STAGING AND TREATMENT OF EPITHELIAL OVARIAN CANCER

  • 1 January 1978
    • journal article
    • review article
    • Vol. 119  (3) , 249-+
Abstract
Recent advances in the staging of ovarian cancer have suggested that many patients with apparently localized (stage I or II) disease have occult dissemination within the abdomen. Approximately 20% of patients classified at laparotomy as having stage I or II ovarian cancer are found by lymphangiography to have abnormal retroperitoneal lymph nodes. In many other patients advanced disease is also detected by peritoneoscopy; with this technique metastases are often discovered on the undersurface of the right diaphragm. These findings may help explain the high recurrence rates after surgical resection or pelvic irradiation, or both, in patients with localized disease. Studies are in progress to determine whether modification of the radiotherapy field to include the right diaphragm will improve survival. Along with improved staging, histologic grading of the degree of anaplasia of the tumor tissue may permit more precise determination of prognosis and therefore better design of therapy. Adjuvant radiotherapy was not shown to improve the survival of patients with stage I disease, but the 5 yr survival of patients with stage II disease is greater for those receiving postoperative radiotherapy than for those undergoing surgery alone. For most patients with advanced disease, radiotherapy is palliative only and carries a high risk of long-term complications. Numerous chemotherapeutic agents used singly can produce an objective response by the tumor. Preliminary data suggest that combination chemotherapy can increase the rate of objective response, but a longer follow-up period is necessary to determine whether this form of therapy can improve survival.