Editorial - Current Opinion in Oncology Sept 2010 issue (ovarian cancer/gyn)

In this issue, we present two generic themes: the first relates to managing patients with ovarian cancer and Glenn McCluggage presents an excellent review of the difficult area of diagnosing and categorizing borderline tumours of the ovary. No multidisciplinary meeting is complete without clinicians asking their pathologist difficult questions relating to the significance of the different appearances that can occur in this group of tumours and whether patients should receive further staging and treatment and how they should be followed up. Glenn McCluggage describes the clinical significance of the different subtypes and appearances and he presents a very clear exposition of the field which will be extremely helpful to clinicians. In this issue, we also take a broad look at ovarian cancer in terms of a review of current thoughts on first-line therapy from Dr D'Hondt and colleagues and an article focused on relapsed disease. The era of targeted therapies in oncology is well and truly upon us and ovarian cancer is very much part of this therapeutic revolution with the development of PARP inhibitors for patients with BRACA mutations and defects. Data are emerging very quickly on the usefulness of PARP inhibition and Stan Kaye and colleagues give an excellent summary of the current position.

Gordon Rustin sets the results of his trial on early versus late treatment of relapsed disease in the wider context of follow-up strategies. The debate relating to the follow-up of patients with ovarian cancer has always been one that has simmered in the background but with the release of the data from Professor Rustin's trial the whole issue of the management of patients following the completion of first-line therapy, has become an area of great interest and much argument. As a companion article, we have an excellent update presented by Drs Moore and MacLaughlan on biomarkers in epithelial ovarian cancer. This sets into context some of the recent data on new biomarkers and their possible usefulness in the important area of ovarian cancer screening.

Many of the most hotly argued controversies in cancer relate to the treatment of patients with early disease. The balance between not compromising potentially curative therapy and causing unnecessary long-term morbidity in cured patients is one that can be very difficult to ascertain because often the data are not mature or available due to the lengthy follow-up required before definitive answers emerge. We present controversies in three areas of gynaecological malignancy relating to the management of early stage disease namely vulva cancer, cervical cancer and endometrial cancer. Professor van der Zee and colleagues describe the current status of sentinel node biopsy for early stage vulva cancer and Drs Al-Mansour and Verschraegen give a very complete review of the data relating to locally advanced cervical cancer and give clinicians clear recommendations. Finally, the issue of the management of lymph nodes in uterine cancer is excellently discussed by Drs Delpech and Barranger.

This issue is very full with a lot of data presented but the authors have described often very complex areas with real clarity and the conclusions that they draw will help all of us who are practising physicians in the area of gynaecological oncology manage our patients better.