IGCS Traveling Scholar Reports 2008


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Traveling Scholar Reports 2008 - 2009

The IGCS Traveling Scholars Program has supported a variety of international training opportunities for physicians and nurses outside of their usual environments. Activities from 2008 and 2009 are summarized below, based on reports from the award recipients. IGCS congratulates the recipients on their achievements, and extends gratitude to the host institutions and mentors who made these experiences possible.


	Agboola Oluwaseun Abosede (Nurse, Nigeria) Christian Fellowship Community Health Centre, Tamil Nadu, India
	The training commenced on the 19th of February and ended on the 7th of March, 2009. I had a retraining programme on cervical cancer screening using the VIA/VILI technique which is the best method for developing countries like ours. Colposcopy, biopsy, cryotherapy and LEEP procedures were also learnt and because the hospital was centrally located, we had a lot of clients coming in for these procedures. I also followed the screening team to villages where women were screened at the community-based screening centers. Dr. Esmy had detailed lecture hours with me on cervical/breast cancers and etiology for various cancers in general. I have gained a great deal of knowledge on cancers related to women, screening for these cancers and their management. I want to thank the IGCS for giving me this opportunity which will greatly improve my services here in Nigeria as a nurse at the gynae oncology unit where I work.
	Dr. Rani Akhil Bhat (Oman) Hotel Dieu de Quebec, Quebec City, Canada
	I had the unique opportunity of undertaking the IGCS Traveling Scholarship with Dr. Marie Plante and her team at the Division of Gynaecologic Oncology at the Hotel Dieu de Quebec in Quebec City, Canada during the period of March/April 2009. The Hotel-Dieu de Quebec is a teaching hospital in Quebec City, is also the oldest hospital in Canada and a leading center for research and treatment of cancer in Canada. I spent most of my time in the operating rooms where I had the opportunity to witness a wide range of laparoscopic procedures for gynaecological malignancies including laparoscopic retroperitoneal lymphadenectomies for cervical cancers, laparoscopic radical hysterectomies, laparoscopic sentinel lymph node biopsies and several other operations for gynaecological malignancies. Although the official working language in Quebec was French, the operating surgeons always made it a point to explain to me in English the steps and technical intricacies of the procedures as they operated. For doctors like me serving in parts of the world where the specialty of gynaecologic oncology is in its infancy, this was a very enlightening time and of great benefit. My time here provided me an insight into the scope of minimally invasive surgery in gynaecologic oncology which was my main objective for this fellowship. I owe my gratitude to Dr. Marie Plante, Chief of the Division of Gynaecologic Oncology for her support at every stage of my fellowship right from the application process to helping with the accommodation arrangements during my stay in Quebec City. Other doctors at the division too have gone out of their way in their effort to help enrich my experience during this fellowship and I appreciate the efforts in particular of Dr. Michel Roy, Dr. Marie-Claude Renaud, and Dr. Jean Grégoire. I would also like to thank Dr. Saleh Al Khusaiby, the dean of Oman Medical College and Dr. Pushpa Dahiya, chief of OB/GYN and my supervising consultant at my home institution for supporting my application for this traveling scholarship. I am thankful to Ms. Erica Riley for her assistance at all stages of this Traveling Scholarship. I remain indebted to the IGCS for providing me this wonderful opportunity which I believe will go a long way in positively influencing patient care in the areas of the world where I serve.
