Ovarian cancer

The behaviour of epithelial cancer of the ovary differs from that of other epithelial tumours that the general surgeon normally contends with for the following reasons: first, it often responds well to incomplete surgery as it is frequently sensitive to chemotherapy and, second, its method of spread is unique. Proper treatment of this lesion must take these characteristics into account. Immediate therapy is excision of the tumour mass and its principal metastases. This normally includes removing the uterus and its adnexae plus the omentum. Only when the remaining tumour masses are small will postoperative chemotherapy be effective. Moreover, the chemotherapy can only be given rationally if the extent of dissemination of the disease is carefully defined. The spread of this malignant tumour is most often by way of free-floating cells in the peritoneal cavity. The tumour cells subsequently deposit in "watersheds" throughout the peritoneal cavity and accumulate on the undersurface of the diaphragm and in the omentum. Staging, which describes this process and its variations, is therefore of great importance and is described in this paper in detail.