Learning Outcomes: Gynaecological Oncology Unit Lead To develop knowledge and skills required by an individual to undertake the role as the Gynaecologial Oncology Unit Lead. Gynaecological Cancers Knowledge Criteria Clinical Competency to be achieved Professional Skills and Attitudes Training support Evidence/ Assessment Broad knowledge of aetiology and differential diagnosis of vulval, cervical, endometrial and ovarian cancer carcinoma Understanding of risk factors for developing vulval,,cervical endometrial and ovarian cancer Understanding diagnostic tests, investigations and staging procedures Understanding genetic predisposition to disease and the role of prophylactic surgery and screening Clinical evaluation of patients with gynaecological cancers Ability to distinguish gynaecological cancers from other malignancies Ability to counsel patients about gynaecological malignancies their treatment and prognosis. Undertake required diagnostic procedures and interpret the results Undertake clinical staging for cervical, vulval and endometrial cancers. Undertake surgical intervention for early stage endometrial cancer [ in patient cohorts identified in National Cancer Plan] Managing Rapid Access pathways for suspected gynaecological cancers. Awareness of psychological and emotional implications for patient and family and staff Realistic recognition of own competence level Use of appropriate external protocols and guidelines Making appropriate tertiary referrals Chairing MDT meetings, and teleconferencing or equivalent with Cancer Centre Attendance of RCOG and other courses relevant to the subject Attendance at MDT and Regional Network Meetings Local/regional protocols Useful Websites www.bgcs.org.uk www.bsccp.org.uk www.cancerbacup.org.uk www.macmillan.org.uk www.ncri.org.uk www.nice.org.uk www.dh.gov.uk/policyandgui dance/healthandsocialcare Topics/Cancer/fs/en Case Log book CbDs Audit projects Certificates of course attendance MDT Attendance Attendance at relevant National Meetings Team observation
Understanding of trophoblastic disease Knowledge of options for treatment and likely outcocmes Knowledge about chemotherapy, radiotherapy and hormonal treatment in gynaecological cancers. Knowledge of recent clinical trials and peer reviewed data Awareness of patient pathways, and referrals mechanism to the Cancer Centre. Ability to discuss different modalities of treatment confidently and advise patients appropriately Ability to inform and counsel patients about clinical trials for treatment options Collaboration with consultant colleagues and colleagues in other specialities and departments Recognition of dynamics of consultation after bad news and ability to iffer patients time and support to make decisions Courses in Counselling Genetic counselling training opportunities through local network or PG courses Knowledge of rare cancers vaginal/fallopian tube Knowledge of patterns of disease relapse Knowledge of palliative care aspects of management
Section 1 VULVAL CANCER Skill ATM: Gynaecological Cancer Unit Lead Observation Direct Supervision Independent Practice Date Signature Date Signature Date Signature Examination of Vulva ( colposcopy) Excisional biopsy of vulval lesion Tumour Staging [Clinical] Patient counselling Patient Referral Radical Vulval cancer surgery
Section 2 CERVICAL CANCER Skill ATM: Gynaecological Cancer Unit Lead Observation Direct Supervision Independent Practice Date Signature Date Signature Date Signature Examination of the cervix (colposcopy) Diagnosis of Cervical Carcinoma Biopsy of Tumour Tumour Staging Patient Counselling Patient Referral Observation of Wertheim s Hysterectomy
Section 3 ENDOMETRIAL CANCER Skill ATM: Gynaecological Cancer Unit Lead Observation Direct Supervision Independent Practice Date Signature Date Signature Date Signature Assessment of PMB Diagnosis of Endometrial Carcinoma Endometrial Sampling Tumour Staging Patient counselling Patient Referral Surgical Management of Endometrial Cancer
Section 4 OVARIAN CANCER Skill ATM: Gynaecological Cancer Unit Lead Observation Direct Supervision Independent Practice Date Signature Date Signature Date Signature Assessment of Possible Ovarian Cancer Use of Risk of Malignancy Index Ascitic Fluid Tap/Paracentesis Patient Counselling on genetic risk/screening Patient counselling on disease and therapy Patient Referral Observation of Ovarian Cancer Surgery
