Of the roughly 7 lakh new cancer cases diagnosed in India each year, more than 1 lakh are gynaecological cancers, ovarian, cervical, uterine, vaginal, vulvar, fallopian tube. In Gujarat, that’s roughly 8,000–10,000 new diagnoses every year, depending on the year and the data source. The number is growing, partly because of better diagnosis, partly because of changing demographic and lifestyle factors.
The other number that matters: in 2026, India has approximately 250–300 fellowship-trained gynaecological oncosurgeons. For a country of 1.4 billion people. The implied ratio, roughly one sub-speciality gynae-onco surgeon per 4–5 million people, is among the lowest in the developed world.
Within Gujarat, the number of fellowship-trained gynaecological oncosurgeons is in the single digits. For a state of 7 crore people.
This article is about why that gap matters, what it means for Gujarati women, and what’s beginning to change.
Why sub-speciality training matters in cancer surgery
The distinction between a general gynaecologist and a gynaecological oncosurgeon matters more than the names suggest. A gynaecologist completes 3 years of post-graduate training in obstetrics and gynaecology, a broad speciality covering pregnancy, childbirth, benign gynaecological surgery, infertility, and general women’s health.
A gynaecological oncosurgeon completes 2–3 additional years of fellowship training specifically in cancer surgery for women. This sub-speciality training covers: – Complex cytoreductive surgery for advanced ovarian cancer – Radical hysterectomy for cervical cancer with detailed pelvic and lymphatic dissection – Staging surgery for endometrial cancer with sentinel lymph node mapping – Vulvar and vaginal cancer surgery – Fertility-preserving cancer surgery for young patients – HIPEC and PIPAC for advanced disease
The technical and decision-making skills developed in this fellowship are not interchangeable with general gynaecological surgical training. International evidence is consistent on this: ovarian cancer outcomes are measurably better when surgery is performed by sub-speciality gynaec oncosurgeons. Surgical completeness, the most important predictor of long-term survival in advanced ovarian cancer, is directly tied to the surgeon’s specific training and case volume.
What the gap costs
For a Gujarati woman with newly diagnosed Stage III ovarian cancer in 2010, the practical choice was: receive surgery from a general gynaecologist or general surgical oncologist nearby, or travel to Mumbai for sub-speciality care. Most families could not absorb the cost and disruption of the Mumbai option. Most cases were operated locally by general surgeons doing their best with the sub-speciality skills they had.
The outcome data from that period in Gujarat reflects this. Survival after Stage III ovarian cancer in Indian sub-speciality centres has been consistently better than in centres without sub-speciality coverage, by margins that translate, at population level, to meaningful numbers of women who lived longer in the sub-speciality settings than they would have in general surgical settings.
This is not a criticism of general gynaecologists or general surgeons. They did the work that the available healthcare infrastructure required them to do. The criticism is of the structural gap that put them in that position.
What’s changing
Several developments over the last 5–7 years have begun to address the gap specifically in Gujarat:
- Sub-speciality training paths have expanded. The number of approved fellowship positions in gynaecological oncology in India has grown, and a small but increasing number of these fellows are now establishing practice in Ahmedabad and other Gujarat cities rather than only in metros.
- Tertiary infrastructure has matured. Sterling Hospitals (Sindhubhavan), KD Hospital, and Welcare Speciality Hospital, among others, have built dedicated oncology infrastructure that supports complex cancer surgery: robotic platforms, dedicated ICU capacity, multidisciplinary tumour boards, ERAS protocols.
- Procedures previously requiring Mumbai are now available locally. HIPEC for advanced ovarian cancer, robotic radical hysterectomy for cervical cancer, fertility-preserving surgery for young patients, PIPAC for recurrent disease, all of these are now performed in Ahmedabad.
- Cost-quality has improved markedly. A typical Ahmedabad tertiary cancer surgery package is 30–50% less expensive than the equivalent Mumbai package, with clinical capability now substantially equivalent for most procedures.
- International certification standards are entering. ESGO (European Society of Gynaecological Oncology) certification, a process that includes verified case volumes, examination, and continuing professional development, is being adopted by a growing number of Indian sub-speciality surgeons.
The cumulative effect is that the practical pathway for a Gujarati woman with a new gynaecological cancer diagnosis in 2026 is materially better than it was in 2016. The remaining gaps are awareness, knowing that sub-speciality care exists locally, and access, getting the right specialist consultation early in the diagnostic pathway.
What still needs to change
The structural problems aren’t solved. Three remain prominent:
Awareness. Most Gujarati women newly diagnosed with gynaecological cancer don’t know to ask for a sub-speciality gynaec oncosurgeon by name. They accept the surgical recommendation from whoever first told them they had cancer. The vocabulary, “gynaec oncologist” versus “gynaecologist” versus “surgical oncologist”, is unclear in the public mind.
Referral pathways. General gynaecologists and general practitioners are the first point of contact for most women. The reflex referral to a sub-speciality specialist is improving but is still inconsistent. Patients are often two steps deep into a treatment plan before someone asks whether a sub-speciality opinion would help.
Awareness of advanced procedures. HIPEC is the clearest example. Most newly diagnosed Stage III ovarian cancer patients in Gujarat are still not informed about HIPEC as part of their initial treatment discussion. The decision to add HIPEC at interval surgery should be made up-front based on stage and surgical plan, not retrospectively after surgery is complete.
What patients and families can do
For families newly navigating a gynaecological cancer diagnosis:
- Ask specifically: “Is the surgeon recommended for my case a sub-speciality gynaecological oncologist?” The phrasing matters. “Cancer surgeon” or “oncologist” can mean many things; “gynaec oncologist” or “gynaecological oncosurgeon” is the specific sub-speciality.
- Ask whether your case has been discussed at a multidisciplinary tumour board. If the answer is no for an advanced case, request that it be.
- Ask about HIPEC and PIPAC eligibility if ovarian cancer is the diagnosis, even if your current team doesn’t perform these procedures.
- Don’t assume Mumbai is necessary. For most procedures, a gynaecological oncologist in Ahmedabad can now provide care equivalent to Mumbai’s sub-speciality centres.
- Use second-opinion infrastructure. Most specialist practices in Ahmedabad now accept WhatsApp report reviews for initial assessment. The cost of asking is small; the cost of not asking can be large.
The bottom line
Gujarat’s gynaecological cancer infrastructure has improved more in the last 5 years than in the previous 25. The remaining gap is largely about awareness and referral patterns rather than absence of capability. For families navigating this diagnosis in 2026, the right specialist exists, the right procedures are available, and the right cost is within reach.
The work that’s left is mostly about closing the information gap between what’s available and what patients know to ask for. That work is everyone’s, clinicians, journalists, patient advocates, families.
About the author
This article was authored by Dr. Nishtha Tripathi Patel (MBBS, DGO, DNB, Fellowship in Gynaecological Oncology, ESGO-certified), an ESGO-certified gynaecological oncosurgeon in Ahmedabad practising at Sterling Hospitals (Sindhubhavan), KD Hospital, and Welcare Speciality Hospital. Reach her practice at +91 76988 00333.
