Ovarian Cancer · Staging/Cytoreduction · Primary vs Neoadjuvant + Fertility-Sparing

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.

Full pathway

1. [Decision] Stage + resectability/performance + fertility wish
   Stage? Able to achieve R0 debulking/performance status? Fertility-sparing? (Goal of debulking = R0 (no visible residual); residual disease size is a key prognostic factor.)
   • Early (suspected FIGO I), completed childbearing → Early → full staging surgery
   • IA G1-2 / borderline / malignant germ cell, young wanting fertility preservation → Early/borderline → fertility-sparing staging
   • Advanced (III-IV), can achieve R0 debulking, good performance → Advanced resectable → primary debulking PDS
   • Advanced (III-IV), not optimally resectable or poor performance/intolerant → Not resectable/poor performance → neoadjuvant + interval debulking
2. [End] Early → full staging surgery
   Early (suspected stage I) → full staging surgery: total hysterectomy + bilateral salpingo-oophorectomy, omentectomy, peritoneal washings + multiple peritoneal biopsies, pelvic/para-aortic node assessment; adjuvant chemotherapy (carboplatin + paclitaxel) by pathology.
3. [End] Early/borderline → fertility-sparing staging
   IA G1-2 / borderline / malignant germ cell tumor, young wanting fertility preservation → fertility-sparing staging (ipsilateral salpingo-oophorectomy + full staging, preserving the uterus and contralateral adnexa); reassess after completing childbearing.
4. [End] Advanced resectable → primary debulking PDS
   Advanced III-IV, can achieve R0, good performance → primary debulking surgery (PDS) to no visible residual + postoperative carboplatin/paclitaxel ± bevacizumab; BRCA/HRD-positive → PARP inhibitor maintenance.
5. [End] Not resectable/poor performance → neoadjuvant + interval debulking
   Advanced, not optimally resectable or poor performance/intolerant → 3 cycles of neoadjuvant chemotherapy then interval debulking (IDS, goal R0) + continued chemotherapy (survival comparable to PDS with fewer complications); laparoscopy can assess resectability.

Source guidelines & references

• Epithelial ovarian cancer management (ESGO/NCCN; EORTC55971/CHORUS PDS vs NACT)

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.

Other pathways