Our Services / Gynaecologic Oncology

Uterine Cancer

Cancer of the uterus (womb), also known as endometrial cancer, is the most common gynaecological cancer in Australia, affecting approximately 1 in 47 women before the age of 85 years old. (Source: Cancer Australia)

Fortunately, the disease tends to be detected early because of abnormal vaginal bleeding or discharge, and it can be completely cured in about 80% of the cases. Certain factors do increase the risk of developing uterine cancer, which include obesity, having a late menopause, and not having any children. In addition, certain inherited conditions such as Lynch syndrome (also known as hereditary non-polyposis colorectal cancer) can significantly increase risk of developing uterine cancer. In such cases, it may be advisable to undergo a prophylactic hysterectomy once the patient has completed her family.

Symptoms

Patients with uterine cancer usually present with abnormal vaginal bleeding such as heavy or irregular periods in younger pre-menopausal women or, more commonly, post-menopausal bleeding. However, having post-menopausal bleeding does not necessarily mean that uterine cancer is present. While it is the most common symptom of the cancer, only 10% to 20% of those with post-menopausal bleeding will actually have uterine cancer as there may be many other reasons for the bleeding.

Diagnosis

Diagnosis of uterine cancer is usually confirmed by an endometrial biopsy, which is a sample of the tissue lining the uterus. This is a simple procedure that can normally be done at WOMEN Centre using a specialised uterine lining sampling device.

In some cases, additional investigation might be necessary – either a hysteroscopy (where a tiny camera is inserted through the cervix to look inside the uterus) and / or a curettage (where the uterine lining is biopsied more extensively using an instrument called a curette, and the biopsy to be tested by a pathologist). These will be done as a day surgery case under a short general anaesthesia.

The results of these investigations will be discussed at the Western Australian Gynaecologic Cancer Service’s Tumour Board Multidisciplinary Team Meeting between our gynaecologic oncologist and a panel of expert gynaecological pathologists and medical oncologists.

Depending on the results, a further X-ray or CT scan of the abdomen and pelvis, and blood tests, may be organised in order to obtain information on whether the cancer has spread and, if so, how far it has spread from the uterus.

Treatment and Surgery

The usual treatment for uterine cancer is a form of surgery called ‘total hysterectomy’ where the entire uterus is removed. Both ovaries and any other visible signs of tumour in the surrounding tissues will be removed.

Hysterectomies can be performed in 3 ways:

Laparoscopy (keyhole surgery) – this is our gynaecologic oncologist's preferred approach for treating uterine cancers and other benign gynaecological conditions. More information here on laparoscopy.
Laparotomy (open surgery) – this is usually chosen if there are specific reasons that laparoscopic surgery cannot be performed such as previous surgeries or pelvic infections which may have left considerable scar tissue in the abdomen as well as if the cancer has spread to such an extent that removal through a laparoscopic approach is not possible.
Vaginal approach – this method is rarely used as it does not allow a good view or access of the abdominal cavity. However, it may sometimes be used in very unwell patients with multiple medical problems who cannot safely undergo either a laparoscopic or open abdominal approach.

One of the first places that uterine cancers spread to is the pelvic lymph nodes, but removing them can lead to increased complications. However, removing these lymph nodes and analysing them help to determine if the cancer has spread and to decide whether it is necessary to have supporting treatment such as chemotherapy or radiation therapy after the surgery. Therefore, the decision on whether or not to remove them will only be made after evaluation of all factors including findings during the surgery.

Chemotherapy and / or Radiation Therapy

In some cases, radiotherapy is a vital part of the treatment of uterine cancer.

Radiation therapy is usually used to treat uterine cancers in more advanced or high-risk cases. The treatment is delivered into the vagina using special applicators, which is less invasive and has fewer side effects. Occasionally for higher risk cases, external beam radiation may be required.

Chemotherapy is usually recommended only for certain types of uterine cancer or if the cancer has spread to the pelvic lymph nodes.

The need for chemotherapy and radiation therapy will be discussed individually for each patient and based on the decision made following discussion between our gynaecologic oncologist and a panel of expert gynaecological pathologists, radiation oncologists and medical oncologists at Western Australian Gynaecologic Cancer Service’s Tumour Board Multidisciplinary Team Meeting.

Note: There are important on-going research trials comparing the effectiveness of different supporting treatments in the fight against gynaecological cancers. Patient enrolment in these trials is very valuable and plays a key role in improving our understanding of cancer and its response to various treatments. You may be invited to participate in a clinical trial; should you have any concern, please do not hesitate to discuss it with our gynaecologic oncologist.

