Ovarian Cancer PDF
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Ovarian Cancer VICC Monograph Series· Volume 11 Ovarian Cancer Edited by F. Gentil . A .C . Junqueira With 126 figures Springer-Verlag Berlin Heidelberg New York 1968 Dr. F. GENTIL and Dr. A. C. JUNQUEIRA Cancer Institute, Hospital A. C. Camargo, Sao Paulo/Brasil ISBN 978-3-642-87757-5 ISBN 978-3-642-87755-1 (eBook) DOl 10.1007/978-3-642-87755-1 AU rights reserved. No part of this book may be translated or reproduced in any form without written permission from Springer~ Verlag. © by Springer-Verlag Berlin· Heidelberg· 1968. Library of Congress Catalog Card Number 67-28184 Softcover reprint of the hardcover 1st edition 1968 The use of general descriptive names, trade names, trade marks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as unclei'stood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. Title-No. 7522 Foreword The incidence of ovarian cancer has progressively increased during the past decade, and its mortality rate has followed a similar course. Conversely, in cancer of the uterine cervix, the mortality rate has diminished. Detection and early diag nosis have been the two responsible factors in achieving the decrease in the number of deaths occurring in cancer of the cervix. The revers~ is true in cancer of the ovary: diagnosis as a rule is only established late, when dissemination has already occurred, thus making the control of the disease much more difficult. Clinical staging thus far has not been in use at many centers, and it therefore becomes very difficult to compare results of treatment since we do not know the exact anatomical extent of the disease. Histopathological classification in cancer of the ovary is still a very controversial subject and a uniform terminology is urgently required. Management of patients with cancer of the ovary varies widely from one institu tion to another. There is no agreement as to how to treat an ovarian neoplasm; by surgery alone, or, by using radiation and chemotherapy as a complement to the operative treatment. In an effort to shed more light on these items, the Patient Care Committee of the UIce held this symposium, which was unique in the broadness of its scope pertaining to every phase of ovarian cancer. The M.D.Anderson Hospital was chosen as the site of the symposium for two very important reasons: 1. because Dr. R. LEE CLARK, its director, is a member of the Patient Care Committee, and 2. because of the important contributions this institution has made in the field of modern cancerology. We would like to take this opportunity on behalf of the UICC to express our deep gratitude to the M. D. Anderson Hospital for the facilities and the hospitality ex tended to us, and our sincere appreciation to all the participants. FERNANDO GENTIL J ANTONIO C. UNQUEIRA Table of Contents General Classification of Ovarian Tumours, L. SANTESSON and H. L. KOTTMEIER 1 Malignant Ovarian Tumours of Mullerian Origin: Some Aspects, A. LUISI. 9 Endometrioid Tumours of the Ovary, G. GRICOUROFF. . . . . . . . . . . 23 Sex-cord Mesenchyme Tumours. Pathologic Classification and its Relation to Prognosis and Treatment, R. E. SCULLY. . . . . . . . . . . 40 Tumours of Germinal Origin, G. TEILUM . . . . . . . . . . . 58 Lipoidic Cell Tumours of the Ovary, G. GRICOUROFF and F. VEITH 74 Metastatic Ovarian Tumours, A. LUISI. . . . . . . . . . . . . 87 Ovarian Cancer: Immunological Aspects. Influence on Prognosis and Treatment, I. DAVIDSOHN, S. KOVARIK and R. STEJSKAL. . . . . . . . . . . . . . 105 Diagnosis of Ovarian Carcinoma by Cul-de-sac Aspiration, R. M. GRAHAM . 122 Cancer Cells in the Blood: Incidence and Importance to Prognosis and Treat ment, S. S. ROBERTS, E. E. MCGREW, J. VALAITIS and W. H. COLE . . . . 134 Clinical Staging in Ovarian Carcinoma, H. L. KOTTMEIER .......... 