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Chapter 093. Gynecologic Malignancies (Part 3)

Table 93-1 Staging and Survival in Gynecologic Malignancies St age Ovarian -Year 5 trial Endome 5 -Year x Surviv al, % Cervi -Year 5 Surviv al, % Surviv al, % 0 — — Carcin oma in situ 00 1 I Confined 9 Confine 8 Confin 8 to ovary 0 d tocorpus 9 ed to uterus 5 II Confined to pelvis 0 7 corpus cervix Involves and 0 8 s Invade beyond 5 6 uterus but not to pelvic wall III Intraabdo minal spread 5–20 1 Extends outside the 0 3 Exten 3 ds to pelvic 5 wall and/or uterus but not outside the true pelvis lower third of vagina, or hydronephros is IV Spread outside abdomen –5 1 Extends outside the true pelvis involves bladder rectum or the or 9 Invade . | Chapter 093. Gynecologic Malignancies Part 3 Table 93-1 Staging and Survival in Gynecologic Malignancies St age Ovarian 5 -Year Surviv al Endome trial 5 -Year Surviv al Cervi x 5 -Year Surviv al 0 Carcin oma in situ 1 00 I Confined 9 Confine 8 Confin 8 to ovary 0 d tocorpus 9 ed to uterus 5 II Confined to pelvis 7 0 Involves corpus and cervix 8 0 Invade s beyond uterus but not to pelvic wall 6 5 III Intraabdo minal spread 1 5-20 Extends outside the uterus but not outside the true pelvis 0 Exten ds to pelvic wall and or lower third of vagina or hydronephros is 3 5 IV Spread outside abdomen 1 -5 Extends outside the true pelvis or involves the bladder or rectum 9 Invade s mucosa of bladder or rectum or extends beyond the 7 true pelvis Prognosis in ovarian cancer is dependent not only on stage but on the extent of residual disease and histologic grade. Patients presenting with advanced disease but left without significant residual disease after surgery have a median survival of 39 months compared to 17 months for those with suboptimal tumor resection. If initial surgery does not produce minimal residual disease a second cytoreductive surgery has been used after the first three cycles of chemotherapy in one trial it was associated with a 6-month improvement in median duration of survival. Another randomized trial where more aggressive debulking surgery was initially carried out was unable to confirm this benefit. Prognosis of epithelial tumors is also highly influenced by histologic grade but less so by histologic type. Although grading systems differ among pathologists all grading systems show a better prognosis for well- or moderately differentiated tumors than for poorly differentiated histologies. Estimated 5-year survivals for patients by tumor grade are well-differentiated 88 moderately differentiated 58 poorly differentiated 27 . The prognostic significance of pre- and postoperative CA-125 levels is uncertain. CA-125 levels generally reflect volume of disease and