The 5-year survival rate of patients with epithelial ovarian cancer correlates directly with the International Federation of Gynecology and Obstetrics (FIGO) surgical stage of disease. The stage can be determined only after exploratory laparotomy and thorough evaluation of all areas except in stage IV disease, which can be diagnosed by cytologically positive pleural fluid or CT-guided biopsy of parenchymal liver lesion. The technique of surgical staging involves making a vertical midline incision, obtaining peritoneal lavage or aspiration of ascites, intact tumor removal, complete abdominal exploration with biopsy of suspicious lesions, random peritoneal biopsies, and pelvic and para-aortic lymph node dissection. The FIGO staging system, revised in 1985, is presented in Box 1-1. Five-year survival rates for early-stage (presumptive stage I and II) disease have been reported as 50% to 90% and for late-stage disease (stages III and IV), 21%.46 A review of 5156 patients in a study based on National Survey of Ovarian Cancer showed a 5-year survival rate of 89%, 58%, 24%, and 12% for stages I, II, III, and IV, respectively. When survival data for ovarian cancer were substratified further to substage division, the 5-year survival rates were 92% for stage IA, 85% for stage IB, 83% for stage IC, 67% for stage IIA, 56% for stage IIB, 51% for stage IIC, 39% for stage IIIA, 26% for stage IIIB, 17% for stage IIIC, and 12% for stage IV.47 The 5-year survival rates based on the SEER cancer statistics review by the National Cancer Institute are 93.1% for localized disease, 69.0% for regional disease, 29.6% for distant disease, and 23.3% for unstaged disease1 (Fig. 1-2).
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