The Bustle of an Academic Feast and the City of Dreams
Dr Ghazal Tansir MD, DM (AIIMS, New Delhi) is a Medical Oncologist doing post-DM Senior Residency at All India Institute of Medical Sciences, New Delhi
Rare malignancies form a niche subgroup of cancers that demands better representation in medical literature. Defined as cancers with an annual prevalence of less than 6 per 100,000 population1, these malignancies pose challenges to clinicians both in research and practise. It is difficult to conduct research among patients with rare malignancies owing to smaller datasets and difficult interpretation of study findings.
In recognition of the need to deliberate on these oft-neglected cancers, oncologists from all over the world congregated for the 20th Conference of the Women’s Cancer Initiative. This annual event, organised by the Tata Memorial Hospital, covered the rare or controversial subjects in the world of gynaecological cancers this year. I was fortunate to attend this meeting which gave me an opportunity to gain insights on numerous rare malignancies, all discussed over one fruitful weekend! A gamut of national and international stalwarts were present during the event, leading to an interesting give and take of academic as well as experience-based knowledge. Gynecologic surgeons (including fertility specialists), medical oncologists, radiation oncologists, pathologists and radiologists led panels and discussed cases after cases with challenging scenarios.
The relevance of such multidisciplinary discussions is paramount in the management of rare diseases2. This is how experts from different specialities can put their minds together and devise personalised plans for each patient. This becomes all the more important in gynecologic cancers because the treatment options also entail potential complications such as infertility and premature menopause. These complications and many other dilemmas were all taken into consideration while discussing malignancies such as ovarian germ cell tumors (GCT), sex cord stromal tumors, rarer epithelial histologies such as clear cell and mucinous carcinomas, neuroendocrine tumors, gestational trophoblastic neoplasias and sarcomas. We were also given insights on how to interpret the data generated from smaller sample sizes owing to rarity of these conditions and the importance of real-world data in this case. The novel and much-needed idea of the initiation of an Indian registry of rare gynecological cancers was also put forth.
As a new entrant into the post-residency phase of my career where I am expected to put my knowledge into practical application, I found certain questions very critical in the discussions. “Whom not to give chemotherapy to?” “Who does not require surgery?” “In whom can we perform a fertility-sparing surgery?” Knowing what not to do is as (or perhaps, more) important than knowing what to do!
I also presented our institutional experience from AIIMS, New Delhi on the management of ovarian germ cell tumors. Oncologists from other centres also shared their own experiences on same histologies and it was interesting to note the management nuances that varied among different setups. The demographic of ovarian GCTs comprises most commonly of young, premenopausal, unmarried females who usually present with symptomatic abdominal masses. The disease usually gets picked up in early stages but the issue remains of improper surgeries undertaken at peripheral centres with no tumor markers being done to establish the diagnosis. Many such patients undergo unnecessarily extensive surgeries where fertility preservation could have been possible. Administration of standard chemotherapy at correct doses and intervals also is extremely vital to secure good survival outcomes. The crux of our observations lay on how a number of our patients are now cured, most resumed their normal menstrual function and many had children after fertility-sparing surgeries and chemotherapy.
Aside from the academic fiesta, it was also my first-ever visit to the bustling city of Mumbai. It was exciting to meet my colleagues and seniors now working at the Tata Memorial Hospital, and to explore Mumbai as a curious tourist. While my observations are also heavily biased by the small number of days I spent in this city as well as many Bollywood-inspired impressions, I did enjoy the vibe of the city and the fast-paced work ethic of the people I encountered. I hope to gain more such experiences of generous sharing of wisdom among fellow specialists at different stages of their career and different branches. This camaraderie is the way forward for benefit of the doctors for their clinical and academic enrichment, which will eventually translate into better and more insightful patient management.
American Cancer Society. Special section: rare cancers in adults. In: American Cancer Society, ed. Cancer Facts & Figures 2017, Atlanta, GA: American Cancer Society, 2017: 30– 39
Rosell L, Wihl J, Hagberg O, Ohlsson B, Nilbert M. Function, information, and contributions: An evaluation of national multidisciplinary team meetings for rare cancers. Rare Tumors. 2019;11:2036361319841696. Published 2019 May 8. doi:10.1177/2036361319841696
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