Presentation and staging

The vast majority of women present with disease that has spread beyond the ovary to involve the peritoneum and other abdomino-pelvic organs. The most common symptoms are of abdominal discomfort and swelling; vaginal bleeding and gastrointestinal and urinary symptoms also occur.

The two main prognostic factors in ovarian cancer are stage and the amount of residual disease after surgery. Five-year survival rates according to stage are as follows:

Table 23.1 Staging of ovarian cancer

Stage

Description

Ia

Tumour confined to one ovary

Ib

Tumour confined to both ovaries

Ic

Tumour Stage I but with capsule ruptured or malignant ascites

II

Tumour with pelvic extension

III

Tumour with peritoneal implants outwith the pelvis or involved

small bowel; retroperitoneal or inguinal nodes

IV

Distant metastases

The majority of patients present with advanced disease (Stage II—IV) with a corresponding poor prognosis. The three-year survival rate for patients with advanced ovarian cancer but no residual disease after surgery is 75%, and for those with maximum residuum less than 1 cm, 50%. Patients who have greater than 2 cm disease after their initial surgery have a poor prognosis with only 20% of patients surviving three years. Median survival times for patients with subopti-mally debulked disease (greater than 1-2 cm) range from 16 to 29 months and from 26 to 96 months for patients with optimally debulked disease.

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