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VI. Carcinoma of the ovary
238 VI.
OVARY CARCINOMAOF THE OVARY
ANATOMY Primary Site. Ovaries are a pair of solid bodies, flattened ovoids 2.0 to 4.0 cm in diameter, that are connected by a peritoneal fold to the broad ligament and by the infundibulo-pelvic ligament to the lateral wall of the pelvis. The peritoneum, including the omentum, the pelvic and abdominal viscera, and the diaphragm are common sites for seeding. The lymphatic drainage occurs by the utero-ovarian and round Nodal Stations. ligament trunks and an external iliac accessory route into the following regional nodes: External iliac, common iliac, hypogastric, lateral sacral, and para-aortic nodes, and rarely, to inguinal nodes. Metastatic Sites. Liver vement also occurs.
metastases
are common. Pulmonary
RUL.RSFOR STAGING OF PIUWARYCARcm
and pleural
invol-
OF TRE OVARY
Only rarely is it possible to come to a final diagnosis of ovarian carcinoma by inspection or palpation or by any of the other methods recommended for clinical staging of carcinoma of the uterus and vagina. Therefore, the Committee on Gynecology Oncology of FIG0 recommends that the clinical staging of primary carcinoma of the ovary should be based on findings by laparascopy or laparotomy, as well as on the usual clinical examination and roentgen studies. of ovarian masses, as well as hysterectomy Thus, laparotomy and resection form the basis for staging. Biopsies of all suspicious sites, such as the omentum, mesentery, liver, diaphragm, and pelvic and para-aortic nodes, are required. The final histologic findings after surgery able) are to be considered in the staging.
(and cytologic
ones when avail-
Clinical studies, if carcinoma of the ovary is diagnosed, radiography of chest. CT may be helpful in both initial follow-up of tumours.
include routine staging and
DRFINITIONS OFTRRSTAGRS IN l%IHARYcARc~oFTREovARY (Correlations Staging exploration
is
Stage I Stage Ia
of the FIGO, UICC and AJCC nomenclatures) based on (see above).
findings
at
clinical
examination
Growth limited to the ovaries Growth limited to one ovary; no ascites No tumour on the external surface; capsule intact
and
surgical
OVARY
Stage Ib Stage Ic*
Stage
II
239
Growth limited to both ovaries; no ascites No tumour on the external surfaces; capsules intact Tumour either Stage Ia or Ib, but with tumour on surface of one or both ovaries; or with capsule ruptured; or with ascites present containing malignant cells or with positive peritoneal washings Growth involving one or both ovaries with pelvic extension
Stage IIa Stage IIb
Extension Extension
Stage IIc*
Tumour either Stage IIa or IIb, but with tumour on surface of one or both ovaries; or with capsule(s) ruptured; or with ascites present containing malignant cells or with positive peritoneal washings
Stage
III
Stage IIIa
Stage 1116
Stage IIIc Stage
IV
and/or metastases to the uterus to other pelvic tissues
and/or tubes
Tumour involvning one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes. Superficial liver metastasis equals Stage III true pelvis but with Tumour is limited to the histologically proven malignant extension to small bowel or omentum Tumour grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces Tumour involving one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces none exceeding 2 cm in diameter. Nodes are negative Abdominal implants greater than 2 positive retroperitoneal or inguinal one or both Growth involving metastases. If pleural effusion is positive cytology to allot a case to Parenchymal liver
cm in diameter and/or nodes ovaries with distant present there must be Stage IV
equals Stage IV criteria * In order to evaluate the impact prognosis of the different allotting case to Stage Ic or IIc it would be of value to know: If the source of malignant cells detected was 1) 2) If a) b)
peritoneal washings or ascites rupture of the capsule was spontaneous or caused by the surgeon
metastasis
for
240
OVARY
HISTOPATEOILIGY
Ovarian carcinoma is a common malignant tumour. It cannot be regarded as an entity. Therapeutic statistics on ovarian cancer are of limited value if attention is not paid to the histological type of the growth. ovarian tumours" The WHO has published a "Histological typing of (International Histological Classification of Tumours, No. 9, 1973) which certainly will help to understand the pathology and behaviour of ovarian neoplasms. The histo-pathological classification of epithelial tumours adopted by the WHOcorresponds in principle with that proposed by FIGO. It should be noted that cases of germ cell tumours, hormonal producing neoplasms, and metastatic carcinomas should be excluded from therapeutic statistics on ovarian epithelial tumours. HIsTo~ICALcLcLssIl?ICATIoNoFTEEcomoN OVARY
1.
Serous
a) b)
c) 2.
3.
4.
PRIHAKY
EPITEELIAL
TamuRs
OF TEIR
cystanas
Serous benign cystadenomas Serous cystadenomas with proliferating activity of the epithelial cells and nuclear abnormalities, but with no infiltrative destructive growth (boderline cases; low potential malignancy) Serous cystadenocarcinomas
Mutinous
cystomas
a) b)
Mutinous benign cystadenomas Mutinous cystadenomas with proliferating activity of the epithelial cells and nuclear abnormalities ,,but with no infiltrative destructive growth (borderline cases; low potential malignancy)
c)
Mutinous
Endaaetrioid
cystadenocarcinomas (similar benign cysts
tumours
to adenocarcinoma in the endometrium)
a)
Endometrioid
b)
Endometrioid tumours with proliferating activity of the epithelial cells and nuclear abnormalities, but with no infiltrative destructive growth (borderline cases; low potential malignancy)
c)
Endometrioid
Clear
cell
tmours
adenocarcinomas (mesonephroid
tumours)
a)
Benign mesonephroid tumours
b)
Mesonephroid tumours with proliferating activity of the epithelial but with no infiltrative destructive cells and nuclear abnormalities, growth (borderline cases; low potential malignancy) Mesonephroid cystadenocarcinomas
c)
OVARY
241
Undifferentiated carcinoma A malignant tumour of epithelial structure that is too poorly differentiated to be placed in any of the groups 1 - 4 or 6. Mixed epithelial tumours Tumours composed of a mixture of two or more of the malignant groups lc, 2c, 3c or 4c described above and where none of them is predominant. Thus, a case should be listed as "mixed epithelial tumour" only if it is not possible to decide which is the predominant structure. The pathologist should always try to find out which is structure and classify the case according to that element. No histology
the
leading
or unclassifiable
Cases where explorative surgery has shown that obvious ovarian epithelial malignant tumour is present, but where no biopsy has been taken, or where the specimen is unclassifiable because' of, for instance, necrosis. RliLJfS RELATING TO STATIMENTS 1.
A statement should preferably comprise at least 10 examined cases per year, but reports of fewer cases will be accepted.
2.
Statements should include all cases of primary common epithelial tumours considered as ovarian carcinoma. The very rare cases where it has not been possible to decide whether the origin of the growth is in the ovary or in the uterine corpus should be included in the statistics on carcinoma of the corpus as well as in the statistics on ovarian cancer (see also Rules for corpus, 2.). Cases of low potential malignancy, often called borderline tumours, should be reported.
3.
Cases where no biopsy has been taken, but where explorative surgery has shown that obvious malignant ovarian tumour is present should be reported.
4.
Cases should be histologically grouped and staged according to the systems adopted by FIG0 (see above). with a view to treatment All patients examined at the institution should be included as well as patients referred for treatment after primary surgery at another hospital. Because of the wide variation in the organisation of cancer services, it is impossible to establish rules for all details of exclusion or collaborators are inclusion of cases. If in doubt or uncertain, requested to apply to the Editorial Office.
5.
242 OVARY 6. The following categories of cases should not be included: a) Patients referred for diagnosis only. b) Recurrent cases of carcinoma of the ovary. c) Cases diagnosed at autopsy. d) Cases with a metastatic ovarian carcinoma from either a genital or extra-genital site. cell e) Non-epithelial tumours, such as dysgerminoma, granulosa tumours, and germ cell tumours. f> Cases of anaplastic inoperable widespread malignant tumours where the gynecologist could not decide the origin of the growth. Such cases should be classified as carcinoma abdominis.
OVARY
243
SIIEHARYAND~ To the Editorial Office of Annual Report 42,786 cases of obviously malignant cases of. epithelial ovarian cancers and 3,181 cases of low potential malignancy were reported to volumes 15 through 21, that is cases treated from 1958 onwards to 1986 inclusive. Table C.1 gives a summary of the treatment results for obviously malignant ovarian cancer given as crude S-year survival rate stage by stage and as a total for each year. The calculated S-year results improved slightly in the end of 1960's but are thereafter essentially unchanged. Please observe that the results for volume 21 are given both as direct crude S-year survival and as actuarial survival. Table C.1
Ovarian cancer. Obviously malignant cases. Five-year crude survival rate by stage. Cases reported to volumes 15 - 21.
Vol.
No. of cases
Year
Stage Ia
Ib
Ic
15
1958-62
2,320
60.7
16
1963-68
4,588
66.7
51.9
17 18
1969-72 1973-75
4,892 5,268
72.0 69.7
62.5 63.9
19 20
1976-78 1979-81
6,724 8,082
72.3 76.6
56.1 67.7
21
1982-86 10,912
IIa
42.0 (Ib IIa)
survival
IIbtc
III
IV
%
31.6(IIb)
6.9
2.6
26.8
49.7
38.0
8.6
5.0
27.3
57.4 50.3
52.2 51.8
37.5 42.4
10.8 13.3
4.6 4.1
30.1 30.5
58.1 59.6
47.7 51.1
42.1 43.5
13.5 17.4
4.5 4.7
29.8 30.9
53.8*
22.75; 8.0*
82.3* 74.9* 67.7" 60.6*
42,786 * S-year actuarial
Total
31.9(35*)
Table C.11 gives a summary of ovarian cancer cases of a low potential malignancy reported from volume 15 through volume 21. The figures speak for an improvement in results from the beginning of 1970's. Thereafter the results are unchanged.
Table C.11
Ovarian cancer. Cases of low potential malignancy. Five-year crude survival rate. Cases reported to volumes 15 - 21.
Vol
Year
No. of cases
Total Stage Ia - IV %
15
1958-62
451
67.2
16 17
1963-68 1969-72
385 403
73.8 73.4
18
1973-75
304
78.6
19 20
1976-78 1979-81
371 542
78.7 77.5
21
1982-86
725
78.6 (89.1)*
3,181 * 5-year actuarial
survival
In Table C.111, the cases of carcinoma of the ovary reported to volume 21 are presented with 3 and 5-year actuarial survival by stage. Please, observe that this table includes obviously malignant cases as well as cases of low potential malignancy. In contrast with the case in previous volumes these data are given as actuarial survival and therefore not directly comparable with the crude survival data given earlier.
OVARY 245 Table CL111
Stage
Carcinoma of the ovary. Patients and five-year actuarial survival obviously malignant cases as well malignancy.)
Patients
No.
treated a
No.
3-year survival %
S-year survival No. % 1134
79.3
403 250
57.0
I II
3073 1469
26.5 12.7
2406 933
85.5 69.0
III IIIa
2342 365
20.2
724 193
33.7
IIIb
580
229
IIIC
1961
5.0 16.9
57.6 44.1
491
IV
1740
15.0
56
0.5
11596
100.0
Incomplete data TOTAL
treated in 1982-86. Three rate by stage.(Includes as cases of low potential
82
22.5 49.0
28.1
87 136
32.9 18.5
219
14.3
74
8.4
5219
49.8
2173
40.9
3.2
Table C.IV gives information about the three-year result. 3.3% of the were lost sight of and 2.0% had died from intercurrent disease.
Table C.IV
Carcinoma of the ovary. year result.
Patients
treated
in 1982-86. Three-
3-year result
No. of
%
patients -,
Alive
5,551
47.9
Died of carcinoma of the ovary Lost sight of
5,431 385
46.8 3.3
229 11,596
2.0 100.0
Died from intercurrent TOTAL
disease
cases
246 OVARY The mean age by stage and histological class is given in Table C.V. An increase in mean age by stage is seen by and large for all histological classes. Table C.V
Carcinoma of the ovary. Patients treated age by stage and histological class.
