“As a society, we need to appreciate women’s health as its own entity”: Meet Srdjan Saso

Srdjan Saso is a consultant gynaecologist and gynaecological cancer surgeon. Here, he shares an insight into his role in treating gynaecological pathologies and advances in research and treatment for ovarian cancer.

What inspired you to go into this field?

A love of using my hands and being practical, working in a pressurised environment, and seeing the effects of your work daily, led me to surgery. I am an advocate for women’s health and this, with the fact that obstetrics and gynaecology combines surgery and medicine, moral and ethical dilemmas and wider societal implications, brought me to this field.

The diversity of gynaecological cancer surgery truly appeals to me. As a result, I have had to become an expert in different types of surgery; for example, cytoreductive (for ovarian cancer), keyhole, open surgery, hysteroscopic, and vulvovaginal to name a few. This is a rare privilege in the world of surgery.

I also appreciate the variety of patients I see, from young women aged 17 to 18, all the way up to women in their eighties and nineties. This means different pathologies and challenges, from fertility to menopause, complex benign conditions and cancer. It is an honour to help young women with their gynaecological pathology and fertility, and to explore reproductive options for cancer survivors.

What does your day to day look like?

My week is split between clinics and operating lists. I am involved in three different clinics: gynaecological cancer, cancer diagnostics and oncofertility. The cancer diagnostics clinic is a one-stop clinic which involves the use of ultrasound (to scan the pelvis) and colposcopy (to examine the cervix) if required. The most common complaints are related to menstrual periods/vaginal bleeding, including heavy or irregular bleeding, bleeding after sex, or postmenopausal bleeding. The other chief complaint is abdominal bloating and pelvic pain. Depending on age, the diagnosis does vary – we tend to be wearier of these symptoms in older women as they can be indicators of precancerous or cancerous pathology.

The oncofertility clinic forms part of the Trust’s ovarian germ cell cancer and trophoblastic service which is one of the biggest in the world and accepts referrals from all over the UK. Within this service, I see women who need surgery to treat their disease and at the same time, their fertility to be protected as they invariably fall within reproductive range.

Within these clinics, I am supported by medical students and a junior trainee, as well as a healthcare assistant who ensures that the patient is comfortable and helps with procedures such as swabs and smears. There is also a cancer nurse specialist (CNS) who is involved when cancer is queried, the patient needs investigations, and an official diagnosis has been made. They spend more time with patients and their families and inform them of next steps and support networks.

You are also involved in research. Tell us about this.

I very much care about how we can cross-fertilise medical and non-medical fields for the benefit of patient care and outcomes. I have three areas of interest. The first is combining gynaecological surgery (mainly cancer-specific) and ultrasound, with a particular focus on fertility-sparing surgery and uterine transplantation. I did my PhD in this area and my supervisors were Professors Sadaf Ghaem-Maghami and Richard Smith, head of uterine transplantation in the UK. In terms of my current professional roles, I support the academic and clinical endeavours of the uterine transplantation team and was involved with the UK’s first womb transplant in 2023.

The second lies in the growing influence of machine learning and artificial intelligence. Most recently, I was the senior author and chief investigator of a study led by Imperial College London researchers which identified that online search data may be used to differentiate between women with malignant and benign gynaecological conditions. Our conclusions suggest that it may be possible to build early detection tools using the internet which can identify women who may be at a higher risk of, in particular, ovarian cancers. We know that ovarian cancer is the most lethal gynaecological cancer, with advanced stage carrying a poor prognosis, despite potential extensive surgery. However, there is currently no screening programme in place for early disease detection. We are therefore hoping to raise funding in the near future to develop a multi-centre study which can confirm these findings in a much larger cohort.

My third interest is around how we can use ultrasound to diagnose ovarian masses and triage those that are more dangerous at a much earlier stage of their development.

What improvements are needed in the realm of women’s health?

As a society, we need to appreciate women’s health as its own entity. There are pathologies that both men and women get, such as diabetes, heart issues and asthma etc but then there is a whole range of conditions that are very specific to women. This should be highlighted by our health system, with added governmental support.

We also need to improve access for women when it comes to diagnosis, management and contraception. Both nationally and globally, the waiting lists for certain benign conditions are horrendous. This isn’t right as non-cancerous conditions such as heavy and painful periods can really affect a woman’s quality of life. Notably, fertility rates in the UK are declining and this has huge ramifications for society.

There is also still a lot of shame around women’s health. We need to empower women and young girls to seek help if they need to and in turn educate men and young boys so that they can support their mothers, partners, friends and colleagues.

Finally, what have been some of your career highlights?

As mentioned above, being part of the team that performed the first UK uterine transplant. I am also proud to be part of the Trust’s Gynaecological Cancer Centre which is one of the best in the world in terms of the number of patients we see, the complexities of our cases and the surgeries we perform. I am grateful to have such wonderfully supportive colleagues who are all trailblazers in their own right.

Another career highlight includes sitting on the scientific committee for the International Society of Ultrasound in Obstetrics & Gynaecology. This committee is responsible for putting together the annual World Congress, which gathers the leading figures in the world of ultrasound related to Women’s health.

Finally, I have recently started doing some collaborative work with a surgical cancer team in Dakar, Senegal. I am passionate about connecting the Trust with centres in low-income countries, especially in Sub-Saharan Africa. I look forward to developing this work further.