Newly and relapsed epithelial ovarian carcinoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Abstract

Surgical staging requires a median laparotomy with a thorough examination of the abdominal cavity according to Federation Internationale de Gynecologie et d’Obstetrique (FIGO) classification guidelines. If disease appears confined to the ovary, biopsy of the diaphragmatic peritoneum, paracolic gutters, pelvic peritoneum, an infracolic omentectomy and sampling or dissection of para-aortic and pelvic nodes are required in addition to peritoneal washings. Surgery should be performed by an appropriately trained gynaecologic oncologist with experience in the management of ovarian cancer [III, B]. Staging is described using the FIGO and American Joint Committee on Cancer (AJCC) classification as in Table I. Established favorable prognostic factors besides surgical stage are: small tumor volume (before and after surgery), younger age, good performance status, cell type other than mucinous or clear cell, well-differentiated tumor and absence of ascites. Low grade, absence of dense adhesions, minimal ascites, subgroups a/b versus c and cell type other than clear cell are considered good prognostic factors for patients with stage I disease. Before surgery and/or chemotherapy, patients should have a CT scan of the abdomen and pelvis, chest X-ray, serum CA125, complete blood count and differential, and biochemistry for renal and hepatic function. The routine use of FDG-PET–CT for initial staging is not recommended.