Stage
Histological
in 1982-1986. Mean
class
Serous
Mutinous
Endometrioid
Clear cell
Undiff. & unspecified
Ia
56.3
50.5
55.9
55.2
55.8
Ib Ic
52.8 56.2
56.5 53.5
53.8
54.5
55.7
53.8
52.2
54.1
IIa
56.9
52.6
56.1
53.8
57.4
IIb
57.0
57.8
55.1
61.4
58.2
IIC III
54.6
55.4 61.0
57.2 59.0
59.2 58.5
58.0
55.7
56.4
55.3
61.8 58.6
55.8
56.9
55.1
59.9
59.8
57.7 59.9
57.6
58.0
58.7
59.9
74.2
58.2 60.3
59.2 62.0
59.2 50.0
61.0 66.9
48.1
50.2
56.9
51.8
IIIa IIIb IIIC IV No stage Low potential malignancy
58.6 53.8
The histogram in Fig. C.l gives the distribution malignant cases and in Fig. C.2 for potentially
by age for obviously malignant tumours.
OVARY
247
The age distribution profile for obviously malignant carcinoma of the ovary is presented in Fig.C.l and for cases of low potential malignancy in Fig.C.2. 74.1% of the obviously malignant cases belong to ages 50 years or more compared to 50.9% for the low potential malignancy cases. Only 8.7% of the obviously malignant cases were younger than 40 years compared to 31.8% of the low potential malignancy cases. Fig C.l Obviously malignant carcinoma of the ovary. Age distribution 30
Percentage of patients
20
10
o-29
Fig.
30-
40-
6s
Carcinoma of the ovary. Casesof low potential Age distribution
c.2 30 ’
60-
70 + Age
malignancy.
Percentage of patients
20 -
o-29
30-
40-
60-
60-
701- Age
248 OVARY TABLE C-VI
Histological class (see p.240 for defin.) Obviously
Carcinoma of the ovary, Stages I-IV. Obviously malignat cases and cases of low potential malignancy, examined in the years 1982-1986, incl., at 100 institutions. Stage distribution and 3 and 5-year actuarial survival rate. Total No. exam
malignant
Stage Ia
Stage Ib
Stage Ic
No. survival exam 3-yr 5-yr % %
No. survival exam 3-yr 5-yr % %
No. survival exam 3-yr 5-yr % %
cases:
IC
5 654
431
87.6
81.5
163
87.7
79.3
318
77.4
66.9
2c
1 256
401
92.2
88.2
30
60.0
55.4
186 81.8
75.2
3c
1 800
323
85.4
82.2
64
84.3
75.6
176
84.8
71.0
621
176
79.1
75.3
4
86
62.9
56.0
1 581
96
80.3
74.6
22
86.4
67.3
73
69.3
58.0
1 427
86.8
82.3
283
83.9
74.9
839
77.8
67.7
4c Undiff. and unspecified TOTAL
10 912"
Cases of low potential
malignancy:
Serous
379
165 93.6
90.8
68
96.9
92.9
21 100.0 100.0
Mutinous Other
317 29
209 9
96.0
92.5
14 1
92.9
85.1
38 2
91.1
91.1
TOTAL
725*
383
95.0
91.9
83 -
96.2
91.6
63 -
94.7
94.7
* Includes
non-staged
patients
The three and five-year actuarial survival by histological class and stage is given in Table C.VI for obviously malignant cases and for low potential malignancy cases.
OVARY
249
Stage
IIa
Stages
IIb
t IIc
Stage
III
Stage
No. exam
survival 3-yr 5-yr % %
No. exam
survival 3-yr 5-yr % %
No. exam
survival 3-yr 5-yr % %
No. survival exam 3-yr 5-yr % %
132
75.5
58.1
485
67.5
55.0
3 123
36.1
24.5
36
63.0
54.0
105
62.9
54.9
369
27.8
103
83.5
68.6
253
71.2
60.4
692
17
62.9
62.9
104
64.3
54.1
37
62.9
52.2
137
52.7
325
74.5
60.6
1084
10
16.8
9.3
21.2
129 16.4
8.6
34.5
24.1
189
9.8
6.0
179
17.7
14.0
55
a.5
4.3
36.8
807
26.4
17.0
409
8.9
6.3
65.7
53.8
5 170
33.1
22.7
1 784 13.9
8.0
32
96.9
93.5
78
91.8
90.3
3
3
15
100.0
100.0
32
70.3
51.3
6
0
1
16
18.8
la.8
0
13
48 -
126
76.6
70.9
9
97.9
95.6
1 002
IV
250 OVARY The study of the actuarial survival by year after treatment and by stage (life table analysis) for serous ovarian carcinomas is presented in Fig. C.3 and C.4. Fig.
Obviously malignant 8610~scarcinoma of the ovary, 1982-1986. Life table presentation by stage I-II.
C.3
-..-. -.-. --..-_ ............. . ...-..
stage I stage la Stage lb
Stage Ic stege II stage Ile Stege Ilb Stage llc
60-I
4020 0
I 1
0
I 2
slwvhral
Fig.
c-4
r 5
I 4
I 3
the
&eaml
Obvioudy malignant serow carcinoma of the ovary, 1982-1986. Life table presentation by stage III-IV.
stage Ill
-Stage llla . . . . Stage ltlb -.-. Stage lllc -Stege IV
0
1
2
3
5
4 survivd
the
(yead
OVARY 251 The actuarial survival by year after treatment and by histological grade for Stage Ia cases respectively Stage IIIb cases is presented in Fig. C.5 and C.6. Fig.
Obviously malignant seroue carcinoma ofthe ovary Stage Ia, 1982-1986. Life table presentation by histological grade.
C.5
Cumulative proportion surviving % 100~
Grade 1 s-s-.... Grade 2 - a
-.
Grade 3
*-..
--..__e - - -_ ---.... - -------. ...*__ ,“- -...., --
--
8060-
00 0
Fig.
C.6
Obvioualy
2
1
malignant
3
4
serous carcinoma
ofthe
Stage IQ 1982-1986. Life table presentation histological grade.
5
ovary
by
Grade 1 .----se. Grade 2
Cumulative proportion surviving %
-
-
Grade3
100
80 60
0
1
2
3
4
5
Survival time (yews)
252 OVARY Three and five-year actuarial survival rate by mode of Ia, Ib and Ic is given in Table C.VII. The choice of these early stages is probably guided by knowledge of which should explain many of the differences in treatment Table C.VII
Carcinoma of the ovary. Patients and five-year actuarial survival in Stages Ia, Ib and Ic.
Stage
Mode
of
676
Ib
90
Ic Not substaged
561
treated in 1982-1986. Three rate by mode of treatment
Surgery combined with No. treated
93.4
233
89.6
393
77 93.2
41
89.6
84
110
80
83.5
28
73.8
202
38
28
88.6
13
79.2
9
Surgery combined with chemotherapy Ia Ib
486 107
Ic 403 Not substaged 23
in Stage given in factors
treatment
Surgery alone Alive at No. kreated 3 years 5 years No. % No. % Ia
treatment treatment predicting results.
Alive
radioth.
at
3 years No. %
5 years No. %
325 90.5
157
88.1
90.3
38
84.9
154 80.6
84
76.3
72
9
2
Surgery combined with chemotherapy and radiotherapy
381 85.1 85 83.7
190 38
81.6 75.0
181 83
135 77.9 59 77.1
86 68.9 37 65.0
287
78.7
114
68.8
186
137 75.0
67
19 76.3
5
70.2
1
1
0
61.2
OVARY 253 Carcinoma of the ovary, low potential -malignancy cases, Stage I - IV are presented in Table C.VIII with 3 and S-year actuarial survival by mode of treatment. Table C.VIII
Carcinoma of the ovary. Patients treated in 1982-86. 747 cases of low potential malignancy, Stage I-IV. Three and fiveyear actuarial survival rate by mode of treatment.
Mode of treatment
No. treated
Alive 3 years No.
%
at 5 years No.
%
Surgery alone
381
314
94.7
146
92.0
Primary surgery t radiotherapy
117
92
92.7
43
89.6
Primary surgery t chemotherapy
197
154
86.1
69
80.7
52
45
94.1
26
94.1
6
2
Primary surgery t comb. rad. t chemotherapy Other
1
Table C.IX gives the 3 and S-year actuarial survival for carcinoma of the ovary Stage Ic and IIc by basis for diagnosis. It would seem that tumours ruptured by the surgeon have a more favourable prognosis than those ruptured spontaneously. Table C.IX
Carcinoma of the ovary, Stage Ic and 11~. Three and five-year actuarial survival rate by basis for the diagnosis.
Criteria
Stage No. treated
Peritoneal
Survival 3 years No. %
5 years No. %
85.2 76.9 71.0
9 71.0 8 67.9 11 61.8
91.4
42
washings
27
Ascites Spontaneous rupture
58 50
21 42 33
95
82
2 4
1 4
Rupture caused by the surgeon Combination of the above mentioned Tumour on the surface
Stage
Ic
1 1
79.7
No. treated
IIc Survival 3 years No. %
5 years No. %
7 30 19
5 15 57.5 12 67.4
1 4 42.5
43
31
1
1
1
0
76.1
8
60.7
13 59.4
0
254 OVARY the Survival by completeness of surgery in Stage III cases. Fig. C.7 gives actuarial survival rate by year after treatment for Stage IIIa cases. The 5-year actuarial survival for cases with growth completely removed was 78.8 per cent compared to 21.6 per cent for cases with residual tumour greater than 2 cm. The corresponding figures for Stage IIIb cases was 54.4 per cent compared to 23.8 per cent (Fig. C.8) and for Stage 111~ 43.3 per cent compared to 11.4 per cent (Fig. C.9).
Fig.
Obviouslymalignant serou~ carcinoma of the ovary
C.7
Stage IDa, lQQ2- 1988. Life table analysis by completeness of surgery. -1 .__._._. 2
cumullrlhreproportion
--
swvMng%
\ 60604040 -I 20
\
3
-*.**... *.-_--.. -=... \\ ---.... -... -....*--...... \ ------.......... \. . . . . .
4
Code for completeness of surgery: l- Growth completely removed 2- Growth incompletely excised, no residual implant greater than 2 cm 3- Growth incompletely excised, residual lesion(s) greater than 2 cm
. . ----
OVAKY Fig.
C.8
Obviously malignant wrous carcinoma of the ovary Stage II& 1982-1986. Life table analysis by completeness of surgery. -1
c . . . . .. 2 -3
Cumulative proportion surviving %
80-
\
6040200 0
I 1
I 2
I 4
I 3 Suwival
Fig.
f 5
time (years1
Obviously malignant serous carcinoma of the ovary &age I& 1982-1986. Life table analysis by completeness of surgery.
C.9
-1 . . . .. . . 2 -3
Cumulative proportion surviving %
100 80 60
L- - -- --0 i
0
I
1
I 2
I 4
I 3 Survival
time M2arsI
r 5
255
OVARY
257
UMBINKDTABIJBFORTKEINDlSADUALINSTITiJTIONS The tabular forms to be used when reporting available on application to the Editorial Radiumhemmet, S-104 01 Stockholm, Sweden.
on carcinoma of the ovary are Office of the Annual Report,
For the definitions of classification by site and staging of carcinoma of the ovary and of the histological classification of the common primary epithelial tumours of the ovary the reader is referred to pp. 238-241. The rules relating to statements to be furnished by collaborators are given on pp. 241-242. Notes
on the
presentation
of
the
material.
Information concerning cases of carcinoma of the ovary examined in the years 1982-1986 has been furnished by 99 of the 147 collaborators. Table C.Xa reviews the three and five-year actuarial survival carcinoma reported by the different institutions (Stages I-IV). Table C.Xb gives the distribution by stage five-year survivors by reporting institution. Survival rates 10 cases.
(per cent) are not calculated
Patients for whom the cause of dead of carcinoma of the ovary.
and the
number of
on samples containing
for
ovarian
three
and
less
than
death was unknown have been registered
as
258
OVARY
TABLE
C.Xa
Obviously malignant cases of carcinoma of the ovary. Stages I-IV (all histological classes) examined in the years 1982-1986.3 and S-year actuarial survival rate.In, formation is also given about numbers of survivors and deaths of carcinoma of the ovary as well as cases lost sight of and cases not treated.
Institution name of institution is given in List of Collaborators
Full
Years reported
Stages No. treated
I
- IV Survivors
3-year
S-year
No.
No.
Argentine
1982-86
61
34
34
Melbourne, MacCallum Carlton, Royal Women's Camperdown, R.P.A.
