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Ebook An atlas of gynecologic oncology (4/E): Part 2

Part 2 book “An atlas of gynecologic oncology” has contents: Epithelial ovarian cancer, surgical management of trophoblastic disease, robotic surgery, gastrointestinal surgery in gynecologic oncology, urologic procedures, fistula repair, plastic reconstructive procedures, and other contents. | 21 Epithelial ovarian cancer Jane Bridges and David Oram preoperative assessment Ovarian cancer continues to be a major therapeutic challenge. Clinicians are disadvantaged by the cancer’s intrinsic characteristics of unreliable, inconsistent symptomatology, accounting for late presentation and poor survival figures. Even when the patient does present early, the preoperative diagnosis of ovarian cancer is frequently a difficult one to make. This is borne out by the fact that 50% of patients with this disease are initially referred to general physicians or general surgeons for investigation of symptomatology or ascites. The development by Jacobs et al. (1990) of a scoring system, the risk of malignancy index (RMI), which incorporates the use of the serum CA125 level, pelvic ultrasound features, and the menopausal status of the patient, has greatly eased this preoperative diagnosing difficulty. The details of the calculation are shown in Figure 21.1, and the RMI has now been validated in clinical practice. Using this calculation to assess the nature of an abdominopelvic mass helps to confirm the diagnosis of malignancy with >95% accuracy. This in turn allows for an appropriate referral to a cancer center, or at least prevents the initial surgery being inappropriately performed by an inexperienced surgeon. The importance of this has been demonstrated in data from the west of Scotland, which confirm improved survival of patients with ovarian cancer if they are managed in a cancer center using a multidisciplinary team approach. Furthermore, accurate preoperative diagnosis enables appropriate counseling to be given to the patient and her family. Appropriate investigation and management planning can be embarked upon in a proactive manner, and by no means the least important consideration is that the patient’s initial surgery and exploration can be performed through the correct surgical incision. preoperative investigations Investigations should include an assessment of