	Dr. Victorino C. Garcia, Jr. (Philippines) Memorial Sloan-Kettering Cancer Center, New York
	I finished my residency in Obstetrics and Gynecology at the University of the Philippines-Philippine General Hospital in 2001. After my training, I went into private practice and was connected to the Government Provincial Hospital, some 250 kilometers north of metro Manila. During that time, I was able to get a grant to visit the Gynecologic Oncology Service of the University of Dusseldorf, Department of Obstetrics and Gynecology, for three months. On my return to my province, I realized that there are a lot of gynecologic cancer cases in the province and that I could have benefited more from my endeavour in Germany if I finished a formal Gynecologic Oncology Fellowship. These were the reasons I went back for a three-year fellowship at the Philippine General Hospital and graduated in December 2007. The thirst for knowledge about cancer continues, and the need to serve the best interests of our patients is paramount. The news of being one of the recipients of the IGCS Traveling Scholarship for 2008 to visit the Memorial Sloan-Kettering Cancer Center (MSKCC) was timely. It was a cold winter morning in February 2008 when I arrived at the MSKCC. I was warmly received by Dr. Dennis Chi, my mentor, and Dr. Richard Barakat, the Chief of Gynecology Service. No time was wasted on my first day, as we started the day to make rounds with the fellows and residents. Every day is operating day. There are approximately one to six surgeries per day done by the Service. The cases range from premalignant to malignant. The Gynecology Service does its own bowel and urinary tract surgeries. Many laparoscopic operations are performed, including robotic surgery. There are a lot of radical operations performed such as: pelvic exenterations, radical abdominal/vaginal trachelectomies, and ovarian tumor debulking with port site insertions. The use of high-technology instruments, including argon beam coagulator, harmonic scalpel, ligasure, sentinel node mapping using lymphazurine dye, radioactive compound and gamma probe, and various staplers. They also do live phone-patch while you wait for the result of a frozen section with a slide view on the LCD monitor. The Service has good retracting instruments that give adequate exposure, which significantly contributes to the success of the operations. Monday is Surgical Grand Rounds. Lecturers from other universities speak about the latest in cancer, from its molecular characteristic to novel diagnostic techniques and treatment. Multidisciplinary Treatment Planning Conference is held on Thursday morning, where medical oncologists, radiation oncologists, gynecologic oncologists, radiologists, pathologists, nurses, fellows and residents are all in attendance. This is preceded by a meeting, either lecture from a guest or faculty or updates from fellows in the Gynecologic Oncology Group (GOG) Trials, or lectures on sexuality in relation to cancer patients. Other presentations include papers to the Society of Gynecologic Oncology Annual Convention, an echo of the said conference, or Mortality and Morbidity Conference, to name a few. As a result of this experience, I realized that most fields in medicine continue to evolve and that minimally invasive surgical procedures like laparoscopy are now indispensible in the diagnosis and management of gynecologic malignancies. We are just starting this in the Philippines. With the advancement of technology and medicine, people now have longer life spans, increasing the occurrence of cancer late in life. Therefore, no one is too old to receive treatment. My stay in New York City was a wonderful experience. Though the cost of living, including rent and food, is high, I enjoyed many astounding encounters with the diversity of the famed metropolis. A stroll in Central Park, riding the intricate, maze-like pathways of the subways and buses, visiting several museums, and watching a Broadway show surely gave me an appreciation of New York. Finally I would like to thank IGCS for giving me this opportunity to have this scholarship and for the visit at MSKCC. I would also like to express my thanks to Ms. Erica Bard Riley for all her help.
	Dr. A.P. Manjunath (India) National Cancer Center Hospital, Chuo-ku, Tokyo
	From March 17-May 14, 2008, I had the position of Visiting Doctor at Gynecology Division, National Cancer Center Hospital, Chuo-ku, Tokyo, and participated in the following weekly schedule. Dr. Tomayasu Kato, Head of the Medical Staff, Gynecology Division, was my mentor. Schedule: Monday: Business meeting 1700-1800 hours (new cases and current treatment plan were discussed). Thursday: Joint conference at 1730-1900 hours (all cases under treatment and new or recurrent cases were discussed) Participated in weekly pathology specimen cutting sessions. Operation list from Monday to Friday. Attended ward rounds. Attended Outpatient Clinic Training Received: I witnessed 25 radical surgeries, eight radical hysterectomies, one radical vulvectomy with lotus flap, one abdominal radical trachelectomy, one ovarian cancer debulking with posterior exenteration, ten cases of total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy for endometrial cancer, five staging laparotomies for ovarian cancer and five other surgeries. I received training on techniques of nerve preservation during radical