Limited-stage ovarian carcinoma

No effective screening test for ovarian carcinoma exists. Consequently, only 25% of patients have limited (FIGO stage I-II) disease, and most of these will be at high risk for recurrence. Management requires categorization of the primary neoplasm as low or high risk. Those at low risk have all the following characteristics: grade I disease limited to the ovary, no tumor on the surface of the ovary, negative peritoneal cytology, and no ascites. The 5-year disease-free survival rate exceeds 90%; hence, surgical resection (total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and careful surgical exploration) followed by observation is the treatment of choice. Patients at high risk have one or more of the following features: grade 2 or 3 disease, disease outside of the ovary, tumor on the surface of the ovary, positive peritoneal cytology, or ascites. Recurrence rates approximate 40%. Platinum-based adjuvant chemotherapy yields a recurrence rate approximately half that obtained with no adjuvant therapy.