Show Notes
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/pelvis Ovarian: CA-125, imaging Cervical/vulvar: Pap history, colposcopy, biopsies, LEEP, CKC
Medical & surgical history — comorbidities, medications, prior abdominal surgeries Family history — relatives affected, cancer type, age at diagnosis Preventive screening — Pap, mammogram, colonoscopy up to date?
DURING THE VISIT
Ask the patient: what is their understanding of why they're here and of next steps? Confirm and fill in gaps from chart review Assess 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 KEY TERMINOLOGY
Cytotoxic agents (e.g., carboplatin, paclitaxel) — target rapidly dividing cells Immunotherapy / checkpoint inhibitors (e.g., pembrolizumab) — immune system targets cancer PARP inhibitors (e.g., olaparib) — prevent DNA repair; used in ovarian cancer Hormonal therapy (e.g., letrozole, an aromatase inhibitor) — for ER/PR+ tumors Adjuvant — 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 summary Cancer type, stage, date of diagnosis Prior surgeries and procedures Current regimen — cycle #, date of last treatment First regimen or has there been a prior line? Review prior side effects and tolerance Labs: ANC, Hgb, Plts, Cr, electrolytes, tumor markers Imaging: no evidence of disease? Partial response? Progression?
DURING THE VISIT
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 time Brief ROS: fatigue, appetite, nausea/vomiting Exam: heart, lungs, abdomen Goal: 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 PURPOSE
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 stage Example: early-stage endometrial cancer → H&P every 3–6 months for first 2–3 years, then every 6–12 months up to 5 years
BEFORE & DURING THE VISIT
Use last clinic note: cancer type, surgeries/treatments, du...
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