Among 3205 patients who needed major gynecologic operations, only 250 (7.8%) had significant ovarian cysts or tumors (170 benign, 38 "low malignant potential," 42 gross cancers). Contrary to prior reports, this study show that most patients with ovarian neoplasia had had some symptoms (duration ranged from two weeks to ten years), or a palpable adnexal mass or both. Associated symptoms have been itemized in categories. Procrastination by patients, after occurrence of the first symptoms, resulted in the growth of later-stage cancers and lower survival rates. It may be inferred from age-incidence graphs that some benign cystadenomas may be present in ovaries for long intervals of time and then may become malignant. The importance of (a) careful recording of histories, (b) periodic pelvic examinations, (c) the use of preoperative methods of differential diagnosis and (d) the differentiation between gross tumor characteristics during operations are discussed. Earlier diagnosis and treatment of ovarian neoplasia are possible and will yield better long-term results.