Background: Ovarian tumors represent a diverse group of neoplasms, ranging from benign to malignant. Their complex histopathological spectrum presents challenges in diagnosis and management. This study aims to provide a detailed analysis of the spectrum of ovarian tumors in a tertiary care hospital, focusing on tumor characteristics, their association with age and size, and outcomes based on tumor stage. Methods: This retrospective study was conducted over five years, involving 400 patients with ovarian tumors. Data on age, tumor size, laterality, histopathological classification, and stage at diagnosis were collected and analyzed. Kaplan-Meier survival analysis was used to evaluate outcomes in malignant cases, and associations between tumor characteristics were assessed using statistical tests. Results: Epithelial ovarian tumors accounted for 65% of the cases, followed by germ cell tumors (20%) and sex cord-stromal tumors (15%). Malignant tumors were most prevalent in older women (>50 years), while germ cell tumors were more common in younger patients. Tumor size was significantly associated with malignancy risk, with tumors >10 cm more likely to be malignant. Five-year survival for malignant tumors was 55%, with advanced-stage tumors having worse outcomes. Conclusion: Epithelial ovarian tumors predominate, particularly in older women, while germ cell tumors are more common in younger women. The findings emphasize the importance of early detection, as tumor size and stage at diagnosis significantly affect survival outcomes.