What are the NCCN guidelines on primary treatment of ovarian cancer?

Updated: Aug 10, 2020
  • Author: Andrew E Green, MD; Chief Editor: Yukio Sonoda, MD  more...
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Answer

According to the National Comprehensive Cancer Network (NCCN) guidelines, surgery is the primary treatment for ovarian cancer, followed in most patients by systemic chemotherapy. The aim of surgery is to confirm the diagnosis, define the extent of disease, and resect all visible tumor. [45]

Additional recommendations are as follows: [45]

  • Initial surgery is comprehensive staging laparotomy, including total abdominal hysterectomy and bilateral salpingo-oophorectomy performed by a gynecologic oncologist
  • For stage 1A or 1C and/or low-risk ovarian tumors, unilateral salpingo-oophorectomy may be acceptable in younger women who wish to retain fertility; comprehensive staging is still required
  • Cytoreductive surgery for stage II, III or IV; residual disease of less than 1 cm is evidence of optimal cytoreduction, although the greatest possible effort should be made to remove all obvious disease
  • Patients with stage III or IV disease who are not fit for surgery should receive neoadjuvant chemotherapy
  • Neoadjuvant chemotherapy is not recommended when surgery is possible, and upfront debulking surgery remains the treatment of choice
  • Only a small percentage of women with epithelial ovarian cancer can be treated with surgery alone; however, for patients with stage IA or IB, observation is recommended because survival is greater than 90% for this group with surgical treatment alone

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