acute abdominal pain, treatment 150

assessment 150

intestinal obstruction, two level 151

squashed stomach syndrome 152

adnexal masses, differential diagnosis 99

ovarian cysts, simple 99, 100

transvaginal scan 100

benign cystadenomas 99

Brenner tumours 104

cell tumours, granulosa 103

endometriomas 101

functional cysts, haemorrhagic 100

mature cystic teratoma, ovary 101

pelvic masses 105

peritoneal pseudocysts 104

Rokitansky nodule 101

thecomas, ovarian fibromas 103

tubal origin, masses 104

uterine fibroids 104

advanced disease, ultrasound-guided biopsy 106

diagnosis, histological 106

carcinoma, ovary, CT 132–53

uses, CT 132

carcinoma, primary 1

databases, GLOBOCAN 2002 2

chemotherapy, disease, advanced, 83

approaches, other treatment 84 (see also systemic)

systemic 83

cisplatin 83

progression-free survival (PFS) 83

Taxus brevifoia 83

chemotherapy, disease, early stage 82

disease-free survival (DFS) 82

International collaboration on ovarian neoplasms (ICON1) 83

chemotherapy, IDS patients 145

bidimensional measurements, WHO criteria 145

complete response unconfirmed (CRU) 145

measurements, response 146

response criteria in solid tumours (RECIST) 146

interval debulking surgery (IDS) 145, 152

chemotherapy, debulking surgery (prior to) 144

post-surgery, baseline 144

cysts, non-neoplastic 20

types 20

cytoreductive surgery, primary 71

cavitron ultrasonic aspirator (CUSA) 72

chemotherapy or upfront surgery (CHORUS) 71, 74 (see also neoadjuvant chemotherapy, primary delayed)

Meigs 71

Scottish randomised trial in ovarian cancer (SCOTROC) 73

detecting malignancy, ultrasound performance 105

Doppler, combined morphology 106

ultrasound, morphological/ Doppler 105, 106

disease, staging, defining extent 123

adenocarcinoma, ovarian, recurrent 124

bowel obstruction, ovarian cancer 125

recurrent disease, detection, tumour response, residual disease, assessment 127

computed tomography (CT) 128

staging, accuracy 126

tumour resectability 127

epidemiology, genetic 1

ovarian cancer, susceptibility, genetic 3

hereditary non-polyposis colorectal cancer (HNPCC) 5 (see also syndromes, familial cancer)

polymorphism, human genomes, types 5

single nucleotide polymorphism (SNPs) 5

susceptibility genes, high penetrance 3

susceptibility genes, high-risk 5

susceptibility, low penetrance 5

syndromes, familial cancer 3

risks, familial 1

Schildkraut, Thompson 2

hormonal factors, reproductive 6 (see also hormonal factors, reproductive, others)

hormone replacement therapy (HRT) 9–10

oestrogen therapy (ET) 9

infertility 8

lactation 7

late menopause, early menarche 6

parity 6

oral contraceptive (OC) pill 7–8

hormonal factors, reproductive 10

age 10

diet 12

endometriosis 11

powder, talcum 10

pelvic inflammatory disease (PID) 12

human papilloma virus (HPV) 12

polycystic ovarian syndrome (PCOS) 12, 13

follicle stimulating hormone (FSH) 12

luteinizing hormone (LH) 12

surgery, pelvic 11

induction chemotherapy, interval debulking 75

Gynecologic Oncology Group (GOG152) 75

laparotomy, staging 69

adjuvant chemotherapy in ovarian neoplasm (ACTION) 70

European Organisation for research and treatment of Cancer (EORTC) 70, 74, 75 (see also induction chemotherapy, interval debulking)

