Ovarian cancer is the leading cause of gynecologic cancer death in the United States. Once an ovarian tumor is identified, a pelvic ultrasound is recommended, including tumor volume and tumor structure. Unilocular and simple septate tumors are unlikely to be malignant and when asymptomatic, can be safely followed conservatively without surgery. Complex ovarian tumors are at an increased risk for malignancy and secondary testing is recommended. Secondary testing may include CA125, OVA1, the RMI, ROMA, or the ACOG referral guidelines. When secondary testing indicates that an ovarian tumor is at high risk for malignancy, referral to a gynecologic oncologist is recommended.