GOSB guideline for management of gynaecological cancers in COVID-19 global pandemic

Outpatient clinic visits:

1. Visit only to
2. New patients.
3. Acute gynae oncologic issue.
4. Those are in active treatment.
5. Limited no. of physicians and health care professions will be involved for ambulatory patients.
6. Residents and Medical students can be dismissed from their duties.
7. Visitors restricted to one person only for physically or psychologically disabled patients. The visitor should be confirmed that she has no CORONA virus infection or not exposed.
8. All routine follow-up/ surveillance, visit should be postponed. Telemedicine / web-based consultation until crisis has stabilized or return to routine operation.
9. For patients having no evidence of disease, routine imaging studies or serum marker

 

 

Disease management

 

Cervical cancer:Early stage cervical cancer - In setting where oncologic surgery is still allowed - standard care is recommended.In settings where access to surgery is limited:

 

1. Stage IB₁ (<2 cm, low risk histology) -- CKC (Cold Knife Conisation ), simple trachelectomy, sentinel lymph node if possible.
2. Stage IB₂ (>2 cm to 3.9 cm, by PET or imaging ) radical surgery postponed by 6-8 wks, Neoadjuvent Chemotherapy considered.
3. Stage IB₃ and above -- Concurrent chemotherapy.

 

 

 

 

Endometrial cancer

 

1. Low risk patients - ( Grade I, Stage IA) considered for hormone therapy.
2. High risk patients with higher-risk histology (grade 2 or 3) considered for TAH, BLSO + Sentenel node.
3. Advanced stage disease (III & IV)    Systemic therapy.

 

 

Ovarian Cancer

1. Suspected early disease thorough evaluation to assess risk of malignancy in adnexal mass.
2. Advanced stage disease   confirmed by biopsy - neo-adjuvant chemotherapy.
3. Patients on NACT, extending treatment plan to six cycles.
4. Patients who have completed all adjuvant chemotherapy - no further treatment.
5. Patients from long distance and on treatment - arrange for local oncologists to avoid travel.
6. Progressive disease on treatment - decision for additional treatment based on clinical judgment.

Note:

1. COVID-19 test should be done and it should be negative 48-72 hours before any procedure.
2. All patients should be considered Covid-19 negative during any procedure.
3. COVID-19 PREVENTIVE MEASURES SHOULD BE STRICTLY FOLLOWED.