Primary Carcinoma of the Ovary

Summary: A series of 413 cases of cancer of the ovary from the N.S.W. Gynaecological Cancer Registry is reviewed in relation to some of the problems set up for examination by the World Health Organisation Committee. A new recommended system of staging is shown and compared to the recent F.I.G.O. method. The frequency of carcinoma of the ovary in relation to other genital carcinoma in women is 12.3% and is only exceeded by cervical cancer, 55.2% and corporeal cancer, 25.8%. The survival rates are discussed and compared with those from other genital sites—cancer of the ovary being the lowest with a cumulative relative 5‐year survival of 32%. Different methods of assessing end results are discussed. In this series the following results were obtained: cumulative relative 5‐year survival 32%; absolute 5‐year survival 25.5%; and relative 5‐year survival 27.9%. Many patients with cancer of the ovary are not diagnosed until the disease is in Stage 3 or 4: in N.S.W. this represents 43% of cases. There was a relative 5‐year survival of 67% for Stage 1a, 30.8% for Stage 1b, 22.2% for Stage 2a, 14.8% for Stage 2b, 1 1.1% for Stage 3 and 4.1% for Stage 4. The effect of rupture at operation or spill from a malignant cyst is discussed in relation to its effect on prognosis. The 5‐year survival rate for 20 patients whose tumour had ruptured was 30%, much lower than the figure of 77% for the 74 patients whose tumour remained intact. When 15 patients in each group with Stage 1a lesions of the same pathological type (papillary) were compared, the figures were even more pronounced‐27% and 87% respectively. Ovarian conservation in patients with early (Stage 1a) tumours was associated with a lower 5‐year survival rate (67% versus 75%). Ascites was reported in 78 patients (19%); this association was of serious prognostic significance since only 3 of the patients (4%) lived 5 years and each of these was in Stage 1a. Ascites was present in only 5 of the patients (3.9%) with Stage 1a tumours. Mucinous carcinomas had a more favourable prognosis (61%‐ 5‐year survival) than anaplastic (28.5%), serous or papillary (26.2%) and endometrioid (24.7%) tumours; germ cell tumours (43%) and granulosa and theca cell tumours (35%) were of an intermediate malignancy. The pathological composition of the tumours was as follows: papillary (44.8%), endometrioid (23.0%), mucinous (12.1%), anaplastic and undefined (12.5%), granulosa and thecoma (5.5%), germ cell (1.9%). A brief description is given of the characteristics that distinguish frank malignancy from malignancy of low potential. Surgery alone was the treatment in 44.3% of the patients, surgery and irradiation in 32.3%, irradiation alone in 10.4%, and 13.0% were untreated. The 5‐year survival figures for surgery alone was 41.1%, for combined treatment was 30.4%, and for radiotherapy alone no patient survived for 5 years. However, 42.3% of those treated by surgery alone comprised the most favourable cases (unruptured Stage 1a) compared with only 15.7% of those treated by combined therapy. Combined therapy gave better results than surgery alone in Stage 1b, 2b and 4. Work relating to chemotherapy after sensitivity testing for the appropriate cytostatic agent is briefly discussed.