1984-86 1984-86 1982-86
120 79 202
49
33 82
46 30 69
Gras Innsbruck Vienna, I. Frauenklinik Vienna, II.Frauenklinik
1982-86 1982-85 1984-86 1982-86
167 91 148 85
80 33 89 27
60 27 78 22
Louvain
1984-86
79
46
39
Sao Paul0
1982-86
87
23
21
Sofia
1984-86
54
30
22
Halifax Montreal, Centre d'0nc. Montreal, HBtel Dieu Montreal, Royal Victoria Ont Ca Found., Kingston Ont Ca Found., Windsor Regina Toronto Vancouver
1984-86 1984-86 1982-86 1982-86 1982-86 1984-86 1984-86 1984-86 1984-86
142 113 62 87 125 36 191 393 368
60 59 33 40 61 16 99 21% 216
54 52 28 32 53 12 73 190 187
1.
Buenos Aires
Australia
3. 4. 6. Austria
7. 8. 9a. 10.
Belgium
11. Brasil
13.
Bulgaria
14. Canada
15. 16. 17. 18. 19. 20. 22. 23. 24.
OVARY
Stages
I-IV
No. of deaths ovarian ca. 3-yr 5-yr
Lost sight of S-year No. %
Actuarial 3-year %
survival S-year %
Total no. not treated
24
24
2
3.3
60.3
60.3
0
66 41 111
69 44 122
0 5 4
6.3 2.0
42.2 45.0 42.4
38.3 40.3 35.9
0 0 3
76 55 51 26
93 62 61 31
6 1 2 30
3.6 1.1 1.4 35.3
so.7 36.3* 61.8 62.7
37.4 26.7* 51.3 47.2
10 0 0 0
32
39
1
1.3
60.0
45.8
0
39
41
25
28.7
47.0
41.8
0
24
32
0
55.6
37.7
0
67 40 25 46 53 16 83 170 133
73 47 30 53 50 19 104 196 157
13 13 1 1 3 1 3 1 5
50.9 59.7 57.1 44.6 54.1 56.8 54.6 56.7 62.3
43.8 44.5 47.9 35.3 46.8 39.8 36.9 46.1 52.0
2 0 1 4 3 0 3 0 1
>k Crude survival
rate
9.2 11.5 1.6 1.1 2.4 2.8 1.6 0.3 1.4
259
260
OVARY
TABLE
Obviously malignant cases of carcinoma of the ovary. Stages I-IV (all histological classes) examined in the years 1982-1986 3 and 5-year actuarial survival rate. Information is also given about numbers of survivors and deaths of carcinoma of the ovary as well as cases lost sight of and cases not treated.
C.Xa
Institution Full
name of institution in List of Collaborators
Years reported
is given
Stages No. treated
I
- IV Survivors
3-year
5-year
No.
No.
Chile
25. 26.
Santiago,P.Jaraquemada Santiago,S.Juan de Dios
1982-86 1982-86
39 30
19 20
18 20
Brno, VUKEO Brno, UJEP
1982-86 1982-86
189 47
99
78 24
Helsinki Turku
1984-85 1984-86
109 40
66 20
Angers Bordeaux Caen Grenoble Lille Nice Rennes
1982,83,86 1982-86 1984-86 1982-86 1982-86 1984 1984-86
60 97 122 37 81 9 111
25 44 43 . 23 19 2 45
18 40 35 22 15 2 37
1982-86 1982-86 1982-86 1984-86 1984-86 1982-86 1985-86 1983-86 1984-86 1982-86 1982-86
105 226 45 260 41 247 67 59 82 178 127
72 96 13 134 16 91 25 37 32 88 36
65 75 12 105 15 67 23 25 29 82 32
Czechoslovakia
28. 29.
25
Finland
31. 32.
59
16
France
33. 34. 35. 37. 38. 40. 41. German
43. 46. 47. 48. 49. 50. 52. 53. 54. 55. 57.
Federal
Berlin Freiburg Fulda Giessen Greifswald Gijttingen Hannover Heidelberg Jena Kiel Leipzig
Republic
OVARY
Stages
I-IV
No. of deaths ovarian ca.
Lost sight S-year
of
3-yr
5-yr
No.
%
%
%
16 10
17 10
2 0
5.1
58.7 60.6
55.5 60.6
0 3
90 20
111 21
0 2
52.0 57.0
39.2 54.2
0 0
37 16
43 20
1 1
64.9 55,s
56.1 40.8
0 0
31 52 76 8 62 7 66
38 56 84 9 66 7 74
2 1 0 6 0 0 0
42.7 45.4 36.5 66.1 20.2
27.9 41.1 24.0 54.1 15.7
39.0
29.3
5 0 0 1 16 0 0
31 123 31 115 17 141 42 22 46 84 86
37 143 32 142 18 163 44 34 49 90 90
1 1 0 1 7 5 0 0 0 4 1
68.7 44.1 32.5 54.5 52.4 39.8 36.8 62.7 40.5 49.8 29.7
59.9 33.6 29.8 42.9 48.0 28.0 33.6 40.3 35.6 45.2 25.8
0 3 2 2 2 4 1 0 2 8 4
4.3 0.9 2,s
3.3 1.0 16.2
1.0 0.4 0.4 17.1 2.0
2.2 0.8
Actuarial 3-year
survival S-year
Total no. not treated
261
262
OVARY
TABLE
C.Xa
Obviously malignant cases of carcinoma of the ovary. Stages I-IV (all histological classes) examined in the years 1982-1986 3 and 5-year actuarial survival rate. Information is also given about numbers of survivors and deaths of carcinoma of the ovary as well as cases lost sight of and cases not treated.
Institution Full name of institution is given in List of Collaborators
58. 59. 60. 61.
Years reported
Stages No. treated
I
-
IV
Survivors 3-year No.
5-year No.
Munich, I. Frauenklinik Munich, Grosshadern Restock Wiirzburg
1982-86 1984-86 1982-86 1982-86
227 165 62 93
85 70 28 29
68 56 24 24
Athens
1982-84
100
51
36
1984-86
9
4
4
1982-86
153
93
91
Greece
62.
Hong Kong
63.
Shatin
Hungary 65. Debrecen Israel
67. 68.
Kfar Saba Tel Hashomer
1982-86
1984-86
18 61
8 29
7 21
Florence Padova
1982-86 1984-86
101 62
39
34
33 28
Kumamoto Nagasaki Okayama Tokyo
1982-86 1984-86 1984-86 1984-86
31 31 30 47
18 11 16 28
15 11 14 27
Seoul
1984-85
25
9
8
1984-86 1982-86
72 123
38 51
33 48
Italy
70. 71. Japan
73. 74. 75. 77. Korea
78.
TheNetherlands 79.
81.
Amsterdam,Acad Med Cent Groningen
OVARY
Stages I-IV No. of deaths ovarian ca.
Lost sight 5-year
3-yr
5-yr
No.
%
%
%
128 85 32 59
145 99 36 64
9 10 2 1
4.0 6.1 3.2 1.1
41.9 46.5 45.0 33.8
32.5 33.1 38.2 28.1
0 0 3 3
41
55
6
6.0
56.0
40.4
0
4
4
1
24
26
33
10 30
11 37
0 0
55 26
60 32
4 0
13 19 14 17
16 19 14 18
0 1 0 0
4
5
12
32 67
37 70
1 4
of
Actuarial 3-year
survival 5-year
Total no. not treated
0 21.6
70.4
66.4
3
44.4 49.8
37.6 36.2
0 0
43.3 57.4
36.8 45.9
0 0
58.1 38.7 52.6 57.4
47.8 38.7 52.6 54.4
0 0 0 0
48.0
86.7
65.0
0
1.4 3.3
52.1 43.0
43.5 38.9
3 0
4.0
3.2
263
264
OVARY
TABLE
C.Xa
Obviously malignant cases of carcinoma Stages I-IV (all histological classes) years 1982-1986 3 and 5-year actuarial Information is also given about numbers and deaths of carcinoma of the ovary lost sight of and cases not treated.
Institution
Years reported
Full name of institution is given in List of Collaborators 82. 83.
Stages No . treated
I
of the ovary. examined in the survival rate. of survivors as well as cases
-
IV
Survivors 3-year
5-year
No.
No.
Rotterdam Tilburg
1984-86 1984-86
98 51
48 34
43 31
Oslo
1984-86
815
423
397
Beijing, Gen Hosp of PLA 1982-86 Shanghai, Int Peace Mat 1984-86 Wuhan, Tongji Hosp 1982-86
21 33 60
8 27 36
7 26 36
Norway 85.
Peoples 87. 90. 91a.
Republic
of
China
Poland 94.
Warsaw
1982-86
385
217
196
Barcelona,H Clin y Prov Barcelona,H San Juan Barcelona, Inst Dexeus Granada Madrid, "12 de Octubre" Madrid, "La Paz"
1984-86 1984 1982-86 1982-86 1982-86 1982-86
48 4 35 73 70 110
24 3 15 35 50 60
21 1 14 33 48 56
1982-86 1982-86 1984-86
500 738 195
222 366 103
180 321 89
1982-86 1983-86 1982-86
68 24 103
26 6 45
22 5 39
1984-86
112
49
41
Spain 101. 102. 103. 104. 105. 106.
107. Gothenburg 108a.Stockholm 110. ijrebro Switzerland 111. 112. 114.
Base1 Bern Zurich
Republic 115.
of
South
Observatory
Africa
OVARY
Stages
I-IV of
Actuarial 3-year
survival 5-year
No. of deaths ovarian ca.
Lost sight 5-year
3-yr
5-yr
No.
%
%
%
50 12
55 15
0 3
5.9
50.0 75.5
42.6 65.8
0 0
373
397
4
0.5
52.1
47.0
1
13 4 21
14 5 21
0 2 2
6.1 3.3
37.4 85.3 60.0
31.7 82.0 60.0
0 1
159
180
9
2.3
55.3
48.3
1
10 1 8 35 16 42
13 2 9 37 18 45
12 0 9 3 4 7
25.0
75.7
67.5
25.7 4.1 5.7 6.4
68.4 49.0 74.2 61.1
63.1 45.9 70.1 57.8
272 352 85
306 392 96
0 4 0
0.5
45.4 51.7 55.6
37.5 45.7 47.8
0 1 0
40 17 55
44 18 61
0 0 0
39.7 27.6 45.8
33.5 22.6 39 ..2
1 0 0
47
55
13
55.1
42.2
1
11.6
Total no. not treated
265
266
OVARY
TABLE
C.Xa
Obviously malignant cases of carcinoma of the ovary. Stages I-IV (all histological classes) examined in the years 1982-1986.3 and 5-year actuarial survival rate. Information is also given about numbers of survivors and deaths of carcinoma of the ovary as well as cases lost sight of and cases not treated.
Institution Full name of institution is given in List of Collaborators
Years reported
Stages No . treated
I
- IV Survivors
3-year
5-year
No.
No.
UnitedKingdom
118. Edinburgh 120. London, Royal Marsden United
126. 128. 129. 131. 133. 134. 135. 137. 139. 140. 141. 142. 143.
States
1984-86 1984-86
225 142
80 58
70 47
1984-86 1984-86 1984-86 1984-86 1984-86 1984-86 1984-86 1984-86 1982-86 1982-86 1984-86 1984-86 1984-86
129 87 35 44 65 52 14 105 56 84 28 95 125
66 42 15 26 38 31 8 68 25 27 5 43 67
55 40 10 21 32 29 7 62 20 19 4 39 61
1982-86 1984-86
232 68
84 25
71 22
of America
Atlanta Boston, Mass Gen Hosp Charleston Chicago, Rush Med Evanston & Maywood Galveston Los Angeles, S Calif C Minneapolis NY Brooklyn, State Univ NY Stony Brook Philadelphia, Hahnemann Philadelphia, Univ Penn Winston-Salem
Yugoslavia
146. Ljubljana 147. Zagreb
OVARY
Stages
I-IV
No. of deaths ovarian ca.
Lost sight 5-year
of
3-yr
5-yr
No.
