Table Of ContentOvarian 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
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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
