Guide for New Gynecologic Patients

Women who are referred to Roswell Park Cancer Institute (RPCI) with a suspicion of gynecologic cancer have many questions about the disease and its diagnosis, treatment and prognosis. General information on these subjects is presented here so that you will know what to expect when you visit RPCI for the first time. Your doctor will explain your specific situation and answer your questions at that time.

Initial Evaluation

Your care at RPCI will be coordinated by an attending physician; a specialist in gynecologic oncology who also is a faculty member of the University at Buffalo School of Medicine and Biomedical Sciences. Your attending physician will review your medical history, do a complete physical examination, and review your pathology slides and past medical records. Following this initial evaluation, your attending physician will recommend that any or all of the following procedures be scheduled for you; either on the same day or in the near future.

  • Ultrasound, CT (computerized tomography) scan, or possibly MRI (magnetic resonance imaging) studies
  • X-ray studies of the bowels (barium enema)
  • X-ray studies of the kidneys and/or bladder (intravenous pyelogram)
  • Chest x-ray

After you have completed the testing process, your attending physician will evaluate the results, discuss them with you and, if needed, outline your treatment plan.

Gynecologic Oncology Team

The Gynecologic Oncology team includes health professionals with different specialties to meet your needs and those of your family. Attending physicians perform surgery and manage all aspects of your care. Gynecologic oncology fellows have completed four-year residency programs in obstetrics and gynecology and are training to become gynecologic oncologists. Fellows assist with your treatment and may see you in the clinic. A Fellow is on-call after office hours and on weekends and holidays to deal with emergencies and to answer questions. Nurse practitioners help arrange your surgery and assist with your care following surgery. Resident physicians in obstetrics and gynecology are receiving advanced training in women’s health care, including treatment of gynecologic cancer. A social worker is available to meet with you and your family to discuss topics such as social and psychological support. A case manager will communicate with your insurance company while you are hospitalized and will coordinate home care services, if needed. If you require chemotherapy after surgery, chemotherapy nurses will meet with you to discuss the type of medicines you will receive and what to expect. They also keep track of laboratory work required during your chemotherapy, and are available during regular office hours to discuss your problems or concerns.

Planning for Hospital Admission

The Gynecologic Oncology office staff will schedule the day of your surgery, the time of your hospital admission, further tests requested by your attending physician, and your preoperative visit to the clinic. The office staff also can answer many of your questions about hospital routines, financial coverage, or other services you might need. You should inform your insurance company of your planned hospitalization. RPCI will call to pre-certify your hospital admission. Your insurance company will generally confirm your admission by letter. Your insurance company may pre-certify hospitalization for a limited time – for example, three or four days. However, your medical team at RPCI will evaluate your condition daily and communicate with your insurance company to justify additional days of hospitalization, if needed. Most patients who have surgery for cancer stay in the hospital from four to seven days.

Treatment

A surgical procedure called an exploratory laparotomy is the first procedure performed to confirm or rule out the presence of gynecologic cancer. Your surgeon will make an incision in the abdomen and examine your reproductive organs. If cancer is found in any organ, that organ, as well as any other organs the cancer might have spread to, will be removed. Following surgery, your attending physician will review the results of pathology studies, determine if your condition warrants radiation therapy and/or chemotherapy, and discuss the treatment plan with you and your family. Radiation therapy and chemotherapy are both designed to kill cancer cells which the surgeon was unable to remove; but each does so in a different way. Radiation therapy is a localized therapy. Strong x-rays are used to kill cancer cells which appear on imaging studies to be clustered in isolated areas. Chemotherapy is a systemic therapy. Medications, usually given intravenously (through a vein), travel throughout the entire body in search of cancer cells which may have spread to other parts of your body through your lymphatic system or the blood stream.

Preparing for Surgery

Your preoperative visit to the Gynecologic Oncology Clinic usually will be scheduled one or two days before your surgery. During your visit, a gynecologic oncology fellow will meet with you to review the treatment plan initiated by your attending physician, answer your questions, and explain, and ask you to sign, the informed consent form for surgery. You may have routine urine and blood studies, as well as a chest x-ray, EKG (electrocardiogram), or other tests before surgery. Then, an anesthesiologist will examine you, discuss the surgical anesthetic you will receive and order medications for sedation before surgery, including sleeping medicines for the night before, if you like. The nurse will teach you breathing exercises that will help prevent lung congestion and leg exercises that will help improve blood circulation while you are less active after surgery. You also will receive instructions to drink only clear liquids the night before surgery and not to eat or drink (not even water) anything after midnight. Your physician may give you additional instructions. If you normally take important medications (e.g., heart, blood pressure, or diabetic medications) in the morning, remember to ask your attending physician whether you should take them (with a sip of water) on the morning of your surgery. Your family or significant others are welcome and encouraged to join you for any of the preoperative discussions or orientations. They also may be with you before you go to the operating room.

