## Clinical Assessment This patient presents with a classic triad of ovarian cancer: postmenopausal status, complex ovarian mass with ascites, and elevated tumor marker (CA-125). The imaging and biochemical findings are highly suspicious for epithelial ovarian cancer (likely serous cystadenocarcinoma given the presentation). ## Rationale for Next Step **Key Point:** In a patient with imaging and clinical findings suspicious for ovarian cancer, staging investigations must precede any definitive surgical intervention. CT abdomen and pelvis with IV contrast is the standard imaging modality to: - Assess tumor extent and local invasion - Evaluate peritoneal involvement and omental caking - Detect distant metastases (liver, lungs, lymph nodes) - Determine surgical resectability and operability - Guide the surgical approach (primary debulking vs. neoadjuvant chemotherapy) Once staging is complete, the findings will determine whether the patient proceeds to: - Primary cytoreductive surgery (if resectable disease), OR - Neoadjuvant chemotherapy followed by interval debulking (if unresectable) ## Why Staging Precedes Surgery **Clinical Pearl:** Ovarian cancer management is stage-dependent. A patient with stage IV disease (distant metastases) or extensive peritoneal involvement may not benefit from aggressive primary surgery and is better served by neoadjuvant chemotherapy. Staging CT prevents unnecessary laparotomy in unresectable cases. **High-Yield:** The International Federation of Gynecology and Obstetrics (FIGO) staging of ovarian cancer requires knowledge of: - Tumor extent (confined to ovary vs. beyond) - Peritoneal involvement - Lymph node status - Distant metastases CT provides this information non-invasively and cost-effectively. 
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