International Federation of Gynaecology and Obstetrics (FIGO) 69–70 (see also cytoreductive surgery, primary)

surgical staging, elements 70

malignancy, ultrasonic diagnosis 96

malignant features 96

adenocarcinoma, differentiated 96

carcinoma, endometrial 97

cystadenocarcinoma, mucinous 98

cystadenocarcinoma, serous 97, 101

transvaginal Doppler 98

primary malignancies, ultrasonic features 96

carcinomas, endometrioid 98

clear cell tumours 98

low malignant potential (borderline), epithelial tumours 98

tumours, germ cell 98

tumours, mucinous 97

tumours, serous 96

metastatic malignancy, ultrasonic features 99

monitoring, therapy 164

computed tomography (CT) 164

Guidelines to evaluate the response to treatment in solid tumors 165

response evaluation criteria in solid tumors (RECIST) 165

ultrasound (US) 164

MR imaging 112, 128 (see also ovarian cancer, MR imaging)

neoadjuvant chemotherapy, primary surgery 73–4

Royal College of Obstetricians and Gynaecologists (RCOG) 74

ovarian cancer 47, 69

silent killer 69

cancers, commonest 48

survival rates 48

ovarian cancer, epidemiology, 1–13

ovarian cancer, epithelial, surgical management 69–78

ovarian cancer, FDG-PET/CT 162–4 (see also monitoring, therapy)

tomography and computed tomography (PET/CT) 162–4

ovarian cancer, MR imaging 112–28

fat-saturated chemical shift 112

apparent diffusion coefficient (ADC) 113

echo planar diffusion weighted imaging (EPDWI) 113

fat-suppression sequences 112

STIR sequences 112

parallel imaging 112

radiofrequency (RF) 112

ovarian cancer, PET, CT 156

ovarian cancer, primary, FDG–PET imaging 158–60

low malignant potential (LMP) 158–60, 168

ovarian cancer, recommendations, summary, CT 152

role 152

pathway 152

ovarian cancer, recurrent, cytoreductive surgery 75

DESKTOP (AGO-OVAR) 76

EORTC (55963 – Larocson study) 75

ovarian cancer, recurrent, palliative surgery 76

model, Krebs and Gopelrud 77

ovarian cancer, relapsed 85

approaches, other treatment 88

approaches 89

therapies, endocrine, 88

therapies, novel 89

chemotherapy 85

anthracyclines 86

etoposide 85

gemcitabine 86

paclitaxel 85

topotecan 85

platinum agents, other 87

capecitabine 87

oxaliplatin 87

vinorelbine 87

response prediction 88

therapy, single-agent vs. combination 87

treatment, time 88 (see also tumour markers)

ovarian cancer, screening, 47–64

ovarian cancer, staging, ultrasound 107

screening 107

CA125 107–8

ovarian carcinoma, medical treatment 82

ovarian carcinoma, ultrasound 94

ovarian masses, MRI characteristics 115

general features, 115

tumours, smooth muscle/fibrotic component 116

specific features 119

cyst adenocarcinoma 120

dysgerminomas 122

epithelial tumours 119

metastases, ovarian 123

Rokitansky protuberance 122

teratomas, ovarian cystic 115, 121 (see also teratoma cystic, benign)

tumour, borderline 121

tumour, collision 121

tumour, germ cell 121

tumour, germ cell, mixed 121

tumour, Sertoli–Leydig cell 122

tumour, sex cord-stromal cell 122

ovarian neoplasm 20, 23 (see also cystadenoma, mucinous)

classification, ovarian tumours, WHO 20–2

ovarian masses 23

picket-fence 24, 26

ovarian tumours, borderline 24

ovarian tumours, histogenesis 24

tumours, transtional cell 24

carcinosarcoma 24

ovarian neoplasm, pathological features 20–42

ovarian tumours, epithelial, invasive 30

clinical patterns 32

dysgerminoma 37

placenta-like alkaline phosphatase (PLAP) 37

fibroma, thecoma 39–40

Meig’s syndrome

ovarian carcinoma 30 (see also ovarian neoplasia, FIGO staging)

ovarian carcinoma, endometrioid 34

adenocarcinoma, endometrioid 35

carcinoma, clear cell 36

hob-nail 35

malignant mixed Mullerian tumour (MMMT) 35

ovarian carcinoma, mucinous 33

adenocarcinoma, mucinous 34

mucinous carcinoma 33

ovarian carcinoma, serous 32

adenocarcinoma, serous 33

cystadenocarcinoma serous 33

ovarian carcinoma, transitional cell, malignant Brenner 36

ovarian neoplasia, FIGO staging 31

ovarian tumours, germ cell 36

teratoma, mature 37

ovarian tumours, metastatic 40 (see also tumour, Kruckenberg)

