Table 2.

Ovarian cancer: priorities in surgical, medical and radiation oncology care

High priority	Medium priority	Low priority
Surgical oncology
Radiologically confirmed intestinal obstruction in newly diagnosed patient. Bowel perforation, peritonitis. Postsurgery complications (perforation, anastomotic leak). Pelvic mass with torsion or causing urinary or intestinal obstruction.	Establishment of cancer diagnosis when high suspicion exists (eg, diagnostic laparoscopy). Primary cytoreductive surgery. Possible interval debulking surgery. following review by multidisciplinary team. Continuation of first-line therapy with postponement of surgery should be considered as an option. Symptomatic patients with inoperable primary or recurrent cancer requiring palliative cancer procedures (eg, diverting colostomy, venting PEG tubes).	Risk-reducing surgery for genetic predisposition to gynaecological cancer. Benign-appearing ovarian cysts/masses. Recurrent cancer requiring palliative resection. Oligometastatic first relapse where complete resection is feasible.
Medical oncology in advanced disease
NACT in symptomatic patients. Postoperative ChT or continuation of postoperative ChT for high-grade serous/endometrioid tumours. Importance of BRCA testing continues as these patients are eligible for PARPi and should be considered for shortened ChT cycles. Continuation of treatment in the context of a clinical trial.*	First-line postoperative ChT in advanced-stage clear cell or mucinous tumours. ChT for high-grade serous/endometrioid symptomatic platinum-eligible recurrent patients.	ChT for high-grade serous/endometrioid platinum non-eligible symptomatic recurrent patients. Symptomatic slowly growing recurrent disease. ChT for recurrent low-grade serous tumours.
Medical oncology in early disease
Adjuvant ChT for stages I–IIA high-grade serous/endometrioid. Continuation of treatment in the context of a clinical trial.*	Adjuvant ChT for stages IC-IIA infiltrative mucinous.	ChT for IC IIA low-grade serous/endometrioid/clear cell/expansile invasion mucinous. IC low-grade serous endometrioid/expansile/invasion mucinous, ChT possible option, considered less essential and to be discussed with the patient, taking into account the risk/benefit ratio.

*For patients on clinical trials, seek information about changes in management for individual studies from the coordinating trials unit for treatment frequency, blood investigations and imaging.

BRCA, breast cancer gene; ChT, chemotherapy; NACT, neoadjuvant chemotherapy; PARPi, poly-ADP ribose polymerase inhibitors; PEG, percutaneous endoscopic gastrostomy.