Predictive factors for a malignant lesion include age and menopausal status, size of the mass, ultrasonographic features, presence of symptoms, CA-125 level, and bilateral involvement. A vertical abdominal incision is the usual approach, but lower abdominal transverse incisions are occasionally performed. At present, information regarding the efficacy and safety of laparoscopic surgery in the management of ovarian cancer is insufficient. A malignant process should be suspected if the unilateral lesion is solid, if it is cystic and larger than 8 cm, or if it has surface excrescences or adhesions to surrounding structures. The presence of ascites is another indication of possible malignancy.
Diagnosis is confirmed by examination of frozen sections after removal of the unilateral tumor.
If disease appears to be early, treatment should consist of total abdominal hysterectomy, bilateral salpingo-oophorectomy, and complete surgical staging. However, in selected young women who desire conservative management, unilateral oophorectomy may be considered in those with surgical stage IA disease and well-differentiated histologic findings. Such patients can be treated with conservative surgery alone without adjuvant chemotherapy. However, adjuvant therapy is required for grade 3 tumors, clear cell tumors, and most cases of stage IC disease. Although the most effective adjuvant therapy in such cases has not been established, chemotherapy is most common.