After Surgery and Treatment

Our gynaecologic oncologist will discuss the best follow-up regime that is tailored to suit each individual patient. For patients living outside Perth’s metropolitan area, arrangements can be made for on-going follow-up with their local general practitioner or gynaecologist.

Uterine cancer is completely cured in the majority of cases; however, it is normal for patients to have regular follow-ups for five years after treatment. It is particularly important to be alert of any new symptoms rather than just relying on follow-up visits. If uterine cancer recurs, it almost always presents with vaginal bleeding or other symptoms, so it is usually detected early which allows for fast, effective treatment of the recurrence.

Hormone Replacement Therapy (HRT) After Uterine Cancer

Patients may be worried about the use of HRT after uterine cancer as the endometrial cells in the uterus normally grow in response to estrogen and similar hormones. However, there has been no evidence from research to show that HRT increases the chance of uterine cancer recurring.

Our gynaecologic oncologist firmly believes that if HRT is indicated because of intolerable post-menopausal side effects (eg hot flushes), then HRT can be safely used without concern with the exception of patients who are at high risk of developing breast cancer or who have a history of breast cancer. There are also certain types of rare uterine cancers like endometrial stromal sarcomas where HRT should not be prescribed. Our gynaecologic oncologist will discuss about HRT with the patient during consultation – if further counselling is required, a referral to our women’s health general physician or gynaecologists with the expertise in this field, can be arranged.

More information here on menopause management.

Our Services / Gynaecologic Oncology

Dr Jason Tan, raised and educated in Perth, received his medical degree from the University of Western Australia in 1998. Thereafter, he completed six years of specialist training in obstetrics and gynaecology and was a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in 2007. He undertook further training and completed his fellowship in advanced gynaecological endoscopy at Monash Medical Centre, Melbourne, in 2008.

Dr Tan trained further for three years to subspecialise in gynaecological oncology at Mercy Hospital for Women, Melbourne; Queensland Centre for Gynaecological Cancers, Brisbane; and Ariake Cancer Research Centre, Tokyo, Japan; and completed the gynaecological oncology subspecialty training in 2010. In addition to that, he completed his fellowship in upper gastrointestinal surgery and bariatric surgery, at Sir Charles Gairdner Hospital in 2011.

Dr Tan’s special interest is surgical management of cancer, particularly in radical debulking surgery, and he specialises in laparoscopic management of gynaecological cancer. He sees patients with cancers of the ovaries, fallopian tubes, cervix, uterus, vulva and vagina. Besides that, he also sees patients with benign gynaecological conditions requiring complex surgery, such as severe endometriosis, fibroids and complex pelvic masses as well as investigation and management of abnormal Pap smears.

Dr Tan pioneered the robotic surgery for gynaecology and gynaecological oncology in Western Australia with the da Vinci System, further enhancing the legacy of minimally invasive surgery pioneered in Perth by the late Dr Tony McCartney. Robot assisted approach is advantageous in highly complicated procedures due to the better vision and dexterity, offered by the robotic instrumentation.

Dr Tan founded the WOMEN Centre, a leading multidisciplinary private centre for women’s health in Western Australia, in 2014. The specialists at WOMEN Centre provide a truly collaborative approach to patient care in order to ensure the best outcome possible and patients regaining their quality of life after treatment.

Besides his practice at WOMEN Centre, Dr Tan devotes his time to the public health service as consultant gynaecological oncologist at King Edward Memorial Hospital, which includes the teaching and training of medical trainees and junior doctors. He is also the current lead clinician for gynaecology and gynaecological oncology for the Western Australia Cancer and Palliative Care Network and a clinical senior lecturer at University of Notre Dame and University of Western Australia as well as preceptor at various surgical skills development workshops.

Qualifications and Training

2011	Fellowship in Upper Gastrointestinal Surgery and Bariatric Surgery – Sir Charles Gairdner Hospital
2010	Gynaecological Oncology Subspecialty, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (CGO)
2008	Fellowship in Advanced Gynaecological Endoscopy – Monash Medical Centre
2007	Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG)
2005	Member of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (MRANZCOG)
1998	Bachelor of Medicine, Bachelor of Surgery – University of Western Australia (MBBS)

Dr Tarek Meniawy manages all aspects of general medical oncology and also subspecialises in gynaecological malignancies, and melanoma. Besides his clinic at WOMEN Centre, Dr Meniawy devotes his time to Sir Charles Gairdner Hospital, King Edward Memorial Hospital and University of Western Australia as a clinical senior lecturer.

