[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
July 1980

Surgery in Ovarian Cancer

Author Affiliations

From the Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, The Johns Hopkins Hospital, Baltimore.

Arch Surg. 1980;115(7):863-868. doi:10.1001/archsurg.1980.01380070051011
Abstract

• Ovarian cancer has the highest mortality of the cancers of the female genital tract. The signs and symptoms of ovarian cancer are either nonexistent or nonspecific. Women who are to undergo exploratory laparotomy without a definite diagnosis should have ovarian cancer considered as part of the differential diagnosis. Therefore, it is important that each surgeon know the current concepts of surgery for ovarian cancer. Documenting true extent of disease in those cases with limited ovarian cancer prevents the need for reexploration before adjuvant therapy. In those cases of disseminated disease, an attempt at tumor reduction should be undertaken, as reduction of tumor aggregates to less than 1.6 cm in greatest diameter improves prognosis. Surgery is the mainstay of therapy for ovarian cancer. Optimal initial surgery prevents the need for reexploration.

(Arch Surg 115:863-868, 1980)

References
1.
Silverberg E:  Cancer statistics, 1979 . CA 29:6-21, 1979.
2.
Cutler SJ, Myers MH, Green SB:  Trends in survival rates of patients with cancer . N Engl J Med 293:122-124, 1975.Article
3.
Cramer DW, Cutler SJ:  Incidence and histopathology of malignancies of the female genital organs in the United States . Am J Obstet Gynecol 118:443-460, 1974.
4.
Lingeman CH:  Etiology of cancer of the human ovary: A review . J Natl Cancer Inst 53:1603-1618, 1974.
5.
Munnell EW:  The changing prognosis and treatment in cancer of the ovary . Am J Obstet Gynecol 100:790-805, 1968.
6.
Parker RT, Parker CH, Wilbanks GD:  Cancer of the ovary: Survival studies based upon operative therapy, chemotherapy and radiotherapy . Am J Obstet Gynecol 108:878-888, 1970.
7.
Survival for Cancers of the Genital Organs. Department of Health and Human Resources Publication 77-992, pp 178-182.
8.
Hudson CN:  The place of surgery in the treatment of ovarian cancer . Clin Obstet Gynaecol 5:700, 1978.
9.
Serov SF, Scully RE: Histological Typing of Ovarian Tumours . Geneva, Switzerland, World Health Organization, 1973.
10.
Tobias JS, Griffiths CT:  Management of ovarian carcinoma: Current concepts and future prospects . N Engl J Med 294:818-823, 877-882, 1976.Article
11.
McGowan L: Gynecologic Oncology . New York, Appleton-Century-Crofts, 1978, p 297.
12.
Fox H, Langley FA: Tumors of the Ovary . London, William Heinemann Medical Books Ltd, 1976, p 24.
13.
Julian CG, Goss J, Blanchard K, et al:  Biologic behavior of primary ovarian malignancy . Obstet Gynecol 44:873-884, 1974.
14.
Malkasian GD Jr, Decker DG, Webb MJ:  Histology of epithelial tumors of the ovary: Clinical usefulness and prognostic significance of the histologic classification and grading . Semin Oncol 2:191-201, 1975.
15.
Aure JC, Høeg K, Kolstad P:  Clinical and histologic studies of ovarian carcinoma . Obstet Gynecol 37:1-9, 1971.
16.
Decker DG, Mussey E, Williams TJ, et al:  Grading of gynecologic malignancy: Epithelial ovarian cancer , in Seventh National Cancer Conference Proceedings . Philadelphia, JB Lippincott Co, 1973, pp 223-231.
17.
