Adnexal tumors are frequent findings during pregnancy but the majority regress spontaneously during the course of pregnancy; however, if a finding suspicious for malignancy persists, further evaluation is necessary. Among the cancers occurring during pregnancy, epithelial ovarian cancer is a rarity. The treatment of ovarian cancer should be individually adapted to the patient, taking the pattern of tumor spread, the woman’s health status and gestational age into account. It is important to take the patient’s individual situation and wishes into account and to jointly determine an appropriate course of action. In the early stages of ovarian cancer cytoreductive and pregnancy-preserving surgery can initially be performed, depending on the gestational age. In diseases which cannot be surgically treated with preservation of fertility or are in an advanced stage, neoadjuvant chemotherapy during pregnancy can be considered, followed by interval debulking surgery after the delivery.