September is Gynaecologic Cancer Awareness Month, and this year it feels particularly significant to me. My career in gynaecological oncology now spans two decades, and when I look back, I realise that cancer has not only shaped my professional life but has changed the way I see women’s healthcare altogether.
When I first trained in this specialty of women’s reproductive health, most of my colleagues chose to do obstetrics. There was something understandably appealing about a specialty filled with pregnancy, babies, new families and happy endings.
Oncology, by comparison, was often regarded as the sadder, heavier side of gynaecology. I remember that perception, but I can honestly say that I have never regretted choosing oncology.
It is not an easy specialty. I have shouldered a great deal of sadness, disappointment and remorse when things have not gone well for my patients. I have watched cancer disrupt lives, relationships, families, careers and futures. Yet I have also witnessed extraordinary courage, resilience and humanity. Cancer may change a person’s life completely, but it does not necessarily dampen the human spirit.
And after seeing so much cancer, I have to admit that I am a little more aggressive in my investigations than some other gynaecologists. When I see a woman with a symptom that does not quite fit, I tend to investigate rather than reassure too quickly. I may even sometimes over-investigate, because I have always found it difficult to ignore that nagging unanswered question in my mind: What if I have missed something? Having seen what happens when cancer is diagnosed late, I would rather investigate appropriately than live with the possibility that I dismissed something important.
This has also made me increasingly aware of some of the misconceptions women have about their own health. Many believe that cancer must cause obvious symptoms, that abnormal bleeding is simply part of getting older, that pelvic discomfort is normal, or that if something is not painful it cannot be serious.
Ovarian cancer is a particularly difficult example. Its early symptoms can be vague or minimal, and women may find themselves going from one consultation to another before anyone considers that something more significant could be happening.
Similarly, I have become increasingly conscious of how often women can be sent from pillar to post, particularly when their symptoms are nonspecific.
Sometimes they are reassured repeatedly, told that their symptoms are attributed to stress, hormones, or simply “getting older”. Most of the time there may indeed be an innocent explanation. But women deserve to be listened to carefully, and persistent or unexplained symptoms deserve appropriate attention.
Twenty years in this field has also taught me that being a doctor is not simply about recognising disease. It is about listening, asking the extra question, knowing when something does not feel right and, perhaps most importantly, understanding the person behind the symptom.
I now have a deep respect for the complexity of women’s health, and very much aware of the need for further research in this area. We can no longer use the average male as standard while extrapolating the results for all women.
I also have a deep respect for cancer itself—not because I admire it, but because I have seen its power to alter lives. It is a formidable disease, but I have also seen how much strength, hope and determination women can summon in confronting it.
September may be Gynaecologic Cancer Awareness Month, but for me, cancer awareness cannot be confined to one month. This is the work I feel passionately about day after day. After two decades, I still care deeply about getting the diagnosis right, finding cancers early where we can, and making sure that women feel heard.
And despite all the difficult days, the bad news and the emotional weight that comes with this specialty, I can say with absolute certainty: I would choose gynae-oncology all over again.
