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Key Recommendations
Diagnostic Strategies
➤ General practitioners should perform a clinical assessment, family
history, and where available, aid diagnosis by ultrasound (abdominal
and transvaginal ultrasound (TVU), Doppler-enhanced) and/or
contrast-enhanced computed tomography (CT) of abdomen and pelvis
(with or without thorax).
➤ In postmenopausal women with symptoms of ovarian cancer, cancer
antigen 125 (CA-125) value can assist in diagnosis.
➤ Ovarian cancer is diagnosed with histologic confirmation in all
settings.
➤ CT-guided biopsy or laparoscopy (with sufficient resources) is
preferred instead of laparotomy to obtain histologic confirmation
prior to any systemic therapy.
Optimal Surgery
➤ The purpose of surgery is to diagnose, stage, and/or for treatment.
➤ Ovarian cancer surgery should be performed by trained gynecologic
oncologists or surgeons with oncology surgical expertise. Refer
patients to highest-resourced level oncology center with oncology
surgical capacity.
➤ Staging: Where feasible, patients with presumed early-stage ovarian
cancer should undergo surgical staging by trained surgeon(s).
In basic settings, surgical staging is not feasible, thus NOT
recommended.
➤ Treatment: Women with advanced ovarian cancer (stage III and IV)
should receive optimal surgical debulking to remove all visible
disease to improve overall survival (OS) by trained surgeon(s).
General statement about chemotherapy:
Access to appropriate evidence-based chemotherapy agents,
contraindications to chemotherapy, and potential side effects of
chemotherapy should be evaluated and managed in every patient. Basic-
resource settings that lack the capacity to provide safe administration of
chemotherapy should refer patients to a higher-level center for evaluation.
Limited settings without skilled capacity should refer patients to settings
with access to specialized care.