%
%
%
143 46
153 56
0 35
24.6
36.4 57.3
31.1 43.5
0 3
58 38 19 14 25 21 6 35 29 44 20 42 52
68 40 24 19 30 23 7 40 34 52 21 46 58
5 3 1 2 0 0 0 1 1 12 3 8 5
0.9 1.8 14.3 10.7 8.4 4.0
53.6 54.7 39.6 67.9 57.9 55.0 56.3 66.5 46.4 44.3 24.3 55.3 50.5
43.4 51.6 24.9 49.2 46.6 46.2 45.0 61.0 35.3 30.7 18.2 50.3 39.7
0 0 4 0 2 3 0 0 0 0 0 0 4
145 42
158 44
0 1
1.5
36.8 37.4
30.3 33.5
4 0
3.9 3.4 2.9 4.5
Actuarial 3-year
survival 5-year
Total no. not treated
267
268
OVARY
TABLE
C.Xb
Obviously malignant cases of carcinoma of the ovary (all histological classes) examined in the years 19821986. Distribution by stage and number of 3 and 5-year survivors.
Institution Full name of institution is given in List of Collaborators
Stage Ia
Stage Ib
No. alive at exam 3-yr 5-yr
No.
No. No. alive at exam 3-yr 5-yr
Argentine
1.
Buenos Aires
19
18
18
2
2
2
Melbourne,MacCallum 12 Carlton, Royal Women's 10 Camperdown, R.P.A. 32
9 9 26
9 9 26
3 0 2
2
2
2
2
Graz Innsbruck Vienna,I.Frauenklinik Vienna,II.Frauenklinik
22 9 24 5
20 8 24 1
19 8 24 1
5 6 8 7
4 4 7 3
Louvain
10
9
9
3
3
2
Sao Paul0
12
9
9
4
2
1
4
4
4
3
3
3
33 16 7 15 34 7 30 73 47
23 13 6 13 28 5 25 65 42
22 12 5 12 26 5 24 64 41
4 2 1 0 3 1 2 11 9
4 1 1
3 1 1
3 0 2 9 9
4
4
4
1
0
Australia
3. 4. 6. Austria
7. 8. 9a. 10.
Belgium
11. Brasil
13.
Bulgaria
14.
Sofia
15. 16. 17. 18. 19. 20. 22. 23. 24.
Halifax Montreal,Centre d'0nc. Montral, Hate1 Dieu Montreal,R. Victoria Ont Ca Found, Kingston Ont Ca Found, Windsor Regina Toronto Vancouver
Chile
25.
Santiago,P.Jaraqoema.
0
OVARY
Stage Ic
Stage II
No. alive at No. exam 3-yr 5-yr
Stage III
No. No. alive at exam 3-yr 5-yr
269
Stage IV
No. No. alive at exam 3-yr 5-yr
No. No. alive at exam 3-yr 5-yr
2
1
1
3
3
3
26
9
9
9
1
1
5 10 22
5 8 18
5 8 15
13 8 21
8 6 13
7 5 9
71 34 90
23 7 17
21 6 14
16 17 35
2 3 6
2 2 3
20 2 11 9
15 1 9 5
10 1 7 5
9 17 9 11
6 7 6 4
4 7 6 3
88 40 81 45
30 13 39 13
23 7 30 9
23 17 15 7
5 0 4 1
7
5
5
10
7
7
44
22
16
5
0
0
8
2
2
52
10
9
11
0
0 1
0 3
3
2
4
3
2
37
16
10
3
1
6 12 3 0 9 0 14 5 32
3 10 2
3 10 2
6
6
12 6 4 0 8
10 5 4 0 7
13 5 25
13 4 24
17 10 4 1 10 0 18 92 84
13 69 66
11 61 56
60 68 38 54 59 26 85 186 158
15 29 18 17 14 10 29 66 62
13 24 15 12 10 6 16 50 49
20 5 9 12 10 2 25 26 37
3 0 2 5 2 1 4 4 12
10
6
6
14
7
7
7
2
1
3
0
0
270
OVARY
TABLE
Obviously malignant cases of carcinoma of the ovary (all histological classes) examined in the years 19821986. Distribution by stage and number of 3 and 5-year survivors.
C.Xb
Institution
Stage Ia
Full name of institution is given in List of Collaborators
26.
Santiago,S.Juan
Stage Ib
No. alive at exam 3-yr 5-yr
No.
No. No. alive at exam 3-yr 5-yr
7
7
7
3
3
3
Brno, VUKEO Brno, UJEP
20 62
18 11
15 11
5 2
5 2
5 2
Helsinki Turku
32 5
27 4
27 3
3 1
3 1
2 1
Angers Bordeaux Caen Grer.oble Lille Nice Rennes
10 6 4 7 3 0 8
9 6 4 5 2
8 6 2 5 2
2 4
2 3
7
7
4
3
25 21 4 39 8 12 10 10 5 34 17 22 13 13 12
23 20 3 31 5 8 8 10 4 30 12 15 11 11 9
23 20 3 27 5 8 8 10 4 30 11 14 9 11 9
Czechoslovakia
28. 29. Finland
31. 32. France
33. 34. 35. 37. 38. 40. 41.
German
43. 46. 47. 48. 49. 50. 52. 53. 54. 55. 57. 58. 59. 60. 61.
Federal
Republic
Berlin Freiburg Fulda Giessen Greifswald Giittingen Hannover Heidelberg Jena Kiel Leipzig Munich,I.Frauenklinik Munich,Grosshadern Restock Wiirzburg
6 1 2 4 1 3 1 1 0 16 2 9 1 1 6
5 1 1 3 1 2 1 0 13 1 5 1 1 5
13 1 5 1 1 4
OVARY
Stage No.
exam
Ic
Stage
No. alive at 3-yr 5-yr
alive
II
Stage
No.
No.
exam
3-yr
at 5-yr
III
271
Stage
IV alive
No.
No.
No.
3-yr
at 5-yr
No.
exam
exam
3-yr
at 5-yr
alive
5
5
5
2
2
2
8
3
3
5
0
0
11 2
6 1
5 1
26 6
16 5
15 4
108 20
48 5
35 5
18 5
6 1
3 1
6 1
3 1
2 1
16 7
11 5
11 5
46 11
21 5
16 4
6 14
1 3
1 1
2 3 6 4 4 0 11
1 2 6 4 3
1 2 6 4 3
6
5
7 14 10 5 7 1 11
1 9 7 3 4 1 6
1 8 7 3 3 1 6
19 53 78 12 44 5 54
7 22 20 8 9 1 19
5 19 15 7 6 1 14
22 18 20 9 23 3 23
7 2 2 3 1 0 3
3 2 2 3 1 0 2
12 7 3 49 0 7 3 5 11 17 3 27 20 9 3
11 6 2 40
11 5 2 32
4 2 5 8 12 3 19 16 6 1
2 2 5 7 10 3 16 13 6 1
24 27 5 51 3 38 10 9 10 20 11 47 14 2 8
11 22 2 30 1 25 7 9 6 15 8 24 7 0 3
8 19 1 23 1 20 6 7 5 14 7 19 3 0 3
28 124 22 91 15 133 33 18 42 49 79 85 95 29 36
18 39 4 24 5 45 7 10 12 14 10 19 32 9 10
15 25 4 18 5 29 6 3 11 13 8 13 27 6 6
10 46 9 26 14 53 10 16 14 41 15 37 22 8 28
3 8 1 5 4 7 0 3 2 3 2 3 3 1 1
3 5 1 2 3 6 0 0 2 1 2 1 3 0 1
272
OVARY
TABLE
Obviously malignant cases of carcinoma of the ovary (all histological classes) examined in the years 19821986. Distribution by stage and number of 3 and 5-year survivors.
C.W
Stage Ia
Institution Full name of institution is given in List of Collaborators
Stage Ib
No. alive at exam 3-yr 5-yr
No.
No. No. alive at exam 3-yr 5-yr
Greece
62.
Athens
12
11
9
7
6
5
Hong Kong
63.
Shatin
0
Hungary 65. Debrecen
19
0 16
16
4
4
4
Israel
67. 68.
Kfar Saba Tel Hashomer
0 6
6
4
0 1
1
1
Florence Padova
9 6
3 5
3 5
5 1
3 1
2 1
Kumamoto Nagasaki Okayama Tokyo
7 5 8 9
7 4 8 8
7 4 7 8
0 0 1 0
1
1
Seoul
2
2
1
1
1
1
Amsterdam,Acad Med C 12 Groningen 15 Rotterdam 7 Tilburg 11
11 14 5 9
11 14 5 9
1 1 3 1
1 1 3 0
1 1 3 0
199
175
173
37
30
29
3
3
3
0
Italy
70. 71. Japan
73, 74. 75. 77. Korea
78.
Tbe Netherlands 79.
81. 82. 83. Norway
85.
Oslo
Peoples
87.
Republic
Beijing,
of
China
G H of PLA
OVARY
Stage Ic
Stage II
No. No. alive at exam 3-yr 5-yr
Stage III
No. No. alive at exam 3-yr 5-yr
273
Stage IV
No. No. alive at exam 3-yr 5-yr
No. No. alive at exam 3-yr 5-yr
17
15
10
6
5
3
43
13
9
15
2
2
2
3
2
2
4
0
0
0
12
9
9
19
12
12
53
31
30
1 0
1
1
1 8
1 8
1 7
15 34
6 12
6 8
4 8
4 8
8 11
4 8
4 7
72 30
4 6 0 10
3 4
3 4
8
8
3 3 2 9
3 1 1 5
1 1 1 5
8
2
2
7
3
4 10 13 14
4 8 9 12
4 8 8 10
13 10 15 10
45
29
29
1
1
1
1
0
46
21
20
5 8
1 10
0 1
0 1
24 11
19 7
1 6
1 1
1 0
12 10 17 18
4 0 6 7
3 0 5 6
5 7 2 1
1 2 0 0
3
4
1
1
3
0
11 8 11 6
9 6 10 5
38 65 45 14
11 18 18 7
8 17 15 7
4 21 15 1
0 2 2 0
92
65
61
321
115
99
121
9
6
2
1
1
10
-?
2
5
0
0
0
274
OVARY
TABLE
Obviously malignant cases of carcinoma of the ovary (all histological classes) examined in the years 19821986. Distribution by stage and number of 3 and 5-year survivors.
C.Xb
Institution
Stage Ia
Full name of institution is given in List of Collaborators
90. Shanghai,Int Peace 91a. Wuhan, Tongji Hosp
No. exam
Stage Ib
No. alive at 3-yr 5-yr
No. No. alive at exam 3-vr 5-yr
2 9
2 9
2 9
4 0
4
4
71
60
58
10
5
5
101. Barcelona,H Clin y Pr 102. Barcelona,H San Juan 103. Barcelona,Inst Dexeus
9 0 5
4
4
4
4
105. Madrid,"12 104. Granada de Octubre" 106. Madrid; "La Paz" SWeden
1: 24
4 4 14 20
4 4 14 20
5 0 0 2 3 2
1 2 2
1 2 2
67 181 59
57 157 54
53 150 51
14 45 11
13 38 10
11 36 9
3 2 19
3 2 16
3 2 15
0 0 3
3
27
22
21
8
5
31 14
27 13
27 13
9 1
5 1
21 18 6 7 11
17 14 3 6 11
16 14 1 6 11
3 3 0 0 3
2 3
Poland 94.
Warsaw
Spain
107. Gothenburg 108a.Stockholm 110. ijrebro Switzerland
111. Base1 112. Bern 114. Zurich Republic
of
South
Africa
115. Observatory United
Kingdom
118. Edinburgh 120. London,Royal Marsden United
126. 128. 129. 131. 133.
