Ovarian cysts and tumours are described in Section 20.7. Here we are concerned with the malignant ones, and particularly with chemotherapy. A patient with a malignant ovarian tumour can have: a cystic adenocarcinoma (40%, and usually arising in a serous cystadenoma), a solid adenocarcinoma (30%), a solid anaplastic carcinoma (15%), or a variety of other tumours (15%), including secondary growths and germ cell tumours (rare, but chemotherapy can cure them). Surgery is the mainstay of treatment. If possible remove the growth entirely, if not take a biopsy. Radiotherapy, and for most tumours chemotherapy, are only of temporary benefit. The prognosis is better for cystic than for solid tumours. Rarely, they may remit spontaneously.
CHEMOTHERAPY is well worth considering. It is useful in the prevention of ascites, and may prolong survival in patients in Stages Two (peritoneal spread within the pelvis) and Three (peritoneal spread throughout the abdomen). It also delays the onset of this distressing problem. 40% of patients respond to cyclophosphamide 1.5 g/m['2] every 21 days for up to 6 courses. If drugs are scarce, this use for them is of low priority. Combined drug regimes have some advantage over this one, but are more expensive.