1) Clinico-pathologic Considerations

Pre-Operative Assessment:

• Complete history and physical, including pelvic and pelvirectal examinations.
• CBC, BUN, Cr
• CA 125 and CEA in all patients
• AFP, HCG, LDH in patients under 40 (To rule out germ cell tumours, see 9.1)
• Chest X-ray
• Barium or Hypaque Enema in patients with possible bowel involvement
• IVP or Renal Ultrasound to rule out obvious ureteric compression
• Neither Pelvic Ultrasound nor CT of the abdomen and pelvis are essential investigations

Surgery provides prognostic information and is therapeutic in its own right.

A review of the prognostic factors influencing outcome of epithelial ovarian carcinoma identified stage, tumour grade and the presence or absence of visible residual disease at the conclusion of initial laparotomy as the three major independent prognostic variables.

Successful treatment of epithelial carcinoma of the ovary is initiated by accurate and aggressive initial surgical management. Optimal surgical debulking has been shown to be the cornerstone of successful ovarian cancer management. As a result of that, it is highly recommended that patients presenting with apparent advanced staged ovarian cancer should be referred to sub-specialist care (Gynecologic Oncologists).

In apparent early stage ovarian cancer, complete staging with multiple biopsies and possibly lymphadenectomy is key to ruling out microscopically advanced disease.

2) Classification Criteria Surface Epithelial-Stromal Tumours

Serous Tumours:

1. Benign
   1. cystadenoma and papillary cystadenoma
   2. surface papilloma
   3. adenofibroma and cystadenofibroma
2. Of borderline malignancy (carcinomas of low malignant potential)
   1. cystic tumour and papillary cystic tumour
   2. surface papillary tumour
   3. adenofibroma and cystadenofibroma
3. Malignant
   1. adenocarcinoma, papillary adenocarcinoma, and papillary cystadenofibroma
   2. surface papillary adenocarcinoma
   3. adenocarcinofibroma and cystadenocarcinofibroma (malignant adenofibroma and cystadenofibroma)

Mucinous Tumours, Endocervical-like and Intestinal-type

1. Benign
   1. cystadenoma
   2. adenofibroma and cystadenofibroma
2. Of borderline malignancy (carcinomas of low malignant potential)
   1. cystic tumour
   2. adenofibroma and cystadenofibroma
3. Malignant
   1. adenocarcinoma and cystadenocarcinoma
   2. adenocarcinofibroma and cystadenocarcinofibroma (malignant adenofibroma and cystadenofibroma)

Endometroid Tumours

1. Benign
   1. cystadenoma
   2. cystadenoma with squamous differentiation
   3. adenofibroma and cystadenofibroma
   4. adenofibroma and cystadenofibroma with squamous differentiation
2. Of borderline malignancy (carcinomas of low malignant potential)
   1. cystic tumour/li>
   2. cystic tumour with squamous differentiation
   3. adenofibroma and cystadenofibroma
   4. adenofibroma and cystadenofibroma with squamous differentiation
3. Malignant
   1. adenocarcinoma and cystadenocarcinoma
   2. adenocarcinoma and cystadenocarcinoma with squamous differentiation
   3. adenocarcinofibroma and cystadenocarcinofibroma (malignant adenofibroma and cystadenofibroma)
   4. adenocarcinofibroma and cystadenocarcinofibroma with squamous differentiation (malignant adenofibroma and cystadenofibroma with squamous differentiation)
4. Epithelial-stromal and stromal
   1. adenosarcoma, homologous and heterologous
   2. mesodermal (mullerian) mixed tumour (carcinosarcoma), homologous and heterologous
   3. stromal sarcoma

Clear Cell Tumours

1. Benign
   1. cystadenoma
   2. adenofibroma and cystadenofibroma
2. Of borderline malignancy (carcinomas of low malignant potential)
   1. cystic tumour
   2. adenofibroma and cystadenofibroma
3. Malignant
   1. adenocarcinoma
   2. adenocarcinofibroma and cystadenocarcinofibroma (malignant adenofibroma and cystadenofibroma)

Transitional Cell Tumours

1. Brenner tumour
2. Brenner tumour of borderline malignancy
3. Malignant Brenner tumour
4. Transitional cell carcinoma (non-Brenner type)

Squamous Cell Tumours

Mixed Epithelial Tumours (Specify Types)

1. Benign
2. Of borderline malignancy (of low malignant potential)
3. Malignant

Undifferentiated Carcinoma