Epithelial ovarian cancer : A clinical epidemiological approach on diagnosis and treatment

Abstract

The main aim of the present thesis was to identify possible shortcomings in diagnostics and treatment in order to improve the outcome for ovarian cancer patients. Especially, the implications of referral practices were described, implications on time to diagnosis investigated, the implications on short–term survival of treatment level, chemotherapy logistics, and tumour biology were analysed. Further we developed a national clinical database for patients with epithelial and non–epithelial ovarian cancers in Norway (OVANOR registry). The present thesis included 907 patients from the time periods 1985–95 (n = 99) and 2002–03 (n = 808). In the first period, patients diagnosed with serous epithelial borderline ovarian tumours and in the second period, patients with epithelial ovarian cancers were enrolled. The designs were both of cross–sectional and follow–up types. All four studies were population–based and three were prospective. The first 3 papers were based on a clinical epidemiological approach while the last paper was based on immunostaining on paraffin-embedded tissue.<br><br>

The majority of patients with invasive disease (94%) and borderline ovarian tumours (75%) had symptoms prior to hospital admission. This demonstrates that invasive ovarian cancer cannot be described as “silent killer”. More patients were referred to surgical or medical units than to gynecological units for emergency help. Patients referred to surgical and medical units had lower performance status. Thirty eight percent of the patients were referred to non–gynecological units before primary diagnosis, which lead to treatment delay compared to patients referred directly to gynecological units. We demonstrated that patients operated at teaching hospitals had improved short–term survival compared to patients operated at non–teaching hospitals. Thus, the present thesis provided evidence that centralization and specialization of ovarian cancer surgery improve the outcome for ovarian cancer patients. No survival benefit was seen among patients with “short surgery chemotherapy interval” (less than six weeks) or survival disadvantage among patients with “long surgery chemotherapy interval” (more than six weeks).<br> Strong positive metallinoprotaese–2 staining was found more frequently in primary serous borderline tumours with non–invasive implants compared to the group without non–invasive implants.