In a younger women <40 years of age with an ovarian/pelvic mass, non-epithelial ovarian neoplasm should be suspected, and appropriate tumour markers should be obtained (see below). All cases of suspected or confirmed non-epithelial ovarian cancer should be referred to BC Cancer for surgical and medical evaluation.

The staging system for non-epithelial ovarian cancers is generally the same as that used for epithelial ovarian cancer as defined by the Fédération Internationale de Gynécologie et d'Obstétrique (FIGO). Stage is the most important prognostic factor established to date for SCSTs; in fact several articles have reported that patients with advanced disease have a significantly poorer survival rate. For GCTs stage is an important prognostic factor as well, though given their sensitivity to chemotherapy treatment even advanced stage disease can have a good prognosis.

Surgery for a careful examination of the abdominal cavity is mandatory¹. The staging procedure typically includes infracolic omentectomy, biopsy of the diaphragmatic peritoneum, paracolic gutters, pelvic peritoneum and peritoneal washings. There is no consensus on systemic lymphadenectomy. In general, it is accepted that only in cases with evidence of nodal abnormality is node dissection required. Endometrial curettage is recommended to rule out concomitant uterine cancers in patient with granulosa cell tumor. 

Other tumour staging includes CT chest/abdomen/pelvis, basic bloodwork and tumour markers. For SCSTs, examples of tumour markers that may be elevated include inhibin, anti-Mullerian hormones, estradiol, androgens and Mullerian inhibiting substance or MIS in granulosa cell tumour; androgens and alpha-fetoprotein in Sertoli-Leydig tumours; alpha-fetoprotein, HCG and LDH in GCTs. In patients with symptoms of hormonal access, appropriate hormonal testing should be performed.