Spread and treatment of advanced ovarian cancer

Most of the common epithelial ovarian cancers present in Stages III and IV. Although the common epithelial ovarian cancer is not truly a cancer that lends itself to surgery, it has been repeatedly reported that prognosis depends upon the amount of disease remaining at the end of the procedure. Nodules of 2 cm or greater usually mean that the patient will not be cured but may get palliation for long periods of time with adjunctive therapy. Therefore, the current philosophy is to be as aggressive as possible, surgically, without creating an inordinate morbidity and mortality. Following combination chemotherapy, if there is no evidence of disease on clinical examination--or by any laboratory or screening method--patients should be offered a second-look operation. Despite aggressive chemotherapy, approximately 50% of these patients will have residual disease at the time of the second-look procedure. In addition, 30% of the patients who have negative second-look operations will present at a later date with a recurrence of their tumour. The stage of disease at the time of the original procedure greatly influences the results, and, as would be anticipated, the results are infinitely better in those patients who have a second-look operation after Stage I cancer has been diagnosed than in patients who have a second-look procedure after an initial staging of Stage III. The best results will be achieved in those patients who have had very aggressive surgery at the initial procedure--followed by combination chemotherapy for approximately six to nine months.(ABSTRACT TRUNCATED AT 250 WORDS)