ABSTRACT
IC Tumour either stage IAor IB but with tumour on the surface of one or both ovaries; or with capsule ruptured; or with ascites present containing malignant cells or with positive peritoneal washings
II Growth involving one or both ovaries with pelvic extension
IIA Extension and/or metastases to the uterus and/or tubes
IIB Extension to other pelvic tissues
IIC Tumour either stage IIA or IIB but with tumour on the surface of one or both ovaries; or with capsule(s) ruptured; or with ascites present containing malignant cells or with positive peritoneal washings
III Tumour involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes. Superficial liver metastases equals Stage III. Tumour is limited to the true pelvis but with histologically verified malignant extension to small bowel or omentum
III A tumour grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seedling of abdominal peritoneal surfaces
IIIB Tumour involving one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2 cm in diameter. Nodes are negative
IIIC Abdominal implants more than 2 cm in diameter and/or positive retroperitoneal or inguinal nodes
IV Growth involving one or both ovaries with distant metastases. If pleural effusion is present there must be positive cytology to allot a case to stage IV; parenchymal liver metastases equals stage IV
UNSUSPECTED OVARIAN DISEASE FOUND AT LAPAROTOMY FOR SUSPECTED BENIGN
GYNAECOLOGICAL PATHOLOGY
ACTION PLAN
1 Check issues of consent-if a woman over 35 is going to theatre for a laparotomy for a possible ovarian cyst then discussion with regard to removal of the ovaries in case of suspicion of malignancy should have taken place
2 Consult gynaecological oncologist if available 3 Take peritoneal fluid or washings for cytology 4 Check baseline CA125 has been taken 5 Carry out a total abdominal hysterectomy and bilateral
salpingooophorectomy with large omental biopsy 6 Do not resect bowel or carry out a colostomy except in dire emergency
without having consent from the patient 7 Inform the oncology team as soon as possible
INTRACTABLE BLEEDING FROM A CERVICAL TUMOUR
It is unusual to have to take a patient to theatre as an acute emergency to deal with bleeding from a cervical tumour. Packing and embolization should be considered if oncologist not available.
