Early Ovarian Carcinoma Definition of Early Ovarian Cancer

Most authors and trials of early ovarian carcinoma have defined "early" stage as FIGO (International Federation of Gynecology and Obstetrics) stages I and II (Box 8-1). The subject of adjuvant chemotherapy for the early stages of ovarian carcinoma has been controversial for decades, and at this time some aspects remain unresolved.

Some of the earlier trials identified subgroups of stage I whose prognosis was excellent and therefore warranted a classification of "low-risk" for cancer recurrence and death. Subsequent studies often stratified the early-stage ovarian cancer populations into low-risk and high-risk groups (Box 8-2).

In 1994, the National Institutes of Health (NIH) convened a Consensus Development Conference on ovarian cancer for the purpose of identifying issues that had sufficiently confirmed data at that time.1 Box 8-3 summarizes the conference's statement on management of stage I cancer. The conference panel could not reach consensus on the need for adjuvant therapy in the subsets of stage I not listed in the

Box 8-1. Early-Stage Epithelial Carcinoma: FIGO (International Federation of Gynecology and Obstetrics) Stages I and II

Stage I:

Growth limited to the ovaries

IA

Growth limited to one ovary; no malignant ascites; no tumor on external surface;

capsule intact

IB

Growth limited to both ovaries; no malignant ascites; no tumor on external surface;

capsules intact

IC

Growth involving one or both ovaries with malignant ascites or peritoneal washings;

or with tumor on external surface; or with ruptured capsule.

Stage II:

Growth involving one or both ovaries with pelvic extension

IIA

Extension or metastases to uterus and/or tubes

IIB

Extension to other pelvic tissues

IIC

Tumor of stage IIa or IIb also with malignant ascites or peritoneal washings; or with

tumor on external surface; or with ruptured capsule(s)

Box 8-2. Definitions of Low-Risk and High-Risk Early-Stage Ovarian Carcinoma

Low Risk

Stage IA or IB, grade 1-2 High-Risk

Stage IA or IB, grade 3 or clear cell

Stage IC (rupture, positive cytology, positive capsule)

Stage II with no residual disease (pelvic disease)

Box 8-3. NIH Consensus Development Conference (1994) Recommendations for

Stage I Management

Patents with stage IA grade 1 and most IB grade 1 tumors do not require adjuvant therapy

All patients with grade 3 tumors require adjuvant therapy

Patients with clear cell carcinoma require adjuvant therapy

Many but not all women with stage IC disease require adjuvant therapy box, and they concluded that the most effective adjuvant therapy had not been established. The panel also recommended that patients with high-risk stage I cancers should be enrolled in clinical trials to identify adjuvant therapy that will improve survival.

These NIH recommendations point out the importance of histologic grade in the prognosis of early-stage disease. Despite numerous studies indicating the association between grade and outcome,2-4 FIGO staging does not incorporate grade. Nevertheless, grade influences decisions on both clinical management and trial design.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment