Page 4 - Guidelines Ovarian Surgery

DIAGNOSIS AND PREOPERATIVE WORKUP

✓ Clinical examination, including abdominal, vaginal, and rectal examinations; assessment of
the breast, groins, axilla, and supraclavicular areas; and auscultation of the lungs should be
performed.

B Routine pelvic (transvaginal and transabdominal) ultrasound should be used as a primary

workup tool in any adnexal mass.

B Specialised pelvic, abdominal, and thoracic complementary imaging should be performed in
case of suspected carcinoma of the ovary, or indeterminate or suspicious masses at routine

ultrasound examination.

A tumour marker assessment should be performed for at least CA 125 levels. HE4 has also

✓ been proposed. Additional markers, including AFP, hCG, LDH, CEA, CA 19-9, inhibin B or
AMH, estradiol, testosterone, would be useful in specific circumstances such as young age, or
imaging suggesting a mucinous, or non-epithelial, or tumour of extra-adnexal origin.

SPECIALISED MULTIDISCIPLINARY DECISION-MAKING

C Women with non-emergency clinical presentation and suspected adnexal/peritoneal

malignancy should be referred to a specialist in gynaecologic oncology2.

✓ Surgery in low-volume and low-quality centres is discouraged. The existence of
an intermediate care facility and access to an intensive care unit management are required.
Participation in clinical trials is a quality indicator.
Treatment should be preoperatively planned at a multidisciplinary team meeting, after
C a workup aimed at ruling out (1) unresectable metastases and (2) secondary ovarian and peritoneal
metastasis from other primary malignancies when family history, symptoms, radiological features,
or Ca125/CEA ratio is suggestive. Informed consent of the patient must be obtained.

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

2 Certified gynaecological oncologist or, in countries where certification is not organized, by a trained surgeon dedicated to
the management of gynaecologic cancer (accounting for over 50% of his or her practice) or having completed an ESGO-accredited
fellowship.

4 • OVARIAN CANCER SURGERY - GUIDELINES •