146 Surgical Management - Conservative Surgery. Indications According to the Type of the Tumour, H. L. KOTTMEIER ................ 157 Intestinal Surgery for Advanced Cancer of the Ovary, A. BRUNSCHWIG and D. G. C. CLARK . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Seropapillary and Endometrioid Carcinoma of the Ovary: Survival Rate after Surgery and Radiotherapy, M. LENZ . . . . . . . . . . . . . . . . . 172 Megavoltage Irradiation in the Management of Malignant Ovarian Tumours, L. DELCLOS. . . . . . . . . . . . . . . . . . . . . . . . . 187 Intraperitoneal Colloidal Radiogold 198Au Therapy in Ovarian Cancer, J. H. MULLER. . . . . . . . . . . . . . . . . . . . 198 Intracavitary Chemotherapy in Ovarian Carcinoma, G. BRULE. . . . . 217 Chemotherapy in Ovarian Cancer, F. RUTLEDGE and B. BURNS . . . . 226 Systemic Chemotherapy in the Treatment of Ovarian Cancer, L. A. NOVIKOVA 239 Total Treatment of Ovarian Cancer. Justification and Importance of the Combination of the Various Therapeutic Methods, A. C. J UNQUEIRA 246 Proposals for the Standardization of the Combined Treatment of Ovarian Cancer, H. L. KOTTMEIER . . . . . . . . . . . . . . . . . . . . . . . . . 257 U.I.C.C. Patient Care Committee Members 1962-1966 Dr. FERNANDO GENTIL (Chairman), Sao Paulo, Brasil Dr. .ANTONIO CARLOS JUNQUEIRA (Secretary), Sao Paulo, Brasil Dr. GEORGE T. PACK, New York, U.S.A. Dr. H. L. KOTTMEIER, Stockholm, Sweden Dr. MASSARU KURU, Tokyo, Japan Dr. R. LEE CLARK, jr., Texas, U.S.A. Dr. MARTIN MIQUEO NARANCIO, Montevideo, Uruguay Dr. ELPIDIO VALENCIA, Manila, Philippines Dr. MARIO MARGOTTINI, Rome, Italy Dr. V. I. YANISHEVSKY (Professor), Moscow, U.S.S.R. Participants F. GENTIL, M.D., Chairman, Chief of Surgical Service, Cancer Institute, Hospital A. C. Camargo, Sao Paulo, Brasil A. C. JUNQUEIRA, M. D., Secretary, Chief of Service, Clinical Research on Radio therapy and Chemotherapy, Cancer Institute, Hospital A. C. Camargo, Assistant. Department of Pharmacology. Sao Paulo Medical School, Sao Paulo, Brasil G. BRULE, M.D., Chief of Solid Tumor Chemotherapy Service, Institut Gustave Roussy (Villejuif), Paris, France A. BRUNSCHWIG, M.D., Chief of Gynecology, Memorial, James Ewing Hospitals, New York City, U.S.A. B. BURNS, jr., M.D., Associate Gynecologist - Section of Gynecology - Depart ment of Surgery, The University of Texas M.D. Anderson Hospital and Tumor Institute, Houston, Texas, U.S.A. I. DAVIDSOHN, M.D., Professor and Chairman, Department of Pathology, Chicago Medical School Director, Department of Experimental Pathology, Mount Sinai Hospital Medical Center, Chicago, Illinois, U.S.A. L. DELCLOS, M.D., Associate Radiotherapist and Associate Professor of Radiology, The University of Texas M.D. Anderson Hospital and Tumor Institute Houston, Texas, U.S.A. G. FLETCHER, M.D., Chief Radiotherapist and Professor of Radiology, The Uni versity of Texas M.D. Anderson Hospital and Tumor Institute, Houston, Texas, U.S.A. J. GRAHAM, M.D., Head, Department of Gynecology, Roswell Park Memorial Insti tute, Buffalo, New York, U.S.A. R. GRAHAM, D.Sc., Associate Gynecologist and Cytologist, Roswell Park Memorial Institute, Buffalo, New York, U.S.A. G. GRICOUROFF, M.D., Head of the Pathological Department, Foundation Curie, Paris, France H. L. KOTTMEIER, M. D., Professor of Gynecology, Radiumhemmet, Stockholm, Sweden M. LENZ, M.D., Professor Emeritus of Clinical Radiology, Columbia University, Consultant Radiotherapist - Presbyterian and Montefiore Hospitals, New York City, U.S.A. XII Participants A. LUISI, M.D., Pathologist, Cancer Institute, Hospital A. C. Camargo - Sao Paulo, Brasil J. H. MULLER, M.D., Chief of the Departments of Radiology and Pathology, Uni versitats-Frauenklinik, Zurich, Switzerland * Prof. L. A. NOVIKOVA, Head, Department of Gynecology, Institut Experimentalnoy i Klinicheskoy Onkologii, Academia Meditsinkikh Nauk, Moscow, U.S.S.R. S. S. ROBERTS, M.D., Attending Surgeon and Acting