Surgery and the Postoperative Period

Surgery may take from two to six hours, followed by two or three hours in the Post-Anesthesia Care Unit, while you recover from the anesthetic. An operating room nurse will keep your family informed during surgery, and your attending physician will talk with them about your condition after surgery. As you awaken, you will become aware of the nurse checking your blood pressure, pulse and temperature frequently. You also will have an intravenous (IV) line and a urinary bladder catheter. Do not be alarmed if you are receiving oxygen or a having a blood transfusion. These procedures are common following surgery.

Back in Your Hospital Room

Breathing and  Exercise You will be encouraged to take deep breaths and to cough deeply every two or three hours. Periodically, nurses will help you to turn in bed and to exercise your feet and legs gently to encourage good circulation. You will be urged to sit on the edge of the bed within 24 hours after your surgery and to begin walking as soon as possible to stimulate your body’s return to normal function. Walking will be encouraged throughout your hospital stay. These activities may be uncomfortable at first. Your physician will order pain relief medications for you, and your nurse will work with you to schedule medications for adequate pain control balanced with rest and increasing activity.

Bowel Function After abdominal surgery, bowel function is normally sluggish due to the anesthetic and the surgical exploration. During surgery, you may have a thin, flexible nasogastric (NG) tube inserted into your stomach through your nose, to drain secretions from your stomach or bowel following surgery. The tube will be removed when bowel function returns to normal. Your doctors and nurses will use a stethoscope to listen to your abdomen for bowel sounds (which indicate the return of function), and ask you to report having gas or bowel movements. Dietary management (daily prune juice, high fiber or high bulk diets) or other bowel programs (stool softener medications or mild laxatives) and increasing your daily intake of fluids will help prevent difficulties associated with persistent slowed bowel function. You may need to continue these measures at home, especially if you are taking pain medicine containing narcotics. When your diet and activity levels return to normal, bowel function usually will as well.

Incision Stitches or staples closing the surgical incision usually will be removed 10 days after surgery. You may notice a reddish to brown discharge from the vagina for several days. This is part of the normal healing process.

Emotions Major surgical procedures consume a great deal of physical and emotional energy. Increased fatigue, hospital confinement, and temporary physical limitations may lead to feelings of nervousness, frustration, and even anger. Although these reactions are normal and temporary, they may distress you. It often helps to share your concerns with a close family member, friend or a member of the staf

Recovering at Home

Before you leave the hospital, you will be told what to expect in the coming days. Although complications are unusual after you leave the hospital, inform your doctor if you have any of the following:

  • Excessive bleeding
  • Fever above 100°F
  • Shaking chills
  • Worsening abdominal pain
  • Unusual pain or swelling in the leg
  • Vomiting
  • Unusual vaginal or wound discharge
  • Disturbing emotional reactions
  • Any other related problems that concern you

 

During your recovery, be sure to get adequate rest and nutrition, and participate in mild physical and diversional activities. A balanced diet of high protein foods will help build your strength and aid healing. Light activity is encouraged in the first two weeks after surgery or until you are seen in the Gynecologic Oncology Clinic for the first time after surgery. Delay driving or prolonged sitting for three or four weeks after surgery. You may begin isometric (tightening) exercises of the abdomen after three or four weeks, but avoid heavy lifting and strenuous exercise for two to three months after surgery. Cancer is a stressful disease and the treatment can be complicated. Each woman reacts differently. You may feel anxious, worried, depressed or bewildered about the way your life and the lives of those close to you will be affected. Allow yourself some time to adjust. Talking to your nurse, physician, family or close friend can help you find answers and emotional support.

Sexuality

Removal of the uterus causes cessation of menstrual periods and loss of childbearing function. In younger women, removal of the ovaries may bring on menopausal (change of life) symptoms such as hot flashes, night sweats, or mood changes. Sometimes these symptoms can be alleviated by taking a hormonal medication, which may be prescribed by your physician. Sexual feeling need not be altered by surgery for cancer. However, sexual intercourse, vaginal douching and the use of tampons should be avoided for four weeks after surgery. Feel free to discuss with your physician or nurse any concerns you and/or your partner have about sexual activity.

Contact Information

Gynecologic Oncology Chemotherapy Nurses • (716) 845-3266, 1419, 1420

Community Cancer Resource Center - 2nd Floor Main Hospital • (716) 845-8659

Gynecologic Oncology Social Worker  • (716) 845-8022

Gynecologic Oncology Clinic • (716) 845-5855

After hours paging operator  - ask for the Gynecologic Oncology Fellow  • (716) 845-2300

Gynecologic Oncology Nursing Unit - 6 West • (716) 845-5795

Roswell Park Cancer Institute  - toll free number • (800) 685-6825

Roswell Park Cancer Institute Cancer Call Center • 877-ASK-RPCI (877-275-7724)