Surgical management of ovarian cancer
P. E. Schwartz
Ovarian cancer represents the second most common cancer of the female
reproductive organs. It is usually not associated with significant warning
signals that led to early diagnosis. The management is based on adequate
surgical staging, removal of as much of the bulk tumor as possible, careful
histologic assessment of the primary cancer and its metastases, and
appropriate postoperative adjuvant therapy. Stage I cancer confined to one
ovary and with a very favorable histology, such as borderline malignant
epithelial cancers, dysgerminoma, granulosa cell tumor, and
Sertoli-Leydig's cell tumor, may be treated with surgery alone. Stage I
epithelial cancers are best treated with a total abdominal hysterectomy,
bilateral salpingo-oophorectomy, and adjuvant chemotherapy or radiation
therapy. Stage I nonepithelial malignant neoplasms are best treated with a
unilateral salpingo-oophorectomy followed by an aggressive combination
chemotherapy. Advanced ovarian cancers regardless of the histologic origin
of the tissue should be treated with aggressive surgery, including complete
removal of the tumor whenever possible followed by adjuvant therapy
selected on the basis of the histologic appearance of the tumor. Complete
remissions for ovarian cancer should be confirmed by second-look operation
prior to discontinuing adjuvant chemotherapy.