Management of early-stage epithelial ovarian cancer.

Because ovarian cancer is asymptomatic until the late stages of the disease and because accurate methods of early detection are lacking, only about 40% of these cancers present in stages I and II. As a result, ovarian carcinoma remains the leading cause of death from gynecologic malignancy in the United States. However, proper management of early cases may lead to a good prognosis for long-term survival and, in some cases, may even permit preservation of reproductive capacity. The appropriate management of these early cases includes meticulous and thorough staging at the time of the initial surgery. In women who do not desire further reproduction, total abdominal hysterectomy and bilateral salpingo-oophorectomy should be carried out. In those who eagerly wish to maintain reproductive potential, the uterus and contralateral ovary may be preserved, providing certain criteria have been met. Patients with stage Ia or Ib grade 1 disease can be followed-up without further therapy after definitive surgery; those with Ic or grade 3 tumors should receive adjuvant therapy. Patients with stage I epithelial ovarian cancer who are without evidence of disease after comprehensive staging surgery and primary adjuvant chemotherapy do not require second-look laparotomy. In the future, laparoscopy will play an increasingly important role in the diagnosis and management of early-stage epithelial ovarian cancer.