hysterectomy. Dr. Kato spent his valuable time in discussing the technique of extended nerve sparing radical hysterectomy (NSRH). I watched operative videos with him on several occasions and discussed the technical aspects of each step. He permitted me to assist surgeries on several occasions. He organized the workshop on cadaver dissection of autonomic nerves during my stay. He also coordinated and arranged for my visit to several cancer centers in Japan. Additional Cancer Center Visits in Japan: Kyoto Medical Center, Kyoto: Visited on three occasions on April 18, 24 and May 1, 2008 and witnessed nerve sparing radical hysterectomy performed by Professor Shingo Fujii, President of Kyoto Medical Center (National Hospital Organization). It was very interesting to learn his meticulous dissection during Okabayashi radical hysterectomy. He showed all the blood vessels and nerves that he had described in his recent publications. His technique of anatomical dissection from surface to bottom with minimal blood loss was very impressive. He demonstrated the confidential step of avascular plane in dissection of posterior leaf of vesicouterine ligament, which was originally described by Okabayashi. He has used operating loop (magnification x 2.5) while operating. I had the opportunity to participate in a pathology meeting on April 18th to review the histopathology slides. Mita Hospital, Tokyo: Watched surgery performed by Dr. Kathase. He performed Okabayashi radical hysterectomy with pelvic and para-aortic lymphadenectomy for stage II B cervical cancer after neoadjuvant chemotherapy on April 17th. Cancer Institute Hospital, Tokyo: Observed nerve sparing Okabayashi radical hysterectomy on May 7th. Hyogo Cancer Center, Akashi, Japan: Observed and assisted four staging laparotomies for ovarian cancer on April 21st under supervision of Professor Ryuichiro Nishimura, Vice President and Director, Department of Gynecologic Oncology. I had the opportunity to participate in a public health education program on cervical cancer. The BS NHK TV programme was telecast on May 29th. The library was good with online access to full text articles. Although the original atlas and publications related to radical surgeries were in the Japanese language, the diagrams and illustrations were informative. It was very interesting to witness the excellent infrastructure for patient care. The technology was amazing regarding medical equipment and electronic patient data management software. Miracle electronic medical record (EMR) software has interesting features where the operative findings in the diagrammatic forms are illustrated and stored with the help of a digital pen. The pathology specimens were photographed and digitally achieved. The pathologically positive areas were outlined in red for clear description. All patient-related details were available through software, including appointments and prescriptions. I also had an opportunity to see PET-CT for management of malignancies. Goals Accomplished: I obtained broad experience in pelvic cancer management. Special training on understanding the cardinal steps of Okabayashi radical hysterectomy was rewarding. The concept and understanding of pelvic autonomic nerves was obtained through the anatomic workshop on cadaver dissection. Exposure to nerve sparing radical hysterectomy and extended nerve sparing technique was beneficial. Achievements in Clinical Practice: Standard nerve sparing and extended nerve sparing concept and techniques of Okabayashi radical hysterectomy will be useful. I learned the precise anatomy necessary for nerve sparing techniques. Participation/Presentations at Seminars, Meetings and Workshops: Participated in the Workshop on abdominal radical trachelectomy at Kitano Hospital, Osaka. Witnessed the live demonstration by Dr. Tadayoshi Nagano on April 8th. Participated in CME and Workshop on Cadaver dissection for pelvic autonomicnerves and delivered guest lecture, “Cervical cancer: Indian perspective” on April 26th at Tokyo Medical and Dental University, Tokyo. Although English was used infrequently for communication, I was able to communicate slowly and discuss cases in multiple sessions. The official communication in meetings, conferences and case discussions was in Japanese. The case sheets, electronic patient data, and prescriptions were also in Japanese. Even so, learning the techniques of surgeries was not a problem. Future Plans: After witnessing the variety of surgical techniques, especially nerve sparing radical hysterectomy, I feel confident to implement the technique in my clinical practice. I have collected the necessary information on surgical instruments and software etc. to improve the infrastructure of my home institute, with my host institute as a model, and to achieve international standards. I hope to get funds from a suitable funding agency for a research grant to establish the infrastructure necessary for implementation of nerve sparing radical hysterectomy at my home institute. Two manuscripts are under preparation for publication in English literature along with my mentor. One manuscript is about anatomical and technical aspects of nerve sparing radical hysterectomy. The other will be to highlight the differences in the technicality of radical hysterectomy in the West (Wertheims-Meigs) and the East (Okabayashi). This is to disseminate the acquired knowledge. Evaluation and Comments: Overall, it was a wonderful experience to witness the Japanese techniques of surgery. Although the training was received at the most expensive city in the world, IGCS generously funded the program. The training period also was adequate. I was able to travel by super express train service, Shinkansein trains (bullet trains) to visit many cancer centers to witness surgeries because of adequate funding. Having been trained to perform the western technique of radical hysterectomy, I had an opportunity to learn the eastern techniques (Okabayashi and Tokyo method) and their modifications, as these techniques are not performed and taught outside Japan. Moreover, there is always a misconception in the literature regarding the radicality of Okabayashi techniques. Because of such traveling scholar programs, the clinicians from developing countries are able to interact with mentors and discuss the challenges faced by them in management in low resource settings. Without the support of IGCS it would not have been possible to get such an experience. I appreciate the efforts of IGCS in encouraging the clinicians from developing countries to participate in such international programs. Acknowledgement: I thank IGCS for financial support. My special thanks to Erica Bard Riley, Administrative Director of the IGCS, for constant advice and help throughout the program. I also appreciate the help and local hospitality extended by my mentor Dr. Tomayasu Kato during my stay in Japan. He was very helpful in organizing my visits to the various cancer centers. Mrs. Sakiko Suzuki, Secretary, Planning Division, was helpful in coordinating the paper work in a timely manner. I thank Professor Kasamatsu, Chief of Gynecology Division, for all his advice and help. I also thank other staff members of the Gynecology Division: Dr. Onda, Dr. Ikida, and Dr. Sawada. I am grateful to Professor Shingo Fujii for taking a personal interest in teaching me his techniques and spending his valuable time in discussing the concept of nerve sparing as well as the Okabayashi technique of surgery. I appreciate him for his wonderful hospitality. I thank Professor Nishimura for permitting me to assist cases. I really appreciate his local hospitality. I thank Dr. Tanikawa, senior resident at NCCH, for all his help as well. At my home institute, I thank Dr. Lavanya Rai, Professor and Unit III Chief, Dept. of Obstetrics & Gynecology, for her invaluable help and advice throughout my programme. My thanks to Dr. RSP Rao, former Dean, Kasturba Medical College, Manipal, for extending all the necessary support for this program. I am grateful to Dr. Pratapkumar, Professor and Head, Dept. of Obstetrics & Gynecology, and Dr. Vidyasagar, MS, Professor and Head, Dept of Radiotherapy and Oncology, for their advice and support. Finally, I wish to thank my wife and colleague, Dr. Girija S. for her constant help and support.
	Dr. Catherine Nyongesa (Kenya) Department of Radiation Sciences, University of the Witwatersrand
	I am a medical specialist in radiation oncology at Cancer Treatment Centre Kenyatta National Hospital. I participate in management of cancer patients with radiotherapy and chemotherapy and nuclear medicine. I also do calls and attend multidisciplinary meetings. I began my training on September 9, 2008 and concluded it on October 31, 2008. Two elements of the training programme included patient protection and the prevention of accidental exposures in radiotherapy. I participated in the Quality Assurance Team for Radiation Oncology (QUATRO) to the Radiation Oncology unit Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa and trained in Brachytherapy for cancer of the cervix and oesophagus. I also drafted a study proposal for the comparison between two fractionation regimens in palliation of patients with oesophageal cancer; 30 Gy in 10 vs. 20 Gy in 5 on Cobalt 60 and formulated a phase 3 randomised trial of primary chemotherapy in breast cancer comparing AC VS FAC in limited resource setting. I submitted two papers to the SASCRO/SASMO Congress by 30th Oct 2008 on Malignant Phyllodes tumour in pregnancy and oncology challenges in developing countries. I also participated in academic programs in management of various malignancies with emphasis on gynaecological malignancies and visited the chemotherapy pharmacy in medical oncology at the Johannesburg Hospital area 495. I collected standard plans for Brachytherapy to be used at our home institution. The two papers I submitted were accepted for oral and poster presentation at SASCRO SASMO Congress held in Cape Town South Africa on 19th-23rd February 2009. I intend serve the cancer patients with the knowledge and skills I acquired. I also hope to do a similar internal audit at the cancer treatment Centre in my country. The Brachytherapy standard plans have been fitted in our system and the Brachytherapy for patients with cervical cancer should be up and running soon. I will be submitting the research proposal I prepared to the ethics committee for approval. I found the host institution suitable for my training and the training programme of high quality. I received excellent guidance and was pleased to be able to work in the centre. I am grateful for the assistance I received from the IGCS and I appreciate their patience in giving me a chance to complete this training. I am also grateful to my home authorities who released me to attend the training.