States
of America
Atlanta Boston,Mass Gen Hosp Charleston Chicago, Rush Med Evanston & Maywood
3
OVARY
Stage
Ic
Stage
No. exam
No. alive at 3-yr 5-yr
4 1 14 4 5 0 12 3
4 1 13 4 3
4 0 13 4 3
9 2
8
26 4
20 3
II
Stage
No. exam
No. alive at 3-yr 5-yr
2
4 1 16 3 3 2 2 14
3 0 13 1 1 1 1 9
3 0 12 1 1 1 1 9
17 3
31 7
19 3
16 3
No. exam
III
277
Stage
No. alive at 3-yr 5-yr
No. exam
16 5 45 29 49 12 54 69
10 3 20 12 14 3 22 32
9 3 16 7 6 2 19 27
16 2 10 12 14 11 16 13
102 37
23 11
19 9
57 11
IV
No. alive at 3-yr 5-yr
7 0
4 0
OVARY CARCINOMAOF THE OVARY
ANATOMY Primary Site. Ovaries are a pair of solid bodies, flattened ovoids 2.0 to 4.0 cm in diameter, that are connected by a peritoneal fold to the broad ligament and by the infundibulo-pelvic ligament to the lateral wall of the pelvis. The peritoneum, including the omentum, the pelvic and abdominal viscera, and the diaphragm are common sites for seeding. The lymphatic drainage occurs by the utero-ovarian and round Nodal Stations. ligament trunks and an external iliac accessory route into the following regional nodes: External iliac, common iliac, hypogastric, lateral sacral, and para-aortic nodes, and rarely, to inguinal nodes. Metastatic Sites. Liver vement also occurs.
metastases
are common. Pulmonary
RUL.RSFOR STAGING OF PIUWARYCARcm
and pleural
invol-
OF TRE OVARY
Only rarely is it possible to come to a final diagnosis of ovarian carcinoma by inspection or palpation or by any of the other methods recommended for clinical staging of carcinoma of the uterus and vagina. Therefore, the Committee on Gynecology Oncology of FIG0 recommends that the clinical staging of primary carcinoma of the ovary should be based on findings by laparascopy or laparotomy, as well as on the usual clinical examination and roentgen studies. of ovarian masses, as well as hysterectomy Thus, laparotomy and resection form the basis for staging. Biopsies of all suspicious sites, such as the omentum, mesentery, liver, diaphragm, and pelvic and para-aortic nodes, are required. The final histologic findings after surgery able) are to be considered in the staging.
(and cytologic
ones when avail-
Clinical studies, if carcinoma of the ovary is diagnosed, radiography of chest. CT may be helpful in both initial follow-up of tumours.
include routine staging and
DRFINITIONS OFTRRSTAGRS IN l%IHARYcARc~oFTREovARY (Correlations Staging exploration
is
Stage I Stage Ia
of the FIGO, UICC and AJCC nomenclatures) based on (see above).
findings
at
clinical
examination
Growth limited to the ovaries Growth limited to one ovary; no ascites No tumour on the external surface; capsule intact
and
surgical
OVARY
Stage Ib Stage Ic*
Stage
II
239
Growth limited to both ovaries; no ascites No tumour on the external surfaces; capsules intact Tumour either Stage Ia or Ib, but with tumour on surface of one or both ovaries; or with capsule ruptured; or with ascites present containing malignant cells or with positive peritoneal washings Growth involving one or both ovaries with pelvic extension
Stage IIa Stage IIb
Extension Extension
Stage IIc*
Tumour either Stage IIa or IIb, but with tumour on surface of one or both ovaries; or with capsule(s) ruptured; or with ascites present containing malignant cells or with positive peritoneal washings
Stage
III
Stage IIIa
Stage 1116
Stage IIIc Stage
IV
and/or metastases to the uterus to other pelvic tissues
and/or tubes
Tumour involvning one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes. Superficial liver metastasis equals Stage III true pelvis but with Tumour is limited to the histologically proven malignant extension to small bowel or omentum Tumour grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces Tumour involving one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces none exceeding 2 cm in diameter. Nodes are negative Abdominal implants greater than 2 positive retroperitoneal or inguinal one or both Growth involving metastases. If pleural effusion is positive cytology to allot a case to Parenchymal liver
cm in diameter and/or nodes ovaries with distant present there must be Stage IV
equals Stage IV criteria * In order to evaluate the impact prognosis of the different allotting case to Stage Ic or IIc it would be of value to know: If the source of malignant cells detected was 1) 2) If a) b)
peritoneal washings or ascites rupture of the capsule was spontaneous or caused by the surgeon
metastasis
for
240
OVARY
HISTOPATEOILIGY
Ovarian carcinoma is a common malignant tumour. It cannot be regarded as an entity. Therapeutic statistics on ovarian cancer are of limited value if attention is not paid to the histological type of the growth. ovarian tumours" The WHO has published a "Histological typing of (International Histological Classification of Tumours, No. 9, 1973) which certainly will help to understand the pathology and behaviour of ovarian neoplasms. The histo-pathological classification of epithelial tumours adopted by the WHOcorresponds in principle with that proposed by FIGO. It should be noted that cases of germ cell tumours, hormonal producing neoplasms, and metastatic carcinomas should be excluded from therapeutic statistics on ovarian epithelial tumours. HIsTo~ICALcLcLssIl?ICATIoNoFTEEcomoN OVARY
1.
Serous
a) b)
c) 2.
3.
4.
PRIHAKY
EPITEELIAL
TamuRs
OF TEIR
cystanas
Serous benign cystadenomas Serous cystadenomas with proliferating activity of the epithelial cells and nuclear abnormalities, but with no infiltrative destructive growth (boderline cases; low potential malignancy) Serous cystadenocarcinomas
Mutinous
cystomas
a) b)
Mutinous benign cystadenomas Mutinous cystadenomas with proliferating activity of the epithelial cells and nuclear abnormalities ,,but with no infiltrative destructive growth (borderline cases; low potential malignancy)
c)
Mutinous
Endaaetrioid
cystadenocarcinomas (similar benign cysts
tumours
to adenocarcinoma in the endometrium)
a)
Endometrioid
b)
Endometrioid tumours with proliferating activity of the epithelial cells and nuclear abnormalities, but with no infiltrative destructive growth (borderline cases; low potential malignancy)
c)
Endometrioid
Clear
cell
tmours
adenocarcinomas (mesonephroid
tumours)
a)
Benign mesonephroid tumours
b)
Mesonephroid tumours with proliferating activity of the epithelial but with no infiltrative destructive cells and nuclear abnormalities, growth (borderline cases; low potential malignancy) Mesonephroid cystadenocarcinomas
c)
OVARY
241
Undifferentiated carcinoma A malignant tumour of epithelial structure that is too poorly differentiated to be placed in any of the groups 1 - 4 or 6. Mixed epithelial tumours Tumours composed of a mixture of two or more of the malignant groups lc, 2c, 3c or 4c described above and where none of them is predominant. Thus, a case should be listed as "mixed epithelial tumour" only if it is not possible to decide which is the predominant structure. The pathologist should always try to find out which is structure and classify the case according to that element. No histology
the
leading
or unclassifiable
Cases where explorative surgery has shown that obvious ovarian epithelial malignant tumour is present, but where no biopsy has been taken, or where the specimen is unclassifiable because' of, for instance, necrosis. RliLJfS RELATING TO STATIMENTS 1.
A statement should preferably comprise at least 10 examined cases per year, but reports of fewer cases will be accepted.
2.
Statements should include all cases of primary common epithelial tumours considered as ovarian carcinoma. The very rare cases where it has not been possible to decide whether the origin of the growth is in the ovary or in the uterine corpus should be included in the statistics on carcinoma of the corpus as well as in the statistics on ovarian cancer (see also Rules for corpus, 2.). Cases of low potential malignancy, often called borderline tumours, should be reported.
3.
Cases where no biopsy has been taken, but where explorative surgery has shown that obvious malignant ovarian tumour is present should be reported.
4.
Cases should be histologically grouped and staged according to the systems adopted by FIG0 (see above). with a view to treatment All patients examined at the institution should be included as well as patients referred for treatment after primary surgery at another hospital. Because of the wide variation in the organisation of cancer services, it is impossible to establish rules for all details of exclusion or collaborators are inclusion of cases. If in doubt or uncertain, requested to apply to the Editorial Office.
5.
242 OVARY 6. The following categories of cases should not be included: a) Patients referred for diagnosis only. b) Recurrent cases of carcinoma of the ovary. c) Cases diagnosed at autopsy. d) Cases with a metastatic ovarian carcinoma from either a genital or extra-genital site. cell e) Non-epithelial tumours, such as dysgerminoma, granulosa tumours, and germ cell tumours. f> Cases of anaplastic inoperable widespread malignant tumours where the gynecologist could not decide the origin of the growth. Such cases should be classified as carcinoma abdominis.
OVARY
243
SIIEHARYAND~ To the Editorial Office of Annual Report 42,786 cases of obviously malignant cases of. epithelial ovarian cancers and 3,181 cases of low potential malignancy were reported to volumes 15 through 21, that is cases treated from 1958 onwards to 1986 inclusive. Table C.1 gives a summary of the treatment results for obviously malignant ovarian cancer given as crude S-year survival rate stage by stage and as a total for each year. The calculated S-year results improved slightly in the end of 1960's but are thereafter essentially unchanged. Please observe that the results for volume 21 are given both as direct crude S-year survival and as actuarial survival. Table C.1
Ovarian cancer. Obviously malignant cases. Five-year crude survival rate by stage. Cases reported to volumes 15 - 21.
Vol.
No. of cases
Year
Stage Ia
Ib
Ic
15
1958-62
2,320
60.7
16
1963-68
4,588
66.7
51.9
17 18
1969-72 1973-75
4,892 5,268
72.0 69.7
62.5 63.9
19 20
1976-78 1979-81
6,724 8,082
72.3 76.6
56.1 67.7
21
1982-86 10,912
IIa
42.0 (Ib IIa)
survival
IIbtc
III
IV
%
31.6(IIb)
6.9
2.6
26.8
49.7
38.0
8.6
5.0
27.3
57.4 50.3
52.2 51.8
37.5 42.4
10.8 13.3
4.6 4.1
30.1 30.5
58.1 59.6
47.7 51.1
42.1 43.5
13.5 17.4
4.5 4.7
29.8 30.9
53.8*
22.75; 8.0*
82.3* 74.9* 67.7" 60.6*
42,786 * S-year actuarial
Total
31.9(35*)
Table C.11 gives a summary of ovarian cancer cases of a low potential malignancy reported from volume 15 through volume 21. The figures speak for an improvement in results from the beginning of 1970's. Thereafter the results are unchanged.
Table C.11
Ovarian cancer. Cases of low potential malignancy. Five-year crude survival rate. Cases reported to volumes 15 - 21.
Vol
Year
No. of cases
Total Stage Ia - IV %
15
1958-62
451
67.2
16 17
1963-68 1969-72
385 403
73.8 73.4
18
1973-75
304
78.6
19 20
1976-78 1979-81
371 542
78.7 77.5
21
1982-86
725
78.6 (89.1)*
3,181 * 5-year actuarial
survival
In Table C.111, the cases of carcinoma of the ovary reported to volume 21 are presented with 3 and 5-year actuarial survival by stage. Please, observe that this table includes obviously malignant cases as well as cases of low potential malignancy. In contrast with the case in previous volumes these data are given as actuarial survival and therefore not directly comparable with the crude survival data given earlier.
OVARY 245 Table CL111
Stage
Carcinoma of the ovary. Patients and five-year actuarial survival obviously malignant cases as well malignancy.)
Patients
No.
treated a
No.
3-year survival %
S-year survival No. % 1134
79.3
403 250
57.0
I II
3073 1469
26.5 12.7
2406 933
85.5 69.0
III IIIa
2342 365
20.2
724 193
33.7
IIIb
580
229
IIIC
1961
5.0 16.9
57.6 44.1
491
IV
1740
15.0
56
0.5
11596
100.0
Incomplete data TOTAL
treated in 1982-86. Three rate by stage.(Includes as cases of low potential
82
22.5 49.0
28.1
87 136
32.9 18.5
219
14.3
74
8.4
5219
49.8
2173
40.9
3.2
Table C.IV gives information about the three-year result. 3.3% of the were lost sight of and 2.0% had died from intercurrent disease.
Table C.IV
Carcinoma of the ovary. year result.
Patients
treated
in 1982-86. Three-
3-year result
No. of
%
patients -,
Alive
5,551
47.9
Died of carcinoma of the ovary Lost sight of
5,431 385
46.8 3.3
229 11,596
2.0 100.0
Died from intercurrent TOTAL
disease
cases
246 OVARY The mean age by stage and histological class is given in Table C.V. An increase in mean age by stage is seen by and large for all histological classes. Table C.V
Carcinoma of the ovary. Patients treated age by stage and histological class.
