (Menopause) Chair. Dr. Sarah Finlayson is Week 4 Chair (Aging and Neoplasia).

In addition, Dr. Sydney Thomson is the Co-Coordinator of this portion of the clinical skills which runs through the second year of medical school.

Congratulations to Dr. Sarah Finlayson who won the Dr. Mike Turko Surgical Teaching Award.

Continuing Medical Education

Members continue to be actively involved in the D.A. Boyes Society Meeting. The 33rd Annual Meeting was held on November 9th, 2007 and included such topics as “Teaching in the OR” [Dr. Sarah Finlayson], “Who not to operate on: Ovarian Cancer” [Dr. Jessica McAlpine] and “Diminishing Role of Lymphadenectomy in Endometrial Cancer” [Dr. Gavin Stuart].

Research Activities

The Division of Gynaecologic Oncology continues to be actively involved in basic and clinical science and this has resulted in numerous publications.

Current projects include:

• Optimizing surgical treatment for endometrial cancer
• National survey of genetic counselors and provincial survey of HNPCC patients regarding knowledge of gynaecologic cancer risks and prevention strategies associated with this syndrome
• Cost-effectiveness analysis of testing criteria for HNPCC among women with endometrial cancer
• Confronting the link between diabetes and endometrial cancer: Population based study to estimate the risk of endometrial cancer among diabetic women according to the medication they use to control their diabetes
• Tubal intra-epithelial carcinogenesis screening (TICS)
• Ovarian cancer early screening project (OCESP)
• Knowledge translation: Role for salpingectomy
• HPV vaccine trials
• Calypso: Multinational randomized trial of the use of pegelated doxyrubicin in the treatment of recurrent epithelial ovarian cancer
• HPV focal study
• Pilot study of the role of HPV testing in the follow-up of conservative treatment of cervical dysplasia
• A preliminary review of 50 invasive cervical cancers diagnosed in British Columbia from 2003 to 2007
• Utility of colo-rectal stents in advanced or recurrent gynaecologic malignancies

Janice Kwon is the recipient of a VCH Lower Mainland Innovation and Integration Fund award and is working on the development of an endometrial cancer research program.

Jessica McAlpine is the winner of a VCHRI’s 2008 In It for Life Investigator Award, which is funded by the VGH & UBC Hospital Foundation.

Mentored Clinician Scientists

Dr. Jessica McAlpine
OvCaRe, VCHRI & BCCA;
UBC Department of Obstetrics & Gynaecology, Division of Gynaecologic Oncology
Mentor: Dr. David Huntsman,
OvCaRe, VCHRI & BCCA;
Ctr for Translational & Applied Genomics, BC Cancer Agency;
UBC Dept. of Pathology & Laboratory Medicine
Title: PARP Inhibitors in Epithelial Ovarian Cancer: Targeted Molecular Therapy in BRCA Null Phenotypes and Mechanisms of Resistance

Drs. Leslie Sadownik, Lori Brotto and Sydney Thomson collaborated on a proposal for a Multi-disciplinary Vulvodynia Program. They were successful and received $300,000 from the Leslie Diamond Health Fund. The program will be the first of its kind in Canada – providing multidisciplinary care from a team of professionals (nurse, physical therapist, psychologist and gynaecologists). Part of the money will go towards exploring the innovative use of technology (website and interactive tools for patients) to educate and support patients across British Columbia with this pain condition. Dr. Sadownik is currently the Program Director and wrote the content for the website www.mvprogram.org, as well as the content for a Vulvodynia section on the Society of Obstetricians and Gynaecologists of Canada website (sexualityandu.ca). 

Dr. Li “Shelley” Shang, an obstetrician/gynaecologist from Ningxia People’s Hospital in P.R. China, spent six months as a Visiting Scholar in the Division. She was the recipient of a competitive scholarship award from the China Scholarship Council and chose to visit our Division given that it is widely known for its clinical care and research. During her stay, she observed some of the surgical procedures and participated in some research projects with members of the Division. We are looking forward to collaborating with her in future research projects.