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Gynecologic Cancer Case Studies

Case Studies: Advanced Ovarian Cancer

Bradley J. Monk, MD, FACOG, FACS, reacts to strategies for managing the case of a 54-year-old woman with newly-diagnosed advanced ovarian cancer based on more recent trial data supporting the use of targeted therapy in the frontline and maintenance settings.

Advanced Ovarian Cancer

Case:  A 54-Year-Old Woman Diagnosed With Advanced Ovarian Cancer

H & P

  • A 54-year-old woman presents after referral from her gynecologist for widespread tenderness, abdominal discomfort, and urinary symptoms. Pelvic exam performed by the gynecologist revealed a suspicious mass on her right ovary.
  • Postmenopausal with two children
  • PE: reveals an obese woman (BMI = 31 kg/m2) with mild hypertension and pre-diabetes; abdomen shows dullness to percussion
    • BP = 130/85 mm Hg
    • Fasting glucose = 115 mg/dL
    • Waist: hip ratio = 0.90

Imaging

  • CT with contrast of the pelvis, abdomen, and chest reveals widespread peritoneal lesions and abdominal lymph node involvement
  • Malignant ascites present

Biopsy and labs:

  • Pathology, high-grade serous adenocarcinoma, ovarian primary
  • BRCA1/2 status: negative
  • CA-125: 785 U/mL

Treatment

  • She underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and tumor debulking; residual disease after cytoreduction = 1.1 cm
  • Diagnosis, stage IIIC ovarian cancer, grade 3
  • Started on every-3-week carboplatin and paclitaxel IV plus bevacizumab every 3 weeks
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