Stage
Histological
in 1982-1986. Mean
class
Serous
Mutinous
Endometrioid
Clear cell
Undiff. & unspecified
Ia
56.3
50.5
55.9
55.2
55.8
Ib Ic
52.8 56.2
56.5 53.5
53.8
54.5
55.7
53.8
52.2
54.1
IIa
56.9
52.6
56.1
53.8
57.4
IIb
57.0
57.8
55.1
61.4
58.2
IIC III
54.6
55.4 61.0
57.2 59.0
59.2 58.5
58.0
55.7
56.4
55.3
61.8 58.6
55.8
56.9
55.1
59.9
59.8
57.7 59.9
57.6
58.0
58.7
59.9
74.2
58.2 60.3
59.2 62.0
59.2 50.0
61.0 66.9
48.1
50.2
56.9
51.8
IIIa IIIb IIIC IV No stage Low potential malignancy
58.6 53.8
The histogram in Fig. C.l gives the distribution malignant cases and in Fig. C.2 for potentially
by age for obviously malignant tumours.
OVARY
247
The age distribution profile for obviously malignant carcinoma of the ovary is presented in Fig.C.l and for cases of low potential malignancy in Fig.C.2. 74.1% of the obviously malignant cases belong to ages 50 years or more compared to 50.9% for the low potential malignancy cases. Only 8.7% of the obviously malignant cases were younger than 40 years compared to 31.8% of the low potential malignancy cases. Fig C.l Obviously malignant carcinoma of the ovary. Age distribution 30
Percentage of patients
20
10
o-29
Fig.
30-
40-
6s
Carcinoma of the ovary. Casesof low potential Age distribution
c.2 30 ’
60-
70 + Age
malignancy.
Percentage of patients
20 -
o-29
30-
40-
60-
60-
701- Age
248 OVARY TABLE C-VI
Histological class (see p.240 for defin.) Obviously
Carcinoma of the ovary, Stages I-IV. Obviously malignat cases and cases of low potential malignancy, examined in the years 1982-1986, incl., at 100 institutions. Stage distribution and 3 and 5-year actuarial survival rate. Total No. exam
malignant
Stage Ia
Stage Ib
Stage Ic
No. survival exam 3-yr 5-yr % %
No. survival exam 3-yr 5-yr % %
No. survival exam 3-yr 5-yr % %
cases:
IC
5 654
431
87.6
81.5
163
87.7
79.3
318
77.4
66.9
2c
1 256
401
92.2
88.2
30
60.0
55.4
186 81.8
75.2
3c
1 800
323
85.4
82.2
64
84.3
75.6
176
84.8
71.0
621
176
79.1
75.3
4
86
62.9
56.0
1 581
96
80.3
74.6
22
86.4
67.3
73
69.3
58.0
1 427
86.8
82.3
283
83.9
74.9
839
77.8
67.7
4c Undiff. and unspecified TOTAL
10 912"
Cases of low potential
malignancy:
Serous
379
165 93.6
90.8
68
96.9
92.9
21 100.0 100.0
Mutinous Other
317 29
209 9
96.0
92.5
14 1
92.9
85.1
38 2
91.1
91.1
TOTAL
725*
383
95.0
91.9
83 -
96.2
91.6
63 -
94.7
94.7
* Includes
non-staged
patients
The three and five-year actuarial survival by histological class and stage is given in Table C.VI for obviously malignant cases and for low potential malignancy cases.
OVARY
249
Stage
IIa
Stages
IIb
t IIc
Stage
III
Stage
No. exam
survival 3-yr 5-yr % %
No. exam
survival 3-yr 5-yr % %
No. exam
survival 3-yr 5-yr % %
No. survival exam 3-yr 5-yr % %
132
75.5
58.1
485
67.5
55.0
3 123
36.1
24.5
36
63.0
54.0
105
62.9
54.9
369
27.8
103
83.5
68.6
253
71.2
60.4
692
17
62.9
62.9
104
64.3
54.1
37
62.9
52.2
137
52.7
325
74.5
60.6
1084
10
16.8
9.3
21.2
129 16.4
8.6
34.5
24.1
189
9.8
6.0
179
17.7
14.0
55
a.5
4.3
36.8
807
26.4
17.0
409
8.9
6.3
65.7
53.8
5 170
33.1
22.7
1 784 13.9
8.0
32
96.9
93.5
78
91.8
90.3
3
3
15
100.0
100.0
32
70.3
51.3
6
0
1
16
18.8
la.8
0
13
48 -
126
76.6
70.9
9
97.9
95.6
1 002
IV
250 OVARY The study of the actuarial survival by year after treatment and by stage (life table analysis) for serous ovarian carcinomas is presented in Fig. C.3 and C.4. Fig.
Obviously malignant 8610~scarcinoma of the ovary, 1982-1986. Life table presentation by stage I-II.
C.3
-..-. -.-. --..-_ ............. . ...-..
stage I stage la Stage lb
Stage Ic stege II stage Ile Stege Ilb Stage llc
60-I
4020 0
I 1
0
I 2
slwvhral
Fig.
c-4
r 5
I 4
I 3
the
&eaml
Obvioudy malignant serow carcinoma of the ovary, 1982-1986. Life table presentation by stage III-IV.
stage Ill
-Stage llla . . . . Stage ltlb -.-. Stage lllc -Stege IV
0
1
2
3
5
4 survivd
the
(yead
OVARY 251 The actuarial survival by year after treatment and by histological grade for Stage Ia cases respectively Stage IIIb cases is presented in Fig. C.5 and C.6. Fig.
Obviously malignant seroue carcinoma ofthe ovary Stage Ia, 1982-1986. Life table presentation by histological grade.
C.5
Cumulative proportion surviving % 100~
Grade 1 s-s-.... Grade 2 - a
-.
Grade 3
*-..
--..__e - - -_ ---.... - -------. ...*__ ,“- -...., --
--
8060-
00 0
Fig.
C.6
Obvioualy
2
1
malignant
3
4
serous carcinoma
ofthe
Stage IQ 1982-1986. Life table presentation histological grade.
5
ovary
by
Grade 1 .----se. Grade 2
Cumulative proportion surviving %
-
-
Grade3
100
80 60
0
1
2
3
4
5
Survival time (yews)
252 OVARY Three and five-year actuarial survival rate by mode of Ia, Ib and Ic is given in Table C.VII. The choice of these early stages is probably guided by knowledge of which should explain many of the differences in treatment Table C.VII
Carcinoma of the ovary. Patients and five-year actuarial survival in Stages Ia, Ib and Ic.
Stage
Mode
of
676
Ib
90
Ic Not substaged
561
treated in 1982-1986. Three rate by mode of treatment
Surgery combined with No. treated
93.4
233
89.6
393
77 93.2
41
89.6
84
110
80
83.5
28
73.8
202
38
28
88.6
13
79.2
9
Surgery combined with chemotherapy Ia Ib
486 107
Ic 403 Not substaged 23
in Stage given in factors
treatment
Surgery alone Alive at No. kreated 3 years 5 years No. % No. % Ia
treatment treatment predicting results.
Alive
radioth.
at
3 years No. %
5 years No. %
325 90.5
157
88.1
90.3
38
84.9
154 80.6
84
76.3
72
9
2
Surgery combined with chemotherapy and radiotherapy
381 85.1 85 83.7
190 38
81.6 75.0
181 83
135 77.9 59 77.1
86 68.9 37 65.0
287
78.7
114
68.8
186
137 75.0
67
19 76.3
5
70.2
1
1
0
61.2
OVARY 253 Carcinoma of the ovary, low potential -malignancy cases, Stage I - IV are presented in Table C.VIII with 3 and S-year actuarial survival by mode of treatment. Table C.VIII
Carcinoma of the ovary. Patients treated in 1982-86. 747 cases of low potential malignancy, Stage I-IV. Three and fiveyear actuarial survival rate by mode of treatment.
Mode of treatment
No. treated
Alive 3 years No.
%
at 5 years No.
%
Surgery alone
381
314
94.7
146
92.0
Primary surgery t radiotherapy
117
92
92.7
43
89.6
Primary surgery t chemotherapy
197
154
86.1
69
80.7
52
45
94.1
26
94.1
6
2
Primary surgery t comb. rad. t chemotherapy Other
1
Table C.IX gives the 3 and S-year actuarial survival for carcinoma of the ovary Stage Ic and IIc by basis for diagnosis. It would seem that tumours ruptured by the surgeon have a more favourable prognosis than those ruptured spontaneously. Table C.IX
Carcinoma of the ovary, Stage Ic and 11~. Three and five-year actuarial survival rate by basis for the diagnosis.
Criteria
Stage No. treated
Peritoneal
Survival 3 years No. %
5 years No. %
85.2 76.9 71.0
9 71.0 8 67.9 11 61.8
91.4
42
washings
27
Ascites Spontaneous rupture
58 50
21 42 33
95
82
2 4
1 4
Rupture caused by the surgeon Combination of the above mentioned Tumour on the surface
Stage
Ic
1 1
79.7
No. treated
IIc Survival 3 years No. %
5 years No. %
7 30 19
5 15 57.5 12 67.4
1 4 42.5
43
31
1
1
1
0
76.1
8
60.7
13 59.4
0
254 OVARY the Survival by completeness of surgery in Stage III cases. Fig. C.7 gives actuarial survival rate by year after treatment for Stage IIIa cases. The 5-year actuarial survival for cases with growth completely removed was 78.8 per cent compared to 21.6 per cent for cases with residual tumour greater than 2 cm. The corresponding figures for Stage IIIb cases was 54.4 per cent compared to 23.8 per cent (Fig. C.8) and for Stage 111~ 43.3 per cent compared to 11.4 per cent (Fig. C.9).
Fig.
Obviouslymalignant serou~ carcinoma of the ovary
C.7
Stage IDa, lQQ2- 1988. Life table analysis by completeness of surgery. -1 .__._._. 2
cumullrlhreproportion
--
swvMng%
\ 60604040 -I 20
\
3
-*.**... *.-_--.. -=... \\ ---.... -... -....*--...... \ ------.......... \. . . . . .
4
Code for completeness of surgery: l- Growth completely removed 2- Growth incompletely excised, no residual implant greater than 2 cm 3- Growth incompletely excised, residual lesion(s) greater than 2 cm
. . ----
OVAKY Fig.
C.8
Obviously malignant wrous carcinoma of the ovary Stage II& 1982-1986. Life table analysis by completeness of surgery. -1
c . . . . .. 2 -3
Cumulative proportion surviving %
80-
\
6040200 0
I 1
I 2
I 4
I 3 Suwival
Fig.
f 5
time (years1
Obviously malignant serous carcinoma of the ovary &age I& 1982-1986. Life table analysis by completeness of surgery.
C.9
-1 . . . .. . . 2 -3
Cumulative proportion surviving %
100 80 60
L- - -- --0 i
0
I
1
I 2
I 4
I 3 Survival
time M2arsI
r 5
255
OVARY
257
UMBINKDTABIJBFORTKEINDlSADUALINSTITiJTIONS The tabular forms to be used when reporting available on application to the Editorial Radiumhemmet, S-104 01 Stockholm, Sweden.
on carcinoma of the ovary are Office of the Annual Report,
For the definitions of classification by site and staging of carcinoma of the ovary and of the histological classification of the common primary epithelial tumours of the ovary the reader is referred to pp. 238-241. The rules relating to statements to be furnished by collaborators are given on pp. 241-242. Notes
on the
presentation
of
the
material.
Information concerning cases of carcinoma of the ovary examined in the years 1982-1986 has been furnished by 99 of the 147 collaborators. Table C.Xa reviews the three and five-year actuarial survival carcinoma reported by the different institutions (Stages I-IV). Table C.Xb gives the distribution by stage five-year survivors by reporting institution. Survival rates 10 cases.
(per cent) are not calculated
Patients for whom the cause of dead of carcinoma of the ovary.
and the
number of
on samples containing
for
ovarian
three
and
less
than
death was unknown have been registered
as
258
OVARY
TABLE
C.Xa
Obviously malignant cases of carcinoma of the ovary. Stages I-IV (all histological classes) examined in the years 1982-1986.3 and S-year actuarial survival rate.In, formation is also given about numbers of survivors and deaths of carcinoma of the ovary as well as cases lost sight of and cases not treated.
Institution name of institution is given in List of Collaborators
Full
Years reported
Stages No. treated
I
- IV Survivors
3-year
S-year
No.
No.
Argentine
1982-86
61
34
34
Melbourne, MacCallum Carlton, Royal Women's Camperdown, R.P.A.