Ozols RF, Garvin AJ, Costa J, et al.  Histologic grade in advanced ovarian cancer . Cancer Treat Rep 63:255-263, 1979.
18.
Webb MJ, Decker DG, Mussey E, et al:  Factors influencing survival in stage I ovarian cancer . Am J Obstet Gynecol 116:222-228, 1973.
19.
Broders AC:  Carcinoma: Grading and practical application . Arch Pathol 2:376-381, 1926.
20.
Kottmeier HC:  Ovarian cancer with special regard to radiotherapy . Am J Roentgenol Radium Ther Nucl Med 3:417-421, 1971.Article
21.
Julian CG, Woodruff JD:  The biologic behavior of low-grade papillary serous carcinoma of the ovary . Obstet Gynecol 40:860-867, 1972.
22.
Katzenstein A-L, Mazur MT, Morgan TE, et al:  Proliferative serous tumors of the ovary: Histological features and prognosis . Am J Surg Pathol 2:339-355, 1978.Article
23.
Hart WR, Norris HJ:  Borderline and malignant mucinous tumors of the ovary: Histologic criteria and clinical behavior . Cancer 31:1031-1045, 1973.Article
24.
Hart WR:  Ovarian epithelial tumors of borderline malignancy (carcinomas of low malignant potential) . Human Pathol 8:541-549, 1977.Article
25.
Decker DG, Malkasian GD Jr, Taylor WF:  The prognostic importance of histologic grading in ovarian carcinoma . Natl Cancer Inst Monogr 42:9-12, 1975.
26.
Long ME, Sommers SC:  Staging, grading and histochemistry of ovarian epithelial tumors . Clin Obstet Gynecol 12:937-954, 1969.Article
27.
Dyson JL, Beilby JOW, Steele SJ:  Factors influencing survival in carcinoma of the ovary . Br J Cancer 25:237-249, 1971.Article
28.
Kurman RJ, Craig JM:  Endometrioid and clear cell carcinoma of the ovary . Cancer 29:1653-1664, 1972.Article
29.
Van Orden DE, McAllister WB, Zerne SRM, et al:  Ovarian carcinoma . Am J Obstet Gynecol 94:195-202, 1966.
30.
Long RTL, Johnson RE, Sala JM:  Variations in survival among patients with carcinoma of the ovary: Analysis of 253 cases according to histologic type, anatomical stage and method of treatment . Cancer 20:1195-1202, 1967.Article
31.
 Symposium on ovarian cancer . Natl Cancer Inst Mongr 42:1-191, 1975.
32.
Scully RE:  Recent progress in ovarian cancer . Human Pathol 1:73-98, 1970.Article
33.
Novak ER, Woodruff JD: Novak's Gynecologic and Obstetric Pathology . Philadelphia, WB Saunders Co, pp 427-448, 1974.
34.
Blaustein A (ed): Pathology of the Female Genital Tract . New York, Springer-Verlag, 1977, pp 505-526.
35.
Barber HRK: Ovarian Carcinoma: Etiology, Diagnosis and Treatment . New York, Masson Publications, 1978, p 69.
36.
Woodruff JD, Murthy YS, Bhaskar TN, et al:  Metastatic ovarian tumors . Am J Obstet Gynecol 107:202-209, 1970.
37.
 Report presented by the Cancer Committee to the General Assembly of FIGO , New York, April 1970. Int J Gynecol Obstet 9:172, 1971.
38.
Bergman F:  Carcinoma of the ovary: A clinicopathological study of 86 autopsied cases with special reference to mode of spread . Acta Obstet Gynecol Scand 45:211-231, 1966.Article
39.
Dyre JC:  Intraperitoneal pressure in the human . Surg Gynecol Obstet 87:472-475, 1948.
40.
Meyers MA:  The spread and localization of acute intraperitoneal effusion . Radiology 95:547-554, 1970.Article
41.
Overholt RH:  Intraperitoneal pressure . Arch Surg 22:691-703, 1931.Article
42.
Feldman GB, Knapp RC:  Lymphatic drainage of the peritoneal cavity and its significance in ovarian cancer . Am J Obstet Gynecol 119:991-994, 1974.
