Standards, Options and Recommendations for initial management of patients with a malignant epithelial ovarian tumor

Suprapubic and transvaginal pelvic ultrasound exploration is indicated for suspected ovarian tumor (standard). Diagnosis and search for extension requ ire surgery and pathology examination. - Systematic preoperative computed tomography is not recommended (standard) . - Surgery for cancer of the ovary is a specialized procedure requiring skil l in cancer, gynecology, visceral surgery and laparoscopic surgery. If the patient is referred to a specialized center after a primary procedure consi dered to be inadequate, a new procedure is recommended for staging. - Residual tumor volume after the primary procedure has prognostic value. - Systematic second look procedures are not recommended for routine practic e (standard). - For patients with grade [A G1 tumors, there is no indication for compleme ntary treatment (standard). - For patients with grade IA G2-3 or clear cell tumors, IB, IC, IIA, there is no standard. Options: no complementary treatment, complementary, chemoth erapy using platinium, complementary external abdominopelvic radiotherapy. A complementary treatment is recommended for grades IC and IIA. Complementary treatment for grades IIB (no residual tissue), IIC (with resi dual tissue), II[ (no residual tissue), is based on: complementary chemothe rapy with platinium, complementary external abdominopelvic radiotheapy (opt ions). - Complementary treatment for advanced forms (IIB (with residual tissue), I IC (with residual tissue), III (with residual tissue) and IV) is based an p olychemotherapy with platinium (standard). Options: platinium combined with paclitaxel (intravenous), platinium combined with cyclophosphamide and/or doxorubicin (intravenous) or intraperitoneal cisplatin combined with cyclop hosphamide (intravenous). - The chemotherapy work-up includes physical examination, assay of serum ma rkers (particularly CA125) and abdominopelvic computed tomography (proof le vel B) (standard). - Physical examination is recommended for monitoring patients in complete r emission with no sign of suspected recurrence (standard). This document was reviewed in April 1977 The working group again validated the Standards Opt ions and Recommendations, without modifications in June 1999.