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.
