CT of epithelial ovarian tumors

Ovarian cancer is the second most common gynecologic malignancy in the Unit ed States and causes more deaths than any other cancer of the female reprod uctive system. Approximately two-thirds of patients have tumors that have s pread beyond the pelvis at the time of diagnosis. Ovarian tumors arise from the surface epithelium or mesothelium, germ cells, or the gonadal stroma. Epithelial ovarian tumors include serous, mucinous, endometrioid, clear cel l, and undifferentiated tumors. In general, the likelihood of malignancy in creases with increasing solid-tissue elements and thicker septa. Surgery is central to the management of ovarian cancer. At the initial exploratory la parotomy, surgicopathologic staging and debulking of the tumor are undertak en. Patients with advanced cancer frequently undergo second-look surgery af ter chemotherapy to detect any residual disease. CT can provide staging inf ormation for preoperative planning and determination of surgical resectabil ity, demonstrate tumor response to therapy, and allow detection of persiste nt or recurrent disease. However, a major limitation of CT is the lack of s ensitivity for detection of small tumor implants, especially on the small i ntestine or mesentery. Dedicated CT of the pelvis is best performed with sp iral CT. Ovarian carcinoma can spread by means of intraperitoneal implantat ion, lymphatic invasion, and hematogenous dissemination.