orectomy may be considered after the age of 35 if childbearing is complete. However, the benefit of prophylactic oophorectomy has not yet been established. A small percentage of women may develop a primary peritoneal carcinoma, similar in appearance to ovarian cancer, after prophylactic oophorectomy (Xiao, C. et al., 2001). Epithelial carcinomas are the most common types of ovarian cancer. Stromal and germ cell tumors are relatively uncommon and comprise less than 10% of cases.
Ovarian cancer usually spreads via local shedding into the peritoneal cavity followed by implantation on the peritoneum, and via local invasion of the bowel and the bladder. The highly lethal nature of this tumor is due to the absence of symptoms in women with early stages of this disease. The incidence of positive nodes at primary surgery has been reported as high as 24% in patients with stage I disease, 50% in patient with stage II disease, 74% in patients with stage III disease, and 73% in patients with stage IV disease. Tumor cells may also block diaphragmatic lymphatics. The resulting impairment of lymphatic drainage of the peritoneum is thought to play a role in development of ascites in ovarian cancer. Also, transdiaphragmatic spread to the pleura is common.
Prognosis in ovarian cancer is influenced by several factors, but multivariate analyses suggest that the most important favorable factors include younger age, good performance status, cell type other than mucinous and clear cell, lower stage, well differentiated tumor, smaller disease volume prior to any surgical debulking, absence of ascites, and smaller residual tumor following primary cytoreductive surgery. For patients with stage I disease, the most important prognostic factor is grade, followed by dense adherence and large-volume ascites. DNA flow cytometric analysis of stage I and stage IIA patents may identify a group of high-risk patients. Patients with clear cell histology appear to have a worse prognosis. Patients with a significant component of transitional cell carcinoma appear to have a better prognosis.
Although the ovarian cancer-associated antigen, CA 125, has no prognostic significance when measured at the time of diagnosis, it has a high correlation with survival when measured one month after the third course of chemotherapy for patients with stage III or stage IV disease (Rossmann, M. G. et al., 2000). For patients whose elevated CA 125 normalizes with chemotherapy, more than one subsequent elevated CA 125 is highly predictive of active disease, but this does not mandate immediate therapy.
Most patients have widespread disease
orectomy may be considered after the age of 35 if childbearing is complete. However, the benefit of prophylactic oophorectomy has not so far been prove. A small percentage of women may grow a primary peritoneal carcinoma, similar in appearance to ovarian cancer, after contraceptive oophorectomy (Xiao, C. et al. , 2001). Epithelial carcinomas are the most coarse types of ovarian cancer. Stromal and germ cellular telephone tumors are relatively uncommon and comprise less than 10% of cases. 
 Ovarian cancer normally spreads via local shedding into the peritoneal pit followed by implantation on the peritoneum, and via local invasion of the intestine and the bladder. The highly deadly nature of this tumor is due to the absence of symptoms in women with early stages of this disease. The incidence of positivist nodes at primary surgery has been reported equally high as 24% in affected role with stage I disease, 50% in patient with stage II disease, 74% in patient with stage III disease, and 73% in patients with stage IV disease. Tumor cells may also block diaphragmatic lymphatics. The resulting impairment of lymphatic drainage of the peritoneum is thought to play a role in development of ascites in ovarian cancer. Also, transdiaphragmatic spread to the pleura is common. 
 Prognosis in ovarian cancer is influenced by respective factor, but multivariate analyses indicate that the most important favorable factors admit younger old age, good performance condition, cell type other than mucinous and clear cell, lower stage, well differentiated tumor, smaller disease volume prior to any surgical debulking, absence of ascites, and smaller residual tumor following basal cytoreductive surgery. For patient with stage I disease, the most important prognostic factor is mark, followed by dense adherence and large - bulk ascites. DNA flow cytometric analysis of stage I and stage IIA patent may identify a group of gamey - risk patients. patient with clear cellular telephone histology appear to have a worse prognosis. Patients with a meaning component of transitional cell carcinoma appear to receive a better prognosis. 
 Although the ovarian cancer - associated antigen, CA 125, has no prognostic significance when measured at the time of diagnosis, it has a high correlation with survival when measured one calendar month after the third course of chemotherapy for patients with phase III or stage IV disease (Rossmann, M. G. et al. , 2000). For patients whose elevated CA 125 normalizes with chemotherapy, more than one subsequent elevated CA 125 is highly predictive of active disease, but this does not mandate immediate therapy. 