	Dr C. A. Okonkwo (Nigeria) University College Hospital, London
	It is with great indebtedness to the IGCS that I write this report on the travel scholarship granted me in Gyne-oncology at the University College Hospital London. I worked under Miss Adeola Olaitan for a period of four weeks, that is from the 2nd – 31st of July 2008. The training I had involved all the areas of standard care in the specialty of Gyne-oncology. The scholarship commenced on the 2nd of July 2008. Prior to this, a weekly time table was given to me by Miss Olaitan. This time table covered the following areas, clinical ward rounds, gyne-oncology out-patient clinics, theatre sessions, rapid access clinic, multi-disciplinary team meetings and colposcopy sessions. The training in Gyne-oncology was very broad and detailed and it included counseling as well as, diagnostic and therapeutic Colposcopy. I was exposed to a variety of Gyne-oncology surgeries, attending theatre sessions with an average of four cases on each list weekly for the entire four-week period. I saw a wide variety of cases as I attended four different Consultant out-patient clinics. My knowledge and understanding of Gyne-oncology was broadened and the various treatment modalities of such lesions was further enhanced by the number of cases I saw in these clinics. I was also present at all multi-disciplinary team meetings which were very enlightening. The need for this training cannot be overemphasized. In Nigeria today cervical cancer is the most common cancer of the female genital tract accounting for 74.4% of female cancers in Benin-City where I work. It is estimated that in Nigeria, about 25,000 new cases of cervical cancer occur every year, also about 64% of our patients present in advanced stages of cancer in our Gyne-oncology unit. It is for these reasons I remain ever grateful to Miss Olaitan, for making this training a reality, and to Mr. Martin Widschwendter, Miss MacDonald and Mr. Tim Mould. Many thanks to Dr. Sue Gessler, clinical psychologist, and all the clinical nurse specialists at the Gyne-oncology unit of University College Hospital London. The time spent during this scholarship has proved inspirational and very rewarding. It would however, be of greater impact if the period of the scholarship can be fixed for a period of three months, as four weeks were not adequate. We have since commenced Colposcopy services in my Hospital and started applying most of what I learnt from Miss Olaitan and her colleagues. I would like to use this medium to appeal to the IGCS to increase the number of scholarships awarded, particularly to Nigerians. Finally thank you, Erica, for your administrative efficiency and the IGCS for the opportunity.
	Dr. Thomas Samuel Ram (India) Long Beach Memorial Medical Center, California
	At the outset, I wish to thank the International Gynecologic Cancer Society for selecting me for this award. I landed in Los Angeles from Chennai via Paris on the 3rd June 2008. I must thank the staff at Radiation Oncology at Long Beach Memorial Medical Center, who had been kind enough to arrange for a guest house very close to the hospital. I started my program on the 4th of June with Dr. Syed Nisar and Dr. Ajmel Puthawala. It was an overwhelming moment for me to be with the pioneers of Gynecological Brachytherapy. I was fortunate enough to see most of the high dose rate brachytherapy procedures done in gynecological malignancies, which included interstitial implants for cervical cancer and vaginal cylinder, which was custom-made by Dr. Syed and his team. Instead of having only one central channel, they had six peripheral channels along the circumference, which gave more freedom to differentially obtain a desired dose distribution. I got to see ovoid only application for vault radiation in patients for whom a vaginal cylinder was not possible because of the patients’ habitus. I also had a chance to see hyperthermia being utilized for locally advanced lesions. I saw some of the recent techniques in external beam radiation therapy for gynecological cancer. It was interesting to see the CT Simulator and the planning systems in the Hospital. I was fortunate enough to see the tomotherapy planning and quality assurance, and the treatment setup and delivery for IMRT using a tomotherapy unit. The Tumor Board meetings were very educative and thought provoking. I was intrigued by the facility of chemotherapy sensitivity and resistance assays being done by the Medical Oncology Lab for the patients requiring chemotherapy. I had the opportunity to closely interact with the medical physics in that Hospital. Dr. Anil Sharma, Chief of Medical Physics, and his team had been kind enough to patiently show me around and allow me to observe simulation, planning and brachytherapy treatment delivery. They offered me various tips and suggestions that we normally do not come across in books or literature. I also had a useful interaction with the radiation therapy technologists. They also very patiently explained to me the setup for treatment on the Tomotherapy Unit, the image guided radiotherapy process. I was again given some of the useful tips, which facilitate the most appropriate matching in IGRT. Apart from the scientific and technical knowledge I received, I was fortunate to interact with the department manager and briefly became acquainted with the organization and management of the Radiation Oncology Department. This was of great help in understanding the system and how it can be utilized to improve patient care and personnel management back at my institution. I wish again to thank IGCS for this opportunity that was provided to me. I hope this experience will help me to improve patient care, teaching and research in our region.
