Management of ovarian carcinoma in young women

On the basis of available information, the following criteria regarding ovarian carcinoma may be considered for the young patient who has not completed her family and is desirous of further childbearing. Any ovarian enlargements must be promptly and adequately evaluated. A lesion of high grade or high stage is not amenable to conservative surgery, and definitive total abdominal hysterectomy, bilateral salpinog-oophorectomy with or without partial omentectomy, and subsequent chemotherapy or radiotherapy are indicated. In the individual who has a low-grade and intracystic or encapsulated ovarian neoplasm, conservative surgery may be considered, provided there is no evidence otherwise of any periotneal or other spread and particularly if the opposite ovary is histologically evaluated, preferably by wedge resection. Data have indicated that this is a reasonable process to consider, and if followed carefully this should allow these individuals to accomplish their childbearing function with minimal risk. In general, because of the bilaterality of ovarian tumors, such conservative surgery probably is indefensible unless these riged criteria are met. It would also seem preferable to complete the surgical procedure with hysterectomy and salpingo-oophorectomy once the patient's family is complete, thus obviating any possible appearance of a malignant tumor in the remaining ovary. The use of exogenous estrogesn would also seem far preferable to the risk of an insidious low-grade tumor that could not be adequately followed.