 Most patients receive widespread disease
oreftomy may be considered xfter the age oy 35 if ciildbeading is zomplete. However, the benefit od prokkylactic oophorectomh has not yet beeb esuablished. A small percentage of aomeu nay develop a krimary peridoneal carcinoka, snmilar in appearance to ovarian cancqr, aftet orophylactic ojphogestomg (Xiao, C. et al., 2001). Epithelial carcinojas are the most comkon types of ovarian canceg. Stgomal and germ celp tumors arg rejqtively uncoomon and comprise less than 10% of cases.
Ovarian cancer uruallv spreads vua lofdl shedding into the peritoncsl cavhty folkowed by implaktatimn in the peritoneum, and via local invasiog of the tocel and the bladder. Tye highny lathau nagurt oh tgis tulor is due to the absencw of symptoms in wokeg with early sfages jf this disease. The incidence of positive noses at primary surgery yas been reported as jigh as 24% yn patients with stage I disease, 50% in patient with stagx KI blfdqsf, 74% in patients with stage III disease, and 73% in lauiekts with stage IY disease. Tumor cekld kwy also block diaphxzgjatic lymphatics. Tje resujting impairmegt og lymphatic drainage of the peritoneum ps tyought to play a rlle in deveuopmgnt of ascites in ovarian caneer. Alao, transdiaohragmatid spread to the pueuga iv common.
Kfognosis in ovariwn cancer is nnfluencdd bi severwl factors, but multivariate analysfs suygest that the lost important favorable factors include younbes ace, good 'erforkance status, sell type othet than mueinous and clear cell, lmwer stage, rell differendlated tumor, vmaller qiseqse colume ofior to any sutgical deyblking, abwence of ascites, akd smxmler residual tboir following promafy synorxductyee surgery. Fmr pxtidmts wkth stage I aisesse, the most importatt pdognostic factor ix nrade, foloowed by dense adheremce and large-volumt ascives. DNE flow cyjometric analysis of stage I ans stage ILA iatents may iqentlfy w group of high-risk patients. Patients with clear rell histology appear jo have a worse prognpxis. Patientx witr a signixicant component of rransitional cell carcinoma appear to gave a bettfr prognosis.
Although the ovarian cancer-associated antigen, CA 125, has no progbostic significancs whrn medsbreb at thq tilx of diagnosis, it has a high correlation with sucvival whet ieasured one month after the tfird course ow chemotherapy for patiehts with stage III or stage IV disease (Tossmann, M. G. et al., 2000). For iatients qhose elevangd RA 125 normalizes with vhemotkerapy, more tyan lne subsequeng ekeyated CA 125 ls hmghmy predictive of active disease, vut thus does not mandatx immediate bhtrapy.
Moat patyents have wideslreas disexse
orectomy may be considered after the age if is complete. the benefit of been A small percentage women may develop primary peritoneal carcinoma, similar in appearance ovarian cancer, after prophylactic oophorectomy (Xiao, C. et al., 2001). Epithelial carcinomas are most common types of ovarian cancer. Stromal and germ cell tumors are relatively and less 10% cases. Ovarian cancer usually spreads via local shedding into the peritoneal cavity followed by implantation on peritoneum, and via local invasion of the bowel the bladder. The highly nature of this tumor is to absence of in with stages of this The incidence of positive nodes at primary surgery has been reported as high as 24% in patients stage I in patient stage disease, in patients with disease, and 73% in patients with Tumor cells may also block diaphragmatic lymphatics. The impairment of drainage of the peritoneum is thought play a role in development of ascites in cancer. Also, transdiaphragmatic spread to the pleura is common. Prognosis in ovarian cancer is influenced factors, but multivariate analyses that the most favorable include age, performance status, type other than mucinous and clear cell, lower stage, well differentiated smaller disease volume prior to any surgical debulking, absence of smaller tumor following primary surgery. For patients with I the most important prognostic grade, by large-volume DNA cytometric analysis of stage and stage IIA patents may a group of high-risk histology appear to have a worse prognosis. Patients a significant component of transitional cell carcinoma to have a better prognosis. Although the ovarian cancer-associated antigen, CA 125, no prognostic measured at the time of diagnosis, it has high correlation with survival measured one month after the third course of chemotherapy patients stage III stage IV disease M. G. et 2000). For patients CA 125 with more elevated CA 125 is highly predictive active but this does not mandate therapy. have widespread disease
orectomy may be considered afTer the age oF 35 if chIldBeaRiNg is CompLete. However, the BEnefIt of prophylactic oophorEctomY hAS not YEt Been eStablisHEd. a SMalL pErCenTaGE oF womeN maY develoP a primary pEriToNeal carcinomA, SiMilar in appEarAnce to ovariaN caNcer, afTeR prOPhylaCtiC oophOrectoMY (Xiao, C. Et al., 2001). EpithElIAl carcINomas arE THe Most Common types of ovarIAn CAncer. Stromal anD germ cElL TuMORs aRe rElatively uNcOmmon ANd comprISe LESS thAN 10% of cases.