Dr Meniawy received his medical degree from Cairo University, Egypt; in 2000 and undertook postgraduate physician training at the Princess Alexandra Hospital, Brisbane. He had further training in medical oncology at Royal Perth Hospital and Sir Charles Gairdner Hospital, and was awarded the Fellowship of the Royal Australasian College of Physicians in 2011. He is a member of the Western Australia Gynaecological Cancer Service and the Western Australia Melanoma Advisory Service.

Dr Meniawy has a keen interest in research and is actively involved in clinical trials including early studies of novel therapies, and large international studies in gynaecological cancer and melanoma. He has a particular interest in tumour immunology and immunotherapy, which have resulted in major breakthroughs in cancer therapies in recent years.

In 2016, Dr Meniawy was awarded a Doctor of Philosophy by the University of Western Australia for his studies on the effects of targeted anti-cancer therapies on the immune system. He is also an active member of the Australia and New Zealand Gynaecological Oncology Group, a not-for-profit organisation, dedicated to gynaecological cancer research.

Qualifications and Training

2016	Doctor of Philosophy – University of Western Australia (PhD)
2011	Fellow of the Royal Australasian College of Physicians (Medical Oncology)
2000	Bachelor of Medicine, Bachelor of Surgery – Cairo University (MBBS)

Dr Paul Cohen is a gynaecologist with special interests in gynaecological oncology and the management of menopausal symptoms in women who have undergone treatment for cancer (including breast, colorectal, haematological and gynaecological cancers).

Dr Cohen completed his medical degree at the University of Oxford in the United Kingdom, and subsequently undertook specialist training in obstetrics and gynaecology in Auckland, New Zealand. He was granted Fellowship of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in 2010 and undertook full time research in the molecular biology of ovarian stromal tumours, for which he was awarded a Doctorate in Medicine by the University of Auckland in 2011. Thereafter, he undertook an additional three years of fellowship in gynaecologic oncology in Brisbane, Newcastle and Sydney, and relocated to Perth in 2013.

Dr Cohen currently works as a gynaecologist and a clinical senior lecturer at King Edward Memorial Hospital, and contributes his expertise to the Western Australia Gynaecological Cancer Service and the Menopausal Symptoms After Cancer Clinic, where he has been actively involved in research and teaching.

Dr Cohen is also the director of gynaecological cancer research at St John of God Subiaco Hospital, where he oversees a number of research projects and supervises undergraduate, Master and PhD students. He is an adjunct professor at the Institute for Health Research, University of Notre Dame, Fremantle.

More information here for gynaecological cancer research at St John of God Subiaco Hospital.

Qualifications and Training

2011	Doctorate of Medicine – University of Auckland (MD)
2010	Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG)
2002	Diploma Obstetrics and Medical Gynaecology – University of Auckland (Dip Obs)
2001	Master of Arts in Physiological Sciences – University of Oxford (MA Oxon)
2000	Bachelor of Medicine, Bachelor of Surgery – University of Oxford (BMBCh)
1997	Bachelor of Arts in Physiological Sciences – University of Oxford (BA)

Dr Stephen Lee - Obstetrician and Gynaecologist

Dr Stephen Lee manages all aspects of general obstetrics and gynaecology, with special interests in advanced laparoscopic surgery, complex gynaecological problems and fertility.

Before relocating to Perth, Dr Lee completed a two-year laparoscopic gynaecology fellowship under the mentorship of Dr Catarina Ang, Head of Gynaecology 1 Unit at Royal Women’s Hospital in Melbourne, an accredited training site of the Australasian Gynaecological Endoscopy and Surgery Society (AGES). During the fellowship, Dr Lee was able to perfect a wide range of minimally invasive gynaecology skills and was invited to speak at AGES and AAGL (American Association of Gynaecologic Laparoscopists) conferences to present his research.

Prior to his fellowship, Dr Lee completed basic obstetrics and gynaecology training at Monash Medical Centre in Melbourne. Subsequently, Dr Lee was a research fellow under the guidance of Associate Professor Sue Walker and Associate Professor Stephen Tong, at The Mercy Hospital for Women and University of Melbourne, investigating intrauterine growth restriction. Thereafter, he travelled to England to work as a clinical fellow in urogynaecology at Nottingham University Hospital under the supervision of Consultant Urogynaecologist Dr Paul Hooper.