	Dr. Suniti Joshi Rawal (Nepal) Royal Women’s Hospital, Melbourne
	It was indeed a pleasant surprise to be selected for an IGCS Traveling Scholarship to study at the Royal Women’s Hospital (RWH), Melbourne. Whilst it was full of excitement and first of the kind in my career so far, I had to hold up the trip by few weeks owing to some unavoidable professional and familial obligations. My heartfelt gratitude to IGCS for granting me this opportunity for acquiring such great learning experience in a completely different and superior environment to the surrounding I had experienced before. Needless to say, my stay of three months in Melbourne was quite comfortable with a satisfactory stipend. I would also like to thank RWH for providing me an accommodation within their hostel facility, which I shared with two fellow doctors. Above all, my sincere appreciation to Professor Michael A Quinn, who is not only a great scholar, but also a supportive and caring person. Under his guidance and observation, I had a great learning experience throughout the period. Procedures like trachelectomy, radical surgeries, pelvic and sentinel lymph node dissections and vulvectomies were diligently shown and taught to me for which I will always be obliged. As a person that I am with an insatiable appetite for knowledge, the only thing I wish for more was more hands-on experience with such a great scholar. Nevertheless I was provided with a few opportunities of assisting him in interesting cases and I look forward to additional opportunities in coming days. Academic sessions conducted inside the hospital includingTumor Boards on Tuesday,and the Radiological and the Departmental meetings on Friday were educational too. Tumor Board, comprising Gynaecologists, Oncologists, Radiologists, Radiotherapists and Pathologists, discussed the patient’s profile and the management process in detail which helped us to perform treatment much effectively. Similarly, my attendance at Radiological meetings helped to enhance and broaden my knowledge of the field with the detailed discussion of MRI, PET scans etc. LEEP and Laser treatment, which we do not have in my country due to lack of resources. Lastly but certainly not the least, hats off to Dr. Deeborah Neesham and Associate Professor Robert Rome, who took keen interest in guiding me and the Research Nurse Juleen, always being there extending a helping hand. Also my heartfelt thanks to all the nurses, staffs and patients of the RWH for helping me learn and making me feel at home.
	Dr. Cagatay Taskiran (Turkey) Memorial Sloan Kettering Cancer Center, New York
	It was the beginning of my great journey to the Memorial Sloan-Kettering Cancer Center when I received the acceptance letter from Prof. Barakat for the three-month period of January 1 to March 29, 2008. Then I applied for the IGCS grant for this trip and they accepted my application. That was really important for me since New York is a very expensive city. Before I went, I had several plans for this period. One of the most important goals for me at MSKCC was the opportunity to observe several different operations, techniques and surgeons. In my first two weeks, I observed 15 laparoscopic endometrial cancer operations and 13 advanced stage ovarian cancer surgeries with extensive debulking. Because there are several operating rooms at MSKCC, each day of the week, from the morning to the evening, you can see several excellent surgeries simply by changing rooms. Laparoscopic endometrial cancer and advanced stage ovarian cancer surgery, including bowel resections and upper abdominal debulking procedures, were the main operations. In addition there were at least two to three robotic operations each week, which enabled me to learn the basic rules of robotic surgery. In the context of minimally invasive surgery, one of the most important surgeries is radical trachelectomy, and I had a chance to see enough of these to be able to perform this valuable operation. One of the most fascinating operations in gynecologic oncology is total pelvic exenteration and there were several within this short period. Retroperitoneal debulking is sometimes very difficult. For one ovarian cancer patient they performed extensive paraaortic resection up to renal vein plus suprarenal and celiac dissections since there were several lymphadenopathies at that region. Weekly surgical round tables were very informative. There were many expert medical oncologists and radiation oncologists, and the discussions were just like a debate session of the Congress, including all the newest literature and ongoing GOG series. The entire team was very friendly during my time at the Cancer Center. There were also several other observers and we had a chance to discuss the level of gynecologic oncology in several different countries. We are still writing to each other and we also organized a group including other MSKCC oberservers. I hope all these people will become expert surgeons in their countries and that we may have a chance at very important collaboration. I heartily thank Professor Barakat for his acceptance of me and for his kindness. I am grateful for such a big center that performs all the different surgical techniques of gynecologic oncology. Finally, I thank IGCS for this valuable grant and Ms. Erica Riley for her help in communication with the Society. Now I am working in my country and I am performing all the operations that I learned at Memorial Sloan Kettering.