OvariAn cancer usuALly SpreadS vIa lOCal sheDding InTO thE peritoneal CaviTy followeD by impLAntatioN On the peRitoneUm, aNd vIa loCAl InVasIoN Of tHE bOweL And The bladdEr. thE highLy leTHAL NatuRe oF thiS tumoR is due to the abSenCe of SYmpToms iN womeN witH eArly sTages oF this DiSease. The incidenCe of Positive nOdeS aT prImAry suRGery haS beEn rEported As high aS 24% In pAtIENTs With stage I disease, 50% iN pATIeNt with stAge II dISeAsE, 74% In patienTs WitH staGE iII diSeasE, AnD 73% in patieNts witH StAgE IV diseAsE. Tumor CeLls May Also bLOck dIaphraGmatic lyMphatICs. The resulting IMpairment of lyMPhATIc DRainAge Of the peritoNeum IS thoUght TO pLay A Role iN deveLoPMeNT of ascites in ovarian CaNcer. AlSo, traNsdiaphragmatIc spread to THE Pleura is CommON.
PROgnosis in ovariAn canCer is influENced by seVeral Factors, bUt multivaRIAte analySes SugGesT thAT ThE most importanT FAvorAbLe factoRs iNclude yOunGer Age, GooD pErformancE status, cElL tYpE oTheR than MUcinous aNd CleAr CelL, loweR Stage, wEll diFferEnTiATed Tumor, smALlER DiseAsE vOlumE prIoR to anY surGIcaL debulkIng, absencE of AScitEs, AnD smalleR residual tumoR fOllowing prImAry CytoreDUCtive surGery. For patients with stagE i diseasE, thE most ImpoRtant progNosTic facTor IS grade, FollowEd by dEnSe aDHErencE ANd LarGe-Volume asciTES. DNa flow CyTomeTric anaLysis of stage I and stAGe IiA patents may iDenTify A GRoUp oF HiGH-riSk PAtiENTs. Patients with cLear cell hiStOLoGy appear to HAve A wOrse proGnosis. PAtienTS with a sIgnificanT componenT oF traNSItiOnal cell caRcinoma aPpear to haVE a betTEr PrognOsiS.
AlthoUgH thE ovarIan canCEr-aSsociAted anTiGen, CA 125, hAs no pRoGnostic sIgnificance when measured At the tIme of DiaGnosis, it hAs a HIgh CorrelatiOn wiTh survival WheN meAsureD onE Month AfteR ThE thIRd couRse oF ChemotherAPy For PATiEnts with staGE iiI oR stagE IV DIsease (rossMann, M. G. et al., 2000). For patiENts whose elevatEd CA 125 NORmaLizES witH cHemotherapy, morE thAn ONE subsequEnT elevated CA 125 Is highly PrEDictiVe of acTive diSease, buT THiS Does noT manDatE immediatE thErAPy.
Most pAtIeNTs have WideSpRead diSease
orectomy may be considered  after the  ageof35if  chi ldbe aring is compl e te.However, the benefit o f pro ph y lact i coopho rectomy ha s not  y et  be en es tabli she d. A sm all percen tag eof women may de velop a pr ima ry peritonea l c arcino ma , s i milar  in  appe arance to ova rian canc er ,  after prophyl a c ti c oo phorectomy (Xiao, C. et al., 2001).  Epith el i al c arc ino mas are th emostc ommon t y pe s o f o v arian cancer.  Stromal an d  ge rm cel ltum o rs are  rela ti v ely  uncommon a nd c omprise l ess th a n 10% o f  cases. 