Dr Lee devotes his time to the public health service as a consultant obstetrician and gynaecologist at King Edward Memorial Hospital. He is keen on improving the education and training of general practitioners, with an interest in women’s health, and budding obstetricians and gynaecologists.

Dr Lee earned his Bachelor of Medicine, Bachelor of Surgery from the University of Melbourne, and he is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. In his spare time, he likes to cycle, play tennis and practise Chinese martial art.

Qualifications and Training

2013	Master of Business Administration, Melbourne Business School, University of Melbourne
2012	Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG)
2010	Member of Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (MRANZCOG)
2007	Postgraduate Diploma in Management, Melbourne Business School, University of Melbourne
2002	Bachelor of Medicine, Bachelor of Surgery – University of Melbourne (MBBS)

Dr Fred Busch - Obstetrician and Gynaecologist

Dr Fred Busch manages all aspects of general obstetrics, including high-risk obstetrics, and gynaecology.

Dr Busch’s special interests in gynaecology include advanced laparoscopic surgery (including hysterectomy and endometriosis), hysteroscopic surgery, pelvic floor repair and incontinence surgery, menorrhagia management, and colposcopy.

Dr Busch received his medical degree from the University of Stellenbosch in South Africa. He trained in the United Kingdom for paediatrics, ear nose and throat surgery, and obstetrics and gynaecology before relocating to Australia. He undertook the integrated obstetrics and gynaecology training program at King Edward Memorial Hospital and was granted Fellowship of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in 2007.

Qualifications and Training

2007	Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG)
2001	Australian Medical Council Equivalency Examinations
2000	Diploma of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (DRANZCOG)
1993	Bachelor of Medicine, Bachelor of Surgery – University of Stellenbosch (MBChB)

Dr Su Hamid - Obstetrician and Gynaecologist

Dr Su Hamid manages all aspects of general obstetrics up to 20 weeks of pregnancy and general gynaecology.

Dr Hamid’s special interests in gynaecology include colposcopy and management of abnormal Pap smear, endometriosis, ovarian cysts, Polycystic Ovarian Syndrome (PCOS), fibroids, pelvic pain, incontinence (including urodynamics) and pelvic organ prolapse, menstrual problems, painful intercourse, post coital bleeding, post-menopausal bleeding, vulval conditions, gynaecological cancer assessment and diagnosis, family planning, infertility assessment, and menopause management.

Dr Hamid graduated with a first class honours in Bachelor of Medical Sciences in 1990 and Bachelor of Medicine and Bachelor of Surgery in 1992, from the University of Nottingham in the United Kingdom. She has been working in obstetrics and gynaecology since 1993 and was granted membership to the Royal College of Obstetricians and Gynaecologists (United Kingdom) in 1998. She completed her Specialist Certificate of Training in Obstetrician and Gynaecologist in 2004 and obtained fellowship of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in 2008. After her move to Australia in 2003, she has worked in Perth, Melbourne and Geraldton. She is multilingual and can consult in Malay and English fluently.

Dr Hamid was born in Malaysia and moved to the United Kingdom where she studied and worked for 20 years before moving to Australia with her family; drawn by the quality of life and abundance of sunshine here. In her spare time, she enjoys working out in the gym and cycling.

Qualifications and Training

2008	Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG)
2004	Specialist Certificate of Training, Obstetrician and Gynaecologist
1998	Member of Royal College of Obstetricians and Gynaecologists (MRCOG)
1992	Bachelor of Medicine, Bachelor of Surgery – University of Nottingham (BM BS)
1990	Bachelor of Medical Sciences – University of Nottingham (B Med Sci)

Dr Jeremy Tan - General, Upper Gastrointestinal and Bariatric Surgeon

Dr Jeremy Tan completed his Bachelor of Medicine, Bachelor of Surgery (MBBS) at the University of Western Australia in 1999. He went on to undertake specialist training is general surgery and was awarded Fellow of the Royal Australasian College of Surgeons in 2007. He further subspecialises in upper gastrointestinal surgery and bariatric surgery after completing his fellowship for both at Sir Charles Gairdner Hospital in 2007.

Dr Tan attends obstetric and gynaecological operations where there may be concurrent surgical problems such as hernias or diseases that involve the bowel. He also contributes his expertise in gynaecological cancer surgery where the tumour deposits are in anatomical locations that require the expertise of a surgeon with extensive upper gastrointestinal surgical experience for a complete resection of tumour.