43.
Fuks Z, Bagshaw MA:  The rationale for curative radiotherapy for ovarian carcinoma . Int J Radiat Oncol Biol Phys 1:21-32, 1975.Article
44.
Feldman GB, Knapp RC, Order SE, et al:  The role of lymphatic obstruction in the formation of ascites in a murine ovarian carcinoma . Cancer Res 32:1663-1666, 1972.
45.
Knapp RC, Friedman EA:  Aortic lymph node metastases in early ovarian cancer . Am J Obstet Gynecol 119:1013-1017, 1974.
46.
Plentl AA, Friedman EA: Lymphatic System of the Female Genitalia: The Morpholologic Basis of Oncologic Diagnosis and Therapy . Philadelphia, WB Saunders Co, 1971.
47.
Keettel WC, Pixley EE, Buchsbaum HJ:  Experience with peritoneal cytology in the management of gynecologic malignancies . Am J Obstet Gynecol 120:174-182, 1974.
48.
Piver MS, Barlow JJ, Lele SB:  Incidence of subclinical metastasis in stage I and II ovarian carcinoma . Obstet Gynecol 52:100-104, 1978.
49.
Creasman WT, Rutledge F:  The prognostic value of peritoneal cytology in gynecologic malignant disease . Am J Obstet Gynecol 110:773-781, 1971.
50.
Rosenoff SH, DeVita VT Jr, Hubbard S, et al:  Peritoneoscopy in the staging and follow-up of ovarian cancer . Semin Oncol 2:223-228, 1975.
51.
Bagley CMJ, Young RC, Schein PS, et al:  Ovarian carcinoma metastatic to the diaphragm—frequently undiagnosed at laparotomy: A preliminary report . Am J Obstet Gynecol 116:397-400, 1973.
52.
Spinelli P, Luini A, Pizzetti P, et al:  Laparoscopy in staging and restaging of 95 patients with ovarian carcinoma . Tumori 62:493-501, 1976.
53.
Day TG Jr, Smith JP:  Diagnosis and staging of ovarian carcinoma . Semin Oncol 2:217-222, 1975.
54.
Fuks Z:  External radiotherapy of ovarian cancer: Standard approaches and new frontiers . Semin Oncol 2:253-266, 1975.
55.
Musumeci R, Banfi A, Bolis G, et al:  Lymphangiography in patients with ovarian epithelial cancer . Cancer 40:1444-1449, 1977.Article
56.
Munnell EW:  Is conservative therapy ever justified in stage I (Ia) cancer of the ovary? Am J Obstet Gynecol 103:641-653, 1969.
57.
Williams TJ, Symmonds RE, Litwak O:  Management of unilateral and encapsulated ovarian cancer in young women . Gynecol Oncol 1:143-148, 1973.Article
58.
Williams TJ, Dockerty MB:  Status of the contralateral ovary in encapsulated low grade malignant tumors of the ovary . Surg Gynecol Obstet 143:763-766, 1976.
59.
Piver MS:  Continued controversies in the diagnosis and treatment of ovarian adenocarcinomas .J Reprod Med 22:119-127, 1979.
60.
Griffiths CT, Grogan RH, Hall TC:  Advanced ovarian cancer: Primary treatment with operation, radiotherapy and chemotherapy . Cancer 29:1-7, 1972.Article
61.
Griffiths CT:  Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma: Symposium on Ovarian Cancer . Natl Cancer Inst Monogr 42:101-104, 1975.
62.
Griffiths CT, Fuller AF:  Intensive surgical and chemotherapeutic management of advanced ovarian cancer . Surg Clin North Am 58:131-142, 1978.
63.
Griffiths CT, Parker LM, Fuller AF Jr:  Role of cytoreductive surgical treatment in the management of advanced ovarian cancer . Cancer Treat Rep 63:235-240, 1979.
64.
Magrath IT, Lwanga S, Carswell W, et al:  Surgical reduction of tumour bulk in management of abdominal Burkitt's lymphoma . Br Med J 2:308-312, 1974.Article
65.
