Jonathan S. Berek, MD

As the population ages over thenext 50 years, the number ofcancer patients is expected todouble from the current 1.3 million to2.6 million, and the majority of thosepatients will be at least 75 years old.[1]Projected increases in life expectancyaccount for this change. For womenliving in industrialized countries, it isestimated that the average life span infuture decades will reach 90 years.[2]Most cancers increase in incidenceand mortality as a population ages,although the causal link between oncogenesisand senescence remainscomplex and elusive. Within the contextof an upsurge in cancer incidence,an analysis of the inequitable treatmentof older patients afflicted withcancer takes on an urgent need.

In their excellent review of intestinal obstruction in women with advanced and recurrent ovarian cancer, Drs. Randall and Rubin indicate that median survivals and quality of life for these patients have improved substantially. Data from the International Federation of Obstetrics and Gynecology (FIGO)[1] and the National Cancer Institute’s Survival, Epidemiology, and End Results (SEER) program[2] indicate that the 5-year disease-free survival for advanced-stage disease has risen over the past several decades from approximately 5% to 20%. Therefore, the palliation of intestinal obstruction secondary to metastatic ovarian cancer has become a more urgent issue. The management of recurrent or chronic intestinal obstruction is often complex, and the authors have carefully substantiated issues related to this complication of the malignancy.

Endometrial carcinoma is the most common gynecologic malignancy in the United States. Most cases are diagnosed at an early stage. However, the outcome for women diagnosed with advanced-stage disease remains poor. The etiology of most endometrial carcinomas stems from the effects of excess estrogen, whether this comes from exogenous or endogenous sources. Differences in epidemiology and presentation suggest the existence of two forms of endometrial cancer: those related to and those unrelated to hormonal stimulation. Most women with endometrial cancer present with abnormal uterine bleeding; endometrial sampling is essential to exclude endometrial carcinoma in such patients. Endometrial cancer is surgically staged, and staging usually includes a hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy also should be performed in selective cases to better assess disease spread and to evaluate the need for adjuvant therapy. Adjuvant treatment may include the use of radiation, progestins, or cytotoxic chemotherapeutic agents. Several clinical trials are underway to compare these treatment modalities, as well as to determine the optimal combination of active chemotherapeutic agents, such as doxorubicin, platinum agents, and paclitaxel (Taxol). [ONCOLOGY 13(12):1665-1675, 1999]

Immune responses are generated in a complex network of cellular and humoral factors. The complexity of this system makes it difficult to generate subsets of cells in vivo that are most effective against cancer cells. The goal of vaccine strategies is to redirect the immune system against cancer cells primarily by generating specific T-cell responses which would be the most effective anti-tumor effector cells.