The study was aimed at assessing the role of adjuvant chemotherapy after radical surgery in early stages of disease. Survival was not significantly different in both the trials. Ovarian epithelial cancers disseminate primarily by surface shedding and by lymphatic spread. Spread occurs mainly by continuity, causing an intra-tansperitoneal dissemination and cells tend to follow the circulatory path of the peritoneal fluid. Ovarian cancer can exfoliate cells before its capsule is disrupted For this reason, it is possible to find malignant cells in the ascites fluid.
Haematogenous spread is uncommon.
Although our understanding of the genetic mechanisms of tumorigenesis is limited, ovarian cancer appears to be the end result of a complex series of genetic changes in cancer-related genes. Clinical-pathologic factors, such as stage, histology, residual disease after primary surgery are the most significant prognostic indicators. Some biological factors, such as genetic abnormalities, DNA ploidy, steroid receptors, affect the natural history of ovarian cancer. With regard to the metastatic pattern, intraperitoneal dissemination and lymphatic spread are the most common metastatic routes, while haematogenous dissemination is uncommon. Central nervous system metastases are rare and carry the worst prognosis.