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|Videos|May 29, 2020
A 68-Year-Old Woman With Stage IV Ovarian Cancer
Author(s)Ramez N. Eskander, MD
Ramez Eskander, MD, presents the case of a 68-year-old woman with stage IV ovarian cancer, and discusses the management approach for this patient and similar cases.
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Case Overview:
Initial Presentation
- A 68-year-old postmenopausal woman presented with fatigue, urinary frequency, early satiety, abdominal bloating and distention
- PMH: HTN, medically treated with lisinopril
- SH: retired; grandmother of 3; never-smoker; social alcohol use
- PE: abdominal distention, bloating, and a positive fluid wave test; otherwise unremarkable
Clinical work-up
- Pelvic exam with transvaginal ultrasound showed a right ovarian mass
- Chest/abdomen/pelvis CT with contrast revealed a right adnexal 5.3-cm complex mass, a suspicious intraparenchymal liver lesion, retroperitoneal lymph node enlargement and concurrent pleural effusion
- Lymph node and adnexal mass biopsy confirmed high-grade, epithelial ovarian cancer; positive cytology of pleural effusion
- T1N1M1
- Germline molecular testing showed BRCA1/2 wild-type, HRD+
- CA-125, 438 U/mL
- ECOG: 1
Treatment
- Patient underwent TAH/BSO, lymph node dissection, with suboptimal debulking; residual disease 1.3 cm
- Paclitaxel/carboplatin/bevacizumab + maintenance bevacizumab
- After 3 cycles, patient underwent second debulking surgery, R0
- Continued on bevacizumab for 6 more cycles
- Achieved partial response, post treatment CA-125, 40 U/mL
- Achieved partial response, post treatment CA-125, 40 U/mL
Follow-up
- At 3 months
- CA-125, 18 U/mL
- Chest/abdomen/pelvis CT showed no gross pelvic masses or nodes
- Pelvic exam was unremarkable
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