Training Courses or sessions Title Signature of educational supervisor Date Authorisation of Signatures please print your name and sign below Name (please print) Signature Completion of Module I confirm that all components of the module have been successfully completed Date Name of Educational Superviser Signature of Educational Superviser
APPENDIX TO GYNAECOLOGICAL ONCOLOGY UNIT LEAD Details of knowledge criteria Broad knowledge of aetiology and risk factors for gynaecological cancers VIN,CIN,BRCA1/2 genes, HNPPC, HPV 16,18,Obesity,Diabetes, Tamoxifen. Relationship with other cancers: i.e. Breast Cancer,Colon Cancers. Family history and risk. Extensive knowledge of Investigations in Gynaecological Cancers Serum Tumour Markers: CA125,CEA, CA19.9. bhcg, Inhibin, Oetrogen - in presentation and follow- up. Imaging Techniques and their use: CT /MRI Scans, Ultrasound and Radiation effects Histopathology : Tumour Types and relevance of tumour grade, lymph vascular space invasion Cytology: basic utility of cytology in cervical smear and fluids The role of investigations in follow-up and relapse. In depth knowledge of clinical presentation, diagnostic tests, and appropriate management of Gynaecological Cancers. Vulval Cancer: Clinical presentation Disease Staging [FIGO] Importance of disease size, site, and histopathology. Imaging requirements role of CT, MRI, CXR Surgical and non-surgical therapies Disease relapse: patterns of relapse, investigations
Cervical Cancer: Clinical presentation, Disease staging, [FIGO] Imaging requirements role of CT, MRI, IVU, CXR Role of surgery Fertility Preserving Surgery Chemo-radiotherapy Disease relapse: patterns of relapse, investigations Endometrial Cancer: Clinical presentation, Disease Staging [FIGO] Role of ultrasound and risk of malignancy. Role of CT, MRI, CXR Identification of low and high risk patients according to histopathology Triaging patients according to ultrasound PMB clinic and their function Disease relapse: patterns of relapse, investigations Ovarian Cancer: Clinical presentation- role of ultrasound, CT imaging, MRI,CXR Disease Staging [FIGO] Trans-vaginal Scan features of malignancy on Scan, Serum blood test: CA125, CEA, CA19.9, bhcg, AFP Risk of Malignancy Index Disease relapse: patterns of relapse, investigations Trophoblast Disease: Clinical Presentation molar pregnancy, partial molar pregnancy, choriocarinoma, risk factors. bhcg and follow up, use of contraceptive, timing of pregnancy Specialist Centres Disease relapse: patterns of relapse, investigations
Good knowledge of options available for treating gynaecological cancers, and palliation of symptoms. The role of surgical and non-surgical interventions, complications, sequelae. Fertility Preservation procedures available in Cervical Cancer: trachalectomy, pelvic lymphadenectomy, pregnancy complications and outcomes. Fertility Preservation in Ovarian Cancer: Chemotherapy in Ovarian Cancer: platinum based therapy, iv and ip treatments, second line therapies, disease response rates. Chemo-radiotherapy in cervical cancer and vulval cancer The role of Radiotherapy in Endometrial cancer: in primary and adjuvant settings Palliative Care: Introduction of service, Do Not Resusitate Criteria, methods of analgesia, Radiotherapy/Chemotherapy in palliation. Role of surgery, tumour excision, bowel diversionary procedure, paracenthesis, pleuridesis. Rarer Gynaecological Cancers: Vaginal Cancer, risk, presentation, basic management. Fallopian tube Carcinomas: Clinical Presentation, basic management. Genetic Risk/Screening: Principles of screening, BRCA1and 2gene, evaluation of risk from family history. HNPCC and risk of ovarian and endometrial cancer. Implications of genetic screening. Understanding of management issues in the provision of Gynaecological Cancer Unit Services Staffing Facilities and equipment Referral patterns and triage Managing a rapid access clinic Patient pathways and time constraints External support Training Clinical protocols, Risk management Audit and research