Voluntary assisted dying in gynaecological cancers: A discussion of the history, ethical principles and international perspectives.

Voluntary assisted dying (VAD) is a provocative and ethically charged subject that will potentially be an increasing component of our clinical practice. This paper aims to give the history of VAD, ethical principles, controversies and international perspectives regarding the laws in each jurisdiction. It provides a discussion on the topic with respect to gynaecological oncology to enable clinicians to feel more comfortable with this difficult subject.

Advances in epithelial ovarian cancer.

BACKGROUND: Most epithelial ovarian cancer occurs in older women, with a mean age at diagnosis of 62 years and an overall five­year survival rate in Australia of 43%. Most women are diagnosed with advanced disease of high-grade serous type with 20-30% five-year survival; 70% relapse within three years of initial treatment. There is no available screening test for ovarian cancer. OBJECTIVE: The aim of this article is to highlight current management and future directions for women diagnosed with epithelial ovarian cancer, particularly the high incidence of underlying genetic mutations and new options for treatment. DISCUSSION: Risk-reducing surgery with bilateral salpingo-oophorectomy is recommended for women at high risk of developing ovarian cancer. Ovarian cancer treatment still centres on surgery and chemotherapy, with aggressive cytoreductive techniques and intraperitoneal treatments being evaluated in advanced disease. Molecular targeting agents are revolutionising treatment options, particularly the poly adenosine diphosphate-ribose polymerase inhibitors, and especially for patients with an underlying BRCA mutation. Other molecular targeting agents, such as vascular endothelial growth factor (VEGF) receptor inhibitors and newer approaches using immunotherapy and molecular targeting, aim to individualise treatment and improve survival in the future.

Menopausal hormonal therapy in gynaecological cancers: An evidence-based approach for clinical management.

Treatment for gynaecological malignancies often requires oophorectomy or loss of ovarian function from adjuvant treatment. Premature or early menopause caused by gynaecological cancer treatment may require menopausal hormonal therapy (MHT) to treat vasomotor symptoms. However, concerns exist due to theoretical risks of stimulation of hormonal-sensitive tumours and hence increasing recurrence risk. There are small numbers of often underpowered fair to poor quality studies indicating that MHT is safe with most gynaecological malignancies. These studies are of variable quality with most being retrospective. We present the available data on this subject relative to the common types of gynaecological cancer.