A joint approach gynaecological cancer surgery with Dr Tan facilitates the highest chance of optimal debulking with lower morbidity when the cancer require extensive surgical debulking in the upper abdomen. Dr Tan is also available for outpatient service such as vasectomy procedure at WOMEN Centre.

Qualifications and Training

2007	Fellowship in Upper Gastrointestinal Surgery and Bariatric Surgery – Sir Charles Gairdner Hospital
2007	Fellow of the Royal Australasian College of Surgeons (FRACS)
1999	Bachelor of Medicine, Bachelor of Surgery – University of Western Australia (MBBS)

Dr Tim Pavy - Specialist Pain Medicine Physician

Dr Tim Pavy, after graduating from the University of Adelaide, trained extensively in anaesthesia and intensive care in South Africa, Zimbabwe, England and Canada. He settled in Perth, in 1987, and is one of the key medical practitioners at King Edward Memorial Hospital, where he founded Australia’s first public Pelvic Pain Clinic in 2008.

Dr Pavy became a fellow of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists in 2000. His particular interests, on which he has published extensively and lectured at national, and international level, include anaesthesia and pain relief for pregnant women, and persistent pelvic pain.

Qualifications and Training

1988	Fellow of the Australian and New Zealand College of Anaesthetists (FANZCA)
1986	Fellow of the Royal College of Anaesthetists (FRCA)
1982	Diploma in Midwifery (Obstetrics) (Dip.Mid.COG)
1980	Diploma in Anaesthesia (DA)
1976	Bachelor of Medicine, Bachelor of Surgery – University of Adelaide (MBBS)

Dr Clayton Golledge - Physician in Infection Management and Clinical Microbiologist

Dr Golledge has more than 25 years of consultant experience as a Physician in Infection Management and Clinical Microbiologist. He trained initially in medicine at Princess Alexandra Hospital in Brisbane, Sir Charles Gairdner Hospital and Royal Perth Hospital. He subsequently completed his microbiology training at Royal Perth Hospital, Sir Charles Gairdner Hospital and Fremantle Hospital.

Dr Golledge did advanced training in infectious diseases at the City Hospital and Western General Hospital in Edinburgh and since 1991 has been a consultant at Sir Charles Gairdner Hospital and also consults at St John Of God Subiaco Hospital, Hollywood Hospital and Bethesda Hospital.

Dr Golledge was instrumental in setting up the inaugural Infectious Diseases Service at Sir Charles Gairdner Hospital and was also responsible for the Western Australia’s first Hospital In The Home Service through Sir Charles Gairdner Hospital.

Qualifications and Training

2011	Fellow of the Royal Geographical Society (FRGS)
2001	Fellow of the Royal College of Physicians (FRCP)
2000	Fellow of the Royal Society of Tropical Medicine (FRSTM)
1995	Fellow of the Australian College of Tropical Medicine (FACTM)
1991	Fellow of the Royal College of Pathologists of Australasia (FRCPA)
1990	Diploma of Tropical Medicine and Hygiene (DTM&H)
1980	Bachelor of Medicine, Bachelor of Surgery – University of Queensland (MBBS)
1977	Bachelor of Medical Science (BSc Med)

Dr Lesley Ramage - Women’s Health General Practitioner

Dr Lesley Ramage has more than 25 years of experience in women’s health as a general practitioner. She obtained her medical degree from Leeds University in the United Kingdom and completed her postgraduate general practitioner training in 1986.

Dr Ramage has worked in general practice since moving to Australia with her family in 1993. Since 2007, she has also held an appointment at King Edward Memorial Hospital where she consults in menopause and menopause symptoms after cancer clinics. She is actively involved in the teaching and training of medical undergraduates and doctors.

Dr Ramage holds a Postgraduate Diploma in Women’s and has been an invited speaker at a number of educational events. She regularly attends local, national and international scientific meetings to keep up to date with new developments in the field of women’s health.

Dr Ramage’s special interests include family planning and the management of menopause (both natural and following a diagnosis of cancer). She performs Pap smears and sexual health screening and provides osteoporosis and cardiovascular disease risk assessments.

Qualifications and Training

2006	Postgraduate Diploma in Women’s Health (PGDip Women’s Health)
1986	Family Planning Certificate
1986	Royal College of General Practice United Kingdom (RCGP)
1983	Bachelor of Medicine, Bachelor of Surgery – Leeds University (MBChB)