Screening Recommendations

■ Women with standard risk (fewer than two first-degree relatives with ovarian cancer): No routine screening recommended

■ Women with high risk (two or more first-degree relatives with ovarian cancer): Genetic testing and counseling

If testing shows one of the hereditary syndromes, perform:

■ Annual transvaginal ultrasound

■ Annual pelvic exam

STAGING

Ovarian cancer is staged surgically, not clinically.

Stage I—tumor limited to ovaries

IA—one ovary, capsule intact IB—both ovaries, capsules intact IC—tumor on ovary surface, capsule ruptured, ascites with malignant cells, or positive peritoneal washings

> 90% 5-year survival

Stage II—pelvic spread

IIA—involvement of uterus/tubes IIB—involvement of other pelvic structures IIC—IIA or IIB plus tumor on ovary surface, capsule ruptures, ascites with malignant cells, or positive peritoneal washings

70% 5-year survival

Stage III—spread to the abdominal cavity

IIIA—positive abdominal peritoneal washings

IIIB—< 2-cm implants on abdominal peritoneal surface IIIC—> 2-cm implants on abdominal peritoneal surface and/or positive retroperitoneal or inguinal nodes

25% 5-year survival

Stage IV—distant metastasis

Parenchymal liver/spleen spread Pleural effusion, skin or supraclavicular nodes

5% 5-year survival

Krukenberg's tumors are ovarian tumors that are metastatic from another primary cancer, usually of colon, breast, or uterine origin.

CA-125 is elevated in 80% of cases of ovarian cancer, but only in 50% of stage I cases. It is most useful as a tool to gauge progression/ regression of disease.

TREATMENT

Surgery is used to get rid of as much of the tumor as possible, as well as to biopsy like sites of spread. This always includes total abdominal hysterectomy/ bilateral salpingo-oophorectomy and often includes lymph node sampling, omentectomy, and bladder and bowel resection. Debulking is the attempt to remove as much of the primary and metastatic tumor sites as possible and is employed in advanced disease.

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