lymphoma, Burkitt’s 41

ovary, stromal tumours, sex cord 38

tumour, granulosa cell 38

tumour, Kruckenberg 40–1

tumours, Sertoli-Leydig cell 40, 41

tumour, yolk sac 38

Schiller-Duval bodies 38

ovarian tumours, mixed, epithelial benign 24

cystadenoma, endometroid 26–7

chocolate cysts 27

endometriosis 27

cystadenoma, mucinous 25, 26

tumour, serous, benign 25

cystadenoma, serous 24, 25

ovarian tumours, borderline epithelial 27

borderline ovarian neoplasm 28

budding 29

flow cytometry 29, 34

ovarian Brenner tumour 30

ovarian neoplasia, endometroid 30

ovarian neoplasia, mucinous 29

ovarian neoplasia, serous 28

peritoneal implants 28

tumour, Brenner 25, 27, 30, 36

pelvic mass, characterisation/diagnosis 113–14

lesions, adnexal 113–14

adnexal masses 113

benign endometriotic cyst, 116, 117

benign teratoma cystic, 115 (see also teratomas, ovarian cystic)

CA125 114, 128

Doppler techniques 114

ovarian tumours, malignant, MRI features 114

ovarian adenocarcinoma 119, 120

borderline tumour, serous papillary 118

peritoneal nodules 120

omental disease 120

positron emission tomography (PET) 156–60, 168

fluorodeoxyglucose (FDG) 156–9, 168

uptake 158, 160, 165–7

image analysis/procedures (PET), general 157

standardized uptake values (SUV) 157

recurrent disease, distant metastases/diagnosis 161

recurrent ovarian cancer, CT 148

coronal reconstruction 149

metastasis, recurrence, unusual sites, CT 150

remission confirmation, CT 146

requirements, screening test 47

positive predictive value (PPV) 49

screening cost 63 (see also UKCTOCS)

screening, techniques 49

modalities, other 55

radioimmunoscintigraphy 55

screening, multimodal 55

advantages 55

transvaginal ultrasound scanning (TVS) 53, 56, 57, 62

tumour markerstumour markers 49

black box technology 54

breast cancer (BC) 62

CA125 49

colour flow Doppler (CD) 53, 62

epithelial ovarian cancer (EOC) 53, 62

family history (FH) 53

mass spectrometry (MS) 54

personal history (PMH) 62

randomised controlled trial (RCT) 53

risk of ovarian cancer (ROC) 50, 56

risk of ovarian cancer alogrithm (ROCA) 53

screening studies 51, 53 (see also target populations)

transabdominal ultrasound (TAS) 53

UKCTOCSUKCTOCS, trial design 50, 56–7, 64

Ultrasound (USS) 53

ultrasound 54

methods, various 54

vaginal examination 49

staging (CT), initial diagnosis 132

CT-guided peritoneal biopsy, technique 142

image guided biopsy, criteria 142–3

needle core biopsies 143

neoadjuvant chemotherapy (before surgery), 132

ovarian cancer, untreated, CT features 134 (see also pre-surgical imaging, accuracy, evidence, current best)

appearances, primary 135

calcified, heavily 139

classification, FIGO 137

contrast-enhanced CT 138

disease, stage II 138

ovarian metastasis, appearances 136

radiological diagnostic oncology group (RDOG) 135, 138–9, 146, 148

pre-surgical imaging, accuracy, evidence, current best 138

biopsy, omental 141, 143

haematoxylin and eosin (H&F) staining 141, 143

image-guided needle core biopsy (IGB) 138–9

immunohistochemical stains 141

intervention (interval) debulking surgery (IDS) 140

lymphoma, non-Hodgkin 141

primary peritoneal carcinoma (PPC) 142

technique, CT 133–4

contrast medium nephrotoxicity (CMN) 134

suspected relapse (CT), follow-up 146

assessment, 147

National Cancer Institute (NCI) 146

target populations 58

population, general 63

population, high-risk 58

UK familial ovarian cancer screening study (UKFOCSS) 58

test acceptability 57

ultrasonic, technique 94

assessment, morphological 94

Doppler, examination 95

pulsatility index (PI) 95

resistance index (RI) 95

new developments 95