Ovarian Cancer Imaging Staging and Resectability

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Staging and resectability assessment
   Confirmed/suspected ovarian cancer — imaging staging and resectability? (Epithelial ovarian/tubal/peritoneal cancer. Abdominopelvic CT is preferred for staging (disease distribution/burden, resectability assessment; ultrasound is for diagnosis/characterization, not staging — Doppler sensitivity for peritoneal metastasis only 69% vs CT 92%/MRI 95%); MRI/DWI (including whole-body) for peritoneal disease/PCI, PET-CT for nodes/distant disease. Signs: omental cake, peritoneal nodules/implants, ascites, right subdiaphragmatic predilection (peritoneal flow).)
   • Confined to the pelvis (ovary/tube ± pelvic organs, I–II) → I–II confined to pelvis · primary debulking
   • Extrapelvic peritoneal implants/retroperitoneal nodes, imaging suggests satisfactory debulking achievable (III) → III satisfactory debulking achievable · primary surgery
   • Unresectable sites involved or distant metastasis (IV) → Unresectable/IV · neoadjuvant chemotherapy
2. [End] I–II confined to pelvis · primary debulking
   I–II confined to pelvis (I confined to ovary/tube; II pelvic spread): primary debulking surgery + full staging (omentectomy, multisite peritoneal biopsies, nodal assessment, peritoneal washings); imaging carefully assesses the contralateral adnexa and peritoneum to avoid missing occult implants.
3. [End] III satisfactory debulking achievable · primary surgery
   III (extrapelvic peritoneal implants IIIB ≤2 cm/IIIC >2 cm or retroperitoneal nodes) with imaging suggesting satisfactory debulking achievable: primary debulking surgery preferred (aim for R0) + adjuvant chemotherapy; preoperative CT/MRI maps disease burden, plans resection extent.
4. [End] Unresectable/IV · neoadjuvant chemotherapy
   Unresectable sites (mesenteric root, extensive small bowel serosa, porta hepatis/hepatoduodenal ligament, bulky diaphragm, multiple liver parenchymal) or IV distant disease (IVA malignant pleural effusion/IVB parenchymal metastasis): neoadjuvant chemotherapy then interval debulking (when satisfactory debulking is unachievable); biopsy/ascites/pleural fluid for characterization, multidisciplinary decision.

Source guidelines & references

• Ovarian cancer FIGO staging and imaging (AJR 2015) · source ↗
• Ovarian cancer CT staging and resectability reporting (Cancer Imaging 2016)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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