Book Review

Ovarian Cancer

N Engl J Med 2003; 349:1780October 30, 2003

Article

Ovarian Cancer
(American Cancer Society Atlas of Clinical Oncology.) Edited by Robert F. Ozols. 246 pp., illustrated, with CD-ROM. Hamilton, Ont., Canada, BC Decker, 2003. $129. ISBN: 1-55009-096-8

Oncologists tend, by nature and occupation, to be optimists, whereas pathologists are more inclined to be pessimists; to put it another way, oncologists are romantics, whereas pathologists are realists. Thus, oncologists point out that in the past few decades substantial progress has been made in the treatment of ovarian cancer, but pathologists, including me, note that the survival rate among patients with this disease has remained unchanged for the past quarter of a century. Both, of course, are right: five-year survival rates are incrementally, albeit slowly, increasing, and our basic understanding of the disease is rapidly evolving, but the survival rate stubbornly remains at about 25 percent.

This book accurately reflects our admixture of gloom and hope about ovarian cancer. The coverage of basic science and epidemiology is outstanding, although the chapter on biology neglects the fact that a substantial proportion of ovarian carcinomas originate in foci of ovarian endometriosis. The pathology of the disease is covered in a chapter that is admirably succinct yet complete, and it is a relief to find that its authors have resisted joining those who are prematurely and perhaps unwisely sounding the death knell of ovarian tumors of borderline malignancy. The chapter on genetics is hard going for nonexperts in that field, but it well repays the reader's effort.

Ovarian-cancer screening, that holy grail, is subjected to hard-eyed critical appraisal, and the clinical chapters cover in detail the use of surgery, radiotherapy, and chemotherapy, both for curative treatment and for palliation. In all the clinical chapters, the discussion is fair and balanced, and each chapter leaves the reader with a clear idea of the optimal management at the present time. A chapter on possible biologic therapeutic agents is, as all such discussions during the past decade have been, hopeful but rather short on actual achievement. The book is abundantly illustrated, although many of the photomicrographs in the pathology chapter have a blue appearance.

There appear to me to be only two important omissions. There is no discussion of the psychosexual problems that may be encountered by women with any form of gynecologic cancer, and little or no consideration is given to the vexing problem of how to treat patients with tumors of borderline malignancy, especially those with peritoneal and omental “implants.” These deficits aside, the book provides comprehensive, virtually encyclopedic, coverage of the present state of knowledge about ovarian cancer. Not everyone reads encyclopedias, but most people enjoy dipping into such works; I certainly enjoyed, and benefited from, repeated dipping into this fine book.

Harold Fox, M.D.
University of Manchester, Manchester M13 9PT, United Kingdom
haroldfox@foxmanu.co.uk