1984-86 1984-86 1982-86
120 79 202
49
33 82
46 30 69
Gras Innsbruck Vienna, I. Frauenklinik Vienna, II.Frauenklinik
1982-86 1982-85 1984-86 1982-86
167 91 148 85
80 33 89 27
60 27 78 22
Louvain
1984-86
79
46
39
Sao Paul0
1982-86
87
23
21
Sofia
1984-86
54
30
22
Halifax Montreal, Centre d'0nc. Montreal, HBtel Dieu Montreal, Royal Victoria Ont Ca Found., Kingston Ont Ca Found., Windsor Regina Toronto Vancouver
1984-86 1984-86 1982-86 1982-86 1982-86 1984-86 1984-86 1984-86 1984-86
142 113 62 87 125 36 191 393 368
60 59 33 40 61 16 99 21% 216
54 52 28 32 53 12 73 190 187
1.
Buenos Aires
Australia
3. 4. 6. Austria
7. 8. 9a. 10.
Belgium
11. Brasil
13.
Bulgaria
14. Canada
15. 16. 17. 18. 19. 20. 22. 23. 24.
OVARY
Stages
I-IV
No. of deaths ovarian ca. 3-yr 5-yr
Lost sight of S-year No. %
Actuarial 3-year %
survival S-year %
Total no. not treated
24
24
2
3.3
60.3
60.3
0
66 41 111
69 44 122
0 5 4
6.3 2.0
42.2 45.0 42.4
38.3 40.3 35.9
0 0 3
76 55 51 26
93 62 61 31
6 1 2 30
3.6 1.1 1.4 35.3
so.7 36.3* 61.8 62.7
37.4 26.7* 51.3 47.2
10 0 0 0
32
39
1
1.3
60.0
45.8
0
39
41
25
28.7
47.0
41.8
0
24
32
0
55.6
37.7
0
67 40 25 46 53 16 83 170 133
73 47 30 53 50 19 104 196 157
13 13 1 1 3 1 3 1 5
50.9 59.7 57.1 44.6 54.1 56.8 54.6 56.7 62.3
43.8 44.5 47.9 35.3 46.8 39.8 36.9 46.1 52.0
2 0 1 4 3 0 3 0 1
>k Crude survival
rate
9.2 11.5 1.6 1.1 2.4 2.8 1.6 0.3 1.4
259
260
OVARY
TABLE
Obviously malignant cases of carcinoma of the ovary. Stages I-IV (all histological classes) examined in the years 1982-1986 3 and 5-year actuarial survival rate. Information is also given about numbers of survivors and deaths of carcinoma of the ovary as well as cases lost sight of and cases not treated.
C.Xa
Institution Full
name of institution in List of Collaborators
Years reported
is given
Stages No. treated
I
- IV Survivors
3-year
5-year
No.
No.
Chile
25. 26.
Santiago,P.Jaraquemada Santiago,S.Juan de Dios
1982-86 1982-86
39 30
19 20
18 20
Brno, VUKEO Brno, UJEP
1982-86 1982-86
189 47
99
78 24
Helsinki Turku
1984-85 1984-86
109 40
66 20
Angers Bordeaux Caen Grenoble Lille Nice Rennes
1982,83,86 1982-86 1984-86 1982-86 1982-86 1984 1984-86
60 97 122 37 81 9 111
25 44 43 . 23 19 2 45
18 40 35 22 15 2 37
1982-86 1982-86 1982-86 1984-86 1984-86 1982-86 1985-86 1983-86 1984-86 1982-86 1982-86
105 226 45 260 41 247 67 59 82 178 127
72 96 13 134 16 91 25 37 32 88 36
65 75 12 105 15 67 23 25 29 82 32
Czechoslovakia
28. 29.
25
Finland
31. 32.
59
16
France
33. 34. 35. 37. 38. 40. 41. German
43. 46. 47. 48. 49. 50. 52. 53. 54. 55. 57.
Federal
Berlin Freiburg Fulda Giessen Greifswald Gijttingen Hannover Heidelberg Jena Kiel Leipzig
Republic
OVARY
Stages
I-IV
No. of deaths ovarian ca.
Lost sight S-year
of
3-yr
5-yr
No.
%
%
%
16 10
17 10
2 0
5.1
58.7 60.6
55.5 60.6
0 3
90 20
111 21
0 2
52.0 57.0
39.2 54.2
0 0
37 16
43 20
1 1
64.9 55,s
56.1 40.8
0 0
31 52 76 8 62 7 66
38 56 84 9 66 7 74
2 1 0 6 0 0 0
42.7 45.4 36.5 66.1 20.2
27.9 41.1 24.0 54.1 15.7
39.0
29.3
5 0 0 1 16 0 0
31 123 31 115 17 141 42 22 46 84 86
37 143 32 142 18 163 44 34 49 90 90
1 1 0 1 7 5 0 0 0 4 1
68.7 44.1 32.5 54.5 52.4 39.8 36.8 62.7 40.5 49.8 29.7
59.9 33.6 29.8 42.9 48.0 28.0 33.6 40.3 35.6 45.2 25.8
0 3 2 2 2 4 1 0 2 8 4
4.3 0.9 2,s
3.3 1.0 16.2
1.0 0.4 0.4 17.1 2.0
2.2 0.8
Actuarial 3-year
survival S-year
Total no. not treated
261
262
OVARY
TABLE
C.Xa
Obviously malignant cases of carcinoma of the ovary. Stages I-IV (all histological classes) examined in the years 1982-1986 3 and 5-year actuarial survival rate. Information is also given about numbers of survivors and deaths of carcinoma of the ovary as well as cases lost sight of and cases not treated.
Institution Full name of institution is given in List of Collaborators
58. 59. 60. 61.
Years reported
Stages No. treated
I
-
IV
Survivors 3-year No.
5-year No.
Munich, I. Frauenklinik Munich, Grosshadern Restock Wiirzburg
1982-86 1984-86 1982-86 1982-86
227 165 62 93
85 70 28 29
68 56 24 24
Athens
1982-84
100
51
36
1984-86
9
4
4
1982-86
153
93
91
Greece
62.
Hong Kong
63.
Shatin
Hungary 65. Debrecen Israel
67. 68.
Kfar Saba Tel Hashomer
1982-86
1984-86
18 61
8 29
7 21
Florence Padova
1982-86 1984-86
101 62
39
34
33 28
Kumamoto Nagasaki Okayama Tokyo
1982-86 1984-86 1984-86 1984-86
31 31 30 47
18 11 16 28
15 11 14 27
Seoul
1984-85
25
9
8
1984-86 1982-86
72 123
38 51
33 48
Italy
70. 71. Japan
73. 74. 75. 77. Korea
78.
TheNetherlands 79.
81.
Amsterdam,Acad Med Cent Groningen
OVARY
Stages I-IV No. of deaths ovarian ca.
Lost sight 5-year
3-yr
5-yr
No.
%
%
%
128 85 32 59
145 99 36 64
9 10 2 1
4.0 6.1 3.2 1.1
41.9 46.5 45.0 33.8
32.5 33.1 38.2 28.1
0 0 3 3
41
55
6
6.0
56.0
40.4
0
4
4
1
24
26
33
10 30
11 37
0 0
55 26
60 32
4 0
13 19 14 17
16 19 14 18
0 1 0 0
4
5
12
32 67
37 70
1 4
of
Actuarial 3-year
survival 5-year
Total no. not treated
0 21.6
70.4
66.4
3
44.4 49.8
37.6 36.2
0 0
43.3 57.4
36.8 45.9
0 0
58.1 38.7 52.6 57.4
47.8 38.7 52.6 54.4
0 0 0 0
48.0
86.7
65.0
0
1.4 3.3
52.1 43.0
43.5 38.9
3 0
4.0
3.2
263
264
OVARY
TABLE
C.Xa
Obviously malignant cases of carcinoma Stages I-IV (all histological classes) years 1982-1986 3 and 5-year actuarial Information is also given about numbers and deaths of carcinoma of the ovary lost sight of and cases not treated.
Institution
Years reported
Full name of institution is given in List of Collaborators 82. 83.
Stages No . treated
I
of the ovary. examined in the survival rate. of survivors as well as cases
-
IV
Survivors 3-year
5-year
No.
No.
Rotterdam Tilburg
1984-86 1984-86
98 51
48 34
43 31
Oslo
1984-86
815
423
397
Beijing, Gen Hosp of PLA 1982-86 Shanghai, Int Peace Mat 1984-86 Wuhan, Tongji Hosp 1982-86
21 33 60
8 27 36
7 26 36
Norway 85.
Peoples 87. 90. 91a.
Republic
of
China
Poland 94.
Warsaw
1982-86
385
217
196
Barcelona,H Clin y Prov Barcelona,H San Juan Barcelona, Inst Dexeus Granada Madrid, "12 de Octubre" Madrid, "La Paz"
1984-86 1984 1982-86 1982-86 1982-86 1982-86
48 4 35 73 70 110
24 3 15 35 50 60
21 1 14 33 48 56
1982-86 1982-86 1984-86
500 738 195
222 366 103
180 321 89
1982-86 1983-86 1982-86
68 24 103
26 6 45
22 5 39
1984-86
112
49
41
Spain 101. 102. 103. 104. 105. 106.
107. Gothenburg 108a.Stockholm 110. ijrebro Switzerland 111. 112. 114.
Base1 Bern Zurich
Republic 115.
of
South
Observatory
Africa
OVARY
Stages
I-IV of
Actuarial 3-year
survival 5-year
No. of deaths ovarian ca.
Lost sight 5-year
3-yr
5-yr
No.
%
%
%
50 12
55 15
0 3
5.9
50.0 75.5
42.6 65.8
0 0
373
397
4
0.5
52.1
47.0
1
13 4 21
14 5 21
0 2 2
6.1 3.3
37.4 85.3 60.0
31.7 82.0 60.0
0 1
159
180
9
2.3
55.3
48.3
1
10 1 8 35 16 42
13 2 9 37 18 45
12 0 9 3 4 7
25.0
75.7
67.5
25.7 4.1 5.7 6.4
68.4 49.0 74.2 61.1
63.1 45.9 70.1 57.8
272 352 85
306 392 96
0 4 0
0.5
45.4 51.7 55.6
37.5 45.7 47.8
0 1 0
40 17 55
44 18 61
0 0 0
39.7 27.6 45.8
33.5 22.6 39 ..2
1 0 0
47
55
13
55.1
42.2
1
11.6
Total no. not treated
265
266
OVARY
TABLE
C.Xa
Obviously malignant cases of carcinoma of the ovary. Stages I-IV (all histological classes) examined in the years 1982-1986.3 and 5-year actuarial survival rate. Information is also given about numbers of survivors and deaths of carcinoma of the ovary as well as cases lost sight of and cases not treated.
Institution Full name of institution is given in List of Collaborators
Years reported
Stages No . treated
I
- IV Survivors
3-year
5-year
No.
No.
UnitedKingdom
118. Edinburgh 120. London, Royal Marsden United
126. 128. 129. 131. 133. 134. 135. 137. 139. 140. 141. 142. 143.
States
1984-86 1984-86
225 142
80 58
70 47
1984-86 1984-86 1984-86 1984-86 1984-86 1984-86 1984-86 1984-86 1982-86 1982-86 1984-86 1984-86 1984-86
129 87 35 44 65 52 14 105 56 84 28 95 125
66 42 15 26 38 31 8 68 25 27 5 43 67
55 40 10 21 32 29 7 62 20 19 4 39 61
1982-86 1984-86
232 68
84 25
71 22
of America
Atlanta Boston, Mass Gen Hosp Charleston Chicago, Rush Med Evanston & Maywood Galveston Los Angeles, S Calif C Minneapolis NY Brooklyn, State Univ NY Stony Brook Philadelphia, Hahnemann Philadelphia, Univ Penn Winston-Salem
Yugoslavia
146. Ljubljana 147. Zagreb
OVARY
Stages
I-IV
No. of deaths ovarian ca.
Lost sight 5-year
of
3-yr
5-yr
No.