	Dr. Anitha Thomas (India) Memorial Sloan-Kettering Cancer Center, New York
	Thank you for providing me with this great opportunity to visit Memorial Sloan-Kettering Cancer Center in New York, as part of the Traveling Scholarship Program of IGCS. It was an enriching experience. I observed at this Center from the 28th of January to the 28th of February 2008. I spent the majority of my time in the operating room, where I got the opportunity to witness many gynaecological oncological surgeries. I was exposed to a lot of new techniques and operating instruments. I was very fortunate to watch procedures like radical trachelectomy, pelvic exenteration, en bloc dissection in advanced ovarian malignancies, diaphragmatic stripping, intraperitoneal chemotherapy placement, robotic hysterectomy and many laparoscopic radical surgeries. Radical hysterectomy with pelvic lymphadenectomy, performed with the aid of laparoscopy, was worth watching. Argon beam laser coagulator, gamma probe, ligasure and endostaples were some of the fantastic instruments. Sentinel node injection for uterine and cervical malignancies was also something new to me. The operating room staff and doctors were very encouraging and took efforts to enlighten us on the procedures. Treatment planning conferences on Thursdays were a great source of information. We discussed various cases, their presentation, pathology, radiology, PET scan and their treatment options. Morbidity and mortality discussions were useful for audit purposes. Presentations made by fellows and visiting professors were informative. This trip was very useful as it gave me insight into the best possible treatment of cancer. The research projects are also very stimulating. What struck me most was this statement: “Cancer is not a sentence, but only a word.” The “never give up” attitude of the professionals I observed is worth inculcating. The fight towards cancer prevention and treatment in women has strengthened. I am glad for the existence of such organizations like IGCS, which helps in the career development of professionals who are interested in this perspective.
	Dr. Shantanu Sharma (India) Long Beach Memorial Cancer Center, Long Beach
	At the outset I would like to thank IGCS for giving me the opportunity to undergo specialized training in gynecologic oncology, which is the utmost need of our patients. My stay at Long Beach Memorial Hospital Cancer Center provided an intellectual environment conducive to acquire the knowledge, skills, and clinical judgment, to manage gynecologic cancer, with special reference to common brachytherapy procedures. I evaluated acute and chronic symptoms in cervical cancer patients using a comprehensive questionnaire together with radiologic and biochemical tests. We also considered the role of antidepressants in pain management, utilization of steroids, and achievement of best possible quality of life. This occurred under the direct supervision of full-time faculty at the Center. During my stay, I also learned about the fundamentals of treatment planning (including CT imaging, data transfer, treatment planning and finally treatment execution); communication (understanding the experience of life-threatening illness, breaking bad news, communicating across cultural barriers, family meetings); and managing challenges in gynecologic oncology education (learning styles, new teaching methodologies). Apart from patient care, there were regular academic activities both of the department and of the institution including grand rounds and tumor board meetings twice each week which gave me the opportunity to interact with the faculty and discuss challenging cases, as well as to share my experiences with them. I was lucky enough to attend the operating rooms with Dr Puthawala and to examine patients under anesthesia and observe the procedures, and be part of the operating team. As the Center is renowned for brachytherapy expertise, I also had the opportunity to observe other malignancies, including head and neck, prostate and lung. Overall, it was a great experience working there. I shall try to fulfill the commitments I have made with my mentor in terms of improving management of gynecologic cancer practice back in India