Ovarian Cancer

Ovarian cancer usually affects postmenopausal females and is sporadic in 90% of cases. It remains the deadliest gynecologic cancer. Although tumors originating in the ovary, fallopian tube, and covering peritoneum fall under this category, their staging/prognosis may defer. Epithelial tumors account for 90% of ovarian malignancy overall. Other types of ovarian tumors include germ cell tumors, being most common in young females, and exemplified by cystic teratoma; and sex cord-stromal tumors, exemplified by granulosa cell tumor that is known for hormonal secretion. The role of screening in detecting ovarian cancer is still limited and controversial; and imaging is no different. The FIGO staging system was revised in 2014, with modification of the substages and definitions so to reflect current understanding and advances. The most common mode of ovarian cancer spread is intraperitoneal, and approximately 70% of patients have peritoneal metastases at staging laparotomy. The primary role of imaging in ovarian neoplasia is to detect the mass, identify malignancy features, and predict spread. MRI and PET/CT–in particular–have the greatest role in detecting recurrence. Management is a combination of staging cytoreductive surgery and chemotherapy. Some improvement in median survival time has been achieved over the last 3 decades, however the overall prognosis–particularly for patients presenting beyond stage II–remains unfavorable.