In Europe 58% of all female cancers occur in women older than 65 years. The incidence of ovarian cancer rises steadily with advancing age during adulthood and peaks in the 7th-8th decades of life. Age-specific analysis reveals that the incidence of and mortality rate from ovarian cancer are continuously increasing in the elderly population. Although more advanced stage at diagnosis seems to be one of the determinants of the worst prognosis of the elderly population, the majority of clinicians seem to be unprepared to treat elderly patients, and a great number of patients are under-treated for the fear of unacceptable side-effects, thus limiting their possibility of survival. Guidelines are clearly needed; including advice on whether to treat at all and whether standard surgery or chemotherapy is feasible in elderly patients with ovarian cancer. Research on MEDLINE using as keywords 'elderly and ovarian cancer' reveals few papers, which reported data in this field. Nonetheless, in this report we will focus on four basic aspects of ovarian cancer in the elderly: the most important factors affecting prognosis, the safety of surgical treatment in aged patients, optimal first and second line chemotherapy, and the use of supportive treatments to improve quality of life.