 Introduction/Background Ovarian cancer is the fifth most common cause of cancer death in women in the United States behind lung, breast, colorectal, and pancreatic cancers, accounting for more than 3% of all cancers in women and causing more deaths than any other gynecologic malignancy [1]. Most of the information in this narrative regarding imaging use for staging and evaluation of recurrence applies to epithelial ovarian cancers. Two major subtypes of epithelial ovarian cancers are distinguished by molecular, genetic, and morphologic characteristics: type 1 being the relatively indolent low-grade serous, low-grade endometrioid, mucinous tumors, transitional (Brenner), and clear cell carcinomas; and type 2 being aggressive neoplasms, including high-grade serous or endometrioid, and undifferentiated cancer [2]. The aggressive (type 2) ovarian cancers most often present in advanced stages, stage III-IV, after the disease has spread widely out of the pelvis [3,4]. This document is mostly reflective of staging and follow-up for type 2 ovarian cancers. The major roles of diagnostic imaging have been to characterize the ovarian mass, determine the extent of preoperative disease, predict tumor resectability, and evaluate response to chemotherapy [4-11]. Surgical staging is both diagnostic and therapeutic, and an experienced gynecologic surgeon (a gynecologic oncologist, specifically) is critical in optimum debulking of this tumor [9,12,13]. However, up to 40% of patients may be understaged at laparotomy [14], and prognosis is tied to the presence of residual tumor after surgery. CA-125 Levels The preoperative evaluation of patients with suspected ovarian carcinoma usually includes a serum (cancer antigen) CA-125 determination. Only about 50% of all patients with stage I ovarian cancer have a true-positive result [4,15-17]. Thus, this test alone is inadequate when used in isolation as a screening tool.
Staging and Follow up of Ovarian Cancer.  Introduction/Background Ovarian cancer is the fifth most common cause of cancer death in women in the United States behind lung, breast, colorectal, and pancreatic cancers, accounting for more than 3% of all cancers in women and causing more deaths than any other gynecologic malignancy [1]. Most of the information in this narrative regarding imaging use for staging and evaluation of recurrence applies to epithelial ovarian cancers. Two major subtypes of epithelial ovarian cancers are distinguished by molecular, genetic, and morphologic characteristics: type 1 being the relatively indolent low-grade serous, low-grade endometrioid, mucinous tumors, transitional (Brenner), and clear cell carcinomas; and type 2 being aggressive neoplasms, including high-grade serous or endometrioid, and undifferentiated cancer [2]. The aggressive (type 2) ovarian cancers most often present in advanced stages, stage III-IV, after the disease has spread widely out of the pelvis [3,4]. This document is mostly reflective of staging and follow-up for type 2 ovarian cancers. The major roles of diagnostic imaging have been to characterize the ovarian mass, determine the extent of preoperative disease, predict tumor resectability, and evaluate response to chemotherapy [4-11]. Surgical staging is both diagnostic and therapeutic, and an experienced gynecologic surgeon (a gynecologic oncologist, specifically) is critical in optimum debulking of this tumor [9,12,13]. However, up to 40% of patients may be understaged at laparotomy [14], and prognosis is tied to the presence of residual tumor after surgery. CA-125 Levels The preoperative evaluation of patients with suspected ovarian carcinoma usually includes a serum (cancer antigen) CA-125 determination. Only about 50% of all patients with stage I ovarian cancer have a true-positive result [4,15-17]. Thus, this test alone is inadequate when used in isolation as a screening tool.