Are all stage III cancers of the ovary really cancers of the ovary?

A recent chemotherapy trial in ovarian carcinoma raised questions about the diagnosis and staging of this disease. Review of the protocol records indicated that all 45 patients had a histologic or cytologic diagnosis of carcinoma. However, in three cases it was not stated how the primary site was determined. Another four cases were not explored, while eight others were explored, but the primary was not identified; the pathologic material was "consistent" with ovarian adenocarcinoma. Thus, one-third (15) of the patients had not had their primary adequately demonstrated. Published studies of advanced ovarian cancer typically refer to the FIGO staging system and imply that the primary lesion was actually identified, but review of the operative report and slide review of the primary lesion are not always described or required. Casually diagnosed cases should be labeled as such and evaluated separately.