Patterns of care in carcinoma of the ovary

Background . During an epidemiologic study of women with ovarian cancer, the type of incision, intraoperative evaluation of the extent of disease, frequency of mistaken diagnosis, and ovarian cancer occurring in women who had a prior hysterectomy were reviewed. Methods . The thoroughness of intraoperative evaluation of the extent of disease as well as the type of incision in 291 women with ovarian cancer was investigated. Within this group 41 women had undergone hysterectomy with retention of one or both ovaries before the diagnosis of ovarian cancer. An additional 43 women were discovered not to have primary carcinoma of the ovary. Results . Seventy‐one percent of the women with transverse incisions had incomplete intraoperative evaluations of the extent of disease compared with 42% of the vertical incision group. Medical record documentation revealed that 97% of the cases operated on by gynecologic oncologists had complete staging evaluations performed, but only 52% and 35% of cases operated on by obstetricians/gynecologists and general surgeons, respectively, were evaluated adequately. Of the 43 women discovered not to have primary carcinoma of the ovary, 5% had benign ovarian tumors, 3% had primary carcinoma of the peritoneum, and 5% had primary carcinoma of the intestines. Women who had their ovaries retained at hysterectomy and later had invasive ovarian cancer had approximately an 80% mortality. Conclusions . The mistaken diagnosis of carcinoma of the ovary can be reduced if surgeons and pathologists improve communications between themselves. The greater use of preoperative second opinions by gynecologic oncologists in women suspected of ovarian cancer should enhance quality of care.