Page 2 - Ovarian cancer surgery - Guidelines for early stages
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Diagnosis & preoperative workup

Clinical examination including abdominal, vaginal and rectal examinations, assessment of the groin, axilla, and
supraclavicular areas, lung and breast should be performed.

Routine pelvic transvaginal) ultrasound and if needed suprapubic must be used as a primary workup tool in any
adnexal mass.

Specialized pelvic and abdominal complementary imaging ultrasound and/or MRI and/or CT scan and/or PET -
CT should be performed in case of undertermined or suspicious masses at routine ultrasound examination.

A thoraco-abdomino-pelvic imaging must be performed in patients with non emergency clinical presentation and
suspected carcinoma of the ovary.

A blood sampling must be taken for blood markers assessement, at least CA 125 levels. Possible additional
markers, including AFP, hCG, LDH, CEA, CA 19-9, inhibin B or AMH, estradiol, testosterone, must be taken in
specific circumstances: young patient, or imaging suggesting a mucinous, or non epithelial, or extra-adnexal
tumour.

Specialized multidisciplinary decision making

Patients with non emergency clinical presentation and suspected malignancy of the adnexa should be referred to
a specialist in gynecologic oncology certified gynaecological oncologist or, in countries where certification is
not organized, by a trained surgeon dedicated to the management of gynecologic cancer accounting for over
50% of his practice or having completed an ESGO accredited fellowship and discussed preoperatively in a
multidisciplinary meeting.

All patients must be reviewed postoperatively at a gynaecological oncology multidisciplinary meeting.

Surgical management

Midline laparotomy is required to manage early ovarian cancers, with the exception of apparent stage I which can
be managed laparoscopically by a gynaecological oncologist with specific expertise in laparoscopy, without
rupture and without contamination of the abdominal cavity and wall.

Intraoperative rupture of a yet unruptured adnexal mass must be avoided.

Total hysterectomy and bilateral salpingo-oophorectomy is standard.

Fertility preserving surgery unilateral salpingo -oophorectomy should be offered to selected premenopausal
patients with apparent stage IA1

When early carcinoma is incidentally found at surgery for a suspected ‘benign’ condition, a second surgical
procedure will be required. When the patient has not been comprehensively staged, a second surgical procedure
must be considered routinely

Laparoscopic surgery is an acceptable approach if performed by a gynecologic oncologist with adequate
expertise to perform a comprehensive staging.

1 discussion on fertility must be mentioned in the patient record; final decision based on final stage and grade :
fertility preservation is accepted in case of stage IA or IC1, low-grade serous or endometrioid carcinoma, or
expansile type mucinous tumours; other stage I substages or pathologic subtypes, subject to individualized
decision; uterine preservation with bilateral salpingo-oophorectomy, can be considered in selected young
patients with apparent stage IB low risk invasive carcinoma and normal endometrial biopsy finding. However,
there is very few data to support this policy.

guidelines.esgo.org | esgo-guidelines@esgomail.org
Published October 2016 by European Society of Gynaecological Oncology
Copyrights: © European Society of Gynaecological Oncology
ESGO Ovarian Cancer Surgery Guidelines (early stage)_v1

                                                                                   OVARIAN CANCER SURGERY - GUIDELINES 
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