Surgical management of ovarian cancer

Ovarian cancer represents the second most common cancer of the female reproductive organs. It is usually not associated with significant warning signals that led to early diagnosis. The management is based on adequate surgical staging, removal of as much of the bulk tumor as possible, careful histologic assessment of the primary cancer and its metastases, and appropriate postoperative adjuvant therapy. Stage I cancer confined to one ovary and with a very favorable histology, such as borderline malignant epithelial cancers, dysgerminoma, granulosa cell tumor, and Sertoli-Leydig's cell tumor, may be treated with surgery alone. Stage I epithelial cancers are best treated with a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and adjuvant chemotherapy or radiation therapy. Stage I nonepithelial malignant neoplasms are best treated with a unilateral salpingo-oophorectomy followed by an aggressive combination chemotherapy. Advanced ovarian cancers regardless of the histologic origin of the tissue should be treated with aggressive surgery, including complete removal of the tumor whenever possible followed by adjuvant therapy selected on the basis of the histologic appearance of the tumor. Complete remissions for ovarian cancer should be confirmed by second-look operation prior to discontinuing adjuvant chemotherapy.