Epithelial ovarian cancer may appear to be confined to the ovaries or pelvis in approximately one-third of patients at exploration, but up to 30% of them will be upstaged following surgical staging. Substage and histotype are the most important prognostic factors that determine the need for adjuvant treatment. Patients with stage Ia or Ib and well-differentiated (other than clear cell) tumors do not require adjuvant treatment. Patients with stage Ia or Ib grade 3 or clear cell histology, as well as any stage Ic and II disease, are at high risk for recurrence. Platinum-based chemotherapy is the mainstay of treatment. Four to six courses are probably adequate, although grade 3 tumors may require further treatment. Preservation of the uterus and the uninvolved contralateral ovary is a viable option in young women with unilateral early disease.