[Diagnosis and primary treatment of malignant epithelial ovarian tumor]

The treatment of ovarian cancer is still a challenge to gynecological oncology. Due to the onset of the disease without significant signs or symptoms in more of 70% of the cases, most patients already show extended metastatic disease once the primary diagnosis has been established. Following the diagnosis--which is late in most of the cases--the initial surgical treatment will be difficult because of commonly vast and rapid intraabdominal tumor growth. Consequently--in many cases--vital residual tumor has to be left in place during surgery; therefore, optimal surgery requires skill, training in surgical oncology and personal experience concerning the spread of the given type of a tumor, all the more than primary surgery has to be placed right in the center of a comprehensive therapeutic concept. Except a few, all patients suffering from ovarian cancer will be in need for post-treatment care. In FIGO stage-III/IV cases the polychemotherapy with the inclusion of platinum-compounds is generally accepted to be the best choice. Sequential therapeutic regimen starting with surgery and followed by polychemotherapy results in remission rates of 70% and more. Specifically high rates of recurrences as well as the lack of convincingly effective treatment protocols--be it for the time after primary surgery or be it for secondary approaches in cases with evidence of recurrent disease--are factors believed to cause the final poor outcome in most of the cases. As there is a tendency to progression or to recurrence specifically in ovarian cancer, knowledge about all established variations of therapeutic alternatives is so far essentially required. Furthermore, the therapy should always follow the principle of 'nihil nocere', but--on the other hand--not withhold an effective palliative treatment to those who are in need for medical help.