%
%
%
143 46
153 56
0 35
24.6
36.4 57.3
31.1 43.5
0 3
58 38 19 14 25 21 6 35 29 44 20 42 52
68 40 24 19 30 23 7 40 34 52 21 46 58
5 3 1 2 0 0 0 1 1 12 3 8 5
0.9 1.8 14.3 10.7 8.4 4.0
53.6 54.7 39.6 67.9 57.9 55.0 56.3 66.5 46.4 44.3 24.3 55.3 50.5
43.4 51.6 24.9 49.2 46.6 46.2 45.0 61.0 35.3 30.7 18.2 50.3 39.7
0 0 4 0 2 3 0 0 0 0 0 0 4
145 42
158 44
0 1
1.5
36.8 37.4
30.3 33.5
4 0
3.9 3.4 2.9 4.5
Actuarial 3-year
survival 5-year
Total no. not treated
267
268
OVARY
TABLE
C.Xb
Obviously malignant cases of carcinoma of the ovary (all histological classes) examined in the years 19821986. Distribution by stage and number of 3 and 5-year survivors.
Institution Full name of institution is given in List of Collaborators
Stage Ia
Stage Ib
No. alive at exam 3-yr 5-yr
No.
No. No. alive at exam 3-yr 5-yr
Argentine
1.
Buenos Aires
19
18
18
2
2
2
Melbourne,MacCallum 12 Carlton, Royal Women's 10 Camperdown, R.P.A. 32
9 9 26
9 9 26
3 0 2
2
2
2
2
Graz Innsbruck Vienna,I.Frauenklinik Vienna,II.Frauenklinik
22 9 24 5
20 8 24 1
19 8 24 1
5 6 8 7
4 4 7 3
Louvain
10
9
9
3
3
2
Sao Paul0
12
9
9
4
2
1
4
4
4
3
3
3
33 16 7 15 34 7 30 73 47
23 13 6 13 28 5 25 65 42
22 12 5 12 26 5 24 64 41
4 2 1 0 3 1 2 11 9
4 1 1
3 1 1
3 0 2 9 9
4
4
4
1
0
Australia
3. 4. 6. Austria
7. 8. 9a. 10.
Belgium
11. Brasil
13.
Bulgaria
14.
Sofia
15. 16. 17. 18. 19. 20. 22. 23. 24.
Halifax Montreal,Centre d'0nc. Montral, Hate1 Dieu Montreal,R. Victoria Ont Ca Found, Kingston Ont Ca Found, Windsor Regina Toronto Vancouver
Chile
25.
Santiago,P.Jaraqoema.
0
OVARY
Stage Ic
Stage II
No. alive at No. exam 3-yr 5-yr
Stage III
No. No. alive at exam 3-yr 5-yr
269
Stage IV
No. No. alive at exam 3-yr 5-yr
No. No. alive at exam 3-yr 5-yr
2
1
1
3
3
3
26
9
9
9
1
1
5 10 22
5 8 18
5 8 15
13 8 21
8 6 13
7 5 9
71 34 90
23 7 17
21 6 14
16 17 35
2 3 6
2 2 3
20 2 11 9
15 1 9 5
10 1 7 5
9 17 9 11
6 7 6 4
4 7 6 3
88 40 81 45
30 13 39 13
23 7 30 9
23 17 15 7
5 0 4 1
7
5
5
10
7
7
44
22
16
5
0
0
8
2
2
52
10
9
11
0
0 1
0 3
3
2
4
3
2
37
16
10
3
1
6 12 3 0 9 0 14 5 32
3 10 2
3 10 2
6
6
12 6 4 0 8
10 5 4 0 7
13 5 25
13 4 24
17 10 4 1 10 0 18 92 84
13 69 66
11 61 56
60 68 38 54 59 26 85 186 158
15 29 18 17 14 10 29 66 62
13 24 15 12 10 6 16 50 49
20 5 9 12 10 2 25 26 37
3 0 2 5 2 1 4 4 12
10
6
6
14
7
7
7
2
1
3
0
0
270
OVARY
TABLE
Obviously malignant cases of carcinoma of the ovary (all histological classes) examined in the years 19821986. Distribution by stage and number of 3 and 5-year survivors.
C.Xb
Institution
Stage Ia
Full name of institution is given in List of Collaborators
26.
Santiago,S.Juan
Stage Ib
No. alive at exam 3-yr 5-yr
No.
No. No. alive at exam 3-yr 5-yr
7
7
7
3
3
3
Brno, VUKEO Brno, UJEP
20 62
18 11
15 11
5 2
5 2
5 2
Helsinki Turku
32 5
27 4
27 3
3 1
3 1
2 1
Angers Bordeaux Caen Grer.oble Lille Nice Rennes
10 6 4 7 3 0 8
9 6 4 5 2
8 6 2 5 2
2 4
2 3
7
7
4
3
25 21 4 39 8 12 10 10 5 34 17 22 13 13 12
23 20 3 31 5 8 8 10 4 30 12 15 11 11 9
23 20 3 27 5 8 8 10 4 30 11 14 9 11 9
Czechoslovakia
28. 29. Finland
31. 32. France
33. 34. 35. 37. 38. 40. 41.
German
43. 46. 47. 48. 49. 50. 52. 53. 54. 55. 57. 58. 59. 60. 61.
Federal
Republic
Berlin Freiburg Fulda Giessen Greifswald Giittingen Hannover Heidelberg Jena Kiel Leipzig Munich,I.Frauenklinik Munich,Grosshadern Restock Wiirzburg
6 1 2 4 1 3 1 1 0 16 2 9 1 1 6
5 1 1 3 1 2 1 0 13 1 5 1 1 5
13 1 5 1 1 4
OVARY
Stage No.
exam
Ic
Stage
No. alive at 3-yr 5-yr
alive
II
Stage
No.
No.
exam
3-yr
at 5-yr
III
271
Stage
IV alive
No.
No.
No.
3-yr
at 5-yr
No.
exam
exam
3-yr
at 5-yr
alive
5
5
5
2
2
2
8
3
3
5
0
0
11 2
6 1
5 1
26 6
16 5
15 4
108 20
48 5
35 5
18 5
6 1
3 1
6 1
3 1
2 1
16 7
11 5
11 5
46 11
21 5
16 4
6 14
1 3
1 1
2 3 6 4 4 0 11
1 2 6 4 3
1 2 6 4 3
6
5
7 14 10 5 7 1 11
1 9 7 3 4 1 6
1 8 7 3 3 1 6
19 53 78 12 44 5 54
7 22 20 8 9 1 19
5 19 15 7 6 1 14
22 18 20 9 23 3 23
7 2 2 3 1 0 3
3 2 2 3 1 0 2
12 7 3 49 0 7 3 5 11 17 3 27 20 9 3
11 6 2 40
11 5 2 32
4 2 5 8 12 3 19 16 6 1
2 2 5 7 10 3 16 13 6 1
24 27 5 51 3 38 10 9 10 20 11 47 14 2 8
11 22 2 30 1 25 7 9 6 15 8 24 7 0 3
8 19 1 23 1 20 6 7 5 14 7 19 3 0 3
28 124 22 91 15 133 33 18 42 49 79 85 95 29 36
18 39 4 24 5 45 7 10 12 14 10 19 32 9 10
15 25 4 18 5 29 6 3 11 13 8 13 27 6 6
10 46 9 26 14 53 10 16 14 41 15 37 22 8 28
3 8 1 5 4 7 0 3 2 3 2 3 3 1 1
3 5 1 2 3 6 0 0 2 1 2 1 3 0 1
272
OVARY
TABLE
Obviously malignant cases of carcinoma of the ovary (all histological classes) examined in the years 19821986. Distribution by stage and number of 3 and 5-year survivors.
C.W
Stage Ia
Institution Full name of institution is given in List of Collaborators
Stage Ib
No. alive at exam 3-yr 5-yr
No.
No. No. alive at exam 3-yr 5-yr
Greece
62.
Athens
12
11
9
7
6
5
Hong Kong
63.
Shatin
0
Hungary 65. Debrecen
19
0 16
16
4
4
4
Israel
67. 68.
Kfar Saba Tel Hashomer
0 6
6
4
0 1
1
1
Florence Padova
9 6
3 5
3 5
5 1
3 1
2 1
Kumamoto Nagasaki Okayama Tokyo
7 5 8 9
7 4 8 8
7 4 7 8
0 0 1 0
1
1
Seoul
2
2
1
1
1
1
Amsterdam,Acad Med C 12 Groningen 15 Rotterdam 7 Tilburg 11
11 14 5 9
11 14 5 9
1 1 3 1
1 1 3 0
1 1 3 0
199
175
173
37
30
29
3
3
3
0
Italy
70. 71. Japan
73, 74. 75. 77. Korea
78.
Tbe Netherlands 79.
81. 82. 83. Norway
85.
Oslo
Peoples
87.
Republic
Beijing,
of
China
G H of PLA
OVARY
Stage Ic
Stage II
No. No. alive at exam 3-yr 5-yr
Stage III
No. No. alive at exam 3-yr 5-yr
273
Stage IV
No. No. alive at exam 3-yr 5-yr
No. No. alive at exam 3-yr 5-yr
17
15
10
6
5
3
43
13
9
15
2
2
2
3
2
2
4
0
0
0
12
9
9
19
12
12
53
31
30
1 0
1
1
1 8
1 8
1 7
15 34
6 12
6 8
4 8
4 8
8 11
4 8
4 7
72 30
4 6 0 10
3 4
3 4
8
8
3 3 2 9
3 1 1 5
1 1 1 5
8
2
2
7
3
4 10 13 14
4 8 9 12
4 8 8 10
13 10 15 10
45
29
29
1
1
1
1
0
46
21
20
5 8
1 10
0 1
0 1
24 11
19 7
1 6
1 1
1 0
12 10 17 18
4 0 6 7
3 0 5 6
5 7 2 1
1 2 0 0
3
4
1
1
3
0
11 8 11 6
9 6 10 5
38 65 45 14
11 18 18 7
8 17 15 7
4 21 15 1
0 2 2 0
92
65
61
321
115
99
121
9
6
2
1
1
10
-?
2
5
0
0
0
274
OVARY
TABLE
Obviously malignant cases of carcinoma of the ovary (all histological classes) examined in the years 19821986. Distribution by stage and number of 3 and 5-year survivors.
C.Xb
Institution
Stage Ia
Full name of institution is given in List of Collaborators
90. Shanghai,Int Peace 91a. Wuhan, Tongji Hosp
No. exam
Stage Ib
No. alive at 3-yr 5-yr
No. No. alive at exam 3-vr 5-yr
2 9
2 9
2 9
4 0
4
4
71
60
58
10
5
5
101. Barcelona,H Clin y Pr 102. Barcelona,H San Juan 103. Barcelona,Inst Dexeus
9 0 5
4
4
4
4
105. Madrid,"12 104. Granada de Octubre" 106. Madrid; "La Paz" SWeden
1: 24
4 4 14 20
4 4 14 20
5 0 0 2 3 2
1 2 2
1 2 2
67 181 59
57 157 54
53 150 51
14 45 11
13 38 10
11 36 9
3 2 19
3 2 16
3 2 15
0 0 3
3
27
22
21
8
5
31 14
27 13
27 13
9 1
5 1
21 18 6 7 11
17 14 3 6 11
16 14 1 6 11
3 3 0 0 3
2 3
Poland 94.
Warsaw
Spain
107. Gothenburg 108a.Stockholm 110. ijrebro Switzerland
111. Base1 112. Bern 114. Zurich Republic
of
South
Africa
115. Observatory United
Kingdom
118. Edinburgh 120. London,Royal Marsden United
126. 128. 129. 131. 133.
States
of America
Atlanta Boston,Mass Gen Hosp Charleston Chicago, Rush Med Evanston & Maywood
3
OVARY
Stage
Ic
Stage
No. exam
No. alive at 3-yr 5-yr
4 1 14 4 5 0 12 3
4 1 13 4 3
4 0 13 4 3
9 2
8
26 4
20 3
II
Stage
No. exam
No. alive at 3-yr 5-yr
2
4 1 16 3 3 2 2 14
3 0 13 1 1 1 1 9
3 0 12 1 1 1 1 9
17 3
31 7
19 3
16 3
No. exam
III
277
Stage
No. alive at 3-yr 5-yr
No. exam
16 5 45 29 49 12 54 69
10 3 20 12 14 3 22 32
9 3 16 7 6 2 19 27
16 2 10 12 14 11 16 13
102 37
23 11
19 9
57 11
IV
No. alive at 3-yr 5-yr
7 0
4 0