Importance of proper staging in ovarian carcinoma.

Therefore, on discovery of a clinical Stage I or II ovarian carcinoma through a previously made subumbilical incision, the incision should be extended above the umbilicus to enable one to inspect the diaphragm and remove the omentum from the transverse colon. Biopsy of any raised lesion of the diaphragm can easily be done with laparoscopic biopsy forceps and is associated with minimal morbidity. Routine biopsy of a normal appearing diaphragm is not advocated. Pelvic and paracolic washings for cytological evaluation for malignant cells are obtained by instilling 100-200 cm3 of saline into the pelvis and a similar amount into the right and left paracolic spaces, respectively, and aspirating the fluid for cytological evaluation. Most women with ovarian cancers are still primarily operated on by gynaecologists who are not trained in para-aortic and pelvic lymph node sampling. Ideally, however, women with clinical Stage I or II ovarian cancers should have biopsy of any palpable para-aortic or pelvic lymph node. Such careful surgical staging will: define those patients who are apt to truly have Stage I or II ovarian cancer; improve and refine adjuvant therapy for Stage I and II ovarian cancer; and allow for adjuvant therapy for patients found to have Stage III ovarian cancer, discovered at the time of surgical staging for presumed localized ovarian cancer. The significance of the latter is seen in Table 10 and in the fact that with the subsequent increase to 61 patients evaluated by the Ovarian Cancer Study Group, the incidence of occult metastases from Stage I and II ovarian cancer remain strikingly unchanged (Young et al, 1983, unpublished observations).