Delclos L, Quinlan EJ:  Malignant tumors of the ovary managed with postoperative megavoltage irradiation . Radiology 93:659-663, 1969.Article
66.
Young RC, Chabner BA, Hubbard SP, et al:  Advanced ovarian adenocarcinoma: A prospective clinical trial of Melphalan (L-PAM) vs combination chemotherapy . N Engl J Med 299:1261-1266, 1978.Article
67.
Edmonson JH, Fleming TR, Decker DG, et al:  Different chemotherapeutic sensitivities and host factors affecting prognosis in advanced ovarian carcinoma vs minimal residual disease . Cancer Treat Rep 63:241-247, 1979.
68.
Young RC:  Ovarian carcinoma: An optimistic epilogue . Cancer Treat Rep 63:333-337, 1979.
69.
Hudson CN:  A radical operation for fixed ovarian tumours . J Obstet Gynaecol Br Commonw 75:1155-1160, 1968.Article
70.
Hudson CN:  Surgical treatment of ovarian cancer . Gynecol Oncol 1:371-378, 1973.Article
71.
Hudson CN, Dendy PP:  Aspects of treatment of more advanced cases of ovarian cancer . Proc R Soc Med 67:798-801, 1974.
72.
Wangensteen OH, Lewis FJ, Tongen LA:  The "second-look" in cancer surgery . Lancet 1:303-307, 1951.
73.
Smith JP, Delgado G, Rutledge F:  Second-look operation in ovarian carcinoma: Postchemotherapy . Cancer 38:1438-1442, 1976.Article
74.
Parks TJ:  Carcinoma of the ovary treated preoperatively with deep x-ray: Report of three cases . Am J Obstet Gynecol 49:676-685, 1945.
75.
Blinick G, Kabakow B, Antopol W, et al:  Management of ovarian carcinoma: A review of 14 years' experience at Beth Israel Hospital . Mount Sinai J Med 39:447-457, 1972.
76.
Frick G, Johnsson JE, Landberg T, et al:  Relaparotomy in advanced ovarian carcinoma . Acta Obstet Gynecol Scand 57:165-168, 1978.Article
77.
Brunschwig A:  Attempted palliation by radical surgery for pelvic and abdominal carcinomatosis primary in the ovaries . Cancer 14:384-388, 1961.Article
78.
Smith GV:  Ovarian tumors: With special reference to some unexpectedly good outcomes in the treatment of cancer of the ovary . Am J Surg 95:336-340, 1958.Article
79.
Smith JP, Rutledge F, Wharton JT:  Chemotherapy of ovarian cancer: New approaches to treatment . Cancer 30:1565-1571, 1972.Article
80.
Smith WG, Day TG, Smith JP:  The use of laparoscopy to determine the results of chemotherapy for ovarian cancer . J Reprod Med 18:257-260, 1977.
81.
Lewis JL Jr, Griffiths T, Morrow CP, et al:  Managing ovarian cancer: The second-look operation . Contemp Obstet Gynecol 12:137-155, 1978.
82.
Reimer RR, Hoover R, Fraumeni JF Jr, et al:  Acute leukemia after alkylating-agent therapy of ovarian cancer . N Engl J Med 297:177-180, 1977.Article
83.
Einhorn N:  Acute leukemia after chemotherapy (Melphalan) . Cancer 41:444-447, 1978.Article
84.
Kapadia SB, Krause JR:  Ovarian carcinoma terminating in acute nonlymphocytic leukemia following alkylating agent therapy . Cancer 41:1676-1679, 1978.Article
85.
LeVeen HH, Wapnick S, Diaz C, et al:  Ascites: Its correction by peritoneovenous shunting . Curr Probl Surg 16:1-61, 1979.Article
86.
Paladine W, Cunningham TJ, Sponzo R, et al:  Intracavitary bleomycin in the management of malignant effusions . Cancer 38:1903-1908, 1976.Article
87.
Leff A, Hopewell PC, Costello J:  Pleural effusion from malignancy . Ann Intern Med 88:532-537, 1978.Article
88.
Clark DGC, Hilaris BS, Ochoa M Jr, et al:  Interdisciplinary approach to advanced ovarian cancer . Surg Clin North Am 54:897-903, 1974.
×