Head of Department, Illinois Research & Educational Hospitals, Associate Professor of Surgery and Acting Head of Department, University of Illinois, College of Medicine, Chicago, Illinois, U.S.A. F. RUTLEDGE, M.D., Chief, Section of Gynecology - Department of Surgery, The University of Texas M.D. Anderson Hospital and Tumor Institute, Houston, Texas, U.S.A. * Prof. L. SANTESSON, M.D., Director, Department of Pathology, Radiumhemmet, Stockholm, Sweden R. E. SCULLY, M.D., Pathologist, Massachusetts General Hospital, Associate Clinical Professor of Pathology, Harvard Medical School, Boston, Massachusetts, U.S.A. Prof. G. TEILUM, M. D., Director, University Institute of Pathological Anatomy, Copenhagen, Denmark * Contributed paper but did not attend. General Classification of Ovarian Tumours L. SANTESSON, M. D. Director, Department of Pathology, Radiumhemmet, Stockholm, Sweden H. L. KOTTMEIER, M. D. Professor of Gynecology, Department of Pathology, Radiumhemmet, Stockholm, Sweden Introduction They consist of the serous and the muci Ovarian cancer is not an entity but a nous cystomas and the endometrioid group of diseases. Studies of the results tumour types. It is obvious that the of treatment must be based on homo classification of these, the most common, genous groups of tumours and not on primary epithelial tumours of the ovary, mixtures of histologically and biologi must be as concise and clearly delineated cally different tumour types. Further as possible, both as to the division more, there still exists a considerable among the three types and to the border degree of confusion as to which tumours line between benign and malignant should be considered as true carcinomas. tumours in each tumour type. Experience It is the lack of generally accepted defini has shown that between obviouslY benign tions of the various histological forms and obviouslY malignant neoplasms there ex that has resulted in the extreme differ ists a group of tumours that, in their clinical ences in long-term results given by behaviour, resemble true carcinomas in as various authors. The importance of much as thry give rise to implantation establishing a standardized, internation metastases and ascites - but have quite a ally acc~pted classification of ovarian tu different course. The general epithelial mours, so that the results ofd ifferent clinics structures are maintained as in benign may be accurately compared, is obvious. tumours but the epithelial cells show Since WALDEYER, in 1870, presented signs of proliferative activity, nuclear a classification partly based on histo abnormalities and pathological mitosis. genesis, many classifications of ovarian However, there is no visible evidence of neoplasms, emphasizing different fea infiltrative destructive growth in the con tures of these tumours, have been given. nectiye tissue of the growth. The out As our knowledge of the complex ova come in these cases is quite different rian structures has increased, the differ from that of true carcinomas, which is ent systems of classification have been why it is essential to separate tumours of changed and the fundamental tumour proliferating cystadenomas without stro types been more and more clearly defined. mal invasion from the ovarian cancers (Figs. 1 and 2). Classification Fig. 3 gives the survival rate in cases Among the ovarian neoplasms, those re of seropapillary cystoma of low potential lated to the Mullerian epithelium constitute malignancy compared with the rate in the vast mqjority of real ovarian tumours. serous carcinomas. Unfortunately many 1 Ovarian Cancer 2 L. SANTESSON and H. L. KOTTMEIER Fig. 1. Patient H. R., age 26. Ovarian tumour. Proliferating serous papillary cystadenoma, "possibly malignant", (Ib). Primary tumour. Photo-micrograph X 90 Fig. 2. Same as Fig. 1. Implantation in the tube X 90
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