Research in gynaecological oncology

Past, Present and Future Gynaecological oncology is a highly research-active specialty with innovative and exciting research in progress across the various facets of the sub-specialty. Research reflects the nature of the multidisciplinary requirements for clinical care, which often involves radiology, histopathology, oncology and molecular oncology. Previous studies have enabled us to understand the development and progression of cancers of the female genital tract. Ongoing research continues to expand the boundaries of our current knowledge and to provide updated information to improve cancer prevention, early detection and development of new medical and surgical treatments. Conventionally, clinical trials in obstetrics and gynaecology which are based on ‘evidence based medicine’ are conceptually reductionist - i.e. every human being is treated as a number and outcomes are defined in terms of numbers needed to treat. In cancer trials, stratified or personalised medicine has been increasingly adopted due to the recognition that individuals may respond differently to treatments, depending on their genetic make-up or the inherent biology of the tumour. The incorporation of knowledge of tumour biology into therapy and trial design has led to so-called ‘umbrella trials’ where a patient can be randomised to receive different anti-cancer treatments, based on tumour biology. In the future, though possibly even more challenging, a similar approach is likely to be adopted by other specialties within obstetrics and gynaecology. The individualisation of therapy has gained immense momentum in the last decade, and will prove a dilemma to health care providers, primarily as such approaches are expensive. Nevertheless, such progress cannot be ignored and will eventually become integrated into standard clinical care, probably sooner rather than later. Progress is difficult to stifle. Because of the complexity of these advances and the need for the specialist to understand and become involved in this evolution, most training programmes now recognise this, and the need to incorporate a research component into the training programme. Types of Research The types of research in oncology may be simplified into four categories i) laboratory-based, ii) translational, iii) ‘epidemiological’ and iv) therapeutic. These are not mutually exclusive, and research can often involve components of all four. Laboratory-based science will often test a specific molecular-based hypothesis, though the findings could identify a novel pathway which is amenable to a therapeutic strategy in humans.