Introduction

Gynaecological oncology services and outcomes have remained suboptimal in most resource-constrained countries due to chronic underfunding.

Challenges

Lack of access to health care by women with gynaecological cancers remains a big challenge in most resourced-constrained envirinments. There is a severe shortage of gynaecological oncologists and a lot of women are managed by generalists leading to suboptimal outcomes.
Very few hospitals in these countries have well established tumour boards to discuss and optimise patient care. Tumour boards have been shown to improve oncological outcomes. Using telemedicine to team up with well established international centres might be a short-term solution but lack of reliable internet in these settings remains a big problem.
Shortage of radiological services especially advanced imaging potentially leads to suboptimal staging for gynaecological oncology patients. Due to the known inadequacies of clinical staging, a significant number of patients end up having surgery when they have advanced disease resulting in poorer outcomes.
Lack of adequate laboratory support for basic investigations and severe shortage of blood products leads to major surgical delays for women eligible for surgery.
Lack of theatre time due to a shortage of anaesthetists, anaesthetic machines, theatre nurses, anaesthetic drugs, intensive care unit beds and payment of theatre user fees by patients remains a big constraint. All these factors lead to significant delays in surgery and potentially worsening cancer outcomes.
There is a huge shortage of radiotherapy machines and personal leading to long delays in women requiring radiotherapy. Coupled with this is the lack of chemotherapy and other basic drugs needed in the treatment of women with cancer.
All these problems result in unsustainable out-of-pocket expenses for cancer patients.

Conclusion

In low-resourced countries, Governments should fully fund cancer treatment in order to improve gynaecological cancer outcomes.

Improvements in imaging over the past 2 decades have vastly increased our ability to accurately stage patients, decide of appropriate therapy and assess response.
PET-CT is ideally placed for use in gynaecological malignancies in particular squamous cell carcinomas as it has a high sensitivity to pick up involved nodes.
PET-CT can, in addition, be part of the radiotherapy planning algorithm and add accurate volume delineation and increased quality assurance in the planning process.
Indications and suggested incorporation into management and treatment protocols will be reviewed.