Ovarian cancer guidelines undergo overhaul. (New options for Recurrent Disease).

HOLLYWOOD, FLA. -- Major changes to national guidelines for ovarian cancer staging and treatment include recommendations for women with borderline or low-malignancy disease, updated chemotherapy recommendations, and additional options for recurrent disease that incorporate new agents.

"This is an era of hope," Dr. Robert J. Morgan Jr. said at the annual conference of the National Comprehensive Cancer Network. "We're seeing median survivals now of up to 5 years, and we're going to continue to see slow improvements in survival over time."

Epithelial ovarian cancer remains the leading cause of death from gynecologic cancer in the United States. Last year, there were an estimated 23,400 new diagnoses and about 13,900 deaths from this disease, according to the NCCN guidelines, which are compiled by a panel of 18 physician experts from leading cancer treatment centers nationwide.

Feedback since the last update in 1998 indicated a need for guidance on patients with borderline tumors, noted Dr. Morgan, staff physician in the department of medical oncology and therapeutics research at City of Hope Cancer Center, Duarte, Calif.

The definition of epithelial ovarian cancer of low malignant potential is a tumor with histologic features suggesting malignancy, but clinical behavior that suggests an excellent prognosis (more than 80% survival at 5 years). The term "low malignant potential" is preferred because "it is confusing to physicians as well as patients when you use the term 'borderline tumor,'" said Dr. Benjamin Greer, director of gynecologic oncology at the University of Washington in Seattle.

Clinicians may be unsure which patients to treat and which ones to merely observe because the potential lethal harm to these patients is small, Dr. Greer said. "Good pathology is critical to make the right decision for the patient."

The pathologic definition of low-malignant-potential disease is the gross appearance of peritoneal carcinomatosis and a microscopic appearance that characteristically fails to reveal evidence of frank invasion by the tumor nodules."