Book Review: Advances in Diagnosis and Management of Ovarian Cancer

Editor: Samir A Farghaly, Springer, ISBN: 078-1-4614-8270-3

Ovarian cancer remains a feared disease as the non-specific symptoms result in delayed diagnosis and presentation with late-stage disease. Samir A Fargaly, the editor, Consultant Obstetrician and Gynecologist at Weill Cornell Medical College, New York, acknowledges in the preface that a woman's lifetime risk of getting ovarian cancer is approximately 1 in 72. It is not a common cancer, ranking ninth in order of frequency, but it is the fifth commonest cause of cancer deaths in women.

It is difficult for the specialist in active practice to appreciate just how many advances in the management of ovarian cancer have occurred over the last 10 years or so. This text book addresses improvements in approaches to screening, detection, surgical and nonsurgical management of the disease, which, as the editor acknowledges in his preface, have enhanced survival of women with ovarian cancer. There is still scope for further improvement and this book underlines some of the challenges.

The recognition of the multidisciplinary approach to the treatment of this disease is implied rather than explicitly stated in this book. The international list of authors range from diagnostic physicians to surgical and nonsurgical oncologists as well psychologists. The breadth of subject matter is ambitious and the chapters are necessarily short.

The concise chapters, relevant to the undergraduate and specialist alike, have been written by recognised experts who bring the wealth of their experience to the text. The chapters are well referenced with current literature. The absence of evidence, where relevant, is declared. The illustrations are clear and appropriate. For example, the chapters on Surface Epithelial Tumors of the Ovary and Pathology of Non-epithelial Malignancies of the Ovary have excellent microscopic photographs that clarify the pathology for the nonspecialist.

The difficulty with making a diagnosis of ovarian cancer makes screening an attractive option. An ideal screening program would be inexpensive, convenient and reproducible, and would detect the disease in its precancerous state where treatment would prevent progression to cancer. None of the current screening trials for the prevention of ovarian cancer has managed to achieve this. The trials for ovarian cancer have explored combinations of tumor markers and ultrasound. The chapter on screening highlights all the important screening trials and their limitations, which include the low prevalence of the disease and deficiencies in our understanding of the early natural history of ovarian cancer.

The authors walk us through the ovarian cancer pathway, from detection, to surgery for presumed early-stage and late-stage disease. The benefits or otherwise of adjuvant chemotherapy are discussed, drawing on important trials such as ICON1 and ACTION. Neo-adjuvant chemotherapy and interval cyto-reductive surgery, as well as the advantages and limitations of intra-peritoneal chemotherapy are covered in sufficient detail, in the context of relevant trials. The psychological aspects of this complex disease are also explored. The emphasis is on the clinical aspects of disease management.

If there is a criticism, it is that the chapters could have been organized in a more logical fashion, addressing screening and detection, genetics, and then management. This might have avoided inevitable overlaps such as between the chapter on Genetic Risks of Ovarian Cancer and Management of Hereditary Breast and Ovarian Cancer. It is worth noting that the 2009 FIGO staging is used, rather than the updated January 2014 version. In my view the opinions expressed about the role of minimal access surgery are somewhat dated.

Overall I enjoyed reading the book and felt it was relevant to my practice. It will make a useful addition to the library of any training fellow in gynecological oncology as well a quick reference source for the experienced specialist.