Ninety percent of women having surgery for early stage ovarian cancer were not thoroughly checked to see if the disease had spread - a step that can mean the difference between life and death, a National Cancer Institute study found.
Doctors who documented this lapse say there are several possible reasons, including ignorance among surgeons about how this lethal form of cancer spreads through-out the body."It certainly is disturbing that people are not getting the treatment that we recommend for them," Dr. Edward Trimble said. "This shows we need to do more physician education to make sure they know the importance of these surgical steps."
Trimble presented the findings this week at the annual meeting of the American Society for Clinical Oncology.
Medical knowledge evolves quickly, and even the most conscientious doctors often have trouble keeping up. To help them, the National Institutes of Health frequently brings together experts to reach a consensus about what doctors should do in fast-changing areas of medicine.
In 1994, a consensus panel drew up new guidelines for treating ovarian cancer, a disease that will be diagnosed in an estimated 26,700 women this year. Only about one-quarter of cases are caught in the early stages, when the disease is highly curable.
The panel recommended that in early stage cases, surgeons should do more than simply remove the cancerous ovary. They should also meticulously examine the abdomen for cancer and take samples of lymph nodes and the fat attached to the stomach to see if microscopic tumors have spread to these areas.
If these samples show the cancer has indeed spread, then chemotherapy is recommended as a possible cure.
Trimble and colleagues reviewed the cases of 785 women who were diagnosed with ovarian cancer in 1991 - three years before the guidelines - to see what kind of care they received.
They found that in 90 percent of early stage ovarian cancer cases, surgeons neglected to take tissue samples, usually from the lymph nodes.
"Doctors may think that all they have to do is take the ovary out, that that's enough treatment," Trimble said.
Dr. Patricia Braly of Louisiana State University said surgeons often are not sure during the operation whether or not the ovary they have removed is cancerous.