Imaging in Advanced Epithelial Ovarian Cancer: Assessment of Peritoneal Spread

Ovarian cancer affects over 250 000 women worldwide, with epithelial ovarian cancer accounting for approximately 90% of cases. Lack of effective screening and absence of early symptoms result in nearly 70% of patients presenting with late-stage disease. A distinct feature of advanced ovarian cancer is that peritoneal spread does not preclude curative surgical resection. Ovarian cancer is staged using the International Federation of Gynecology and Obstetrics, or FIGO, system, last updated in 2014. US is the first-line imaging modality for evaluating the symptomatic female pelvis, while MRI is the best modality for characterizing US-indeterminate adnexal masses. CT is the current standard of care to assess disease extent in advanced ovarian cancer, guiding treatment selection and surgical planning. Diffusion-weighted MRI may complement CT in the detection of disease in hard-to-resect areas. This article provides a practical approach to assessing and reporting peritoneal carcinomatosis, highlighting the importance of imaging in mapping disease extent and the added value of diffusion-weighted MRI in improving tumor visualization, especially in unresectable or hard-to-resect areas. The article also discusses the role of PET in initial staging and detecting recurrence. Furthermore, it highlights the role of radiologists as key members of the multidisciplinary team and emphasizes the importance of disease-specific structured reporting for clear communication.