We report our experience in the management of patients with carcinosarcoma of the ovary, a rare but aggressive variant of ovarian cancer. Forty patients were treated at a single centre, which is the largest reported series. The median age at diagnosis was 65 years (range 45-86) and the median Karnofsky performance (KP) status was 70. Thirty-two patients (80%) presented with FIGO stage III or IV disease. Twenty-four had heterologous and 14 homologous carcinosarcoma on review of histopathology, but there was no significant difference in survival between these groups (P=0.28). Twenty-seven of the 40 patients had bulk residual disease present after surgery and this was associated with a worse prognosis (P=0.045). Chemotherapy was given to 32 patients (80%) of whom 26 (81%) received platinum-based regimens. Of these 32 patients, three (9.4%) achieved a complete response (CR), 10 (31%) a partial response (PR), five (16%) had stable disease, 10 (31%) had progressive disease and four were not assessable. Of the 19 patients who had a CR, PR or stable disease after chemotherapy or were unevaluable (stage Ic), the median survival was 29.6 months. Currently, seven patients are still alive although one has cancer. The overall censored median survival was 8.7 months after a median follow-up of 34 months, and the 1- and 5-year survival were 40 and 7.5%, respectively.

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The distinction between borderline ovarian tumours (BOT) and ovarian carcinoma is made by histopathological assessment. Of 64 patients managed according to institutional BOT protocols, 27 (42%) had been referred with a diagnosis of ovarian carcinoma that was subsequently changed to BOT following histopathological review. The 70% 6-year event-free survival of the patients with a revised diagnosis was not significantly different from those who were referred with a diagnosis of BOT. This change in diagnosis is important as it avoids the need for chemotherapy for most patients and results in patients receiving appropriate information concerning prognosis. Interestingly, 24 patients (38.1%) reported a family history of epithelial cancer, a finding that has not been reported previously.© 2000 Cancer Research Campaign

Ovarian cancer is the commonest cause of gynaecological cancerrelated death in the UK (Association of Cancer Physicians, 1994). In the northwest of England, the annual incidence is 183 cases per million and, between 1989 and 1991, 1085 cases were recorded in the North West Cancer Registry (unpublished data). The optimal management of ovarian carcinoma is defined in the Scott Report (Scott, 1991) and 1993 consensus statements on advanced epithelial ovarian cancer (Allen et al, 1993). These state that an experienced gynaecological surgeon should attempt optimum cytoreduction (debulking), including total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO) and infracolic omentectomy. Those with suspected early FIGO (International Federation of Obstetricians & Gynaecologists) stage disease (Shepherd, 1992) should have ascitic fluid or peritoneal washings sent for cytological evaluation, together with random peritoneal biopsies and diaphragmatic scrapings. Adhesions or suspicious areas should be biopsied, and the liver and diaphragm palpated to assess the extent of the disease. Some have also advocated routine retroperitoneal lymphadenectomy. Those with more advanced disease should undergo debulking of all macroscopic disease. Patients should then have further appropriate staging investigations and should receive chemotherapy from a nonsurgical oncologist who is trained in the field (Scott, 1991; Allen et al, 1993). A multidisciplinary approach has been associated with improved survival (Junor et al, 1994). We have performed a retrospective audit of the initial surgical management of patients with newly diagnosed epithelial ovarian carcinoma referred for chemotherapy to the Department of Medical Oncology at the Christie Cancer Centre in 1996. The aim was to assess the compliance with surgical guidelines for the management of epithelial ovarian carcinoma.  Currently, all primary surgery for ovarian cancer in northwest England is performed in district general hospitals. Women with ovarian cancer can then be referred to a non-surgical oncologist at the Christie Cancer Centre. All cases of ovarian cancer referred to the Department of Medical Oncology during 1996 were included in the audit, which was conducted using standard criteria (National Centre for Clinical Audit, 1997). A retrospective review of the Christie Hospital case notes, and referring hospital correspondence, pathology reports and operation notes, was performed to determine:

NISHMKAWA AND TAKAGI (1922) suggested an inhibitory influence of the spleen on hepatic regeneration which was later corroborated by the observation of Scnmidt (1924). Later Higgins and Priestley (1932) and more recently PerezTamayo and Romero (1958) and Sengupta and Aikat (1967) have observed that in splenectomised animals, the rate of regeneration of liver after partial hepatectomy was significantly accelerated. Basu and Aikat (1963) observed that splenectomy with or without an appropriate shunt operation in established cases of hepatic cirrhosis produced marked clinical and haematological improvements in a large percentage of the patients. Clinical improvement was characterised by marked morphological improvement as noted in serial biopsies. In their experimental studies they observed that splenectomy could alter the hepatotoxic effect of carbon tetrachloride; so in splenectomised rats cirrhosis could not be produced after continuous administration of carbon tetrachloride. These observations suggested an inhibitory control of spleen on hepatic regeneration after toxic necrosis.The present study was motivated to study the effect of splenectomy on the advent of hepatic neoplasia induced by 3'-methyl-4-dimethylaminoazobenzene (3'-Methyl-DAB) in the rat.Sequential analysis of the advent of hepatic neoplasia both benign and malignant was undertaken mainly by histological characterisation of the lesions produced from early stages up to a period of 20 weeks, when definite microscopic foci of distinctive tumour tissue were encountered. MATERIALS AND METHODSMale and female Wistar rats from the ages of 3 to 4 months and weighing 105 to 150 g. were used. The majority of the rats were raised in the laboratory. They were fed a standard diet, but deficient in riboflavin, and water was given ad libitum.3'-Methyl-DAB was incorporated in a 0-06 per cent concentration in the diet. To ensure total assimilation in a smaller group of rats the drug was emulsified in groundnut oil and was fed through a rubber catheter with the help of a syringe, 6 days a week (6 mg. of carcinogen in 0 5 ml. of oil per rat). The drug was administered to a group of normal rats and a group of rats splenectomised at least one month before the start of the experiment. Splenectomy was performed