Gynecologic oncology clinic can feel intimidating for a new intern — the patients are complex and the terminology is dense. In this episode, Dr. Liang breaks down the three visit types you'll encounter (new patient, chemo clearance, and surveillance), what to prechart, and what your role is as the resident in each one.
Visit Type 1: New Patient Visits
BEFORE CLINIC — PRECHARTING
Ask: Why are they here?Confirmed cancer diagnosis (pathology in hand)?Concern for cancer only — no pathology yet?Seeking second opinion after treatment elsewhere?Hereditary cancer syndrome (Lynch, BRCA)?HPI — how did the patient present? What symptoms?Workup by primary cancer type:Uterine: endometrial sampling, TVUS, CT abdomen/pelvisOvarian: CA-125, imagingCervical/vulvar: Pap history, colposcopy, biopsies, LEEP, CKCMedical & surgical history — comorbidities, medications, prior abdominal surgeriesFamily history — relatives affected, cancer type, age at diagnosisPreventive screening — Pap, mammogram, colonoscopy up to date?Ask the patient: what is their understanding of why they're here and of next steps?Confirm and fill in gaps from chart reviewAssess functional status → ECOG performance status (impacts candidacy for surgery/treatment)Exam: heart, lungs, abdomen — defer pelvic exam until attending is present"The tissue is the issue" — cancer cannot be confirmed without pathology (endometrial sampling, biopsy, or surgical pathology)Visit Type 2: Chemo Clearance Visits
Cytotoxic agents (e.g., carboplatin, paclitaxel) — target rapidly dividing cellsImmunotherapy / checkpoint inhibitors (e.g., pembrolizumab) — immune system targets cancerPARP inhibitors (e.g., olaparib) — prevent DNA repair; used in ovarian cancerHormonal therapy (e.g., letrozole, an aromatase inhibitor) — for ER/PR+ tumorsAdjuvant — chemo after surgery (most common)Neoadjuvant — chemo before surgery (to downsize disease; often used in advanced ovarian cancer)Maintenance therapy — additional treatment after initial surgery + chemo to delay recurrence (PARP inhibitors, bevacizumab)BEFORE THE VISIT — FOCUSED CHART REVIEW
Pull up last clinic note → one-liner + oncologic summaryCancer type, stage, date of diagnosisPrior surgeries and proceduresCurrent regimen — cycle #, date of last treatmentFirst regimen or has there been a prior line?Review prior side effects and toleranceLabs: ANC, Hgb, Plts, Cr, electrolytes, tumor markersImaging: no evidence of disease? Partial response? Progression?How did they tolerate the last cycle?Ask about previously reported side effects — better or worse? Any new ones?Look up key side effects for their specific regimen ahead of timeBrief ROS: fatigue, appetite, nausea/vomitingExam: heart, lungs, abdomenGoal: confirm labs are acceptable, patient is tolerating treatment, and disease is not progressing. You are not expected to manage the regimen as a resident.Visit Type 3: Surveillance Visits
Patients who have completed treatment and currently have no evidence of disease (NED)Monitor for signs of recurrence — frequency and duration vary by cancer type and stageExample: early-stage endometrial cancer → H&P every 3–6 months for first 2–3 years, then every 6–12 months up to 5 yearsBEFORE & DURING THE VISIT
Use last clinic note: cancer type, surgeries/treatments, duration of NEDAny chronic side effects from treatment?Any tumor markers or imaging being followed?During visit: ask about any new symptomsROS: weight changes, appetite, abdominal pain, bladder/bowel function, vaginal bleedingUpToDate — great starting point for any topic overviewNCCN (free account at nccn.org) — guidelines for staging, treatment, and surveillanceTopics to Review Over Time:
Endometrial cancer: risk factors, surgical staging, fertility-sparing managementOvarian cancer: approach to the complex adnexal mass, tumor markers, surgical stagingCervical cancer: risk factors, Pap smear guidelines, colposcopy, LEEP, cold knife coneVulvar cancer: risk factors and treatment optionsHereditary syndromes: Lynch and BRCA — surveillance guidelines and risk-reducing surgeryHost: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency.
Guest Speaker: Angela Liang, MD – OB/GYN resident at The Johns Hopkins Hospital. She will be starting gynecologic oncology fellowship at the University of Pennsylvania.
Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.