8 - CT in Carcinoma of the Ovary

Summary

Introduction

CT is used at all points along the patient pathway in ovarian cancer: (i) at initial diagnosis and in staging prior to debulking surgery or neoadjuvant chemotherapy; (ii) following debulking surgery and prior to chemotherapy; (iii) for assessment of treatment response during chemotherapy including those patients being considered for interval debulking surgery (IDS); (iv) for confirmation of remission; (v) at suspected relapse; (vi) to assess complications of the disease or its treatment including presentations with acute abdominal pain.

It is important to have a well understood protocol for the use of CT in routine clinical practice, where the likelihood of CT providing clinically useful information is the guide to its utility. However, there should be the flexibility to tailor imaging to individual needs. In the context of clinical trials, there are typically more rigid and exhaustive protocols prescribed. In problem cases multidisciplinary discussion should be used to define the clinical issues to be resolved by imaging.

CT at Initial Diagnosis and in Staging

Prior to Surgery or Neoadjuvant Chemotherapy

When faced with a woman with an ovarian mass the gynaecologist is required to make a judgement about the likelihood of malignancy. After clinical assessment, ultrasound and CA-125 estimation are the first-line investigations. Based on these three evaluations women can be divided into those with (1) an ovarian mass and evidence of peritoneal spread (the presence of ascites almost always indicates this) or (2) an ovarian mass but no clear evidence of spread.