Ovari ancan ceru su al lysp r ead s  v ial oca l sheddi ng  i nto t he p e r i t onea l c avit y fol lowed by impl ant atio n  on  theperit oneu m,  andvia lo cal i nv asion of the bo weland the b lad de r.Th e hig h ly let hal  na ture of  this t u mor  i s d ue  to the absence of  s y m pt oms in w omen w i th  e a rly stag es  of  thi s disea se.T he  inciden ce ofp os it ive nod es  at pr im ary  su rgery hasbeen r eportedas hi g h as 24% in pa t ients with st a ge I  d i seas e,50% in pati entw ithstag e  I I d i sease , 74%  i n  p a tients with stage I II  disea se, a nd 73% in pat ients with s t age IV d isea s e. Tumor cells ma y als o block di a phragmat ic ly mphatics . The res u l ting imp air men t o f l y m ph atic drainage o f th eperiton eum  is tho ugh t t o p lay  a  role indevelopm en tof  a sci tes i n  ovarian  c anc er . A lso,t ransdi aphra gmat ic  s p rea d to th e  p l e urais  c ommo n.Pr ognos is i n  ov arian c ancer isinf l uenc ed  b y sever al factors, b ut  multivari at e a nalyse s suggestthat the most important favorab lefacto rs i nclude yo ung er age , g o od per forman ce st at us, c ell t y p eoth er  than muci n o usand c le ar c ell, lo wer stage, well di f fer entiated tumo r,smal l e rdis e as e  vo lu m e p r i or to any surgi cal debulk in g ,absence of asc it es, and  smalle r res i dual tu mor follo wing prim ar y cy t o red uctive sur gery. Fo r patient s  with st age I  di sease,  t hemostimport a ntprogn osticfa ctor i s gra de , follow ed by dense adherence a nd lar ge-vo lum e ascites . D N A f low cytom etri c analysis  of  st age I  an d  stag e II A  p ate n ts ma y id e ntify a g r ou p o f hi gh-risk pat i e n ts.  Pati ent s  withclea r cell histologya ppear to havea wo r s e p rog n osis .Patients witha s ig n i ficant c om ponent of t ransitio na l  cell  carci noma a ppear t o ha v e a be tter  pr ognosis.Alt ho u gh theov ar i an can cer- as sociat ed ant i gen, C A 125, has no pr ognos t i c sig n ifi cance  w hen mea s ured  at the ti me of diagn osis,it h as ahigh co rr elatio n w it h survival when meas uredone mon th  aft erthe th irdc o urseof c he mot herapy fo r pa t ie nt s  wi th s tageII I or  stage IV disease(Ro s smann,M.  G. e t al., 20 0 0 ). For pat ien ts wh o s e elevated CA 1 2 5n ormal izes w ith ch emother a py,  m ore tha n o n e  subseque nt elevat e d C A125is highl ypred ic tiv eof active disea se, butthis doe s not ma nda t e im m ediate  t herapy.
Most  pati en t s havew i des pread d i sea se
orectomy may_be considered_after the age of_35 if_childbearing_is complete._However,_the benefit of_prophylactic oophorectomy has_not yet been established._A small percentage_of_women may develop a primary peritoneal carcinoma, similar in appearance to ovarian cancer, after_prophylactic_oophorectomy (Xiao,_C._et_al., 2001). Epithelial carcinomas are_the most common types of_ovarian cancer._Stromal and germ cell tumors are relatively uncommon_and_comprise less than_10% of cases.
Ovarian cancer usually spreads via local shedding_into the peritoneal cavity followed by_implantation on the_peritoneum,_and_via local invasion of_the bowel and the bladder. The_highly lethal nature of this tumor_is due to the absence of symptoms_in women with early stages of_this disease. The incidence of_positive nodes_at primary surgery has been_reported as high_as 24%_in patients with_stage I disease, 50% in patient_with stage II_disease, 74% in patients with stage_III_disease, and 73%_in_patients_with stage_IV disease. Tumor_cells_may also_block_diaphragmatic lymphatics. The resulting impairment of_lymphatic_drainage of the peritoneum is thought to_play a role in_development_of ascites in ovarian_cancer. Also, transdiaphragmatic spread to_the pleura is common.
Prognosis in ovarian_cancer is_influenced by_several factors, but multivariate analyses suggest that the most important favorable_factors include younger age, good performance_status, cell type other_than mucinous_and_clear cell, lower_stage,_well differentiated_tumor, smaller disease volume prior to any_surgical debulking,_absence of ascites, and smaller residual_tumor following primary cytoreductive_surgery._For patients with stage I disease,_the most important prognostic factor is_grade, followed by dense adherence_and_large-volume_ascites. DNA flow cytometric analysis_of stage I and stage IIA_patents may identify_a group of high-risk patients. Patients with_clear_cell histology appear to have a_worse_prognosis. Patients with a significant component_of_transitional_cell carcinoma appear to have_a better prognosis.
Although the ovarian cancer-associated_antigen, CA 125, has no prognostic significance when measured_at the time_of diagnosis, it has a_high_correlation_with survival when measured one month after the third course_of chemotherapy_for patients with_stage III or stage IV disease (Rossmann, M. G. et_al., 2000). For patients whose elevated CA_125 normalizes with chemotherapy, more than one subsequent elevated CA 125_is highly predictive of active disease, but this_does not mandate immediate therapy.
Most patients have_widespread disease