Management of Mucinous Ovarian Carcinoma

Initial Diagnostic Workup

The National Comprehensive Cancer Network recommends gastrointestinal tract evaluation and CEA level to rule out occult GI primary that has metastasized to the ovaries 1, 2, 3
PAX8 immunostaining may help differentiate primary from metastatic disease 1, 2
Standard ovarian cancer workup applies, including imaging and tumor markers 1

The National Comprehensive Cancer Network recommends completion surgery with comprehensive staging including bilateral salpingo-oophorectomy, total hysterectomy, pelvic washings, omentectomy, and peritoneal biopsies 1
Appendectomy is specifically recommended at primary surgery in all patients with suspected or confirmed mucinous ovarian tumors 1, 2, 3

For Stage IA or IB disease, postoperative observation and monitoring are recommended, as most of these tumors are benign or borderline 1, 2, 3, 4
For Stage IC disease, postoperative options include observation, intravenous carboplatin with either paclitaxel or docetaxel, 5-FU/leucovorin/oxaliplatin, and capecitabine/oxaliplatin 1, 2, 3, 4
For Stages II to IV disease, postoperative options include chemotherapy using standard epithelial ovarian cancer regimens, 5-FU/leucovorin/oxaliplatin, and capecitabine/oxaliplatin 1, 2, 3, 4

5-year disease-free survival is approximately 80% to 90% overall, with excellent prognosis in early-stage disease 1, 2, 4, 5
Patients typically present at younger age (20-40 years) than high-grade serous ovarian cancer 1, 2, 5

Failure to perform appendectomy during primary surgery is a critical pitfall to avoid 1, 2, 3
Inadequate workup to exclude metastatic disease, including GI evaluation and CEA level, is a critical pitfall to avoid 1, 2, 3